Bone & Joint Journal最新文献

{"title":"Stem migration and bone density at ten years : a randomized radiostereometry and dual-energy X-ray absorptiometry study on a short uncemented hip stem with and without a collar.","authors":"Sébastien Daudi, Vasileios Zampelis, Ola Belfrage, Gunnar Flivik","doi":"10.1302/0301-620X.107B9.BJJ-2024-1720.R1","DOIUrl":"10.1302/0301-620X.107B9.BJJ-2024-1720.R1","url":null,"abstract":"<p><strong>Aims: </strong>Short, uncemented hip stems might provide a favourable alternative in total hip arthroplasty (THA) by preserving proximal bone mass through reduced strain-adaptive remodelling. We evaluated and compared the migration and periprosthetic bone remodelling of a short stem with and without a collar, using radiostereometric analysis (RSA) to measure implant migration and dual-energy X-ray absorptiometry (DXA) to evaluate periprosthetic bone remodelling. In this study we present ten-year follow-up results, completing previously published two- and five-year RSA and DXA studies.</p><p><strong>Methods: </strong>A total of 50 patients (34 males) underwent THA due to osteoarthritis and were randomized to either a collared or collarless short stem. Patients were followed for ten years with repeated RSA and DXA examinations. Patient-reported outcome measures (PROMs), Hip disability and Osteoarthritis Outcome Score, EuroQol five-dimension questionnaire, and Forgotten Joint Score were collected.</p><p><strong>Results: </strong>A total of 45 patients remained at the ten-year follow-up. RSA showed early implant stabilization and osseointegration within three months after an initial subsidence of 0.62 mm (95% CI 0.33 to 0.91) for collared and 0.76 mm (95% CI 0.55 to 0.96) for collarless stems. Minimal further migration was observed up to ten years. Net bone mineral density at ten years was -3.3% (95% CI -9.2 to 2.7) and -2% (95% CI -7.3 to 3.4) in collared and collarless stems, respectively. The presence of a collar did not result in any statistically significant differences either for RSA or DXA results. PROMs improved as expected, and remained high up to ten years in both groups. None of the stems was revised.</p><p><strong>Conclusion: </strong>The short stem remains stable at ten years and preserves bone mass, both with and without a collar. These findings support the continued use and further evaluation of this type of short, uncemented stem.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 9","pages":"865-872"},"PeriodicalIF":4.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975557","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":"Purchase of both proximal and distal fragments by the calcar screw is critical when using a locking plate in the treatment of proximal humeral fractures : the role of the calcar screw as a medial bridging screw.","authors":"Kyosun Hwang, Kanghun Yu, Jin Hyeok Lee, Jun-Gyu Moon, An Seong Chang, Jung Ho Park, Hyun Gon Kim, Woong Kyo Jeong","doi":"10.1302/0301-620X.107B9.BJJ-2024-1649.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.107B9.BJJ-2024-1649.R1","url":null,"abstract":"<p><strong>Aims: </strong>Inferior positioning of the calcar screw is important in the purchase of medial screws when treating proximal humeral fractures with a locking plate. However, the impact of the overall trajectory of the calcar screw has not been investigated. The aim of this study was to investigate whether the failure of a calcar screw to purchase both proximal and distal fragments would contribute to an increased risk of failure of fixation in these patients.</p><p><strong>Methods: </strong>Patients who underwent locking plate fixation for a proximal humeral fracture between January 2012 and December 2022 were retrospectively reviewed. They were divided into two groups: a purchase group (P) in whom the calcar screw intersected the fracture line on postoperative anteroposterior radiographs, indicating purchase of both proximal and distal fragments; and a non-purchase group (NP) in whom the screw did not have purchase in both fragments. A total of 163 patients were included; 102 and 61 in the P and NP groups, respectively. We compared the rates of failure of fixation between these groups and performed a multivariable logistic regression analysis to identify the risk factors for failure of fixation.</p><p><strong>Results: </strong>The rate of failure of fixation was significantly higher in the NP group (31.2%; 19 of 61) compared with the P group (3.9%; 4 of 102) (p < 0.001). There were no significant differences between the groups in terms of medical comorbidities, reduction of the fracture, or fixation status. Stepwise multivariable regression identified diabetes (odds ratio (OR) 4.36 (95% CI 1.23 to 16.78); p = 0.025), medial cortical translation of > 5 mm (OR 4.70 (95% CI 1.07 to 21.29); p = 0.039), and NP (OR 16.10 (95% CI 4.72 to 71.62); p < 0.001) as significant risk factors for failure of fixation.