Bone & Joint Journal最新文献

{"title":"Risk factors for idiopathic cubital tunnel syndrome : development and surgical intervention from a nationwide population-based cohort study.","authors":"Jung Il Lee, Jong Woong Park, Chan Mi Park, Seokjin Kong, Duk Hee Lee","doi":"10.1302/0301-620X.108B5.BJJ-2025-0884.R2","DOIUrl":"https://doi.org/10.1302/0301-620X.108B5.BJJ-2025-0884.R2","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this nationwide population-based cohort study was to identify the risk factors associated with the development of idiopathic cubital tunnel syndrome (CuTS), and the factors which influence the requirement for surgery in these patients.</p><p><strong>Methods: </strong>We analyzed data from 43,189 patients newly diagnosed with idiopathic CuTS between January 2009 and December 2021, using the Korean National Health Insurance Service database. They were identified using diagnostic codes, procedural codes for surgery, and/or electrodiagnostic study codes. Patients with cervical radiculopathy, brachial plexopathy, polyneuropathy, previous CuTS and recent fracture, dislocation, or arthroplasty of the elbow were excluded. Age- and sex-matched controls were selected at a 1:5 ratio. Logistic regression identified risk factors for the development of CuTS, and Cox proportional hazards regression determined factors associated with surgical treatment. A false discovery rate-adjusted p-value < 0.05 was considered significant.</p><p><strong>Results: </strong>Risk factors for the development of CuTS included carpal tunnel syndrome (CTS), arthritis of the elbow, rheumatoid arthritis (RA), gout, depression, dyslipidaemia, hypertension, obesity, metabolic syndrome, diabetes, current smoking, anaemia, and hazardous alcohol drinking, in decreasing order of odds ratios. A total of 7,810 patients (18%) underwent surgery. Factors associated with surgery included CTS, arthritis of the elbow, RA, hypertension, obesity, metabolic syndrome, diabetes, current smoking, and hazardous alcohol drinking, in decreasing order of hazard ratios. Regular exercise significantly reduced the risk of both the development of CuTS and the requirement for surgery.</p><p><strong>Conclusion: </strong>In this large cohort study, we identified risk factors for the development of idiopathic CuTS and its surgical treatment, many of which parallel those for CTS. These findings may guide clinicians in risk stratification, prevention, and management of patients with idiopathic CuTS, and provide insights into the shared aetiology.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"657-662"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822543","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":"Superior compared with anteroinferior plating for mid-shaft fractures of the clavicle : a meta-analysis.","authors":"Marc Boutros, Guy Awad, Akin Adio, Jad Lawand, Peter Boufadel, Adam Z Khan, Brian W Hill, John G Horneff, Joseph A Abboud","doi":"10.1302/0301-620X.108B5.BJJ-2025-1271.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.108B5.BJJ-2025-1271.R1","url":null,"abstract":"<p><strong>Aims: </strong>Superior plating has long been the routine surgical approach for mid-shaft fractures of the clavicle. However, concerns about the prominence of the plate and neurological risk have led to an increased interest in anteroinferior plating. Whether anteroinferior plating offers comparable or improved outcomes without compromising the stability of fixation has been investigated in several studies. The aim of this meta-analysis was to evaluate the clinical outcomes, complications, and complication-related outcomes following superior compared with anteroinferior plating of mid-shaft fractures of the clavicle.</p><p><strong>Methods: </strong>A comprehensive search was conducted in PubMed, Scopus, Cochrane Library, and Google Scholar until 22 August 2025. Randomized controlled trials and observational studies comparing superior and anteroinferior plating techniques for mid-shaft clavicular fractures in adults were included. A total of 13 studies met the inclusion criteria, including 1,433 adult patients with these fractures. The outcomes which were assessed included the Constant-Murley score (shoulder function), Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, neurological injury, implant removal, postoperative pain (visual analogue scale), time to union, the rates of nonunion and infection, and operating time.</p><p><strong>Results: </strong>Anteroinferior plating yielded significantly higher Constant-Murley scores compared with superior plating (mean difference -1.91 (95% CI -3.25 to -0.57); p = 0.005). Anteroinferior plating was also associated with a significantly lower risk of minor neurological injury compared with superior plating, with a risk ratio of 3.69 (95% CI 1.03 to 13.25; p = 0.050). There were no significant differences in the mean DASH score (p = 0.110), implant removal (p = 0.350), postoperative pain (p = 0.620), nonunion rate (p = 0.250), infection rate (p = 0.600), time to union (p = 0.520), or operating time (p = 0.580) between the groups.