Bone & Joint Journal最新文献

{"title":"A comparison of the long-term results of anterior lumbar interbody fusion and total disc arthroplasty: a prospective randomized controlled trial with a mean follow-up of 14 years.","authors":"Michael Putzier, Jasmin Fussi, Thilo Khakzad, Chris Lindemann, Timo Karl Zippelius, Patrick Strube","doi":"10.1302/0301-620X.107B6.BJJ-2024-1646.R1","DOIUrl":"10.1302/0301-620X.107B6.BJJ-2024-1646.R1","url":null,"abstract":"<p><strong>Aims: </strong>This prospective randomized study compares the clinical and radiological long-term outcomes of single-level anterior lumbar interbody fusion (ALIF) and total disc arthroplasty (TDA).</p><p><strong>Methods: </strong>Patients with symptomatic single-level degenerative disc disease (DDD) at L4/5 or L5/S1 were randomly assigned to groups ALIF or TDA. Clinical evaluations using the Oswestry Disability Index (ODI) and visual analogue scale (VAS) for pain were conducted preoperatively, at three, 12, and 24 months, and after a mean follow-up of 14 years (12.2 to 15.9). Radiological assessments included radiographs in two planes and flexion-extension views. Additionally, CT was performed in the ALIF group to evaluate fusion after 24 months. Complications and patient satisfaction were recorded. Outcomes were analyzed for the entire cohort and by spinal segment.</p><p><strong>Results: </strong>Of the 120 patients included (60 per group), 28 were lost to follow-up, including three excluded because of revision surgery. In the remaining patients, significant improvements in ODI and VAS were seen over time (all p < 0.001). Clinical scores had declined slightly by final follow-up but remained better than the preoperative levels. No significant overall differences were found between ALIF and TDA. However, subgroup analysis revealed that ALIF outperformed TDA at L5/S1 (ODI posthoc test at final follow-up p = 0.005): outcomes were comparable at L4/5.</p><p><strong>Conclusion: </strong>Both ALIF and TDA are safe and effective methods of treating single-level DDD. ALIF is preferable at L5/S1 due to biomechanical factors, such as variability in the centre of rotation and sagittal profile types, which have a negative impact on the outcomes of TDA at this level. Conversely, at L4/5, both procedures give comparable results. These findings emphasize the importance of considering segment-specific anatomical and biomechanical factors in surgical decision-making for DDD.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 6","pages":"639-648"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192384","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 UK multicentre cohort study of clinical outcomes of proximal femoral replacement for nononcological conditions : the EndoProsthetic Replacement for nonOncological conditions (EPRO) study.","authors":"Maheshi P Wijesekera, Hemant Pandit, Jeya Palan, Sameer Jain, Jamie East, Corey D Chan, James N Hadfield, Mohammed As-Sultany, Eslam Abourisha, Catherine James, Chryssa Neo, Liam Z Yapp, Al-Amin M Kassam, Timothy Petheram, Henry Wynn Jones, Nicholas C Eastley, Chloe E H Scott","doi":"10.1302/0301-620X.107B6.BJJ-2024-1304.R1","DOIUrl":"10.1302/0301-620X.107B6.BJJ-2024-1304.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study aims to determine the outcomes of proximal femoral replacement (PFR) for nononcological conditions.</p><p><strong>Methods: </strong>This was a multicentre retrospective cohort study across six UK centres. The primary outcome was the local complication rate. Secondary outcomes were blood transfusions, critical care requirements, return to baseline mobility and residence status, systemic complications, reoperations, and mortality rates. Implant survival analysis was performed using Kaplan-Meier methodology with local complication as the endpoint, and was compared by surgical indication, stem length, and construct stem ratio (CSR).