</p><p><strong>Conclusion: </strong>Failure of the calcar screw to purchase both the proximal and distal fragments was associated with a significantly higher rate of failure of fixation in the surgical treatment of proximal humeral fractures using a locking plate.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 9","pages":"942-949"},"PeriodicalIF":4.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975522","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":"Periprosthetic femoral fracture following hip arthroplasty : which component design and fixation method has the lowest risk of reoperation?","authors":"Sjur Børsheim, Torbjørn Berge Kristensen, Geir Hallan, Jan-Erik Gjertsen, Ove Furnes, Eva Dybvik, Stein Atle Lie, Håvard Dale","doi":"10.1302/0301-620X.107B9.BJJ-2024-1706.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.107B9.BJJ-2024-1706.R1","url":null,"abstract":"<p><strong>Aims: </strong>Periprosthetic femoral fracture (PPFF) is a major complication following hip arthroplasty. This study examined the influence of femoral component design and fixation method on the risk of reoperation for PPFF.</p><p><strong>Methods: </strong>We analyzed data on femoral component type use for primary hip arthroplasty stems reported to the Norwegian Arthroplasty Register and the Norwegian Hip Fracture Register from 1 January 2005 to 31 December 2023. The study included 187,576 well-documented femoral components used in hemi- and total hip arthroplasties which were assessed by Cox regression. The femoral components were categorized into five groups: 1) cemented composite beam (n = 30,415), and two types of cemented polished taper-slip components; 2) double-tapered (n = 52,255); 3) triple-tapered (n = 13,894), and two types of uncemented femoral components; 4) wedged collarless (n = 38,389); and 5) wedged collared (n = 40,853). Endpoint was reoperation for PPFF (revisions and osteosyntheses).</p><p><strong>Results: </strong>A total of 1,398 femoral components (0.7%) were reported with a reoperation due to PPFF. The risk of reoperation was significantly higher for cemented double-tapered (adjusted hazard rate ratio (aHRR) 4.0 (95% CI 3.1 to 5.2), cemented triple-tapered (aHRR 4.0 (95% CI 2.9 to 5.6)), uncemented wedged collarless (aHRR 7.3 (95% CI 5.6 to 9.5)), and uncemented wedged collared (aHRR 3.5 (95% CI 2.6 to 4.6)) components compared to cemented composite beam components. Cemented triple-tapered prostheses exhibited a similar risk of reoperation (aHRR 1.0 (95% CI 0.8 to 1.3)) to cemented double-tapered components. Uncemented wedged collarless prostheses were associated with a higher risk of PPFF (aHRR 2.1 (95% CI 1.8 to 2.5)) compared to uncemented wedged collared designs.</p><p><strong>Conclusion: </strong>To minimize the risk of PPFF, cemented composite-beam femoral components should be the surgeon's preferred choice. If cementing is not an option, uncemented wedged collared components are the best alternative. Opting for a cemented triple-tapered design does not improve outcomes compared to double-tapered component.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 9","pages":"873-884"},"PeriodicalIF":4.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975529","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 duration of antibiotic prophylaxis in primary hip and knee arthroplasty.","authors":"Ian W Kennedy, Fares S Haddad","doi":"10.1302/0301-620X.107B9.BJJ-2025-0546","DOIUrl":"https://doi.org/10.1302/0301-620X.107B9.BJJ-2025-0546","url":null,"abstract":"","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 9","pages":"858-861"},"PeriodicalIF":4.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975633","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 outcomes in patients undergoing reverse shoulder arthroplasty for dislocation arthropathy : a matched case-control study.","authors":"Sarah I Goldfarb, Laurence Okeke, Piotr Łukasiewicz, Prashant Meshram, James H Padley, Edward G McFarland","doi":"10.1302/0301-620X.107B9.BJJ-2024-1328.R2","DOIUrl":"https://doi.org/10.1302/0301-620X.107B9.BJJ-2024-1328.R2","url":null,"abstract":"<p><strong>Aims: </strong>Dislocation arthropathy of the shoulder is an advanced arthritis resulting from recurrent glenohumeral dislocation with or without previous stabilization surgery. The aim of this study was to compare the clinical results of reverse total shoulder arthroplasty (RTSA) in patients with dislocation arthropathy with those with primary osteoarthritis (OA) and glenoid bone loss.