Bone & Joint Journal最新文献

{"title":"Efficacy of continuous local antibiotic perfusion for fracture-related infections : a multicentre retrospective cohort study.","authors":"Shunsuke Takahara, Yukichi Zenke, Daisuke Himeno, Shinnosuke Yamashita, Hokuto Morii, Keisuke Oe, Takahiro Niikura, Akihiro Maruo","doi":"10.1302/0301-620X.108B5.BJJ-2025-1307.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.108B5.BJJ-2025-1307.R1","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this multicentre retrospective study was to evaluate the efficacy of continuous local antibiotic perfusion in the management of patients with a fracture-related infection.</p><p><strong>Methods: </strong>The study included 170 patients with a fracture-related infection who were treated surgically at ten tertiary trauma centres between January 2019 and December 2022, with a minimum follow-up of one year. They were divided into continuous perfusion (n = 105) and non-continuous perfusion (n = 65) groups. The primary outcome was reoperation within one year. Secondary outcomes included recurrence of infection and acute renal failure. Univariate and multivariate logistic regression analyses were performed, followed by propensity score matching based on the classification of the elements of a fracture-related infection, to address baseline imbalances.</p><p><strong>Results: </strong>The rate of reoperation within one year was significantly lower in the continuous antibiotic perfusion group than in the non-continuous perfusion group (20.0% vs 43.1%; p = 0.002). The rate of recurrent infection was also significantly lower in the continuous perfusion group (12.4% vs 32.3%; p = 0.003). After multivariable adjustment, continuous perfusion remained independently associated with a reduced risk of reoperation (adjusted odds ratio (OR) 0.30 (95% CI 0.13 to 0.70)) and recurrence of infection (adjusted OR 0.28 (95% CI 0.11 to 0.73)). In the propensity score-matched cohort, continuous perfusion also remained significantly associated with a reduced risk of reoperation (18.6% vs 44.1%; p = 0.005) and recurrence of infection (8.5% vs 32.2%; p = 0.002). The incidence of acute renal failure did not differ significantly between the groups.</p><p><strong>Conclusion: </strong>Continuous local antibiotic perfusion was associated with a significantly lower rate of reoperation and recurrent infection in patients with a fracture-related infection, without an apparent increase in the rate of acute renal failure.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"726-734"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822522","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":"Are we failing technology, or is it failing us?","authors":"Fares S Haddad","doi":"10.1302/0301-620X.108B5.BJJ-2026-0462","DOIUrl":"https://doi.org/10.1302/0301-620X.108B5.BJJ-2026-0462","url":null,"abstract":"","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"567-569"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822527","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":"Reoperation in the year following a hip fracture : a nationwide cohort study in England.","authors":"Rita Patel, Andrew Judge, Antony Johansen, Muhammad K Javaid, Elsa M R Marques, Yoav Ben-Shlomo, Petra Baji, Xavier L Griffin, Tim Chesser, Celia L Gregson, Marianne Bradshaw, Sarah Drew, Rachael Gooberman-Hill, Jill Griffin, Katie Whale","doi":"10.1302/0301-620X.108B5.BJJ-2025-1414","DOIUrl":"https://doi.org/10.1302/0301-620X.108B5.BJJ-2025-1414","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to characterize the risk of reoperation in the year after surgery for a hip fracture in England.</p><p><strong>Methods: </strong>Patients aged ≥ 60 years who presented with a hip fracture at 159 English hospitals during a three-year period between April 2016 and March 2019, were identified and linked with anonymized data from routinely collected data sources (Hospital Episodes Statistics, Civil Death Registration, National Hip Fracture Database), and followed up to 365 days. The Office of Population Censuses and Surveys (OPCS) Classification of Interventions and Procedures codes identified all patients with a hip fracture who had a reoperation, and descriptive statistics were calculated.</p><p><strong>Results: </strong>A total of 164,691 patients presented with a hip fracture during the study period. Their mean age was 83 years (SD 8.6), and 70.8% were female. During the following 365 days, 4.6% had at least one reoperation. This varied from 2.3% to 9.4% between different hospitals. Reoperation was most common for patients with a sub-trochanteric fracture fixed with a cephalomedullary nail, at 7.2%. The most common indication for reoperation within 30 days of the initial surgery was infection, and after 30 days it was periprosthetic fracture. Reoperation was less common among older patients. Those aged ≥ 90 years had a risk of reoperation of 3.7% compared with 6.2% for patients aged between 60 and 69 years. A total of 27.3% died within 365 days of the initial presentation, but the rate of mortality was similar for those who did and those who did not have a reoperation (28.0% vs 27.3%).