Bone & Joint Journal最新文献

{"title":"Beyond alignment : expanding the dimensionality of total knee arthroplasty.","authors":"Michael J Dunbar, Fares S Haddad","doi":"10.1302/0301-620X.108B9.BJJ-2026-0910","DOIUrl":"https://doi.org/10.1302/0301-620X.108B9.BJJ-2026-0910","url":null,"abstract":"","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 9","pages":"1075-1077"},"PeriodicalIF":4.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867354","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":"Impact of combined medial and lateral bone marrow lesions on clinical outcomes after medial unicompartmental knee arthroplasty : a retrospective cohort study.","authors":"Guanglei Cao, Anhong Wang, Qing Liu, Jian Liu, Yuan Liu, Ye Huang","doi":"10.1302/0301-620X.108B9.BJJ-2025-1736.R2","DOIUrl":"https://doi.org/10.1302/0301-620X.108B9.BJJ-2025-1736.R2","url":null,"abstract":"<p><strong>Aims: </strong>Although the influence of medial bone marrow lesions (BMLs) on outcomes after medial unicompartmental knee arthroplasty (UKA) has been studied, the impact of concomitant lateral compartmental BMLs remains unclear. This study aims to determine whether the lateral BMLs, in addition to medial BMLs, influence clinical outcomes in patients undergoing medial UKA.</p><p><strong>Methods: </strong>We retrospectively reviewed patients who underwent medial UKA between January 2016 and December 2019 and had preoperative MRI. A total of 86 patients with isolated medial BMLs (BML-M) and 38 with combined medial and lateral BMLs (BML-M+L) were included. Clinical outcomes were assessed using the Numeric Rating Scale (NRS) and Oxford Knee Score (OKS). Radiological evaluation included pathological radiolucent lines, osteoarthritis progression in the lateral compartment, mechanical femorotibial angle (mFTA), and postoperative alignment zones. The proportion of patients achieving the minimal clinically important difference (MCID) for each score and a well-aligned mechanical axis was also calculated. Multivariable linear regression was employed to determine whether concomitant lateral BMLs independently influenced OKS improvement.</p><p><strong>Results: </strong>The mean follow-up was 6.4 years (SD 1.1). Both groups demonstrated significant improvements from baseline in NRS and OKS (both p < 0.001). No significant differences were found in preoperative and postoperative mFTA between the two groups. No pathological radiolucent lines were detected in either group and no significant difference was found in the radiological progression of the lateral compartment between the BML-M group and the BML-M+L group (12.8% (n = 11) vs 13.1% (n = 5); p = 0.550). There were no between-group differences in either preoperative or postoperative scores, or in the proportion of patients reaching the MCID for NRS or OKS, or in the patients attaining a well-aligned mechanical axis. In the multivariable model, combined medial and lateral compartmental BMLs were not independently associated with OKS improvement (<i>β</i> = 0.548 (95% CI -3.400 to 4.490); p = 0.784).</p><p><strong>Conclusion: </strong>In MRI-selected medial UKA patients with medial BMLs, mild concomitant lateral BMLs, in the absence of severe lateral cartilage wear and lateral meniscal extrusion, were not associated with inferior mid-term patient-reported outcomes or alignment.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 9","pages":"1121-1128"},"PeriodicalIF":4.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867375","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":"Necrotizing fasciitis.","authors":"Timothy O White, Andrew Daniel Ablett, Chryssa Neo, Nick D Clement, Chris G Moran, Marina S Morgan, Andrew D Duckworth","doi":"10.1302/0301-620X.108B9.BJJ-2026-0255.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.108B9.BJJ-2026-0255.R1","url":null,"abstract":"<p><p>Necrotizing fasciitis is a rapidly progressive, life-threatening infection originating in a fascial plane which requires emergency surgery. Although uncommon, with an incidence of 0.63 per 100,000 per year, it affects the limbs in 40% of cases and carries a 22% 30-day mortality rate. The diagnosis is principally clinical. Severe pain, out of proportion to any visible abnormality of the skin, is the cardinal early feature, frequently accompanied by tenderness beyond the area of erythema, swelling, and local hypoaesthesia. Crucially, the skin may initially appear normal or nearly normal while rapid fascial destruction progresses beneath. Laboratory investigations, imaging, and scoring systems lack sufficient sensitivity and specificity to confirm or exclude the diagnosis and must not delay surgical exploration. The suspected diagnosis is confirmed or excluded by a diagnostic incision to the fascial plane. Necrotizing fasciitis is classified into four types based on the microbiology: polymicrobial (type I), Gram-positive monomicrobial (type II), Gram-negative monomicrobial (type III), and fungal (type IV). The focus of treatment is emergency radical excision of all necrotic tissue to healthy margins and broad-spectrum antibiotics. Surgery should not be delayed by medical management, imaging, or inter-hospital transfer. Failure to recognize and act within six hours of presentation is associated with a five-fold increased risk of mortality and amputation, while survivors of delayed surgery report health-related quality of life comparable to death. Postoperative review within six hours is mandatory. This annotation complements the publication of the British Orthopaedic Association Standards on musculoskeletal infections, and provides recommendations for orthopaedic surgeons managing patients with necrotizing fasciitis.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 9","pages":"1078-1086"},"PeriodicalIF":4.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867420","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":"Secondary patella resurfacing following primary total knee arthroplasty : patient-reported outcomes, satisfaction, and patient-acceptable symptom state.","authors":"Nick D Clement, Thomas Parsons, Thomas Botfield-Gray, Ricci Plastow, Irrum Afzal, Nardeen Kader, Sarkhell Radha, Deiary F Kader","doi":"10.1302/0301-620X.108B9.BJJ-2026-0002.R2","DOIUrl":"https://doi.org/10.1302/0301-620X.108B9.BJJ-2026-0002.R2","url":null,"abstract":"<p><strong>Aims: </strong>Our aims were to assess joint-specific outcome (JSO), health-related quality of life (HRQoL), and patient satisfaction following secondary patella resurfacing (SPR), and to define a patient-acceptable symptom state (PASS).</p><p><strong>Methods: </strong>This retrospective study was conducted over 16 years (October 2006 to December 2022) and included 182 patients undergoing SPR. Patient demographic details, American Society of Anesthesiologists (ASA) grade, preoperative and postoperative (one year: n = 158 and two years: n = 143) Oxford Knee Score (OKS), EQ-5D, and EQ-VAS scores, as well as postoperative satisfaction, were obtained from a local arthroplasty register.</p><p><strong>Results: </strong>There were clinically meaningful and statistically significant (p < 0.001) improvements in the OKS, with a mean change of 6.8 (95% CI 4.7 to 8.9) and 8.1 (95% CI 5.9 to 10.2) points, and in the EQ-5D of 0.174 (95% CI 0.110 to 0.238) and 0.187 (95% CI 0.119 to 0.255) at both one and two years, respectively. There were 126 (79.7%) and 120 (85.7%) satisfied patients at one and two years, respectively. Prior satisfaction with the index total knee arthroplasty (TKA) (one year only: odds ratio (OR) 10.4 (95% CI 3.10 to 34.85); p < 0.001) and increasing time from primary TKA to the SPR (one year: OR 1.37 (for each additional year) (95% CI 1.03 to 1.81); p = 0.028, and two years: OR 2.32 (95% 1.23 to 4.38); p = 0.009) were independently associated with satisfaction. A 2.5-year threshold provided the optimal cutoff for predicting satisfaction, yielding sensitivities of 66.3% and 70.7% and specificities of 67.9% and 68.8% at one and two years, respectively. Thresholds predicted a PASS in the OKS were 20 and 22 at one and two years, respectively. For EQ-5D, the thresholds were 0.500 at both timepoints, and for EQ-VAS were 60 and 63 at one and two years, respectively. At a median follow-up of ten years, no re-revisions were undertaken, and 52 patients (28.1%) died.</p><p><strong>Conclusion: </strong>SPR was associated with clinically meaningful improvements in JSO and HRQoL, with high levels of patient satisfaction. Prior satisfaction with the index TKA and longer time to SPR were independently associated with satisfaction, with patients undergoing SPR after 2.5 years more likely to be satisfied. The identification PASS thresholds offer benchmarks for evaluating success.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 9","pages":"1129-1137"},"PeriodicalIF":4.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867486","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 of venous thromboembolism after knee, hip, or shoulder arthroplasty : a retrospective cohort study of 476,620 procedures using linked hospital and primary care data.","authors":"Subhashisa Swain, Nadja Leith, Sarah Brown, Cynthia Wright Drakesmith, Jonathan L Rees, Clare Bankhead, John Powell","doi":"10.1302/0301-620X.108B9.BJJ-2025-1018.R2","DOIUrl":"https://doi.org/10.1302/0301-620X.108B9.BJJ-2025-1018.R2","url":null,"abstract":"<p><strong>Aims: </strong>Arthroplasty is a widely used surgery for end-stage arthritis, but venous thromboembolism (VTE) remains a major postoperative complication. Most previous studies have relied solely on hospital data; no study has examined the effect of national clinical guidelines on the rates of VTE in the UK. This study aimed to assess VTE trends after arthroplasty using linked primary and secondary care data, and the impact of the National Institute for Health and Care Excellence (NICE) guidelines in the UK on VTE rates after arthroplasty.