</p><p><strong>Methods: </strong>This was a retrospective matched cohort study including 22 patients with dislocation arthropathy who were treated by one surgeon between 2011 and 2021 and a matched group of 44 patients who were also treated with RTSA, for OA. All patients had a minimum follow-up of two years and were treated with one of two RTSA systems, both with a lateralized glenoid sphere, a 135° neck-shaft angle and an uncemented humeral component, but differing by inlay versus onlay humeral tray. The glenoids were reamed eccentrically until there was at least 90% cover of the baseplate. No bone grafting or augmented glenoid components were used. Range of motion (ROM) and patient-reported outcome measures (PROMs) were recorded preoperatively and at final follow-up.</p><p><strong>Results: </strong>Implant survival at final follow-up was 100% in the dislocation arthropathy group and 98% in the OA group. Both groups showed significant improvements in all PROMs and all ROMs, and there was no significant difference in these improvements between the groups. The complication rate was similar in the two groups (9% in the dislocation arthropathy group and 11% in the OA group).</p><p><strong>Conclusion: </strong>The clinical results of RTSA performed in patients with dislocation arthropathy were comparable to those in a matched group of patients with OA. Although these findings suggest that RTSA is a successful surgical treatment for patients with dislocation arthropathy, longer follow-up is needed.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 9","pages":"924-930"},"PeriodicalIF":4.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975494","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":"Standard compared with fracture-specific components in reverse shoulder arthroplasty for proximal humerus fractures : a meta-analysis of clinical outcomes.","authors":"Adinun Apivatgaroon, Tanawan Kongmalai, Pinkawas Kongmalai","doi":"10.1302/0301-620X.107B9.BJJ-2024-1508.R2","DOIUrl":"10.1302/0301-620X.107B9.BJJ-2024-1508.R2","url":null,"abstract":"<p><strong>Aims: </strong>Reverse total shoulder arthroplasty (RSA) is a well-established treatment for proximal humerus fractures in elderly patients. However, the clinical advantages of standard humeral components compared to fracture-specific components remain unclear. This meta-analysis compares the clinical outcomes and complication rates of standard compared with fracture-specific components in RSA.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted according to the PRISMA guidelines. PubMed, Scopus, and Cochrane Library databases were searched from inception to 12 August 2024. Comparative studies reporting clinical outcomes between standard components and fracture-specific components in RSA for proximal humerus fractures were included. Data on functional scores, range of motion, tuberosity healing, and complications were extracted. Meta-analyses were performed using fixed or random-effects models based on heterogeneity, and risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) and the Cochrane Risk of Bias Tool (RoB2). Weighted mean difference (WMD) was used as the effect size estimator for continuous outcomes, and risk ratio (RR) for dichotomous outcomes. Sensitivity analysis was performed to assess the robustness of the findings.</p><p><strong>Results: </strong>Six studies involving 436 patients (142 with standard components and 294 with fracture-specific components) were included. The pooled analysis found no significant differences between the two component types in functional outcomes (visual analogue scale (VAS): WMD 0.22; American Shoulder and Elbow Surgeons (ASES): WMD -7.43; Constant score: WMD -3.08) or postoperative range of motion (abduction: WMD 1.08°; internal rotation: WMD 0.35°; external rotation: WMD -2.76°; forward flexion: WMD -4.27°). Complication rates, including tuberosity failure (RR 1.34), scapular notching (RR 1.09), and component loosening (RR 1.64), were also comparable.</p><p><strong>Conclusion: </strong>This meta-analysis demonstrates no significant differences in clinical outcomes or complication rates between standard components and fracture-specific components in RSA, suggesting comparable performance in the treatment of proximal humerus fractures. While the findings offer potentially useful insights, they should be interpreted in the context of the limited number of included studies and possible risk of bias.