</p><p><strong>Conclusion: </strong>Reoperation after surgery for a fracture of the hip is common. These novel data can enable informed shared decision-making for this high-risk group of patients.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"698-706"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822520","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 Fracture Anatomy, Separation, and Tuberosity involvement (FAST) classification of displaced proximal humeral fractures using 3D-CT.","authors":"C Michael Robinson, Ewan B Goudie","doi":"10.1302/0301-620X.108B5.BJJ-2025-1161.R2","DOIUrl":"https://doi.org/10.1302/0301-620X.108B5.BJJ-2025-1161.R2","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to assess displaced proximal humeral fractures using 3D-CT. The hypothesis was that it would be possible to classify these fractures systematically based upon recurring anatomical patterns of injury, and that this would be useful in predicting the outcomes.</p><p><strong>Methods: </strong>CT scanning was performed in 993 patients who sustained a proximal humeral fracture between September 2014 and April 2020, with anonymized measurements of the anatomical features and displacement of the head-shaft fracture, and the extent of the involvement of the tuberosities in 3D reconstructed views. We used exploratory factor analysis and cluster analysis to generate anatomically distinct groups of fractures. The classification was simplified by data reduction techniques and cross-tabulation of initial cluster groupings of head-shaft and tuberosity displacement to produce the most practical system possible. We compared the demographic details, the prevalence of soft-tissue injury, and complications between the groups. Five surgeons independently classified 100 CTs from the series on two occasions six weeks apart, to evaluate observer reliability.</p><p><strong>Results: </strong>The mean age of the patients was 65.1 years (21 to 92), 745 (75%) were female, and 844 fractures (85%) occurred in simple falls. Of the 993 fractures which were evaluated, 928 (93.4%) could be classified using three major criteria of the head-shaft Fracture Anatomy, the degree of head-shaft Separation, and number of fractures of the Tuberosities (FAST) classification. Specific anatomical patterns had a higher risk of early skin compromise and neurovascular complications. Nonoperatively treated patients with head-shaft separation had a higher risk of nonunion (one-year hazard ratio (HR) 6.5, 95% CI 3.9 to 10.9), and those with fractures of one or both tuberosities had a higher risk of developing osteonecrosis (five-year HR 4.1, 95% CI 2.1 to 8.1). Substantial levels of observer agreement were achieved for the final classification.</p><p><strong>Conclusion: </strong>Proximal humeral fractures have recurring anatomical features which can be classified using 3D-CT. The classification is useful in counselling patients about the threat of early soft-tissue injury and the risk of delayed complications after nonoperative treatment.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"716-725"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822602","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 epidemiology and outcomes of periprosthetic femur fractures : the Scottish National Audit of Periprosthetic Femur Fractures (SNAP Femur) study.","authors":"Matthew J Kennedy, Nick D Clement, Luke Farrow, Ian W Kennedy, Thomas Harding, Calum Blacklock, Rose S Penfold, Jon V Clarke, Andrew D Duckworth, Alasdair M J MacLullich, Phil J Walmsley, Andrew J Hall, Andrew J Hall, Alan Howieson, Alasdair MacLullich, Alistair Macey, Andrew Duckworth, Anthony Gibson, Aurélie G C Hay-David, Calum Blacklock, Chris Gee, Conor McCann, David Munn, Euan Harris, Fahd Mahmood, Gemma Toland, Graeme Nicol, Hamzah Hanif, Henrietta Stockdale, Ian Kennedy, India Cox, Isabelle Cochrane, Janice Wong, Jon Clarke, Joseph Duncumb, Jun Leow, Justine Burt, Karen Adam, Kirsty Milne, Lauren Ross, Luke Farrow, Mannix O'Boyle, Mariam Sattar, Matthew Arnold, Matthew Kennedy, Nick Clement, Paul Ryan, Phil Walmsley, Quintin Liao, Rob Sinnerton, Roberto Alho, Rose Penfold, Roshan Raghavan, Sam MacKenzie, Thomas Harding","doi":"10.1302/0301-620X.108B5.BJJ-2025-0979.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.108B5.BJJ-2025-0979.R1","url":null,"abstract":"<p><strong>Aims: </strong>Periprosthetic femur fracture (PFF) data capture in national registries is recognised to be limited. The aim of this study was to use hospital level data to establish patient characteristics, describe PFF management and mortality (including standardized mortality rate (SMR)), and compare outcomes to native hip fractures (NHF) using Scottish Hip Fracture Audit (SHFA) data.</p><p><strong>Methods: </strong>A nationwide retrospective cohort study was conducted of all patients aged ≥ 50 years sustaining a PFF managed in 16 centres between 1 January and 31 December 2019. Data collected included patient demographic details, PFF, and management characteristics, along with outcomes including frailty and mortality. Comparison of PFF with NHF data was performed. Independent associations of PFF and mortality were evaluated with Cox regression survival analysis that were adjusted for confounders.