</p><p><strong>Methods: </strong>We used the Clinical Practice Research Datalink (CPRD) Aurum version, the largest primary care database in the UK, and linked hospital and death data for patients undergoing knee, hip, or shoulder arthroplasty between October 2007 and September 2019. The outcome was VTE event within six months of surgery. Trends in VTE were assessed using the Cox-Stuart trend test, and the impact of seasonality and clinical guidelines introduced in 2010, 2012, and 2018 via logistic regression with a polynomial function.</p><p><strong>Results: </strong>A total of 476,620 arthroplasty records were included. The overall VTE incidence was 1.5% (knee (1.6%), hip (1.4%), and shoulder arthroplasty (1%)). More than 30% of the VTEs were found through the linked data. A decline in VTE rates was observed over time for hip (p = 0.004) and knee arthroplasty (p = 0.001). Introduction of NICE guidelines did not significantly change the VTE rate in knee and hip arthroplasty. In shoulder arthroplasty, VTE decreased by 9% after the introduction of the 2018 guidelines. Seasonal variation in the VTE risk differed by joint.</p><p><strong>Conclusion: </strong>Future research should investigate the factors driving the seasonal association in VTE rates, and determine why shoulder arthroplasty showed a unique response after 2018.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 9","pages":"1138-1146"},"PeriodicalIF":4.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867506","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 efficacy to climate accountability : the case for embedding environmental outcomes in orthopaedic trials.","authors":"Luke Farrow, Scott Purdie, Jonathan T Evans, Tom Krause, Marion Campbell","doi":"10.1302/0301-620X.108B8.BJJ-2026-0558","DOIUrl":"https://doi.org/10.1302/0301-620X.108B8.BJJ-2026-0558","url":null,"abstract":"<p><p>There is increasing global recognition of the importance of sustainability in the design and delivery of healthcare, including trauma and orthopaedics. There has, however, to date been little focus on providing high-quality research which includes environmental outcomes to guide clinical practice. This annotation explores the importance of including sustainability outcomes using three key carbon-related domains, and highlights the urgent need for the incorporation of sustainability outcomes into future clinical trials.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 8","pages":"975-978"},"PeriodicalIF":4.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649695","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":"Use of neurolytic nerve blocks and mortality in nonoperative management of hip fracture patients : a nationwide population study in the Netherlands.","authors":"Hanne-Eva van Bremen, Marte Inge Lommerse, Johannes H Hegeman, Henk J Schuijt, Jan Willem Kallewaard, Hugo H Wijnen, Lotta J Seppala, Nathalie van der Velde, Hanna C Willems, W P Achterberg, F Malgo, A H Calf, P W van Egmond, E R Flikweert, M J Heetveld, J H Hegeman, M C Trappenburg, S C Voeten, F J G Wijdicks, F S Würdemann, C L P van de Ree","doi":"10.1302/0301-620X.108B8.BJJ-2025-1465.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.108B8.BJJ-2025-1465.R1","url":null,"abstract":"<p><strong>Aims: </strong>Nonoperative management may be suitable for very frail hip fracture patients; in these instances, neurolytic nerve blocks with phenol could act as a long-term analgesic, with potentially fewer disadvantages compared with systemic analgesia. While neurolytic nerve blocks are being used more frequently in end-of-life care, there are limited data on how often they are used, and what long-term outcomes they achieve in patients with hip fractures. This study aims to evaluate the association between neurolytic nerve block use and mortality in patients with hip fractures managed nonoperatively, while also exploring the characteristics of patients who receive these blocks.</p><p><strong>Methods: </strong>A retrospective population-based cohort study was conducted including patients with a hip fracture aged 70 years and older, who were treated nonoperatively between 1 January 2024 and 31 December 2024. The primary outcome was mortality, comparing patients who received a neurolytic block with those who did not.