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 9","pages":"931-941"},"PeriodicalIF":4.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975615","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":"Corrigendum.","authors":"Lars H W Engseth, Frank-David Øhrn, Anselm Schulz, Stephan M Röhrl","doi":"10.1302/0301-620X.107B8.BJJ-2025-00057","DOIUrl":"https://doi.org/10.1302/0301-620X.107B8.BJJ-2025-00057","url":null,"abstract":"","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 8","pages":"857"},"PeriodicalIF":4.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762065","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":"Treatment of osteonecrosis of the femoral head in Ficat stage III after femoral neck fracture in children and adolescents by basicervical femoral neck rotational osteotomy.","authors":"Zhendong Zhang, Hui Cheng, Ningtao Ren, Haigang Jia, Yong Li, Wei Chai, Dianzhong Luo, Hong Zhang","doi":"10.1302/0301-620X.107B6.BJJ-2024-1105.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.107B6.BJJ-2024-1105.R1","url":null,"abstract":"<p><strong>Aims: </strong>Osteonecrosis of the femoral head (ONFH) after femoral neck fracture poses challenges in children, particularly at Ficat stage III. Limited effective treatments are available. This study explores basicervical femoral neck rotational osteotomy (BFNRO) for ONFH following fracture of the femoral neck in children and adolescents, and evaluates its outcomes.</p><p><strong>Methods: </strong>Children and adolescents with ONFH (Fiat stage III) following fracture who underwent BFNRO at our centre from June 2017 to September 2022 were included. Follow-up exceeded one year, with data on modified Harris Hip Score (mHHS), range of motion (ROM), patient satisfaction, femoral head collapse, necrotic area repair, leg length, and osteoarthritis (OA) progression recorded.</p><p><strong>Results: </strong>This study included 15 patients (15 hips; eight male and seven female) with a mean age of 12.9 years (10 to 17). Nine patients had BFNRO alone, and six had combined periacetabular osteotomy. Rotation angles varied from 70° to 90° for anterior rotation and 110° to 135° for posterior rotation. Nine patients had femoral neck fixation in a varus position (10° to 30°). The postoperative contour of the weightbearing area of the femoral head has significantly improved in all patients. At a mean follow-up of 28.6 months (12.2 to 72.7), mean mHHS significantly improved (65.2 (SD 8.6) to 90.2 (SD 5.8); p < 0.001). Only one patient showed femoral head further collapse. Patients experienced no/mild hip pain (visual analogue scale 0 to 3), slight restriction in ROM, and mild limb shortening. Two patients had OA progression. No infections or nerve injuries were observed, and no arthoplasies undertaken.</p><p><strong>Conclusion: </strong>Even with late stage ONFH after fracture, BFNRO in children and adolescents can provide positive early to mid-term results by relocating the necrotic area and restoring the integrity of the anterior-lateral column of the femoral head, thereby preventing femoral head collapse and delaying the onset of severe OA.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 6 Supple B","pages":"70-75"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192420","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 distal femoral replacement for nononcological conditions : the EndoProsthetic Replacement for nonOncological conditions (EPRO) study.","authors":"Maheshi P Wijesekera, Hemant Pandit, Sameer Jain, Jeya Palan, Corey D Chan, James N Hadfield, Mohammed As-Sultany, Tanmay Talavia, Eslam Abourisha, Catherine James, Chryssa Neo, Liam Z Yapp, Timothy Petheram, Henry Wynn Jones, Nicholas C Eastley, Robert U Ashford, Chloe E H Scott","doi":"10.1302/0301-620X.107B6.BJJ-2024-1303.R1","DOIUrl":"10.1302/0301-620X.107B6.BJJ-2024-1303.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study aims to determine the outcomes of distal femoral replacements (DFRs) for nononcological conditions.</p><p><strong>Methods: </strong>This was a multicentre retrospective cohort study across five UK centres between 1 August 2009 and 1 April 2023. The primary outcome was the local complication rate. Secondary outcomes assessed were blood transfusion rate, critical care requirements, return to baseline mobility and residence status, systemic complication rates, reoperation rate, and mortality rates. Implant survival analysis was performed using Kaplan-Meier methodology with local complication as the endpoint. Binary logistical regression was performed to identify risk factors for developing local complications. The study included 227 DFRs with a median age of 78.2 years (IQR 70.1 to 84.0). Indications were periprosthetic femoral fracture (PFF) (n = 74; 33%), aseptic revision arthroplasty (n = 45; 20%), acute trauma (n = 42; 19%), infected revision arthroplasty (n = 40; 18%), chronic/failed trauma (n = 14; 6%), and complex primary arthroplasty (n = 12; 5%). Median follow-up was 3.9 years (IQR 1.5 to 7.1).