Bone & Joint Journal最新文献

{"title":"Looking after patients with hip fracture in low- and middle-income countries.","authors":"Irewin Tabu, Rebecca Ivers, Matt L Costa","doi":"10.1302/0301-620X.106B12.BJJ-2024-0652","DOIUrl":"10.1302/0301-620X.106B12.BJJ-2024-0652","url":null,"abstract":"<p><p>In the UK, multidisciplinary teamwork for patients with hip fracture has been shown to reduce mortality and improves health-related quality of life for patients, while also reducing hospital bed days and associated healthcare costs. However, despite rapidly increasing numbers of fragility fractures, multidisciplinary shared care is rare in low- and middle-income countries around the world. The HIPCARE trial will test the introduction of multidisciplinary care pathways in five low- and middle-income countries in South and Southeast Asia, with the aim to improve patients' quality of life and reduce healthcare costs.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 12","pages":"1369-1371"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773948","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":"Considerations of morphometry and phenotypes in modern knee arthroplasty.","authors":"Darren B Chen, Jil A Wood, William Griffiths-Jones, Johan Bellemans, Fares S Haddad, Samuel J MacDessi","doi":"10.1302/0301-620X.106B12.BJJ-2023-1269.R1","DOIUrl":"10.1302/0301-620X.106B12.BJJ-2023-1269.R1","url":null,"abstract":"<p><p>As advancements in total knee arthroplasty progress at an exciting pace, two areas are of special interest, as they directly impact implant design and surgical decision making. Knee morphometry considers the three-dimensional shape of the articulating surfaces within the knee joint, and knee phenotyping provides the ability to categorize alignment into practical groupings that can be used in both clinical and research settings. This annotation discusses the details of these concepts, and the ways in which they are helping us better understand the individual subtleties of each patient's knee.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 12","pages":"1363-1368"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773980","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":"Can blood flow restriction therapy improve quality of life and function in dissatisfied knee arthroplasty patients?","authors":"Lenka Stroobant, Ewoud Jacobs, Nele Arnout, Stefaan Van Onsem, Thomas Tampere, Arne Burssens, Erik Witvrouw, Jan Victor","doi":"10.1302/0301-620X.106B12.BJJ-2024-0553.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.106B12.BJJ-2024-0553.R1","url":null,"abstract":"<p><strong>Aims: </strong>Approximately 10% to 20% of knee arthroplasty patients are not satisfied with the result, while a clear indication for revision surgery might not be present. Therapeutic options for these patients, who often lack adequate quadriceps strength, are limited. Therefore, the primary aim of this study was to evaluate the clinical effect of a novel rehabilitation protocol that combines low-load resistance training (LL-RT) with blood flow restriction (BFR).</p><p><strong>Methods: </strong>Between May 2022 and March 2024, we enrolled 45 dissatisfied knee arthroplasty patients who lacked any clear indication for revision to this prospective cohort study. All patients were at least six months post-surgery and had undergone conventional physiotherapy previously. The patients participated in a supervised LL-RT combined with BFR in 18 sessions. Primary assessments included the following patient-reported outcome measures (PROMs): Knee injury and Osteoarthritis Outcome Score (KOOS); Knee Society Score: satisfaction (KSSs); the EuroQol five-dimension five-level questionnaire (EQ-5D-5L); and the pain catastrophizing scale (PCS). Functionality was assessed using the six-minute walk Test (6MWT) and the 30-second chair stand test (30CST). Follow-up timepoints were at baseline, six weeks, three months, and six months after the start.