</p><p><strong>Results: </strong>There were 328 PFFs (mean age 79 years (SD 10), 66% female (n = 217)). Compared with NHF, PFF patients were less frail (median Clinical Frailty Scale (CFS) 4 (IQR 3 to 5) vs 5 (IQR to 7); p < 0.001) and more likely to be home-dwelling (91% vs 76%; p < 0.001). The majority of PFFs were related to arthroplasty implants (n = 307 (93.5%) to: 228 hip (70%) and 79 knee (24%)). There were 175 patients (53%) managed with fixation, 99 (30%) with revision arthroplasty, and 50 (15%) managed nonoperatively. The one-year mortality rate and SMR were 20.8% (95% CI 16.2 to 25.0) and 2.74 (95% CI 2.10 to 3.40) for PFFs compared with 29% (95%CI 28.0-30.0) and 3.66 (95% CI 3.6 to 3.8) in NHFs, respectively. Factors independently associated with increased mortality risk were interprosthetic fractures (adjusted hazard ratio (aHR) 2.65 (95% CI 1.41 to 5.00); p = 0.003), male sex (aHR 1.76 (95% CI 1.11 to 2.78); p = 0.015), older age (per year aHR 1.07 (95% CI 1.04 to 1.11); p < 0.001), and higher pre-injury frailty (CFS 5 to 9: aHR 4.16 (95% CI 1.18 to 14.7); p = 0.027). Time to theatre and management strategy were not independently associated with increased mortality.</p><p><strong>Conclusion: </strong>PFFs are associated with an increased mortality risk, and result in functional decline. Coding limitations mean most PFFs are likely missed in arthroplasty registries, underestimating the true incidence. National registry integration and tailored multidisciplinary pathways, similar to those for NHF, are essential for improving outcomes and healthcare planning.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"707-715"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822567","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":"Factors influencing the preferred method of fixation in total hip arthroplasty : a national survey of practice with consultant orthopaedic surgeons in the UK.","authors":"Petra Baji, Cecily Palmer, Andrew J Moore, Michael R Whitehouse, Jonathan T Evans, Elsa M R Marques","doi":"10.1302/0301-620X.108B5.BJJ-2025-0712.R1","DOIUrl":"10.1302/0301-620X.108B5.BJJ-2025-0712.R1","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to report the findings of a national survey of consultant hip surgeons in the UK investigating their practice and factors which influence their choice of the method of fixation when undertaking primary elective total hip arthroplasty (THA).</p><p><strong>Methods: </strong>An online survey was conducted in 2024 with questions about surgeons' practice, a rating exercise with open text questions, and a discrete choice experiment (DCE). In the DCE, surgeons were presented with ten randomly assigned profiles of patients described by age, sex, level of activity, risk of medical problems, and risk of fracture, and were asked to choose their preferred method of fixation (cemented, uncemented, or hybrid) for each.</p><p><strong>Results: </strong>A total of 101 consultants performing a mean 121 (SD 81) primary elective THAs annually for a mean 12.5 years (SD 8.5) completed the survey. For patients aged < 70 years, 61 (60%) would use hybrid, 31 (31%) uncemented, and nine (9%) cemented THAs. For patients aged > 70 years, 56 (55%) would use hybrid, 33 (33%) cemented, 11 (11%) uncemented, and one (1%) a reverse hybrid. In the DCE, the most influential characteristics of a patient were their age and level of activity. For a 'moderately active' male patient, the probability of surgeons choosing a cemented THA was 10% at the age of 65 years and 39% at the age of 85 years. These probabilities were 15% and 47% for a female patient. An increased perceived risk of fracture decreased the probability of choosing an uncemented THA. A total of 24 surgeons chose the same implant regardless of the patient's profile. In the rating exercise, the most influential factors besides the characteristics of the patient were the revision rate, the personal audit of the surgeon's practice, and the published evidence and guidelines. Analysis of free-text responses identified further important influencing factors such as the patient's anatomy and bone quality, and the surgeons' training, skill, and experience.</p><p><strong>Conclusion: </strong>This is the largest survey of UK consultant hip surgeons providing an understanding of the determinants of choices of the type of THA when undertaking primary THA in patients with hip osteoarthritis. These findings will inform the implementation of the findings of studies involving THA in relation to the practices of surgeons in the 'real world'.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"597-606"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822611","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 clinical relevance of single-photon emission CT/CT after reverse shoulder arthroplasty.","authors":"Tiboud Van Brabant, Louis Clerens, Robbe Waterschoot, Lieven De Wilde, Anne Karelse, Alexander Van Tongel","doi":"10.1302/0301-620X.108B5.BJJ-2025-0814.