</p><p><strong>Conclusion: </strong>Anteroinferior plating provides significantly better shoulder function with a significantly reduced risk of minor neurological injury compared with traditional superior plating. These findings support the growing adoption of anteroinferior plating as a safe and effective alternative for the surgical treatment of mid-shaft fractures of the clavicle.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"578-587"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822535","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":"Isolated hamstring tendon autograft should be avoided in high-risk patients undergoing anterior cruciate ligament reconstruction : a New Zealand ACL Registry study.","authors":"Richard Rahardja, Hamish Love, Mark G Clatworthy, Simon W Young","doi":"10.1302/0301-620X.108B5.BJJ-2025-0181.R4","DOIUrl":"https://doi.org/10.1302/0301-620X.108B5.BJJ-2025-0181.R4","url":null,"abstract":"<p><strong>Aims: </strong>Younger patients are at the highest risk of repeat injury after anterior cruciate ligament (ACL) reconstruction. The hamstring tendon autograft remains the most popular choice of graft in the world, but its use in these high-risk patients is controversial. The aim of this study was to compare revision rates between the bone-patellar tendon-bone (BTB) and hamstring tendon autografts in a high-risk patient population.</p><p><strong>Methods: </strong>Prospective data recorded in the New Zealand ACL Registry were analyzed. Primary ACL reconstructions performed between April 2014 and March 2022 were included, allowing for a minimum follow-up of two years. High-risk patients were analyzed using the following criteria: age between 14 and 25 years, ACL rupture during sporting activity, time from injury to surgery within 12 months, grade 2 pivot shift, and a minimum preinjury Marx activity score of 8. The rate of revision was compared between the BTB and hamstring tendon autografts using a univariate chi-squared test and multivariable Cox regression survival analysis to calculate hazard ratios (HRs) with 95% CIs.</p><p><strong>Results: </strong>A total of 3,482 high-risk primary ACL reconstructions were analyzed. A lateral extra-articular procedure was performed in 175 cases with no revisions performed during the study period. The rate of revision was 11.4% (238/2,091) with the hamstring tendon autograft versus 4.3% (60/1,391) with the BTB autograft (p < 0.001). The hamstring tendon autograft had a 2.5-times higher risk of revision compared with the BTB autograft (adjusted HR 2.5 (95% CI 1.9 to 3.3); p < 0.001). The number needed to treat with a BTB autograft to prevent one revision was 14 patients.</p><p><strong>Conclusion: </strong>Isolated hamstring tendon autograft has a high rate of revision and should be avoided in high-risk patients undergoing ACL reconstruction.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"616-621"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822578","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":"Recovery trajectory and patient-specific predictors following periacetabular osteotomy : a 24-month prospective study.","authors":"Vincent Justus Leopold, Stéphane Poitras, John C Clohisy, Ira Zaltz, Ernest L Sink, Sasha Carsen, Etienne Belzile, Paul E Beaulé","doi":"10.1302/0301-620X.108B5.BJJ-2025-1450.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.108B5.BJJ-2025-1450.R1","url":null,"abstract":"<p><strong>Aims: </strong>Periacetabular osteotomy (PAO) is the gold-standard treatment for symptomatic hip dysplasia. While long-term joint preservation and functional improvement are documented, early postoperative recovery trajectories and predictors of meaningful improvement remain unclear.</p><p><strong>Methods: </strong>This prospective multicentre cohort study is a secondary analysis of a randomized trial including 218 patients (mean age 27.1 years (SD 7.7); 83.2% female (181/218)) undergoing PAO with or without hip arthroscopy. We aimed to 1) determine the timing and proportion of patients achieving minimal clinically important difference (MCID, + 26), substantial clinical benefit (SCB, + 42), and patient-acceptable symptom state (PASS, ≥ 65) on the 33-item International Hip Outcome Tool (iHOT-33) within 24 months; and 2) identify predictors of threshold achievement. Correction was assessed by lateral centre-edge angle (LCEA) and acetabular index. Logistic regression evaluated patient- and surgery-specific factors.