</p><p><strong>Results: </strong>There were 230 PFRs in 226 patients with a median age of 76.0 years (IQR 66.9 to 83.7). Indications were periprosthetic femoral fracture (n = 62; 27%), infected revision arthroplasty (n = 55; 24%), chronic/failed trauma (n = 41; 18%), aseptic revision arthroplasty (n = 38; 17%), acute trauma (n = 33; 14%), and complex primary arthroplasty (n = 1; 0.5%). Median follow-up was 4.2 years (IQR 1.9 to 7.2). The local complication rate was 27% (n = 62). The most common local complications were dislocation (n = 27; 12%) and periprosthetic joint infection (n = 22; 10%). Blood transfusion was required in 86 patients (37%). Overall, 90 patients (39%) required critical care facilities. A return to baseline mobility and residence was observed in 127 (55%) and 200 (87%) patients, respectively. The six-month systemic complication rate was 9% (n = 21) and the reoperation rate was 21% (n = 48). The 30-day and one-year mortality rates were 2% (n = 4) and 8% (n = 19), respectively. The two-year implant survival rate was 78.0% (SE 2.8). Survival rates did not differ significantly by surgical indication, stem length, or CSR.</p><p><strong>Conclusion: </strong>This is the largest study of PFR for nononcological conditions. Due to high local complication and reoperation rates, it should be considered a salvage option for complex hip reconstruction and patients should be counselled appropriately.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 6","pages":"625-631"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192397","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 prognostic value of the modified Glasgow Prognostic Score in the management of patients with chondrosarcoma : a multicentre study.","authors":"Ofir Ben Gal, James Doonan, Naeil Lotfi, Samuel McMahon, Gavin Baker, Gillian Cribb, Corey David Chan, M Ather Siddiqi, Sanjay Gupta","doi":"10.1302/0301-620X.107B6.BJJ-2024-0596.R2","DOIUrl":"10.1302/0301-620X.107B6.BJJ-2024-0596.R2","url":null,"abstract":"<p><strong>Aims: </strong>The prognostic role of systemic inflammatory biomarkers in patients with chondrosarcoma remains unclear, and evidence is lacking. The modified Glasgow Prognostic Score (mGPS) is an inflammation-based prognostic score consisting of preoperative CRP and albumin. This has been validated for a number of carcinomas and soft-tissue sarcoma, where its use is recommended. This national multicentre study aimed to investigate the prognostic significance of preoperative systemic inflammatory biomarkers, primarily the mGPS, in the prediction of survival in patients with a chondrosarcoma.</p><p><strong>Methods: </strong>Patients who had undergone an elective resection of a primary or secondary chondrosarcoma between January 2006 and December 2020 were identified from the prospectively maintained databases of seven collaborating UK bone sarcoma units. Laboratory and clinical data, as well as oncological outcomes, were collected from the patient records with a minimum of two years of follow-up. Data were analyzed using Kaplan-Meier survival and uni- and multivariate analysis.</p><p><strong>Results: </strong>A total of 549 patients were included in our study. We found that increased mGPS, tumour grade, size, age, local recurrence, metastasis, and inflammatory markers were significantly associated with reduced overall survival. mGPS was able to stratify the overall survival of patients in all grades of chondrosarcoma, especially when divided into mGPS score 0 versus mGPS 1 or 2.</p><p><strong>Conclusion: </strong>Our findings indicate that inflammatory markers and mGPS strongly correlate with the survival of patients with a chondrosarcoma. We recommend its use in their early assessment to better stratify prognosis, reinforce decision-making, and potentially improve outcomes.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 6","pages":"649-656"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192404","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":"Long-term outcome of nonoperative treatment of Perthes' disease : only 19% total hip arthroplasty at a mean follow-up of 48 years.","authors":"Anders Wensaas, Chiara Blatti, Terje Terjesen, Stefan Huhnstock","doi":"10.1302/0301-620X.107B6.BJJ-2024-1310.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.107B6.BJJ-2024-1310.R1","url":null,"abstract":"<p><strong>Aims: </strong>The outcome in Perthes' disease deteriorates with increasing follow-up, ending with total hip arthroplasty (THA) in patients with severe complaints. The purpose of this study was to assess the prevalence of THA according to length of follow-up and to define risk factors for THA.