</p><p><strong>Results: </strong>Six weeks of BFR with LL-RT improved all the PROMs except the sports subscale of the KOOS compared to baseline. Highest improvements after six weeks were found for quality of life (QoL) (mean 28.2 (SD 17.2) vs 19 (SD 14.7); p = 0.002), activities of daily living (mean 54.7 (SD 18.7) vs 42.9 (SD 17.3); p < 0.001), and KSSs (mean 17.1 (SD 8.8) vs 12.8 (SD 6.7); p < 0.001). PROMs improvements continued to be present at three-month and six-month follow-up compared to baseline. However, no significant differences were observed in the paired comparisons of the six-week, three-month, and six-month follow-up. The same trends are observed for the 6MWT and 30CST.</p><p><strong>Conclusion: </strong>The reported regime demonstrates improved QoL and function of dissatisfied knee arthroplasty patients. In light of this, the pathway described may provide a valuable and safe treatment option for dissatisfied knee arthroplasty patients for whom therapeutic options are limited.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 12","pages":"1416-1425"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773871","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":"Willingness to participate in placebo-controlled surgical trials of the knee.","authors":"Laura Wall, Samantha Bunzli, Elizabeth Nelson, Lyndon J Hawke, Mesfin Genie, Madeleine Hinwood, Danielle Lang, Michelle M Dowsey, Phillip Clarke, Peter F Choong, Zsolt J Balogh, L S Lohmander, Francesco Paolucci","doi":"10.1302/0301-620X.106B12.BJJ-2023-1266.R2","DOIUrl":"https://doi.org/10.1302/0301-620X.106B12.BJJ-2023-1266.R2","url":null,"abstract":"<p><strong>Aims: </strong>Surgeon and patient reluctance to participate are potential significant barriers to conducting placebo-controlled trials of orthopaedic surgery. Understanding the preferences of orthopaedic surgeons and patients regarding the design of randomized placebo-controlled trials (RCT-Ps) of knee procedures can help to identify what RCT-P features will lead to the greatest participation. This information could inform future trial designs and feasibility assessments.</p><p><strong>Methods: </strong>This study used two discrete choice experiments (DCEs) to determine which features of RCT-Ps of knee procedures influence surgeon and patient participation. A mixed-methods approach informed the DCE development. The DCEs were analyzed with a baseline category multinomial logit model.</p><p><strong>Results: </strong>The proportion of respondents (surgeons n = 103; patients n = 140) who would not participate in any of the DCE choice sets (surgeons = 31%; patients = 40%), and the proportion who would participate in all (surgeons = 18%; patients = 30%), indicated strong views regarding the conduct of RCT-Ps. There were three main findings: for both surgeons and patients, studies which involved an arthroscopic procedure were more likely to result in participation than those with a total knee arthroplasty; as the age (for patients) and years of experience (for surgeons) increased, the overall likelihood of participation decreased; and, for surgeons, offering authorship and input into the RCT-P design was preferred for less experienced surgeons, while only completing the procedure was preferred by more experienced surgeons.</p><p><strong>Conclusion: </strong>Patients and surgeons have strong views regarding participation in RCT-Ps. However, understanding their preferences can inform future trial designs and feasibility assessments with regard to recruitment rates.