Bone & Joint Journal最新文献

{"title":"Failed radial head arthroplasty treated by removal of the implant.","authors":"Juan Ameztoy Gallego, Blanca Diez Sanchez, Afonso Vaquero-Picado, Samuel Antuña, Raul Barco","doi":"10.1302/0301-620X.106B11.BJJ-2024-0330.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.106B11.BJJ-2024-0330.R1","url":null,"abstract":"<p><strong>Aims: </strong>In patients with a failed radial head arthroplasty (RHA), simple removal of the implant is an option. However, there is little information in the literature about the outcome of this procedure. The aim of this study was to review the mid-term clinical and radiological results, and the rate of complications and removal of the implant, in patients whose initial RHA was undertaken acutely for trauma involving the elbow.</p><p><strong>Methods: </strong>A total of 11 patients in whom removal of a RHA without reimplantation was undertaken as a revision procedure were reviewed at a mean follow-up of 8.4 years (6 to 11). The range of motion (ROM) and stability of the elbow were recorded. Pain was assessed using a visual analogue scale (VAS). The functional outcome was assessed using the Mayo Elbow Performance Score (MEPS), the Oxford Elbow Score (OES), and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Radiological examination included the assessment of heterotopic ossification (HO), implant loosening, capitellar erosion, overlengthening, and osteoarthritis. Complications and the rate of further surgery were also recorded.</p><p><strong>Results: </strong>The indications for removal of the implant were stiffness in five patients, aseptic loosening in five, and pain attributed to the RHA in three. The mean time interval between RHA for trauma to removal was ten months (7 to 21). Preoperatively, three patients had overlengthening of the implant, three had capitellar erosion, six had HO, and four had radiological evidence of loosening. At the final follow-up, the mean the flexion-extension arc improved significantly by 38.2° (95% CI 20 to 59; p = 0.002) and the mean arc of prono-supination improved significantly by 20° (95% CI 0 to 72.5; p = 0.035). The mean pain VAS score improved significantly by 3.5 (95% CI 2 to 5.5; p = 0.004). The mean MEPS improved significantly by 27.5 (95% CI 17.5 to 42.5; p = 0.002). The mean OES improved significantly by 9 (95% CI 2.5 to 14; p = 0.012), and the mean DASH score improved significantly by 23.5 (95% CI 7.5 to 31.6; p = 0.012). Ten patients (91%) had HO and osteoarthritis. Two patients underwent further surgery due to stiffness and pain, respectively.</p><p><strong>Conclusion: </strong>Simple removal of the implant at revision surgery following a failed RHA introduced following trauma provides satisfactory mid-term results with an acceptable risk of complications. Osteoarthritis, instability, and radioulnar impingement were not problems in this series.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 11","pages":"1327-1332"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559102","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":"Core Outcome Domains for Elbow Replacement (CODER).","authors":"Adam C Watts, Catriona McDaid, Catherine Hewitt, Marcus Bateman, Jonathan P Evans, Deborah Higgs, Ben Hughes, Toni Luokkala, Chris Smith, Elaine Uppal","doi":"10.1302/0301-620X.106B11.BJJ-2024-0352.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.106B11.BJJ-2024-0352.R1","url":null,"abstract":"<p><strong>Aims: </strong>A review of the literature on elbow replacement found no consistency in the clinical outcome measures which are used to assess the effectiveness of interventions. The aim of this study was to define core outcome domains for elbow replacement.