</p><p><strong>Results: </strong>Radiological parameters improved significantly (mean LCEA 18.7° (SD 8.4°) to 32.2° (SD 5.7°); acetabular index 12.8° (SD 7.6°) to 1.6 (SD 6.3°), both p < 0.001). iHOT-33 improved from 34.2 (SD 16.4) preoperatively to 61.4 (SD 24.0) at six months, 72.8 (SD 22.0) at 12 months, and 78.0 (SD 21.0) at 24 months (p < 0.001). At six, 12, and 24 months, MCID was achieved by 70.2%, 71.5%, and 80.3% of patients; SCB by 52.8%, 64.6%, and 74.6%; and PASS by 56.3%, 73.5%, and 79.6%. Most recovery occurred within the first year, with continued gains thereafter. Multivariable analysis identified higher BMI as negative predictor for MCID, SCB, and PASS at 12 months (OR 0.88 to 0.89; p = 0.015 to 0.019). Residual undercorrection, reflected by higher postoperative acetabular index, reduced odds of MCID at 12 months (OR ~ 0.80 (95% CI 0.67 to 0.95); p = 0.011). Older age lowered the likelihood of PASS (OR 0.94 (95% CI 0.89 to 0.999); p = 0.047). Labral repair was negatively associated with PASS at six months (OR 0.27 (95% CI 0.09 to 0.89); p = 0.031), but not thereafter.</p><p><strong>Conclusion: </strong>Most patients achieve clinically meaningful improvement within the first postoperative year, with further recovery into the second. Elevated BMI, older age, and residual undercorrection reduce the likelihood of reaching thresholds, while concomitant labral repair may temporarily delay early symptom acceptability.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"607-615"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822545","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 compared with conservative treatment with a self-directed exercise programme in moderate-to-severe hip osteoarthritis: a randomized controlled trial.","authors":"Aapo Talonpoika, Lauri Karttunen, Antti Jaroma, Toni Rikkonen, Joonas Sirola, Jussi Mäki, Jukka Huopio, Sarang Qazi, Tuomas Selander, Jari Arokoski, Heikki Kröger","doi":"10.1302/0301-620X.108B5.BJJ-2025-0858.R2","DOIUrl":"https://doi.org/10.1302/0301-620X.108B5.BJJ-2025-0858.R2","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to compare clinical, performance-based, and patient-reported outcomes between patients with moderate-to-severe hip osteoarthritis (OA) who were treated with total hip arthroplasty (THA) or conservative treatment with a self-directed exercise programme.</p><p><strong>Methods: </strong>We conducted a single-centre, randomized controlled trial including 120 participants with radiologically confirmed moderate-to-severe hip OA (Kellgren-Lawrence grades 2 to 4). Participants were randomly allocated (1:1) to receive either THA combined with postoperative rehabilitation or a self-directed exercise programme. The primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Harris Hip Score (HHS) at 12 months. Minimal clinically important differences (MCIDs) were predefined as 11 points for WOMAC and 15.9 points for HHS. Secondary outcomes included WOMAC at six months, as well as WOMAC subscales, health-related quality of life (HRQoL) RAND 36-Item Health Survey 1.0 (RAND-36) domains, and physical performance tests (chair stand, 40 m walk, and stair climb).</p><p><strong>Results: </strong>At 12 months, the THA group demonstrated significantly greater improvements than the conservative group in WOMAC total score (-30.9 (95% CI -34.9 to -27.0) vs -3.7 (95% CI -8.2 to 0.9; between-group difference -27.1 points (95% CI -32.4 to -21.8)) and HHS (29.8 (95% CI 25.8 to 33.9) vs 5.7 (95% CI 2.4 to 9.0); difference 24.1 (95% CI 19.6 to 28.7)), both exceeding MCID thresholds. Overall, 23 participants (38%) in the conservative group underwent THA during the study; two participants in the THA group declined surgery. The THA group also showed superior gains across all performance-based tests and most RAND-36 domains.</p><p><strong>Conclusion: </strong>In patients with moderate-to-severe hip OA, THA combined with postoperative rehabilitation provides clinically meaningful improvements in pain, function, and HRQoL compared with a self-directed exercise programme alone. These findings reinforce THA as the preferred option for eligible patients.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"588-596"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822582","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 accuracy of three classification systems used for periprosthetic joint infection : a comparative study of the McPherson, PJI-TNM, and JS-BACH classifications.","authors":"João de Sousa Seixas, Laís Simonato Altoé, Ana Cláudia Santos, Ana Ribau, Daniel Esteves Soares, Andre Dias Carvalho, Miguel Abreu, Ricardo Sousa","doi":"10.1302/0301-620X.108B5.BJJ-2025-1141.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.108B5.BJJ-2025-1141.R1","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to evaluate and compare the prognostic value of three classification systems for periprosthetic joint infection (PJI) - McPherson, PJI-TNM, and JS-BACH - by analyzing their association with three key clinical outcomes: recurrence of infection after the initial treatment, final PJI status, and PJI-related mortality.