Bone & Joint Journal最新文献

{"title":"Natural history of solitary osteochondroma : a retrospective analysis of 236 patients in South Korea.","authors":"Myung-Jin Sung, Chung-Hyeon Kim, Sung Taek Jung, Sungmin Kim","doi":"10.1302/0301-620X.108B8.BJJ-2026-0089","DOIUrl":"https://doi.org/10.1302/0301-620X.108B8.BJJ-2026-0089","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to analyze the natural history of solitary osteochondroma and determine how skeletal maturity influences tumour behaviour and treatment outcomes.</p><p><strong>Methods: </strong>A retrospective analysis of 236 patients with solitary osteochondroma (151 skeletally immature, 85 skeletally mature) was undertaken. Skeletal maturity was defined as bone age ≥ 18 years in males and ≥ 17 years in females. Tumour characteristics, disease progression, indications for surgery and recurrence rates were evaluated. Interobserver reliability for bone age assessment was excellent (intraclass correlation coefficient (ICC) 0.92 (95% CI 0.88 to 0.95)).</p><p><strong>Results: </strong>Spontaneous regression occurred exclusively in skeletally immature patients (17.2% (n = 26) vs 0%; p < 0.001). Skeletally immature patients predominantly presented with sessile lesions (76.2%; n = 115), had lower surgical needs (31.8%; n = 48), but higher progression rates (9.9% (n = 15) vs 1.2% (n = 1); p = 0.013). Skeletally mature patients showed more stable disease but required surgery more often (54.1%; n = 46). Among skeletally immature patients with regression, independent predictors were younger age at diagnosis (odds ratio (OR) 0.82 (95% CI 0.73 to 0.92); p < 0.001), proximal humeral location (OR 10.59 (95% CI 2.01 to 55.85); p = 0.005), and humeral shaft location (OR 38.93 (95% CI 4.81 to 315.10); p = 0.001). The optimal cutoff age for regression prediction was 14.8 years. No local recurrence occurred in the 94 operated patients.</p><p><strong>Conclusion: </strong>Skeletal maturity fundamentally determines the natural history of osteochondroma. Conservative management with serial radiological follow-up is recommended for young patients, particularly those with humeral lesions, given their substantial potential for spontaneous regression. Earlier surgical intervention should be considered for skeletally mature patients with persistent symptoms.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 8","pages":"1060-1067"},"PeriodicalIF":4.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649714","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":"Glucagon-like peptide-1 receptor agonists are associated with improved 90-day outcomes after total hip and knee arthroplasty : a systematic review and meta-analysis.","authors":"Branavan Rudran, Christopher D J Little, Antony J R Palmer, Andrew Judge, Alberto Carli, Andrew J Price, Abtin Alvand","doi":"10.1302/0301-620X.108B8.BJJ-2025-1486.R2","DOIUrl":"10.1302/0301-620X.108B8.BJJ-2025-1486.R2","url":null,"abstract":"<p><strong>Aims: </strong>Obesity and diabetes are risk factors for developing osteoarthritis and associated with worse outcomes following total hip (THA) and total knee arthroplasty (TKA). Glucagon-like peptide-1 receptor agonists (GLP-1as) improve glycaemic control and promote weight loss. The aim of this study was to assess the impact of GLP-1a treatment on 90-day surgical complications following THA and TKA.</p><p><strong>Methods: </strong>A systematic review was undertaken according to PRISMA guidelines. Studies were included if they reported at least one outcome of interest following primary THA or TKA. In all the studies which were included, a GLP-1a was prescribed for the management of type 2 diabetes mellitus or for weight loss in obese patients. The primary outcome was the 90-day surgical complication rate in the combined THA and TKA cohort. The 90-day surgical complications were defined as: periprosthetic joint infection (PJI), wound dehiscence, periprosthetic fracture (PPF), haematoma, nerve injury, or surgical site infection (SSI). Secondary outcomes included 90-day medical complications and readmission rates, all-cause revision, healthcare costs, and length of stay.