</p><p><strong>Methods: </strong>A real-time Delphi survey was conducted over four weeks using outcomes from a scoping review of 362 studies on elbow replacement published between January 1990 and February 2021. A total of 583 outcome descriptors were rationalized to 139 unique outcomes. The survey consisted of 139 outcomes divided into 18 domains. The readability and clarity of the survey was determined by an advisory group including a patient representative. Participants were able to view aggregated responses from other participants in real time and to revisit their responses as many times as they wished during the study period. Participants were able to propose additional items for inclusion. A Patient and Public Inclusion and Engagement (PPIE) panel considered the consensus findings.</p><p><strong>Results: </strong>A total of 45 respondents completed the survey. Nine core mandatory domains were identified: 'return to work or normal daily role'; delivery of care was measured in the domains 'patient satisfaction with the outcome of surgery' and 'would the patient have the same operation again'; 'pain'; 'revision'; 'elbow function'; 'independence in activities of daily living'; 'health-related quality of life'; and 'adverse events'. 'Elbow range of motion' was identified as important by consensus but was felt to be less relevant by the PPIE panel. The PPIE panel unanimously stated that pain should be used as the primary outcome domain.</p><p><strong>Conclusion: </strong>This study defined core domains for the clinical outcomes of elbow replacement obtained by consensus from patients, carers, and healthcare professionals. Pain may be used as the primary outcome in future studies, where appropriate. Further work is required to define the instruments that should be used.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 11","pages":"1306-1311"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559087","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":"Delayed fixation of distal radial fractures beyond three weeks after initial failed closed reduction increases the odds of reoperation.","authors":"Lauren L Nowak, Joel Moktar, Patrick Henry, Taylor Dejong, Michael D McKee, Emil H Schemitsch","doi":"10.1302/0301-620X.106B11.BJJ-2023-1349.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.106B11.BJJ-2023-1349.R1","url":null,"abstract":"<p><strong>Aims: </strong>We aimed to compare reoperations following distal radial fractures (DRFs) managed with early fixation versus delayed fixation following initial closed reduction (CR).</p><p><strong>Methods: </strong>We used administrative databases in Ontario, Canada, to identify DRF patients aged 18 years or older from 2003 to 2016. We used procedural and fee codes within 30 days to determine which patients underwent early fixation (≤ seven days) or delayed fixation following CR. We grouped patients in the delayed group by their time to definitive fixation (eight to 14 days, 15 to 21 days, and 22 to 30 days). We used intervention and diagnostic codes to identify reoperations within two years. We used multivariable regression to compare the association between early versus delayed fixation and reoperation for all patients and stratified by age (18 to 60 years and > 60 years).</p><p><strong>Results: </strong>We identified 14,960 DRF patients, 8,339 (55.7%) of whom underwent early surgical fixation (mean 2.9 days (SD 1.8)). In contrast, 4,042 patients (27.0%) underwent delayed fixation between eight and 14 days (mean 10.2 days (SD 2.2)), 1,892 (12.7%) between 14 and 21 days (mean 17.5 days (SD 1.9)) and 687 (4.6%) > 21 days (mean 24.8 days (SD 2.4)) post-fracture. Patients who underwent delayed fixation > 21 days post-fracture had a higher odds of reoperation (odds ratio (OR) 1.33 (95% CI 1.11 to 1.79) vs early fixation). This worsened for patients aged > 60 years (OR 1.69 (95% CI 1.11 to 2.79)). We found no difference in the odds of reoperation for patients who underwent delayed fixation within eight to 14 or 15 to 21 days post-fracture (vs early fixation).