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 12","pages":"1408-1415"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774019","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":"Sohail Nisar, Jonathan Lamb, Antony Johansen, Robert West, Hemant Pandit","doi":"10.1302/0301-620X.106B12.BJJ-2024-00052","DOIUrl":"https://doi.org/10.1302/0301-620X.106B12.BJJ-2024-00052","url":null,"abstract":"","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 12","pages":"1494"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773986","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 validate the RAND/UCLA appropriateness criteria algorithm for anatomical total shoulder arthroplasty for streamlining the clinical decision-making process.","authors":"Krishna Mandalia, Stephen Le Breton, Christopher Roche, Sarav S Shah","doi":"10.1302/0301-620X.106B12.BJJ-2023-1459.R1","DOIUrl":"10.1302/0301-620X.106B12.BJJ-2023-1459.R1","url":null,"abstract":"<p><strong>Aims: </strong>A recent study used the RAND Corporation at University of California, Los Angeles (RAND/UCLA) method to develop anatomical total shoulder arthroplasty (aTSA) appropriateness criteria. The purpose of our study was to determine how patient-reported outcome measures (PROMs) vary based on appropriateness.</p><p><strong>Methods: </strong>Clinical data from a multicentre database identified patients who underwent primary aTSA from November 2004 to January 2023. A total of 390 patients (mean follow-up 48.1 months (SD 42.0)) were included: 97 (24.9%) were classified as appropriate, 218 (55.9%) inconclusive, and 75 (19.2%) inappropriate. Patients were classified as \"appropriate\", \"inconclusive\", or \"inappropriate\", using a modified version of an appropriateness algorithm, which accounted for age, rotator cuff status, mobility, symptomatology, and Walch classification. Multiple pre- and postoperative scores were analyzed using Pearson's chi-squared test and one-way analysis of variance (ANOVA). Postoperative complications were also analyzed.</p><p><strong>Results: </strong>All groups achieved significant improvement in mean PROM scores postoperatively. \"Appropriate\" patients experienced significantly greater improvement in visual analogue scale (VAS) and American Shoulder and Elbow Surgeons (ASES) score compared to \"inconclusive\" and \"inappropriate\". The appropriate group had a significantly greater proportion of patients who achieved minimal clinically important difference (MCID) (95.8%; n = 93) and substantial clinical benefit (SCB) (92.6%; n = 89). Overall, 13 patients had postoperative complications. No significant differences in postoperative complications among classifications were found.</p><p><strong>Conclusion: </strong>Our data clinically validate the RAND/UCLA aTSA appropriateness criteria algorithm, allowing for more rapid and reliable determination of aTSA candidacy. \"Appropriate\" patients were more likely to achieve MCID and SCB for ASES scores compared to \"inappropriate\" patients. Among \"appropriate\" patients who did not achieve SCB, 50% (n = 4) had a postoperative complication. There was a significantly higher proportion of postoperative complications among those who did not achieve SCB across all three groups. Only 7.1% (n = 1) of patients who did not achieve SCB in the inappropriate group had a postoperative complication. Thus, it can be inferred that the failure to reach SCB in the appropriate group was likely to be due to a postoperative complication, whereas for patients deemed \"inappropriate\", failure to reach SCB may be secondary to factors accounted for within our algorithm.