</p><p><strong>Results: </strong>A total of 78 studies were reviewed, and ten matched cohort studies with a total of 96,356 patients (30,350 THAs and 66,606 TKAs) were included. The mean age of the patients was 61.9 years; 60.1% female (n = 57,939). Two studies had a serious risk of overall bias and eight had a moderate risk. The confidence of evidence according to the GRADE assessment was very low for all but one outcome measure (healthcare cost: moderate). The rate of 90-day surgical complications was lower in the GLP-1a cohort (pooled risk ratio (RR) 0.73). The use of a GLP-1a lowered the 90-day medical complications and readmission rates (RR 0.78 and RR 0.79 (I² = 61.6%), respectively). At two years, the revision rate ranged from 1.7% to 3.3% for the GLP-1a cohort and 1.7% to 4.5% for the controls. Sub-group analysis showed a stronger association in the THA group, in which the use of a GLP-1a was associated with significantly lower rates of 90-day surgical complications (RR 0.63), 90-day medical complications (RR 0.55), and 90-day readmissions (RR 0.82). In contrast, the use of a GLP-1a in the TKA group was only sigificantly associated with a lower 90-day readmission rate (RR 0.77).</p><p><strong>Conclusion: </strong>GLP-1a treatment before THA and TKA potentially reduces the 90-day surgical and medical complications and 90-day readmission rates in high-risk diabetic and obese patients. The use of a GLP-1a may also be associated with substantial cost savings.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 8","pages":"986-994"},"PeriodicalIF":4.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A matter of definition : variation in treatment success of fracture-related infections.","authors":"Noémie Reinert, Alessia Poggioli, Willem-Jan Metsemakers, Martin Clauss, Richard Kuehl, Mario Morgenstern, Mario Morgenstern, Noémie Reinert, Alessia Poggioli, Martin Clauss, Richard Kuehl, Rik Osinga, Nader Maai, Florian Frank, Fintan Moriarty","doi":"10.1302/0301-620X.108B8.BJJ-2026-0019.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.108B8.BJJ-2026-0019.R1","url":null,"abstract":"<p><strong>Aims: </strong>The establishment of the fracture-related infection (FRI) consensus definition and the FRI classification system provide a foundation for research and the development of clinical recommendations. To date, however, the evaluation of treatment success is still impeded by a lack of clear and standardized outcome definitions. We hypothesized that applying different outcome measurements to the same cohort of FRI patients results in significantly different treatment success rates.</p><p><strong>Methods: </strong>Adult patients undergoing curative surgery for FRI at the Center of Musculoskeletal Infections, University Hospital Basel, between 1 January 2020 and 31 December 2023 were included in this prospective cohort study. Treatment success was evaluated by review of patient charts; after one year of follow-up according to seven predefined outcome definitions (S1 to S7): no infection persistence at one year (S1); no recurrence within one year (with the same (S2) or a new (S3) pathogen); bony union (S4); no infection recurrence, or persistence and bony union (S5); no unplanned revision surgery (S6); and bony union and no infection recurrence, or persistence and no unplanned revision surgery (S7).</p><p><strong>Results: </strong>In total, 106 patients with 112 confirmed FRIs were included. At one year, treatment success varied significantly (p < 0.001) between the different outcome definitions: for S1 the success rate was 95.5% (n = 107), for S2 89.3% (n = 100), for S3 92.9% (n = 104), and for S6 60.7% (n = 68). In cases with healed fractures (n = 28) success rate was 100% for S1 to 3 definitions and 92.9% for S6 (n = 26). In cases with non-healed fractures (n = 84) the success rate decreased significantly from 94.0% (n = 79) for the S1 definition to 39.3% for S7 (n = 33; p < 0.001), with 50% of these patients (n = 42) undergoing an unplanned revision surgery. In unhealed fractures a recurrent infection (p < 0.013) and the need for an unplanned revision surgery (p < 0.001) were significantly more frequent than in healed fractures.</p><p><strong>Conclusion: </strong>At the one-year follow-up, treatment success differed significantly within a single cohort depending on the outcome metric used to define success.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 8","pages":"1038-1044"},"PeriodicalIF":4.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649661","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":"Autologous impaction bone grafting of a cemented acetabular component in primary total hip arthroplasty in young patients: a randomized controlled trial.","authors":"Diederik R de Boer, Patricia Pasman, Roelina Munnik-Hagewoud, Martijn J Q Steinweg, Mireille A Edens, Pieter B A A van Driel, Harmen B Ettema","doi":"10.1302/0301-620X.108B8.BJJ-2025-1692.R2","DOIUrl":"10.1302/0301-620X.108B8.BJJ-2025-1692.R2","url":null,"abstract":"<p><strong>Aims: </strong>This randomized controlled trial (RCT) aimed to compare clinical and radiological outcomes of cemented acetabular component in primary total hip arthroplasty (THA) in patients aged under 60 years with and without autologous impaction bone grafting (IBG).