</p><p><strong>Methods: </strong>Patients were recruited from the radiological archive at Oslo University Hospital HF. In total, 229 patients (244 hips) were included in the study (184 males). The mean age at diagnosis was 6.2 years (2.1 to 13.7). A total of 105 hips (43%) were classified as spherical, 93 (38%) as ovoid, and 46 (19%) as flat. The mean time from diagnosis to follow-up was 48 years (27 to 72). Inclusion criteria were patients with nonoperative treatment for Perthes' disease and ≥ 25 years' follow-up. Sphericity of the femoral head at the healing stage was classified with the modified Stulberg method, which is a three-group classification based on the shape of the femoral head: spherical, ovoid, or flat. Information regarding THA was provided by the Norwegian Arthroplasty Register.</p><p><strong>Results: </strong>Overall, 47 hips (19%) had undergone THA at a mean patient age of 46 years (22 to 72). The most important prognostic factors for THA were femoral head sphericity and age at onset. The frequency of THA was 3% in hips with spherical femoral heads, 25% in ovoid heads, and 46% in flat heads. Age ≥ six years was associated with THA more frequently than age < six years (28% and 10%, respectively). Kaplan-Meier survival analysis showed a survival rate at 50 years' follow-up of 99% (95% CI 96 to 100) in spherical hips, 76% (95% CI 66 to 86) in ovoid hips, and 48% (95% CI 29 to 67) in flat hips.</p><p><strong>Conclusion: </strong>After a mean follow-up of 48 years, 47 of 244 nonoperatively treated hips had undergone THA (19%). The results indicate that the aim of treatment should be to obtain a spherical femoral head.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 6","pages":"657-662"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192402","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":"Intra-articular antibiotics : a direct approach to the treatment of infected cementless total hip arthroplasty.","authors":"Frans-Jozef Vandeputte, Mathieu Gevers, Hans Welters, Kristoff Corten","doi":"10.1302/0301-620X.107B6.BJJ-2024-0853.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.107B6.BJJ-2024-0853.R1","url":null,"abstract":"<p><strong>Aims: </strong>The use of intra-articular antibiotics in the treatment of periprosthetic joint infection (PJI) can achieve a concentration which is sufficient to eradicate a biofilm. This may mitigate the need for removal of infected but well-fixed cementless components of a total hip arthroplasty (THA). However, the use of percutaneous catheters might lead to multiresistance or persistent multiorganism infections. The aim of this study was to report the results of a series in which an intra-articular antibiotic infusion was added to a single-stage revision for infected cementless THAs.</p><p><strong>Methods: </strong>A total of 18 patients underwent 18 single-stage revision THAs which were performed for acute (n = 9) or chronic (n = 9) PJI, following a primary (n = 12) or revision (n = 6) cementless THA. After an extensive debridement, modular components were replaced, but all well-fixed components were retained. Two Hickmann catheters were introduced into the joint space, through which intra-articular antibiotics were introduced for two weeks. Intravenous antibiotics were also administered during this time, followed by oral antibiotics until three months after surgery.</p><p><strong>Results: </strong>At a mean follow-up of 5.4 years (3.3 to 7.19), all patients had a normal ESR and white blood cell count. The CRP remained slightly elevated in three patients, although they were pain-free and showed no signs of infection. No patient developed antibiotic-related renal or systemic dysfunction postoperatively.</p><p><strong>Conclusion: </strong>We found that for the treatment of an infected cementless THA, retention of well-fixed components was feasible, with the addition of intra-articular antibiotics to a standard single-stage regime. None of the 18 patients had persistent infection or catheter-induced drug resistance, at a mean follow-up of 5.4 years.