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.108B5.BJJ-2025-0814.R1","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to evaluate the clinical value of single-photon emission CT (SPECT)/CT in detecting postoperative complications following reverse shoulder arthroplasty (RSA).</p><p><strong>Methods: </strong>This was a retrospective study involving 87 patients who underwent SPECT/CT after RSA. Of these, 73 presented with pain affecting the RSA, and 14 served as a control group with an asymptomatic RSA on one side. SPECT/CT images were analyzed using standardized anatomoclinical zones, and the uptake of tracer was graded from 0 to 3. Grades 0 and 1 were considered as minor, whereas grades 2 and 3 were classified as major uptake. The SPECT/CT findings were correlated with previous clinical evaluation and classified as those in symptomatic or asymptomatic patients.</p><p><strong>Results: </strong>Major tracer uptake was frequently seen in symptomatic patients around the acromion and spine of the scapula, with intense uptake in those with a fracture. In contrast, asymptomatic patients had minimal uptake around the scapula. There was major uptake in the glenoid in most patients, gradually declining over time in asymptomatic findings. Patterns of uptake in symptomatic patients were seen in association with infection, heterotopic ossification, scapular notching, and aseptic humeral loosening. The uptake was low in the humeral shaft in asymptomatic patients but increased after eight to 12 months in association with aseptic humeral loosening. Major uptake was also often seen in the acromioclavicular and sternoclavicular joints and the cervicothoracic spine in both symptomatic and asymptomatic patients.</p><p><strong>Conclusion: </strong>SPECT/CT effectively detects (stress) fractures, particularly involving the acromion and spine of the scapula. Its clinical value is more limited for differentiating infection, heterotopic ossification, scapular notching, and aseptic humeral loosening, especially during the first postoperative year. Aseptic loosening can be assessed more reliably by focusing on the humeral shaft. Differentiating the findings in symptomatic and asymptomatic patients in the acromioclavicular, sternoclavicular, and cervicothoracic regions remains difficult. Targeted infiltrations of local anaesthetic and steroid remain primarily diagnostic, with SPECT/CT providing anatomical localization when the source of the pain remains unclear.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"663-672"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822525","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":"Medium-term recovery of patients with complex lower limb fractures : follow-up study of fracture types in the Wound Healing in Surgery for Trauma (WHIST) trial.","authors":"En Lin Goh, M Sofia Massa, Juul Achten, Matthew L Costa","doi":"10.1302/0301-620X.108B5.BJJ-2025-0948.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.108B5.BJJ-2025-0948.R1","url":null,"abstract":"<p><strong>Aims: </strong>Complex fractures of the lower limb are serious injuries, but little is known about longer-term recovery. The aim of this study was to report disability, pain, and health-related quality of life (HRQoL) of patients with different fracture types up to five years after operative treatment for complex lower limb fractures.</p><p><strong>Methods: </strong>This study involved secondary analysis of fracture types in the follow-up study of the Wound Healing in Surgery for Trauma (WHIST) trial population. Adults aged ≥ 16 years with complex fractures of the lower limb who received operative treatment at 24 hospitals in the UK were followed up for five years after surgery. The primary outcome was the Disability Rating Index (DRI). Secondary outcomes were HRQoL (EuroQol five-dimension five-level (EQ-5D-5L) questionnaire), and the incidence of neuropathic pain using the Doleur Neuropathique Questionnaire (DN4).</p><p><strong>Results: </strong>The study cohort comprised 868 patients who completed at least one set of outcome data of the long-term follow-up study and had fracture type data available. The fracture distribution of the study cohort was acetabulum n = 67 (7.8%), hip n = 249 (28.7%), femur diaphysis n = 119 (13.7%), distal femur n = 72 (8.3%), tibia diaphysis n = 82 (9.4%), proximal tibia n = 193 (22.2%), distal tibia n = 40 (4.6%), and tibia plafond n = 46 (5.3%). There were marked improvements in DRI and EQ-5D-5L across all fractures at one year, but little improvement thereafter. Almost all patients who reported neuropathic pain at one year continued to experience persistent pain at five years.</p><p><strong>Conclusion: </strong>In this secondary analysis of the five-year follow-up study, we observed a similar pattern of recovery across all lower limb fractures. The high levels of disability and lower QoL experienced by patients in the year after their injury are persistent, and patients are unlikely to return to their preinjury health state in the medium term.