</p><p><strong>Methods: </strong>A single-centre, triple-blinded RCT was conducted in patients aged 18 to 59 years undergoing primary THA without acetabular defects. Patients were randomized to receive either IBG or no IBG. Noninferiority of IBG was assessed for the primary endpoint, the Hip disability and Osteoarthritis Outcome Score (HOOS) sub-scale for activities of daily living (ADL) at one-year follow-up. Secondary outcomes included other patient-reported outcome measures (PROMs), perioperative outcomes, complications, and radiological outcomes. Radiographs assessed acetabular component and centre of rotation positioning, offset changes, and the presence of radiolucent lines in the bone-cement interface.</p><p><strong>Results: </strong>A total of 131 patients were randomized. No significant group differences were found for the HOOS-ADL sub-scale at one year (mean difference 1.9 points (95% CI -4.85 to 8.7); p = 0.578), meeting the criteria for noninferiority. Furthermore, there was no effect of group on the scores for other PROMs. Surgery duration (+ 7.5 minutes; p < 0.001) and blood loss (+ 100 ml; p = 0.001) were significantly higher in the IBG group. Complication and revision rates were comparable. Radiologically, the IBG group had significantly fewer radiolucent lines in the bone-cement interface than the control group at one-year follow-up (p < 0.001). Compared with preoperatively, the postoperative position of the centre of rotation was less superior and medial in the IBG group (p = 0.024).</p><p><strong>Conclusion: </strong>The use of autologous IBG with a cemented acetabular component in primary THA in young patients is noninferior to standard cemented fixation regarding short-term clinical outcomes. IBG improves vertical position of the centre of rotation and early radiological fixation by reducing radiolucent lines around the cup, suggesting potential benefits for long-term acetabular component survival.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 8","pages":"995-1002"},"PeriodicalIF":4.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649668","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":"Reducing complications after resection of pelvic bone sarcomas : an aggregation of marginal gains.","authors":"Lee M Jeys, Vineet Kurisunkal, Michael C Parry, Guy Morris, Jonathan D Stevenson, Minna K Laitinen","doi":"10.1302/0301-620X.108B8.BJJ-2025-1713.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.108B8.BJJ-2025-1713.R1","url":null,"abstract":"<p><strong>Aims: </strong>Primary pelvic bone sarcomas are rare and their treatment remains complex, with reconstruction after resection remaining controversial due to high complication and revision rates. Both prosthetic and non-prosthetic reconstructions carry risks including infection, implant failure, wound problems, and reoperation. The aim of this study was to review the changes in the management of these patients over the 20-year period between 2003 and 2023.</p><p><strong>Methods: </strong>This was a retrospective cohort study including 479 patients who underwent surgery for a primary pelvic sarcoma during this time, divided into a historical (2003 to 2012) and a modern (2013 to 2023) group. Postoperative complications and the rates of return to theatre (RTT) were compared, and factors associated with improved outcomes were analyzed.</p><p><strong>Results: </strong>Early RTT within six weeks decreased significantly from 22% in the historical cohort (n = 38) to 14% in the modern cohort (n = 42; p = 0.021). Historically, the ilioinguinal incision was associated with a 44% early rate of RTT (n = 8), compared with 10% when using the question mark incision in the modern cohort (n = 10). In the modern cohort, the rate of early RTT was similar between those with prosthetic (17%; n = 13) and non-prosthetic reconstructions (13%; n = 29) (p = 0.344), although the long-term rate of RTT remained significantly higher in the prosthetic group (p = 0.007).</p><p><strong>Conclusion: </strong>These findings show a clear reduction in complications and rates of RTT following pelvic resection and reconstruction for patients with a primary pelvic bone sarcoma. Although no single factor can fully account for this improvement, it probably reflects a progressive refinement of surgical strategy combined with both technical and organizational advances. These were due to changes in surgical approach and an increased use of navigation and patient-specific implants, improved preoperative imaging and planning, and a more precise understanding of oncological margins and pelvic biomechanics. The centralization of care has also not only concentrated cases into high-volume centres but has encouraged further sub-specialization within these centres, allowing cumulative expertise to develop among a limited number of highly experienced surgeons. Ongoing refinement of surgical technique leading to fewer revisions due to reduced early complications and dislocations, supported by multidisciplinary decision-making, will remain key to achieving further progress.