</p><p><strong>Conclusion: </strong>These data suggest that DRF patients with fractures with unacceptable reduction following CR should be managed within three weeks to avoid detrimental outcomes. Prospective studies are required to confirm these findings.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 11","pages":"1257-1262"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559089","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":"UK Foot and Ankle Thromboembolism (UK-FATE).","authors":"Jitendra Mangwani, Linzy Houchen-Wolloff, Karan Malhotra, Sarah Booth, Aiden Smith, Lucy Teece, Lyndon W Mason, Rabia Shaikh, Wilam Alfred, Imobhio Okhifun, Ece Cinar, Nelson Bua, Krishna Vemulapalli, Ashok Acharya, Richard Gadd, John Money-Taylor, Rohit Kantharaju, Abhijit Bhosale, Suchita Bahri, Rosie Broadbent, Isabella Drummond, Neil Jones, Savan Shah, Thuwarahan Ravindrarjah, Zaid Yasen, Kunjshri Singh, Ruqaiya Al-Habs, Lucky Jeyaseelan, Abdullah Habbiba, Thomas Walker, Maximilian Dewhurst, Nisha Glasgow, Dominic Eze, Gary Carter, Praveen Rajan, Vijay Patil, Omer Amer, Kalim Malik, Pranavan Pavanerathan, Arijit Mallick, Ilias Seferiadis, Verity Currall, Preetha Sadasivan, Sunil Kumar, Shahrukh R Sanjani, Maria Ciaccio, Brijesh Ayyaswamy, Pradeepsyam Prasad, Mr Anand, Dr Sunilraj, Suzanne Lane, Swetha Prathap, Raghubir Kankate, Ioannis Aktselis, Kinner Davda, Arvind Vijapur, Mohammed Tayyem, Jackie Chau, Muhammad S Azhar, Simon Sturdee, Halima Hussain, Sarah Sonde, Muhammad Q Luqman, Rahy Farooq, Gareth Wells, Aneil Shenolikar, Michiel Simons, Paul Hodgson, Rhys Thomas, Sam Stevens, Yahya Elhassan, Adebowale Adeniyi, Will Aspinall, Vinay Joseph, Miriam Day, Aureola Tong, Claire Joyner, Muhammed Alzaranky, Osman Elhassan, Kishor Chhantyal, Abhishek Arora, Zain Abiddin, Robert Kucharski, Irfan Ahmad, Junaid Zeb, Usman Ishaq, Jija Thomas, Kowshik Jain, Rupinderbir Deol, Rad Faroug, Karan Johal, Simon Mordecai, Miltiadis Argyropouos, Amit Chawla, Mohamed Ibrahim, Marta Pereira, Lynne Barr, Elda Julies, Francesca Hill, Smriti Kapoor, James Bailey, Ishani Mukhopadhyay, Sarina Rana, Hamza Tarig, Mahdi Qualaghassi, Sheena Seewoonarian, Barry Rose, Georgina Crate, Sarah Abbott, Christopher Fenner, Ryan Geleit, Sohail Yousaf, Nimra Akram, Zahra Al-Hubeshy, Bhavi Patel, Mohamed Hussein, Callum Clark, Jasdeep Giddie, Raman Dega, Kishore Dasari, Gurbinder Nandhara, Pritesh Kumar, Prateek Gupta, Hope Poole, Pamela Zace, Farhan Alvi, Jagan Jacob, Raji Reddy, Vaishnav Sateesh, Andrea Gledhill, James Craven, Matt Cichero, Ben Yates, Ayla Newton, John Grice, Nicholas Fawcett, Hossam Fraig, Farouk Hamad, Daniel Marsland, Robin Elliot, Yaser Ghani, Suresh Chandrashekhar, Ravi K Millan, Andrew Clark, Kashed Rahman, Mark Sykes, Zoe Little, Jawaad Saleem, Lewis Jolly, Aman Jain, Ansar Qadri, Sophy Rymaruk, Avadhut Kulkarni, Mohanrao Garabadi, Meraj Akhtar, Munier Hossain, Shamael Yunus, Maleeha Saleem, Joanna Fong, Amirul Islam, Ben Nusir, James Chapman, David Holmes, Neville Mamoowala, Kieran Almond, Claire Wright, Ethan Caruana, Thomas Watson, Georgia Allison, Anand Pillai, Imad Madhi, Mazin Alsalihy, Khadija Elamin, Chee Rong Yip, Lucy Tew, Rohan Dahiya, Thomas Goff, Oliver Bagshaw, Henry Slade, Paul Andrzejowski, Ayoub Gomati, Chris Drake, Jamie Hind, Rebecca Morgan, Ahmed Khalaf, Adeel Ditta, Arul Ramasamy, Joshua McIntyre, Calum Blacklock, Scott Middleton, Robert Clayton, Alex Hrycaiczuk, Christopher Thornhill, Gowsikan Jeyakumar, Delani Vaithilingam, Kate Potter, Bilal Jamal/Pete Chan, Muyed Mohamed, Debbie Fraser, Ahmed Elhalawany, James Beastall, Gerard Cousins, Perrico Nunag, David Loveday, Akshdeep Bawa, Rebecca Gilmore, Kerstin Schankat, Andrew Walls, Nicole Corin, Peter Robinson, Steve Hepple, William Harries, Andrew Riddick, Ian Winson, Luke Marsh, Muhammad A