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"681-687"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822604","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":"Wrong-level spinal surgery : a multicentre analysis of 34,544 consecutive cases.","authors":"Masayuki Furuya, Takahito Fujimori, Shota Takenaka, Yukitaka Nagamoto, Tomiya Matsumoto, Yoshifumi Takahashi, Motoki Iwasaki, Seiji Okada","doi":"10.1302/0301-620X.108B5.BJJ-2025-1129.R2","DOIUrl":"https://doi.org/10.1302/0301-620X.108B5.BJJ-2025-1129.R2","url":null,"abstract":"<p><strong>Aims: </strong>Wrong-level spinal surgery (WLSS) is a rare but serious event. Previous studies have been constrained by small sample sizes and voluntary survey methodologies, resulting in variable incidence rates and insufficient data. This study aimed, first, to determine accurately the incidence of WLSS in different regions of the spine; second, to identify high-risk situations and causative mechanisms; and third, to analyze event characteristics in detail, including the timing of recognition, corrective management, and patient-surgeon conflicts.</p><p><strong>Methods: </strong>This study was a retrospective analysis of a prospectively collected multicentre registry, involving 34,544 consecutive patients who had undergone spinal surgery for degenerative disorders at 27 affiliated hospitals between January 2012 and December 2022. WLSS data were collected, and lumbar WLSS cases were investigated for method of level identification, causative mechanisms, timing of error recognition, corrective actions, and patient-surgeon conflicts.</p><p><strong>Results: </strong>A total of 40 cases of WLSS were identified, giving an overall incidence of 0.12% (95% CI 0.09 to 0.16). Regional incidence varied significantly: thoracic 0.42% (95% CI 0.16 to 1.08), lumbar 0.13% (95% CI 0.09 to 0.18), and cervical 0.05% (95% CI 0.02 to 0.12; p = 0.004). Of the lumbar procedures, extracanal disc herniation had a significantly higher risk than intracanal herniation (3.41% (95% CI 1.17 to 9.558) vs 0.16% (95% CI 0.07 to 0.35); p < 0.001). Causative mechanisms were categorized as intraoperative disorientation (81.3%) or image misinterpretation (18.8%). Intraoperative disorientation occurred exclusively at levels involving L4/5 or L5/S1. Errors were recognized before patient extubation in 84.4% of cases: all underwent corrective surgery before the reversal of anaesthesia. However, patient-surgeon conflicts still arose in 18.8% of lumbar cases, including 18.5% of those who had undergone reoperation under the same anaesthetic.</p><p><strong>Conclusion: </strong>The incidence of WLSS varies significantly by spinal region, with thoracic surgery and extracanal disc herniation being at highest risk. Intraoperative disorientation, particularly at the lower lumbar levels, was the primary reason. Patient-surgeon conflicts can occur even when errors are recognized and corrected immediately.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"673-680"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822518","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 association between tibial slope and posterior tibial tilting, not wear, in uncemented total knee arthroplasty : a secondary analysis of a five-year radiostereometry study.","authors":"Ruud de Ridder, Bart L Kaptein, Bart G Pijls, Rob G H H Nelissen, Herman H Kaptijn","doi":"10.1302/0301-620X.108B5.BJJ-2025-1092.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.108B5.BJJ-2025-1092.R1","url":null,"abstract":"<p><strong>Aims: </strong>The primary objective of this study was to evaluate the influence of postoperative slope on the five-year tibial component migration and wear following uncemented cruciate-retaining condylar-stabilized total knee arthroplasty (TKA). Secondary objectives included the association between postoperative slope and clinical and functional outcomes.</p><p><strong>Methods: </strong>This observational study was a secondary analysis of a randomized controlled trial of 93 TKAs on insert materials. Tibial component migration and insert wear were measured across three postoperative slope groups (small (≤ 5°), intermediate (6° to 9°), and large (≥ 10°)) using radiostereometric analysis at three, six, 12, 24, and 60 months postoperatively. Patient-reported outcome measures were collected preoperatively and at all follow-up timepoints.</p><p><strong>Results: </strong>There was an association between tibial component migration and postoperative tibial slope: the group with the largest postoperative tibial slope showed the largest posterior tilting. At five years, there was no difference in insert wear between the small, intermediate, and large slope groups. There was also no association between postoperative slope and functional or patient-reported outcomes.</p><p><strong>Conclusion: </strong>TKA implanted with more than 10° of slope showed increased tibial component migration and posterior tilting, independent of the native slope. At five years, there was no influence of slope on wear or functional outcomes.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"634-642"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822609","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}