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 12","pages":"1451-1460"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773973","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 National Joint Registry Data Quality Audit of elbow arthroplasty.","authors":"Zaid Hamoodi, Joanne Shapiro, Adrian Sayers, Michael R Whitehouse, Adam C Watts, Jennifer Abbott, Sarah Abbott, Oliver Adebayo, Kashif Ahmad, Philip Ahrens, Michael Akinfala, Nawfal Al-Hadithy, Majed Al-Najjar, Rouin Amirfeyz, Sudhi Ankarath, Fiona Ashton, Kelly Aulton, Sunil Auplish, Jane Austin, Segun Ayeko, Raja Azhar, Rish Bahia, Steven Baines, Marisol Baldomir, Sneha Barai, Benjamin Barkham, Emily Barrett, Timothy Batten, Luckshman Bavan, Jonathan Baxter, Sera Beaumont, James Bentley, Gev Bhabra, Mahendar Bhat, Ankit Bhatt, Mahmoud Bhingraj, Aqeel Bhutta, Samuel Bingham, Jenny Blastland, David Boardman, Michael Boateng, Kasia Bojarska, Khalis Boksh, Simon Booker, Sebastian Borreshi, Michael Bould, Lesley Boulton, Linda Brannan, Zarina Breidaka, Rachel Brereton, Mark Brinsden, Joanne Brooker, Sabine Brookes, Cheryl Broux, Elke Brown, Jacqueline Browne, Richard Bryant, James Buchanan, Lisa Buck, Karen Burnett, Melanie Burrows, Jill Burt, David Burton, Usman Butt, Barry Campaner, Jaime Candal-Couto, Hannah Carvell, Jagannath Chakravarthy, Somashree Chatterji, Salma Chaudhury, Govind S Chauhan, Adrian Chojnowski, Janani Cittambalam, David Clark, Malgorzata Gosia Clarke, Ben Clarke, Andrew Clelland, Roz Cochrane, Karen Colbridge, Hayley Cook, Becky Cooper, Elizabeth Correa, Joanna Craven, Jason Crawford, Sherri Curtis, Rory Cuthbert, Jeremy Dainton, Lisa Dale, Sammy Davies, Joanne Davis, Vicky Davis, Ben Dean, Tom Dehler, Sonu Dennis, Jacob Der Tavitian, Aravind Desai, Sukhraj S Dhillon, Richard Dias, Graham Dickinson, Margo Dirckx, Oliver Dixon, Charles Docker, Ronald Dodenhoff, Peter Domos, Kingsleypaul Draviaraj, Steven Drew, Caroline Duff, Sarah Duffin, Paula Durham, Kirstie Earnshaw, Jefin Edakalathur, Michelle Edwards, Zain Elahi, Samantha Else, Moustafa Emara, Khemerin Eng, Alireza Esfandiari, Colin Esler, Jon Evans, Alicia Everall, Alistair Eyre-Brook, Muhamed Farhan-Alanie, Simon Federer, Sharon Ferdinandus, Marie Finch, Jochen Fischer, Catherine Flood, Christine Forde, Justin Forder, Lisa Fowler, Marieta Franklin, Hamez Gacaferi, David Gamble, Sunil Garg, Vicki Gill, Jean Ginley, Emma Glancey, Gemma Glanville, Aimen Gmati, Karen Goddard, Jay Goel, Carly Goldsmith, Ben Gooding, Fiona Goodwin, Benjamin Goring, Will Goude, Paul Guyver, Samuel Haines, Aziz Haque, Thomas Hardley, Susan Haritonow, Louise Harnett, Joanna Harris, Margaret Harris, Jane Harrison, Isabelle Hauffe, Archie Hawken, Dave Hawkes, Stuart Hay, Mia Haywood, Siddhant Hedge, Susan Hickey, Anne Hickinson, Deborah Higgs, Richard Hill, Sharyn Hill, Jamie Hind, Maria Hitchcock, Terry Holdcroft, Emily Holdcroft, Ann Holliday, Siobhan Hudson, Hazel Hughes, Rabia Imtiaz, Sheeraz Iqbal, Yamen Jabr, Crystal Jackson, Jackie Jameson, Odette Jayme, Andrew Jennings, Cara Jenvey, Elizabeth Jewitt, Andreea Jimenez, John Joby, Adrian Jones, Neil Jones, Jadranka Jovanovic, Vanessa Kabala, Niel Kang, Gulnaz Kausor, Sarah Kaynes, Conal Keane, Lauren Keen, Gaynor Kelly, Matthew Kent, Jonathan Kent, Carla Kerr, Julie Kerr, Christina King, Anthony Kinnair, Gemma Kinsley, Alastair Konarski, Jacqueline Kord, Hari Kumar, Sachin Kumar, Rebecca Lafferty, Patrick Lancaster, William Levitt, Alexandria Lewin, Yueyang Li, Ignatius Liew, Martin Yizhe Lim, Stephen Lipscombe, Edith Lynch, Scott MacInnes, Paula Madden, Nick Maddocks, Ravindra Mahajan, Rachel Mahoney, Sheraz Malik, Syed Mannan, Alexandros Maris, Michael Markey, Christy Martin, Rebecca Martin, Stanley Masunda, George Mazis, Anne-Marie Mcauliffe, Tim McBride, Amy McGowan, Nicolee Mckeown, George McLauchlan, Debbie McNally, Joel Melton, Jane Miller, Cathy Millyard, Claire Mitchell, Foad Mohamed, Abdalla Mohamed, Helen Charlotte Montgomery, Darren Munn, John Mutimer, Rajesh Nanda, Daniel Neen, Lynne Newton, Ashley Newton, Aly Nicholl, Jessica Nightingale, Emma Ogden, Peter Orton, Lynda Oswald, Kelly Page, Maria Paius, Madhavan Papanna, Neelam Patel, Claudia Paul, Chris Peach, Derek Pegg, Sue Penfold, Eleanore Phillips, Greg Pickering, Christos Plakogiannis, Julie Platt, Craig Pole, Richard Potter, Kate Povall, Riten Pradhan, Ganesh Prasad, Karen Price, Julie Pride, Afnan Prins, Layth Qazzaz, Ajay Radhakrishnan, Ashwanth Ramesh, Adil Rashid, Abbas