Bashir, Jigyasa Saini, Henry Atkinson, Rajiv Limaye, Sarah Johnson-Lynn, Mohit Sethi, George Flanagan, Akram Uddin, Ian Reilly, Rebecca Martin, Andrea Pujol-Nichol, Natalie Carroll, Alexander Boucher, Mustafa Alward, Yuland Myint, Katherine Butler, Adrian Kendal, Mark Bugeja, Justin Mooteeram, Farid Saedi, Togay Koc, Zeid Morcos, Gregory Robertson, Natal Holmes, Howard Tribe, Tim Pearkes, Ahmed Soliman, Anil Prasanna, Kar Teoh, Sanil Kamat, Abhijit Bajracharya, James Reeves, Mbori Ngwayi, Galal Imtiaz, Noah Blackmore, Benjamin Lau, Arjun Naik, Eleanor Tung, Siddhartha Murhekar, Robbie Ray, Shirley Lyle, Nilesh Makwana, Kahlan A Kaisi, Musab Al-Musabi, Mike Dean, Adrian Hughes, Kimberley Shuttlewood, Matthew Welck, Shelain Patel, Adam Sykes, Mahesh M Thibbaiah, Hosain Hadi, Anil Haldar, Amir G Ardakani, Priyanka Jani, Vladislav Kutuzov, James Gibbons, Daniel Trussler, Eve Hawley, Sabeen Akhtar, Harshadkumar D Rajgor, Basil Budair, Hari Prem, James Mckenzie, Daniel Thurston, Michael O'Sullivan, Mohammed Elmajee, Erika Pond, Wajiha Zahra, Catriona Heaver, Kueni Igbagiri, Andrew Gaukroger, Matthew Solan, Christian Peacock, Ka S Fan, Tristan Barton, Derek Robinson, Selina Graham, Julian Zeolla, Samuel Everett, Mohammad Iqbal, Lysander Gourbault, Shashwat Singh, Cary Tang, Mariam Tarhini, Shahrukh Khan, Satishkumar Balasubramanian, Caroline Lever, Vaibhav Bansod, Kartik Iyengar, Abdul Wadood, Lara McMillan, Eugene Toh, Stanley Masunda, Simon Federer, Faheem Ahmad, Ahmed Lashin, Ahmed Kaddah, Emmanuel Oladeji, Ed Dawe, Ciaran Nolan, Khalil El-Bayouk, Vivek Dhukaram, Anna Chapman, Laura Beddard, Alex Thomas, Vipul Garg, Heath Taylor, Nikki Kelsall, Charline Roslee, Nimra Akram, Hamish Lowdon, Ahmed Kamel-Sherif, Anette Jones, Alistair Best, Mate Zabaglo, Junaid Sayani, Olive Kyaw, Chan Khin, Ramla Ali, Yousufuddin Shaik, Natasha Hossain, Lucia Valente, Adam Ajis, Abhijit Guha, Melwyn Pereira, Atif Ayoub, Vlad Paraoan, Nayeem Hali, Charles Baird, Raj Kugan, Ahmad Abdallatif, Mark Blomfield, Gillian Jackson, James Craven, Anubhav Malhotra, Aileen Toner, Luke Render, Connor Ashley, Richard Limb, Robert Smith, Luke Hughes, Hannah Matthews, Fleur Shiers-Gelalis, Jason Ting, Stuart Place, Adam Budgen, James Stanley, Charlie Jowett","doi":"10.1302/0301-620X.106B11.BJJ-2024-0128.R1","DOIUrl":"10.1302/0301-620X.106B11.BJJ-2024-0128.R1","url":null,"abstract":"<p><strong>Aims: </strong>Venous thromboembolism (VTE) is a potential complication of foot and ankle surgery. There is a lack of agreement on contributing risk factors and chemical prophylaxis requirements. The primary outcome of this study was to analyze the 90-day incidence of symptomatic VTE and VTE-related mortality in patients undergoing foot and ankle surgery and Achilles tendon (TA) rupture. Secondary aims were to assess the variation in the provision of chemical prophylaxis and risk factors for VTE.</p><p><strong>Methods: </strong>This was a multicentre, prospective national collaborative audit with data collection over nine months for all patients undergoing foot and ankle surgery in an operating theatre or TA rupture treatment, within participating UK hospitals. The association between VTE and thromboprophylaxis was assessed with a univariable logistic regression model. A multivariable logistic regression model was used to identify key predictors for the risk of VTE.</p><p><strong>Results: </strong>A total of 13,569 patients were included from 68 sites. Overall, 11,363 patients were available for analysis: 44.79% were elective (n = 5,090), 42.16% were trauma excluding TA ruptures (n = 4,791), 3.50% were acute diabetic procedures (n = 398), 2.44% were TA ruptures undergoing surgery (n = 277), and 7.10% were TA ruptures treated nonoperatively (n = 807). In total, 11 chemical anticoagulants were recorded, with the most common agent being low-molecular-weight heparin (n = 6,303; 56.79%). A total of 32.71% received no chemical prophylaxis. There were 99 cases of VTE (incidence 0.87% (95% CI 0.71 to 1.06)). VTE-related mortality was 0.03% (95% CI 0.005 to 0.080). Univariable analysis showed that increased age and American Society of Anesthesiologists (ASA) grade had higher odds of VTE, as did having previous cancer, stroke, or history of VTE. On multivariable analysis, the strongest predictors for VTE were the type of foot and ankle procedure and ASA grade.