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 8","pages":"1052-1059"},"PeriodicalIF":4.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649692","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":"Increased risk of early failure of multiply revised total hip arthroplasty.","authors":"Taisha Marie D'Apollonio, Marieke L T Hopman, Thomas Sullivan, John Matthew Abrahams, Neil P Sheth, Lucian Bogdan Solomon, Stuart Adam Callary","doi":"10.1302/0301-620X.108B8.BJJ-2025-1379.R2","DOIUrl":"https://doi.org/10.1302/0301-620X.108B8.BJJ-2025-1379.R2","url":null,"abstract":"<p><strong>Aims: </strong>As the demand for revision total hip arthroplasty (rTHA) grows, understanding how successive revision procedures influence implant survivorship and patient outcomes becomes increasingly important. This study aimed to evaluate the association between revision number and implant survivorship following aseptic rTHA.</p><p><strong>Methods: </strong>We analyzed 845 aseptic rTHAs performed between January 2003 and December 2023. Index primary THA dates, rTHA sequence, and reoperations were sourced and verified using hospital records, national registry data, and radiological records. Cases were stratified by revision number: first (R1), second (R2), or third and beyond (R3+). Re-revision risk was evaluated using cumulative incidence functions and Fine-Gray competing-risk regression, with death treated as a competing event.</p><p><strong>Results: </strong>Of 845 rTHAs (717 patients), 838 (710 patients) with confirmed index THA were included: 598 R1, 155 R2, and 85 R3+. At two years, cumulative incidence of re-revision was 10.2% (95% CI 8.0 to 12.9) for R1, 14.2% (95% CI 9.6 to 20.8) for R2, and 17.7% (95% CI 11.0 to 27.7) for R3+. Unadjusted competing-risk regression demonstrated a higher cumulative incidence of re-revision in R2s compared with R1s. However, after multivariable adjustment, revision number was not independently associated with a statistically significant increase in re-revision risk. Across all revision groups, the highest risk of failure occurred within the first two postoperative years, particularly following rTHA for instability.</p><p><strong>Conclusion: </strong>Re-revision following aseptic rTHA occurs most frequently within the first two postoperative years, with instability representing the dominant mode of early failure. Although multiply revised hips demonstrate poorer survivorship in unadjusted analyses, competing-risk models substantiated that rTHA number alone was not independently associated with a significantly increased risk of re-revision. These findings emphasize the importance of early risk mitigation strategies and informed patient counselling in the setting of repeated rTHA.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 8","pages":"1003-1011"},"PeriodicalIF":4.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649701","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":"Preoperative predictors of patient-reported outcomes after joint-preserving forefoot surgery for rheumatoid arthritis : a case series.","authors":"Yuki Etani, Takaaki Noguchi, Makoto Hirao, Gensuke Okamura, Atsushi Sugimoto, Seiji Okada, Ken Nakata, Kosuke Ebina","doi":"10.1302/0301-620X.108B8.BJJ-2025-1801.R1","DOIUrl":"10.1302/0301-620X.108B8.BJJ-2025-1801.R1","url":null,"abstract":"<p><strong>Aims: </strong>Forefoot deformities are common in patients with rheumatoid arthritis (RA) and often impair quality of life. Patient-reported outcome measures (PROMs), including the Self-Administered Foot Evaluation Questionnaire (SAFE-Q), are increasingly used to assess surgical outcomes; however, the preoperative conditions needed to achieve favourable postoperative PROMs remain unclear. This study aimed to identify factors associated with postoperative SAFE-Q scores (mean score across five sub-scales, maximum 100) and determined preoperative cutoff values predictive of achieving predefined postoperative SAFE-Q thresholds (≥ 70 or ≥ 90).