Rashid, Damir Rasidovic, Emily Ratford, Jan Rayner, Jae Rhee, Matthew Rice-Evans, Martha Ricketts, Deborah Roach, Eve R Waters, Simon Robinson, Paul Robinson, Samantha Rodgers, Emma Rogers, Aaron Rooney, Dan Rossouw, Bibhas Roy, Maseh Sadiqi, Markus Sagmeister, David Samy, Paige Sanders, Kelly Sanderson, Dilraj Sandher, Nastaran Sargazi, Mark Saunders, Nicky Saunders, Kim Savage, Seif Sawalha, Melissa Schouw, Gareth Scott, Gunther Selzer, Lucia Sepesiova, Sohan Shah, Shantanu Shahane, Grant Shaw, Suzani Shrestha, John Shutt, Nashat Siddiqui, Sijin Sidharthan, Adrian Simons, Vera Simpson, Pierre Sinclair, Paul Siney, Jagwant Singh, Bijayendra Singh, Harvinder Singh, Apurv Sinha, Callum Smith, Christopher Smith, Kerry Smith, Brinda Somanchi, Muhab Soufan, Cynthia Southgate, Jeremy Southgate, Nicola Spearpoint, Rebecca Stainer, Richard Stevens, Batya Stimler, Andrew Stone, Danielle Suter, Charlie Talbot, Tareq Tareef, Kanthan Theivendran, Beverely Thomas, William Thomas, Andrew Thompson, Jackie Thompson, Elizabeth Thornhill, Andrew Titchener, Michael Townley, Tina Tozer, Jennie Truman, Adam Truss, Rob Turner, Lee Van Rensburg, Vinayak Venugopal, Sam Vollans, Louise Waller, Anna Walsh, Aleena Waraich, Nicholas Wei, William James White, Mark Wilkinson, Daniel Williams, Philip Williams, Nicola Williams, Stephanie Wilson, David Wood, Shirley Yadu, Tejas Yarashi, Julian Zeolla, Nasri H Zreik, Ben Ollivere","doi":"10.1302/0301-620X.106B12.BJJ-2023-1372.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.106B12.BJJ-2023-1372.R1","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this audit was to assess and improve the completeness and accuracy of the National Joint Registry (NJR) dataset for arthroplasty of the elbow.</p><p><strong>Methods: </strong>It was performed in two phases. In Phase 1, the completeness was assessed by comparing the NJR elbow dataset with the NHS England Hospital Episode Statistics (HES) data between April 2012 and April 2020. In order to assess the accuracy of the data, the components of each arthroplasty recorded in the NJR were compared to the type of arthroplasty which was recorded. In Phase 2, a national collaborative audit was undertaken to evaluate the reasons for unmatched data, add missing arthroplasties, and evaluate the reasons for the recording of inaccurate arthroplasties and correct them.</p><p><strong>Results: </strong>Phase 1 identified 5,539 arthroplasties in HES which did not match an arthroplasty on the NJR, and 448 inaccurate arthroplasties from 254 hospitals. Most mismatched procedures (3,960 procedures; 71%) were radial head arthroplasties (RHAs). In Phase 2, 142 NHS hospitals with 3,640 (66%) mismatched and 314 (69%) inaccurate arthroplasties volunteered to assess their records. A large proportion of the unmatched data (3,000 arthroplasties; 82%) were confirmed as being missing from the NJR. The overall rate of completeness of the NJR elbow dataset improved from 63% to 83% following phase 2, and the completeness of total elbow arthroplasty data improved to 93%. Missing RHAs had the biggest impact on the overall completeness, but through the audit the number of RHAs in the NJR nearly doubled and completeness increased from 35% to 70%. The accuracy of data was 94% and improved to 98% after correcting 212 of the 448 inaccurately recorded arthroplasties.</p><p><strong>Conclusion: </strong>The rate of completeness of the NJR total elbow arthroplasty dataset is currently 93% and the accuracy is 98%. This audit identified challenges of data capture with regard to RHAs. Collaboration with a trauma and orthopaedic trainees through the British Orthopaedic Trainee Association improved the completeness and accuracy of the NJR elbow dataset, which will improve the validity of the reports and of the associated research.