</p><p><strong>Conclusion: </strong>The 90-day incidence of symptomatic VTE and mortality related to VTE is low in foot and ankle surgery and TA management. There was notable variability in the chemical prophylaxis used. The significant risk factors associated with 90-day symptomatic VTE were TA rupture and high ASA grade.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 11","pages":"1249-1256"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559125","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":"Radiolucent lines and revision risk in total knee arthroplasty using the conventional versus the Attune S+ tibial baseplate.","authors":"Maria A Smolle, Maximilian Keintzel, Kevin Staats, Christoph Böhler, Reinhard Windhager, Amir Koutp, Andreas Leithner, Stefanie Donner, Tobias Reiner, Tobias Renkawitz, Manuel-Paul Sava, Michael T Hirschmann, Patrick Sadoghi","doi":"10.1302/0301-620X.106B11.BJJ-2024-0084.R3","DOIUrl":"10.1302/0301-620X.106B11.BJJ-2024-0084.R3","url":null,"abstract":"<p><strong>Aims: </strong>This multicentre retrospective observational study's aims were to investigate whether there are differences in the occurrence of radiolucent lines (RLLs) following total knee arthroplasty (TKA) between the conventional Attune baseplate and its successor, the novel Attune S+, independent from other potentially influencing factors; and whether tibial baseplate design and presence of RLLs are associated with differing risk of revision.</p><p><strong>Methods: </strong>A total of 780 patients (39% male; median age 70.7 years (IQR 62.0 to 77.2)) underwent cemented TKA using the Attune Knee System) at five centres, and with the latest radiograph available for the evaluation of RLL at between six and 36 months from surgery. Univariate and multivariate logistic regression models were performed to assess associations between patient and implant-associated factors on the presence of tibial and femoral RLLs. Differences in revision risk depending on RLLs and tibial baseplate design were investigated with the log-rank test.</p><p><strong>Results: </strong>The conventional and novel Attune baseplates were used in 349 (45%) and 431 (55%) patients, respectively. At a median follow-up of 14 months (IQR 11 to 25), RLLs were present in 29% (n = 228/777) and 15% (n = 116/776) of the tibial and femoral components, respectively, and were more common in the conventional compared to the novel baseplate. The novel baseplate was independently associated with a lower incidence of tibial and femoral RLLs (both regardless of age, sex, BMI, and time to radiograph). One- and three-year revision risk was 1% (95% CI 0.4% to 1.9%)and 6% (95% CI 2.6% to 13.2%), respectively. There was no difference between baseplate design and the presence of RLLs on the the risk of revision at short-term follow-up.</p><p><strong>Conclusion: </strong>The overall incidence of RLLs, as well as the incidence of tibial and femoral RLLs, was lower with the novel compared to the conventional tibial Attune baseplate design, but higher than in the predecessor design and other commonly used TKA systems.