</p><p><strong>Methods: </strong>This was a retrospective cohort study using a prospectively maintained institutional database. All patients who underwent surgery for PJI of the hip or knee between January 2011 and December 2022 were included, provided that they had a minimum of two years of follow-up, unless they had earlier recurrence of infection or had died. Each case was classified according to the three systems and grouped into three levels of severity (A: less severe; B: intermediate; C: most severe) to allow direct comparison. Associations between the variables of the classification systems and outcomes were examined using chi-squared and Fisher's exact tests. Discriminative ability was assessed using receiver operating characteristic (ROC) curve analysis and the area under the curve was calculated for each outcome.</p><p><strong>Results: </strong>Of the 186 patients who were included, recurrence after initial treatment occurred in 50 (26.9%) and PJI-related mortality in 19 patients (10.2%). Among the sub-categories of the classifications, host-related variables consistently correlated with most outcomes across all systems. Local extremity grade/soft-tissues also correlated with recurrence after initial treatment throughout. The JS-BACH classification was significantly associated with all three outcomes: recurrence (p = 0.002), final PJI status (p = 0.008), and mortality (p < 0.001). It also showed the best discriminative ability on ROC analysis. PJI-TNM was significantly associated with the final status (p = 0.004) and mortality (p = 0.002), but not with recurrence of infection. The McPherson classification was only significantly associated with the final PJI status (p = 0.039). Patients classified as 'limited options' in JS-BACH had a 28.6% mortality rate, while none in the 'uncomplicated' group died or required suppressive antibiotic treatment.</p><p><strong>Conclusion: </strong>The JS-BACH classification system showed the best prognostic performance, correlating with all the outcomes which were evaluated and offering a balanced combination of simplicity, clinical use, and predictive value. The host status remained a critical predictor regardless of which classification system was used.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"643-649"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822590","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":"Acetabular components and additive manufacturing: does it all add up? : a literature review of the current themes around the use of additive manufacturing in orthopaedic acetabular implants.","authors":"Jack Hurst, Richard O C Oreffo, Douglas G Dunlop","doi":"10.1302/0301-620X.108B5.BJJ-2025-0710.R2","DOIUrl":"https://doi.org/10.1302/0301-620X.108B5.BJJ-2025-0710.R2","url":null,"abstract":"<p><p>Advances in 3D printing, known as additive manufacturing (AM), have allowed for the production of highly porous trabecular metals (TMs) that aim to 'mimic' human bone and facilitate bony ingrowth. AM is increasingly being used to produce acetabular implants which incorporate TMs to varying degrees, to try and create a well-fixed acetabular component and, as a result, reduce the rate of aseptic loosening. This review details the history of uncemented acetabular implants and the developmental milestones towards these novel 3D-printed components, highlighting key steps in the complex design rationale of these intricate designs and why they are thought to be beneficial. To date, there has been no clear consensus on the optimum structural design or even manufacturing technique for acetabular implants, despite the plethora of AM implants already widely available on the market. Further evaluation of the manufacturing literature, as summarized, displays a paucity of preclinical studies or appropriate biological models that account for the dynamic stresses seen across a newly implanted acetabular component and the implications for a clinical setting. This review evaluates the differences seen across previous studies and implants which are currently commercially available. We highlight the need for further comparisons and evaluation of this rapidly evolving area of orthopaedics, together with suggestions to advance the field.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"570-577"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822435","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":"Age and symptom severity as predictors of outcomes following shockwave therapy in Achilles tendinopathy : a single-centre observational study.","authors":"Anne-Marie Hutchison, Paul Williams, Claire J Topliss, Owen Bodger, Rhys Whelan, David J Beard","doi":"10.1302/0301-620X.108B5.BJJ-2025-0706.R2","DOIUrl":"https://doi.org/10.1302/0301-620X.108B5.BJJ-2025-0706.R2","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to determine the factors associated with positive outcomes from extracorporeal shockwave therapy (ESWT) in patients with chronic Achilles tendinopathy, and to develop and evaluate a simple predictive model for clinical use.