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 12","pages":"1461-1468"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774018","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 rim syndrome revisited.","authors":"William Z Morris, Shamrez Haider, Sean T Hinds, David Podeszwa, Henry Ellis, Lauren Osborne, Nicholas Anable, Daniel Sucato","doi":"10.1302/0301-620X.106B12.BJJ-2024-0164.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.106B12.BJJ-2024-0164.R1","url":null,"abstract":"<p><strong>Aims: </strong>There has been limited literature regarding outcomes of acetabular rim syndrome (ARS) with persistent acetabular os in the setting of acetabular dysplasia. The purpose of this study was to characterize a cohort of adolescent and young adult patients with ARS with persistent os and compare their radiological and clinical outcomes to patients with acetabular dysplasia without an os.</p><p><strong>Methods: </strong>We reviewed a prospective database of patients undergoing periacetabular osteotomy (PAO) for symptomatic acetabular dysplasia between January 1999 and December 2021 to identify hips with preoperative os acetabuli, defined as a closed triradiate cartilage but persistence of a superolateral os acetabulum. A total of 14 hips in 12 patients with persistent os acetabuli (ARS cohort) were compared to 50 randomly selected 'control' hips without persistent os acetabuli. Preoperative and postoperative radiographs were measured for markers of dysplasia: lateral centre-edge angle, anterior centre-edge angle, acetabular inclination, and migration index. Union of the os was determined in patients with ≥ six months' follow-up. Patient-reported outcome measures (PROMs) included the University of California, Los Angeles (UCLA) activity score and modified Harris Hip Score (mHHS, maximum score 80) completed at one year postoperatively.</p><p><strong>Results: </strong>There was no significant difference between the ARS and control cohorts with regard to sex distribution (p = 0.270), age at surgery (p = 0.186), or BMI (p = 0.442). Preoperatively, the ARS cohort had more severe dysplasia, including lower lateral centre-edge angle (-9.3° (SD 12.5°) vs 7.6° (SD 10.7°); p < 0.001) and greater acetabular inclination (33.9° (SD 8.2°) vs 21.8° (SD 8.7°); p < 0.001). Postoperatively, 6/13 (46%) hips with ≥ six months of radiological follow up demonstrated union of the os. There was no difference between the ARS and control cohorts at one year in UCLA score (9.1 (SD 1.5) vs 8.2 (SD 1.9); p = 0.167) or mHHS (73.4 (SD 9.5) vs 69.9 (SD 8.8); p = 0.312).</p><p><strong>Conclusion: </strong>ARS with persistent acetabular os may occur in more severe dysplasia. Union occurs in 50% cases following corrective PAO.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 12","pages":"1393-1398"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773854","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":"Acute Lisfranc injury management.","authors":"Freideriki Poutoglidou, Bart van Groningen, Louise McMenemy, Robin Elliot, Daniel Marsland","doi":"10.1302/0301-620X.106B12.BJJ-2024-0581.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.106B12.BJJ-2024-0581.R1","url":null,"abstract":"<p><p>Lisfranc injuries were previously described as fracture-dislocations of the tarsometatarsal joints. With advancements in modern imaging, subtle Lisfranc injuries are now more frequently recognized, revealing that their true incidence is much higher than previously thought. Injury patterns can vary widely in severity and anatomy. Early diagnosis and treatment are essential to achieve good outcomes. The original classification systems were anatomy-based, and limited as tools for guiding treatment. The current review, using the best available evidence, instead introduces a stability-based classification system, with weightbearing radiographs and CT serving as key diagnostic tools. Stable injuries generally have good outcomes with nonoperative management, most reliably treated