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 11","pages":"1240-1248"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559110","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":"Old problems, new problems, and some solutions.","authors":"Fares S Haddad","doi":"10.1302/0301-620X.106B11.BJJ-2024-1050","DOIUrl":"https://doi.org/10.1302/0301-620X.106B11.BJJ-2024-1050","url":null,"abstract":"","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 11","pages":"1197-1198"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559108","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":"Hemiarthroplasty in young patients.","authors":"Hazimah Mahmud, Dong Wang, Andra Topan-Rat, Anthony M J Bull, Christian H Heinrichs, Peter Reilly, Roger Emery, Andrew A Amis, Ulrich N Hansen","doi":"10.1302/0301-620X.106B11.BJJ-2024-0432.R2","DOIUrl":"https://doi.org/10.1302/0301-620X.106B11.BJJ-2024-0432.R2","url":null,"abstract":"<p><strong>Aims: </strong>The survival of humeral hemiarthroplasties in patients with relatively intact glenoid cartilage could theoretically be extended by minimizing the associated postoperative glenoid erosion. Ceramic has gained attention as an alternative to metal as a material for hemiarthroplasties because of its superior tribological properties. The aim of this study was to assess the in vitro wear performance of ceramic and metal humeral hemiarthroplasties on natural glenoids.</p><p><strong>Methods: </strong>Intact right cadaveric shoulders from donors aged between 50 and 65 years were assigned to a ceramic group (n = 8, four male cadavers) and a metal group (n = 9, four male cadavers). A dedicated shoulder wear simulator was used to simulate daily activity by replicating the relevant joint motion and loading profiles. During testing, the joint was kept lubricated with diluted calf serum at room temperature. Each test of wear was performed for 500,000 cycles at 1.2 Hz. At intervals of 125,000 cycles, micro-CT scans of each glenoid were taken to characterize and quantify glenoid wear by calculating the change in the thickness of its articular cartilage.</p><p><strong>Results: </strong>At the completion of the wear test, the total thickness of the cartilage had significantly decreased in both the ceramic and metal groups, by 27% (p = 0.019) and 29% (p = 0.008), respectively. However, the differences between the two were not significant (p = 0.606) and the patterns of wear in the specimens were unpredictable. No significant correlation was found between cartilage wear and various factors, including age, sex, the size of the humeral head, joint mismatch, the thickness of the native cartilage, and the surface roughness (all p > 0.05).</p><p><strong>Conclusion: </strong>Although ceramic has better tribological properties than metal, we did not find evidence that its use in hemiarthroplasty of the shoulder in patients with healthy cartilage is a better alternative than conventional metal humeral heads.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 11","pages":"1273-1283"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559104","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":"Outcomes following revision of a failed primary reverse shoulder arthroplasty.","authors":"Olivia O'Malley, Joanna Craven, Andrew Davies, Sanjeeve Sabharwal, Peter Reilly","doi":"10.1302/0301-620X.106B11.BJJ-2024-0032.R1","DOIUrl":"10.1302/0301-620X.106B11.BJJ-2024-0032.R1","url":null,"abstract":"<p><strong>Aims: </strong>Reverse shoulder arthroplasty (RSA) has become the most common type of shoulder arthroplasty used in the UK, and a better understanding of the outcomes after revision of a failed RSA is needed. The aim of this study was to review the current evidence systematically to determine patient-reported outcome measures and the rates of re-revision and complications for patients undergoing revision of a RSA.