</p><p><strong>Results: </strong>Of 1,415 nonoperatively managed patients (mean age 86 years (SD 6.75)), 633 (45%) received neurolytic nerve blocks. These patients were more frail, had greater levels of dependence, malnourishment, and immobility, and were diagnosed with a displaced fracture more often than those who did not receive a block. Nerve block patients also showed significantly lower mortality at seven days (24.9% (n = 120) vs 39.0% (n = 138); p < 0.001), but higher mortality at three months (74.9% (n = 361) vs 68% (n = 68.1); p = 0.036) and six months (89.7% (n = 384) vs 72.9% (n = 258); p = 0.027). The adjusted hazard ratio at 30 days was 0.73 (95% CI 0.61 to 0.88; p = 0.001).</p><p><strong>Conclusion: </strong>Neurolytic nerve blocks have emerged as part of nonoperative hip fracture management in the Netherlands and are associated with lower short-term mortality. Furthermore, our nonoperatively managed cohort appeared less frail than earlier Dutch cohorts, suggesting a broadening of patient selection.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 8","pages":"1029-1037"},"PeriodicalIF":4.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649698","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":"Natural history of solitary osteochondroma : a retrospective analysis of 236 patients in South Korea.","authors":"Myung-Jin Sung, Chung-Hyeon Kim, Sung Taek Jung, Sungmin Kim","doi":"10.1302/0301-620X.108B8.BJJ-2026-0089","DOIUrl":"https://doi.org/10.1302/0301-620X.108B8.BJJ-2026-0089","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to analyze the natural history of solitary osteochondroma and determine how skeletal maturity influences tumour behaviour and treatment outcomes.</p><p><strong>Methods: </strong>A retrospective analysis of 236 patients with solitary osteochondroma (151 skeletally immature, 85 skeletally mature) was undertaken. Skeletal maturity was defined as bone age ≥ 18 years in males and ≥ 17 years in females. Tumour characteristics, disease progression, indications for surgery and recurrence rates were evaluated. Interobserver reliability for bone age assessment was excellent (intraclass correlation coefficient (ICC) 0.92 (95% CI 0.88 to 0.95)).</p><p><strong>Results: </strong>Spontaneous regression occurred exclusively in skeletally immature patients (17.2% (n = 26) vs 0%; p < 0.001). Skeletally immature patients predominantly presented with sessile lesions (76.2%; n = 115), had lower surgical needs (31.8%; n = 48), but higher progression rates (9.9% (n = 15) vs 1.2% (n = 1); p = 0.013). Skeletally mature patients showed more stable disease but required surgery more often (54.1%; n = 46). Among skeletally immature patients with regression, independent predictors were younger age at diagnosis (odds ratio (OR) 0.82 (95% CI 0.73 to 0.92); p < 0.001), proximal humeral location (OR 10.59 (95% CI 2.01 to 55.85); p = 0.005), and humeral shaft location (OR 38.93 (95% CI 4.81 to 315.10); p = 0.001). The optimal cutoff age for regression prediction was 14.8 years. No local recurrence occurred in the 94 operated patients.</p><p><strong>Conclusion: </strong>Skeletal maturity fundamentally determines the natural history of osteochondroma. Conservative management with serial radiological follow-up is recommended for young patients, particularly those with humeral lesions, given their substantial potential for spontaneous regression. Earlier surgical intervention should be considered for skeletally mature patients with persistent symptoms.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 8","pages":"1060-1067"},"PeriodicalIF":4.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649714","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":"Glucagon-like peptide-1 receptor agonists are associated with improved 90-day outcomes after total hip and knee arthroplasty : a systematic review and meta-analysis.","authors":"Branavan Rudran, Christopher D J Little, Antony J R Palmer, Andrew Judge, Alberto Carli, Andrew J Price, Abtin Alvand","doi":"10.1302/0301-620X.108B8.BJJ-2025-1486.R2","DOIUrl":"10.1302/0301-620X.108B8.BJJ-2025-1486.R2","url":null,"abstract":"<p><strong>Aims: </strong>Obesity and diabetes are risk factors for developing osteoarthritis and associated with worse outcomes following total hip (THA) and total knee arthroplasty (TKA). Glucagon-like peptide-1 receptor agonists (GLP-1as) improve glycaemic control and promote weight loss. The aim of this study was to assess the impact of GLP-1a treatment on 90-day surgical complications following THA and TKA.</p><p><strong>Methods: </strong>A systematic review was undertaken according to PRISMA guidelines. Studies were included if they reported at least one outcome of interest following primary THA or TKA. In all the studies which were included, a GLP-1a was prescribed for the management of type 2 diabetes mellitus or for weight loss in obese patients. The primary outcome was the 90-day surgical complication rate in the combined THA and TKA cohort. The 90-day surgical complications were defined as: periprosthetic joint infection (PJI), wound dehiscence, periprosthetic fracture (PPF), haematoma, nerve injury, or surgical site infection (SSI). Secondary outcomes included 90-day medical complications and readmission rates, all-cause revision, healthcare costs, and length of stay.