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 6 Supple B","pages":"3-8"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192412","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 Burch-Schneider Reinforcement Ring : 200 cases over a 40-year period with a mean follow-up of 11 years.","authors":"Darius Marti, Florine Petitat, Alexander F Heimann, Vlad Popa, Emanuel Gautier, Matthieu Hanauer, Julien Hirt, Joseph M Schwab, Moritz Tannast","doi":"10.1302/0301-620X.107B6.BJJ-2024-1106.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.107B6.BJJ-2024-1106.R1","url":null,"abstract":"<p><strong>Aims: </strong>The Burch-Schneider Reinforcement Ring (BSRR) was developed to manage significant acetabular defects and prevent protrusion in complex primary and revision total hip arthroplasties. This study evaluates the long-term performance of the BSRR over four decades, focusing on survival, patient-reported outcomes, radiological evidence of loosening, complication rates, and factors associated with implant failure.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 200 hips treated with the BSRR at the Cantonal Hospital of Fribourg, Fribourg, Switzerland, from January 1974 to December 2018. Clinical and radiological data were reviewed, and patients were followed through clinical visits, questionnaires, and registry data. Outcomes were assessed using standardized scoring systems and radiological evaluations. Kaplan-Meier survival analysis and Cox proportional hazards modelling were used to identify factors associated with implant failure.</p><p><strong>Results: </strong>The cumulative survival of the BSRR was 72% (95% CI 50 to 100) at 20 years with any clinical or radiological failure as the endpoint, and 97% (95% CI 95 to 100) at 20 years for revision of the BSRR specifically. Clinical outcomes showed moderate improvements at final-follow-up, with a mean Harris Hip Score of 53.4 (SD 25.3) and a Hip disability and Osteoarthritis Outcome Score of 72.8 (SD 18.6). Radiologically at final follow-up, the BSRR demonstrated good stability, with 1.5% of cases (n = 2) showing probable loosening and low rates of osteolysis (3% acetabular (n = 4) and 14% femoral (n = 18)). The primary predictor of implant failure was the Paprosky Grade IV acetabular defect, with a hazard ratio of 4.4 (95% CI 1.2 to 15.7).</p><p><strong>Conclusion: </strong>The BSRR remains an effective solution for acetabular revision surgery, providing consistent long-term outcomes. Its durability makes it a valuable tool in orthopaedic surgery, especially when managing significant bone loss.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 6 Supple B","pages":"23-30"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192416","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 hip arthroplasty in patients with angular proximal femoral deformities.","authors":"Louis Dagneaux, Matthew P Abdel, Rafael J Sierra, David G Lewallen, Robert T Trousdale, Daniel J Berry","doi":"10.1302/0301-620X.107B6.BJJ-2025-0305.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.107B6.BJJ-2025-0305.R1","url":null,"abstract":"<p><strong>Aims: </strong>An angular proximal femoral deformity, in association with osteoarthritis (OA) of the hip, considerably increases the technical complexity of primary total hip arthroplasty (THA). The aims of this study were to determine the long-term implant survival, the risk factors for failure, complications, and clinical outcomes of contemporary primary THA in this difficult group of patients.</p><p><strong>Methods: </strong>Our institutional total joint registry was used to identify 119 primary THAs performed in 108 patients with an angular proximal femoral deformity, between January 1997 and September 2017. The deformity was related to a previous femoral osteotomy in 102 THAs (86%), and developmental or metabolic disorders in 17 THAs (14%). A total of 62 hips (53%) had a predominantly varus deformity. The mean age of the patients was 44 years (SD 13), their mean BMI was 29 kg/m² (SD 6), and 70 (59%) were female. An uncemented femoral component with metaphyseal fixation was used in 35 THAs (30%), an uncemented femoral component with diaphyseal fixation in 34 (29%), an uncemented modular femoral component with a metaphyseal fixation sleeve in 29 (24%), and a cemented femoral component in 21 (18%). Simultaneous corrective femoral osteotomy was performed in 22 THAs (18%). Kaplan-Meier survival and Harris Hip Scores (HHSs) were reported. The mean follow-up was eight years (2 to 22).