</p><p><strong>Methods: </strong>MEDLINE, Embase, CENTRAL, and the Cochrane Database of Systematic Reviews were searched. Studies involving adult patients who underwent revision of a primary RSA for any indication were included. Those who underwent a RSA for failure of a total shoulder arthroplasty or hemiarthroplasty were excluded. Pre- and postoperative shoulder scores were evaluated in a random effects meta-analysis to determine the mean difference. The rates of re-revision and complications were also calculated.</p><p><strong>Results: </strong>The initial search elicited 3,166 results and, following removal of duplicates and screening, 13 studies with a total of 1,042 RSAs were identified. An increase in shoulder scores pre- to postoperatively was reported in all the studies. Following revision of a RSA to a further RSA, there was a significant increase in the American Shoulder and Elbow Surgeons Score (mean difference 20.78 (95% CI 8.16 to 33.40); p = 0.001). A re-revision rate at final follow-up ranging from 9% to 32%, a one-year re-revision rate of 14%, and a five-year re-revision rate of 23% were reported. The complication rate in all the studies was between 18.5% and 36%, with a total incidence of 29%.</p><p><strong>Conclusion: </strong>This is the largest systematic review of the outcomes following revision of a RSA. We found an improvement in functional outcomes after revision surgery, but the rates of re-revision and complications are high and warrant consideration when planning a revision procedure.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 11","pages":"1293-1300"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559109","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":"Frail patients require instrumentation of a more proximal vertebra for a successful outcome after surgery for adult spine deformity.","authors":"Oluwatobi O Onafowokan, Pawel P Jankowski, Ankita Das, Renaud Lafage, Justin S Smith, Christopher I Shaffrey, Virginie Lafage, Peter G Passias","doi":"10.1302/0301-620X.106B11.BJJ-2024-0369.R2","DOIUrl":"https://doi.org/10.1302/0301-620X.106B11.BJJ-2024-0369.R2","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to investigate the impact of the level of upper instrumented vertebra (UIV) in frail patients undergoing surgery for adult spine deformity (ASD).</p><p><strong>Methods: </strong>Patients with adult spinal deformity who had undergone T9-to-pelvis fusion were stratified using the ASD-Modified Frailty Index into not frail, frail, and severely frail categories. ASD was defined as at least one of: scoliosis ≥ 20°, sagittal vertical axis (SVA) ≥ 5 cm, or pelvic tilt ≥ 25°. Means comparisons tests were used to assess differences between both groups. Logistic regression analyses were used to analyze associations between frailty categories, UIV, and outcomes.</p><p><strong>Results: </strong>A total of 477 patients were included (mean age 60.3 years (SD 14.9), mean BMI 27.5 kg/m² (SD 5.8), mean Charlson Comorbidity Index (CCI) 1.67 (SD 1.66)). Overall, 74% of patients were female (n = 353), and 49.6% of patients were not frail (237), 35.4% frail (n = 169), and 15% severely frail (n = 71). At baseline, differences in age, BMI, CCI, and deformity were significant (all p = 0.001). Overall, 15.5% of patients (n = 74) had experienced mechanical complications by two years (8.1% not frail (n = 36), 15.1% frail (n = 26), and 16.3% severely frail (n = 12); p = 0.013). Reoperations also differed between groups (20.2% (n = 48) vs 23.3% (n = 39) vs 32.6% (n = 23); p = 0.011). Controlling for osteoporosis, baseline deformity, and degree of correction (by sagittal age-adjusted score (SAAS) matching), frail and severely frail patients were more likely to experience mechanical complications if they had heart failure (odds ratio (OR) 6.6 (95% CI 1.6 to 26.7); p = 0.008), depression (OR 5.1 (95% CI 1.1 to 25.7); p = 0.048), or cancer (OR 1.5 (95% CI 1.1 to 1.4); p = 0.004). Frail and severely frail patients experienced higher rates of mechanical complication than 'not frail' patients at two years (19% (n = 45) vs 11.9% (n = 29); p = 0.003). When controlling for baseline deformity and degree of correction in severely frail and frail patients, severely frail patients were less likely to experience clinically relevant proximal junctional kyphosis or failure or mechanical complications by two years, if they had a more proximal UIV.