with immobilization and non-weightbearing for six weeks. Displaced or comminuted injuries require surgical intervention, with open reduction and internal fixation (ORIF) being the most common approach, with a consensus towards bridge plating. While ORIF generally achieves satisfactory results, its effectiveness can vary, particularly in high-energy injuries. Primary arthrodesis remains niche for the treatment of acute injuries, but may offer benefits such as lower rates of post-traumatic arthritis and hardware removal. Novel fixation techniques, including suture button fixation, aim to provide flexible stabilization, which theoretically could improve midfoot biomechanics and reduce complications. Early findings suggest promising functional outcomes, but further studies are required to validate this method compared with established techniques. Future research should focus on refining stability-based classification systems, validation of weightbearing CT, improving rehabilitation protocols, and optimizing surgical techniques for various injury patterns to ultimately enhance patient outcomes.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 12","pages":"1431-1442"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773867","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":"Cutibacterium acnes periprosthetic joint infections.","authors":"Christopher N Warne, Sean Ryan, Elizabeth Yu, Douglas R Osmon, Daniel J Berry, Matthew P Abdel","doi":"10.1302/0301-620X.106B12.BJJ-2024-0437.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.106B12.BJJ-2024-0437.R1","url":null,"abstract":"<p><strong>Aims: </strong><i>Cutibacterium acnes</i> (<i>C. acnes</i>; previously known as <i>Propionibacterium acnes</i> or <i>P. acnes</i>) periprosthetic hip and knee infections are under-reported. While culture contamination with <i>C. acnes</i> occurs, true infections are important to recognize and treat. We sought to describe the demographics and treatment outcomes of patients with <i>C. acnes</i> periprosthetic joint infections (PJIs) of the hip and knee.</p><p><strong>Methods: </strong>Patients with <i>C. acnes</i> PJI between January 2005 and December 2018 were retrospectively reviewed utilizing the institutional total joint registry. Patients with monomicrobial PJI and two or more positive cultures were considered to have true <i>C. acnes</i> PJI. Patients with polymicrobial infection or with only one positive culture were excluded. This resulted in 35 PJIs (21 hips and 14 knees); the patients' mean age was 63 years (35 to 84) and 15 (43%) were female. Mean follow-up was five years (1 to 14).</p><p><strong>Results: </strong>The median time to positive culture was five days (IQR 5 to 6) and median synovial fluid cell count was 22,583 cells (IQR 15,200 to 53,231). The median ESR was 25 mm/hr (IQR 7 to 37), and CRP was 15 mg/l (IQR 3 to 29). Of the 35 PJIs, 18 (51%) were treated with chronic antibiotic suppression without surgical intervention, and the remainder were treated with two-stage exchange arthroplasty. The two-year survival free of any revision was 94%. Four patients failed treatment due to symptomatic infection, with three treated with two-stage exchange and one treated with irrigation and debridement with modular component exchange for a survival rate of 89% and 83% at two and five years, respectively.</p><p><strong>Conclusion: </strong>Laboratory evidence of <i>C. acnes</i> PJI in this cohort was typical compared to more conventional organisms. Cultures grew more quickly than previously thought in patients with <i>C. acnes</i> PJI. Treatment with two-stage exchange or chronic antibiotic suppression alone both had few treatment failures at mid-term follow-up.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 12","pages":"1426-1430"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773991","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}