Bone & Joint Journal最新文献

{"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":"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}

{"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}