</p><p><strong>Results: </strong>The ten-year survival free of femoral loosening, any femoral revision, any revision and any reoperation was 95%, 93%, 90%, and 88%, respectively. A total of 13 revisions were undertaken, for aseptic femoral loosening in three, fracture of the femoral component in two, dislocation in two, aseptic acetabular loosening in two, polyethylene liner exchange in two, and infection in two. A preoperative varus deformity was associated with a higher risk of any revision (hazard ratio (HR) 12.5, p = 0.020), and those with a simultaneous osteotomy had a higher risk of any reoperation (HR 3.6, p = 0.023). The mean HHSs improved significantly from 52 preoperatively to 82 at ten years (p < 0.001).</p><p><strong>Conclusion: </strong>In the largest series to date of primary THAs in patients with hip OA and an angular proximal femoral deformity, we found a good ten-year survival free from any revision. Varus deformities, particularly those treated with a simultaneous osteotomy due to the magnitude or location of the deformity, had a higher rate of further surgery.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 6 Supple B","pages":"101-108"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192419","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":"Bridging innovation to implementation in artificial intelligence fracture detection : a commentary piece.","authors":"Mohammed Khattak, Patrick Kierkegaard, Alison McGregor, Daniel C Perry","doi":"10.1302/0301-620X.107B6.BJJ-2024-1567.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.107B6.BJJ-2024-1567.R1","url":null,"abstract":"<p><p>The deployment of AI in medical imaging, particularly in areas such as fracture detection, represents a transformative advancement in orthopaedic care. AI-driven systems, leveraging deep-learning algorithms, promise to enhance diagnostic accuracy, reduce variability, and streamline workflows by analyzing radiograph images swiftly and accurately. Despite these potential benefits, the integration of AI into clinical settings faces substantial barriers, including slow adoption across health systems, technical challenges, and a major lag between technology development and clinical implementation. This commentary explores the role of AI in healthcare, highlighting its potential to enhance patient outcomes through more accurate and timely diagnoses. It addresses the necessity of bridging the gap between AI innovation and practical application. It also emphasizes the importance of implementation science in effectively integrating AI technologies into healthcare systems, using frameworks such as the Consolidated Framework for Implementation Research and the Knowledge-to-Action Cycle to guide this process. We call for a structured approach to address the challenges of deploying AI in clinical settings, ensuring that AI's benefits translate into improved healthcare delivery and patient care.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 6","pages":"582-586"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192400","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":"Durom hip resurfacing at 15 years : predictive factors for failure.","authors":"Thomas R Williamson, Ian W Kennedy, Mark R J Jenkinson, Ben Wheelwright, Nicholas Kane, R M Dominic Meek","doi":"10.1302/0301-620X.107B6.BJJ-2024-1045.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.107B6.BJJ-2024-1045.R1","url":null,"abstract":"<p><strong>Aims: </strong>A range of metal-on-metal hip resurfacing (MoM-HR) implants have shown good functional outcomes, but some have been associated with adverse reactions to metal debris (ARMD) and early failure, requiring regular follow-up and monitoring of the blood metal ion levels. The aim of this study was to report the minimum 15-year survival of the Durom hip resurfacing system (Zimmer Biomet, USA), the functional outcome, and factors which were predictive of failure.</p><p><strong>Methods: </strong>A consecutive series of patients undergoing Durom MoM-HR at a single centre between January 2000 and December 2008 were included. Demographic variables, the size of the implant, radiological parameters, and the most recent blood metal ion levels were collected. The primary outcome measure was failure; secondary outcome measures included the Oxford Hip Score (OHS). Multivariable logistic regression was used to predict failure and identify the factors most strongly associated with failure.