</p><p><strong>Results: </strong>A total of 78 studies were reviewed, and ten matched cohort studies with a total of 96,356 patients (30,350 THAs and 66,606 TKAs) were included. The mean age of the patients was 61.9 years; 60.1% female (n = 57,939). Two studies had a serious risk of overall bias and eight had a moderate risk. The confidence of evidence according to the GRADE assessment was very low for all but one outcome measure (healthcare cost: moderate). The rate of 90-day surgical complications was lower in the GLP-1a cohort (pooled risk ratio (RR) 0.73). The use of a GLP-1a lowered the 90-day medical complications and readmission rates (RR 0.78 and RR 0.79 (I² = 61.6%), respectively). At two years, the revision rate ranged from 1.7% to 3.3% for the GLP-1a cohort and 1.7% to 4.5% for the controls. Sub-group analysis showed a stronger association in the THA group, in which the use of a GLP-1a was associated with significantly lower rates of 90-day surgical complications (RR 0.63), 90-day medical complications (RR 0.55), and 90-day readmissions (RR 0.82). In contrast, the use of a GLP-1a in the TKA group was only sigificantly associated with a lower 90-day readmission rate (RR 0.77).</p><p><strong>Conclusion: </strong>GLP-1a treatment before THA and TKA potentially reduces the 90-day surgical and medical complications and 90-day readmission rates in high-risk diabetic and obese patients. The use of a GLP-1a may also be associated with substantial cost savings.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 8","pages":"986-994"},"PeriodicalIF":4.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649674","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 matter of definition : variation in treatment success of fracture-related infections.","authors":"Noémie Reinert, Alessia Poggioli, Willem-Jan Metsemakers, Martin Clauss, Richard Kuehl, Mario Morgenstern, Mario Morgenstern, Noémie Reinert, Alessia Poggioli, Martin Clauss, Richard Kuehl, Rik Osinga, Nader Maai, Florian Frank, Fintan Moriarty","doi":"10.1302/0301-620X.108B8.BJJ-2026-0019.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.108B8.BJJ-2026-0019.R1","url":null,"abstract":"<p><strong>Aims: </strong>The establishment of the fracture-related infection (FRI) consensus definition and the FRI classification system provide a foundation for research and the development of clinical recommendations. To date, however, the evaluation of treatment success is still impeded by a lack of clear and standardized outcome definitions. We hypothesized that applying different outcome measurements to the same cohort of FRI patients results in significantly different treatment success rates.</p><p><strong>Methods: </strong>Adult patients undergoing curative surgery for FRI at the Center of Musculoskeletal Infections, University Hospital Basel, between 1 January 2020 and 31 December 2023 were included in this prospective cohort study. Treatment success was evaluated by review of patient charts; after one year of follow-up according to seven predefined outcome definitions (S1 to S7): no infection persistence at one year (S1); no recurrence within one year (with the same (S2) or a new (S3) pathogen); bony union (S4); no infection recurrence, or persistence and bony union (S5); no unplanned revision surgery (S6); and bony union and no infection recurrence, or persistence and no unplanned revision surgery (S7).</p><p><strong>Results: </strong>In total, 106 patients with 112 confirmed FRIs were included. At one year, treatment success varied significantly (p < 0.001) between the different outcome definitions: for S1 the success rate was 95.5% (n = 107), for S2 89.3% (n = 100), for S3 92.9% (n = 104), and for S6 60.7% (n = 68). In cases with healed fractures (n = 28) success rate was 100% for S1 to 3 definitions and 92.9% for S6 (n = 26). In cases with non-healed fractures (n = 84) the success rate decreased significantly from 94.0% (n = 79) for the S1 definition to 39.3% for S7 (n = 33; p < 0.001), with 50% of these patients (n = 42) undergoing an unplanned revision surgery. In unhealed fractures a recurrent infection (p < 0.013) and the need for an unplanned revision surgery (p < 0.001) were significantly more frequent than in healed fractures.</p><p><strong>Conclusion: </strong>At the one-year follow-up, treatment success differed significantly within a single cohort depending on the outcome metric used to define success.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 8","pages":"1038-1044"},"PeriodicalIF":4.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649661","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}