</p><p><strong>Methods: </strong>An observational study was carried out on patients with chronic Achilles tendinopathy, managed through the therapist-led Tendo Achilles Pathway (TAP), who did not respond to physiotherapy and podiatry. Logistic regression was used with potential predictors including age, sex, symptom duration, athletic status, type of onset, use of insoles, bilateral symptoms, body side and symptom location, neovessel presence, and severity measurements (Victoria Institute of Sport Assessment-Achilles (VISA-A) and visual analogue scale (VAS)).</p><p><strong>Results: </strong>The sample (n = 183) were mostly female (60%, 110/182), had a median age of 53 years (IQR 24 to 86), and had experienced symptoms from three months to 14 years, with pain most commonly reported in the tendon body (58%, 105/181). Overall, 30% (19/63) were athletes, 55% (54/99) wore insoles, and 89% (54/61) had insidious onset. The mean baseline VAS and VISA-A scores were 57 (SD 23) and 33 (SD 17), respectively. ESWT led to positive outcomes in 46% and only milder initial symptoms and older age were associated with better outcomes (p < 0.05).</p><p><strong>Conclusion: </strong>This study presents an analysis of the rate and determinants of positive outcome at three months following ESWT in patients with Achilles tendinopathy. Age and symptom severity emerged as significant predictors of positive treatment success. Furthermore, we developed a very simple predictive model with potential clinical utility.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"650-656"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822506","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":"Cost-effectiveness of treatment strategies for non-displaced osteoporotic femoral neck fractures in older adults in Ontario, Canada.","authors":"Pakpoom Ruangsomboon, Yu Qing Huang, Onlak Ruangsomboon, Davis Tam, Michael Zywiel, Bheeshma Ravi, David M J Naimark","doi":"10.1302/0301-620X.108B5.BJJ-2025-0673.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.108B5.BJJ-2025-0673.R1","url":null,"abstract":"<p><strong>Aims: </strong>This economic evaluation study assessed the cost-effectiveness of six treatment strategies for non-displaced osteoporotic femoral neck fractures (NDFNFs) in older adults using a Markov cohort model from the Ontario, Canada, public payer perspective.</p><p><strong>Methods: </strong>A probabilistic Markov chain Monte Carlo decision analysis model was developed to compare six strategies: 1) cemented femoral fixation total hip arthroplasty (THA; hybrid, cemented femoral component/uncemented cup - 'cemented THA'); 2) cementless THA; 3) cemented hip hemiarthroplasty (HHA); 4) cementless HHA; 5) internal fixation (IF); and 6) conservative treatment. The base case cohort consisted of Canadian patients presenting with a NDFNF aged 65 years, modelled with a lifetime horizon. Outcomes included quality-adjusted life-months (QALMs), lifetime costs (discounted at 1.5% annually), net monetary benefits (NMBs), and incremental cost-effectiveness ratios (ICERs). All costs are presented in Canadian dollars (CAD, $). The cost-effectiveness threshold (λ) was $4,166.67 per QALM. The primary outcome measure was expected NMBs, and the preferred strategy was the one with the highest expected NMBs over the lifetime horizon.</p><p><strong>Results: </strong>The estimated mean costs were $6,054 (IF), $11,995 (cemented THA), $11,011 (cemented HHA), $11,854 (cementless HHA), $15,405 (cementless THA), and $7,617 (conservative treatment). Cemented THA yielded the highest QALMs (192.7). Cemented THA had the highest NMB ($790,784). Cementless THA, cementless HHA, and conservative treatment were absolutely dominated while cemented HHA was extendedly dominated. After excluding dominated strategies, the ICER for cemented THA compared with IF was $127.5 per QALM, indicating that cemented THA is cost-effective relative to IF. At a λ of $4,166.67 per QALM, cemented THA was the most cost-effective strategy in 48.7% of simulations, followed by cemented HHA (31.2%) and IF (17.9%).</p><p><strong>Conclusion: </strong>Cemented femoral fixation THA is the most preferred strategy (highest expected NMB at λ) for NDFNFs in 65-year-old patients. When evaluated against a λ of $4,166.67 per QALM, cemented THA outperforms cementless THA, HHA, IF, and conservative treatment.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"688-697"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822598","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":"Bone cements: strengthening oversight.","authors":"Sayf Faraj, James Li, Warran Wignadasan, Andreas Fontalis, Fares S Haddad","doi":"10.1302/0301-620X.108B.BJJ-2026-0346","DOIUrl":"https://doi.org/10.1302/0301-620X.108B.BJJ-2026-0346","url":null,"abstract":"","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B ","pages":"xxx"},"PeriodicalIF":4.6,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147475976","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}