</p><p><strong>Results: </strong>A total of 695 hips in 597 patients, 61.2% of whom were male, were included. The mean age of the patients was 51.5 years (SD 8.7). Survival at a mean follow-up of 15.2 years (SD 1.9) was 86.6% (602 of 695 hips). Implant survival was significantly increased in males (92.2% (95% CI 89.7 to 94.8) vs 77.8% (95% CI 72.8 to 82.7); p < 0.001) and with femoral components sized ≥ 50 mm (91.7% (95% CI 88.7 to 94.7) vs 82.3% (95% CI 78.4 to 86.2); p < 0.001). Failure was mostly due to aseptic loosening (42 hips; 6%) and ARMD (27 hips; 3.9%). The mean postoperative OHS was 31.9 (SD 13.5) for patients requiring revision and 41.8 (SD 9.2) for those not requiring revision (p < 0.001). Predictive factors of failure in the regression model included sex, the angle of inclination and migration of the acetabular component, the postoperative OHS and the blood chromium ion levels (Pseudo-R² 0.279). Standardized regression coefficients were greatest for migration of the acetabular component (0.855) and OHS (-0.606).</p><p><strong>Conclusion: </strong>This study presents the longest reported follow-up for the Durom MoM-HR, with excellent survival and functional outcomes at 15 years' follow-up in males and with ≥ 50 mm femoral components. Most failures were due to aseptic loosening. Migration of the acetabular component and symptomatology (OHS) were the factors which most strongly predicted failure.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 6 Supple B","pages":"55-61"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192409","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":"Femoral head reduction osteotomy with simultaneous periacetabular osteotomy for severe femoral head deformities.","authors":"Paulo Rego, Ines Mafra, Rui Viegas, Carlos Silva, Reinhold Ganz","doi":"10.1302/0301-620X.107B6.BJJ-2024-1009.R2","DOIUrl":"https://doi.org/10.1302/0301-620X.107B6.BJJ-2024-1009.R2","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to describe femoral head reduction osteotomy (FHRO) and review its safety, the radiological correction which may be obtained, and the clinical results at a minimum follow-up of two years.</p><p><strong>Methods: </strong>A total of 12 patients (12 hips) with a severe deformity of the femoral head, mainly from Perthes' disease, underwent FHRO using the surgical hip dislocation technique with an extended retinacular flap. Their mean age was 17 years (12 to 25). Radiographs were obtained before and after surgery to evaluate morphological parameters, articular congruence, and cartilage damage. Preoperative arthro-MRI was used to evaluate the condition of the cartilage and the spatial distribution of the damage. The clinical outcome was assessed using the Non-Arthritic Hip Score (NAHS), the Hip Outcome Score (HOS), and the modified Harris Hip Score (mHHS).</p><p><strong>Results: </strong>At a mean follow-up of 4.6 years (2 to 9), all osteotomies had healed unremarkably and no patient had symptomatic avascular necrosis. The mean femoral head size index changed significantly from 120% (SD 10) before surgery to 100% (SD 10) after surgery (p = 0.004). The mean femoral head sphericity index also changed significantly from 71% (SD 10) to 91% (SD 7) (p = 0.002). The mean femoral head extrusion index changed significantly from 37% (SD 17) to 9% (SD 6) (p = 0.002). The mean NAHS score improved significantly from 41 (SD 18) to 69 points (SD 9) (p = 0.002). The mean HOS score also improved significantly from 56 (SD 24) to 83 (SD 17) (p = 0.010) and the mean mHHS score improved significantly from 46 (SD 15) to 76 points (SD 13) (p = 0.004).</p><p><strong>Conclusion: </strong>Thus far, in this series, FHRO could be considered to be a safe surgical procedure with considerable potential for correcting severe deformities of the hip and improving patient-reported outcome measures.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 6 Supple B","pages":"76-83"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192411","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}