</p><p><strong>Conclusion: </strong>Frail patients are at risk of a poor outcome after surgery for adult spinal deformity due to their comorbidities. Although a definitively prescriptive upper instrumented vertebra remains elusive, these patients appear to be at greater risk for a poor outcome if the upper instrumented vertebra is sited more distally.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 11","pages":"1342-1347"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559103","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":"Understanding the role of machine learning in predicting progression of osteoarthritis.","authors":"Simone Castagno, Benjamin Gompels, Estelle Strangmark, Eve Robertson-Waters, Mark Birch, Mihaela van der Schaar, Andrew W McCaskie","doi":"10.1302/0301-620X.106B11.BJJ-2024-0453.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.106B11.BJJ-2024-0453.R1","url":null,"abstract":"<p><strong>Aims: </strong>Machine learning (ML), a branch of artificial intelligence that uses algorithms to learn from data and make predictions, offers a pathway towards more personalized and tailored surgical treatments. This approach is particularly relevant to prevalent joint diseases such as osteoarthritis (OA). In contrast to end-stage disease, where joint arthroplasty provides excellent results, early stages of OA currently lack effective therapies to halt or reverse progression. Accurate prediction of OA progression is crucial if timely interventions are to be developed, to enhance patient care and optimize the design of clinical trials.</p><p><strong>Methods: </strong>A systematic review was conducted in accordance with PRISMA guidelines. We searched MEDLINE and Embase on 5 May 2024 for studies utilizing ML to predict OA progression. Titles and abstracts were independently screened, followed by full-text reviews for studies that met the eligibility criteria. Key information was extracted and synthesized for analysis, including types of data (such as clinical, radiological, or biochemical), definitions of OA progression, ML algorithms, validation methods, and outcome measures.</p><p><strong>Results: </strong>Out of 1,160 studies initially identified, 39 were included. Most studies (85%) were published between 2020 and 2024, with 82% using publicly available datasets, primarily the Osteoarthritis Initiative. ML methods were predominantly supervised, with significant variability in the definitions of OA progression: most studies focused on structural changes (59%), while fewer addressed pain progression or both. Deep learning was used in 44% of studies, while automated ML was used in 5%. There was a lack of standardization in evaluation metrics and limited external validation. Interpretability was explored in 54% of studies, primarily using SHapley Additive exPlanations.</p><p><strong>Conclusion: </strong>Our systematic review demonstrates the feasibility of ML models in predicting OA progression, but also uncovers critical limitations that currently restrict their clinical applicability. Future priorities should include diversifying data sources, standardizing outcome measures, enforcing rigorous validation, and integrating more sophisticated algorithms. This paradigm shift from predictive modelling to actionable clinical tools has the potential to transform patient care and disease management in orthopaedic practice.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 11","pages":"1216-1222"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559126","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}