</p><p><strong>Results: </strong>The local complication rate was 21% (48 cases). The most common local complications were periprosthetic joint infection (n = 22; 10%), PFF (n = 7; 3%), and aseptic loosening (n = 7; 3%). Blood transfusion was required in 57 patients (25%), while 67 (30%) required critical care facilities. A return to baseline mobility and residence was observed in 94 (50%) and 183 (83%) patients, respectively. The six-month systemic complication rate was 12% (n = 27) and the reoperation rate was 16% (n = 36). The 30-day and one-year mortality rates were 3% (n = 6) and 9% (n = 21), respectively. The two-year implant survival rate was 80.9% (SE 2.8). Binary logistic regression demonstrated surgery for infected revision arthroplasty, an increasing construct:stem ratio, and increasing operating time were associated with a higher risk of failure (p < 0.05).</p><p><strong>Conclusion: </strong>This is the largest study of DFR for nononcological conditions. Due to high local complication and reoperation rates, it should be considered as a salvage option for complex knee reconstruction and patients should be counselled appropriately.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 6","pages":"632-638"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192386","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":"Effective treatment using a single-stage revision with non-contact low frequency ultrasonic debridement in the treatment of periprosthetic joint infection : a prospective single-arm study.","authors":"Baochao Ji, Chenchen Yang, Abudousaimi Aimaiti, Fei Wang, Guoqing Li, Xiaogang Zhang, Yicheng Li, Li Cao","doi":"10.1302/0301-620X.107B6.BJJ-2024-0848.R2","DOIUrl":"https://doi.org/10.1302/0301-620X.107B6.BJJ-2024-0848.R2","url":null,"abstract":"<p><strong>Aims: </strong>In the surgical treatment of a periprosthetic joint infection (PJI), traditional mechanical debridement can only remove visibly infected tissue; not all of the biofilms can be removed. The aim of this study was to report the results of a single-stage revision using non-contact low-frequency ultrasonic debridement (NLFUD) in the treatment of chronic PJIs.</p><p><strong>Methods: </strong>This was a prospective study of patients undergoing single-stage revision for chronic PJI, between August 2021 and June 2022. After mechanical debridement, an 8 mm handheld non-contact low-frequency ultrasound probe was used for debridement at a frequency of 25 ± 5 kHz and power of 90%, for five minutes. Each debridement lasted for ten seconds, with three-second intervals. The probe repeatedly sonicated all soft-tissue and bony surfaces. Before and after NLFUD, 25 ml of fluid was extracted from the surgical field for bacterial culture and counting. Chemical debridement was then used to irrigate the whole field. The bacteriological findings, recurrence of infection, and complications were recorded.</p><p><strong>Results: </strong>A total of 45 patients (25 infected total hip arthroplasties (THAs) and 20 infected total knee arthroplasties (TKAs)) were included. Overall, 43 patients (95.6%) were free of infection at a mean follow-up of 29 months (24 to 33). There were no complications relating to the ultrasonic debridement, with no neurovascular or muscle injury, no poor wound healing, and no fat liquefaction. The rate of positive culture in the fluid from the surgical field before ultrasonic debridement was 40.0% (18/45), and it significantly increased to 75.6% (34/45) after ultrasonic debridement (p = 0.001). The median number of colony-forming units (CFUs) before debridement was 307 CFU/ml (IQR 225 to 585) significantly improved to 2,372 CFUs/ml (IQR 2,045 to 2,685; p < 0.001) after debridement.</p><p><strong>Conclusion: </strong>We found that a favourable short-term control of infection can be achieved in these patients by a single-stage revision using NLFUD, without associated complications. However, further robust evidence is required to confirm the clinical benefits of using NLFUD under these circumstances.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 6 Supple B","pages":"9-14"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192410","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}