</p><p><strong>Methods: </strong>In this multicentre, retrospective case series, 101 feet in 80 patients (including 21 bilateral cases) with RA who underwent forefoot surgery between July 2015 and July 2023 were analyzed (mean age at surgery 65.8 years (SD 10.7); 79 female patients). Inclusion criteria were symptomatic forefoot deformities with available SAFE-Q data pre-surgery and at ≥ one year post-surgery. Procedures included modified scarf osteotomy and offset shortening osteotomies for the metatarsals. SAFE-Q scores, Japanese Society for Surgery of the Foot scores, radiological parameters, and disease activity were evaluated pre- and postoperatively. Multiple regression identified preoperative factors associated with postoperative SAFE-Q scores, and significant variables were further assessed using receiver operating characteristic (ROC) analyses to determine preoperative cutoff values for postoperative SAFE-Q thresholds (≥ 70 and ≥ 90).</p><p><strong>Results: </strong>Postoperatively, the median SAFE-Q score was 84.8 (IQR 73.0 to 92.3), a significant improvement over the preoperative median score of 48.9 (IQR 34.9 to 67.5; p < 0.001). Multivariable analysis showed that older age and lower preoperative SAFE-Q scores were associated with lower postoperative SAFE-Q scores (β -0.286 (95% CI -0.486 to -0.086) and 0.505 (95% CI 0.319 to 0.691), respectively). ROC analysis identified cutoffs of 54.0 for preoperative SAFE-Q (area under the curve (AUC) 0.644) and 70 years for age (AUC 0.722) when predicting a postoperative score ≥ 90.</p><p><strong>Conclusion: </strong>Higher preoperative SAFE-Q scores and younger age at surgery were linked to improved postoperative outcomes. Although their predictive accuracy is limited, these thresholds may help estimate postoperative function and support preoperative counselling and shared decision-making.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 8","pages":"1012-1020"},"PeriodicalIF":4.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649704","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":"Non-medical surgical delay increases one-year mortality following hip fracture.","authors":"Christopher Busby, Jessica Nightingale, Christopher Deacon, Dan Deakin, Ana Valdes, Benjamin J Ollivere, Christopher Moran","doi":"10.1302/0301-620X.108B8.BJJ-2025-1689.R1","DOIUrl":"10.1302/0301-620X.108B8.BJJ-2025-1689.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to assess the association between surgical delay due to non-medical reasons and one-year mortality in patients with hip fracture, and to explore whether a dose-response relationship exists between increasing time to surgery and mortality risk.</p><p><strong>Methods: </strong>A retrospective cohort analysis was performed using prospectively collected data from the Nottingham Hip Fracture Database. A total of 5,414 patients aged ≥ 60 years admitted with a fragility femoral fracture to a major trauma centre between April 2016 and March 2023 were reviewed. Time to theatre was measured from emergency department arrival to anaesthetic start. Delays beyond 36 hours were categorized as either medical or logistical. The primary outcome was all-cause one-year mortality with a secondary outcome being length of stay (LOS). Multivariable Cox proportional hazards models were used to assess associations, adjusting for age, sex, comorbidity, and cognition.</p><p><strong>Results: </strong>Of the cohort, 38.5% (n = 2,083) experienced surgical delay beyond 36 hours; 27.5% (n = 1,490) due to limited surgical capacity and 11.0% (n = 593) due to medical unfitness. After adjusting for age, sex, comorbidity, and cognition, delay due to logistical factors was associated with a 20% increase in one-year mortality (hazard ratio (HR) 1.20 (95% CI 1.06 to 1.36); p = 0.004). A secondary analysis excluding medically unfit patients demonstrated a stepwise increase in hazard with increasing time to theatre, suggesting a dose-response effect. LOS was also increased with delay to theatre by one day in this cohort.</p><p><strong>Conclusion: </strong>Delayed surgery beyond 36 hours, due to lack of surgical capacity, is independently associated with increased mortality following hip fracture. These findings reinforce the need for protected surgical capacity and prioritization of prompt surgery to improve outcomes in this vulnerable population.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 8","pages":"1021-1028"},"PeriodicalIF":4.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649689","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":"Beyond BMI cut-offs : optimizing risk, not excluding patients.","authors":"Abtin Alvand, Branavan Rudran, Fares S Haddad","doi":"10.1302/0301-620X.108B8.BJJ-2026-0441","DOIUrl":"https://doi.org/10.1302/0301-620X.108B8.BJJ-2026-0441","url":null,"abstract":"","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 8","pages":"972-974"},"PeriodicalIF":4.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649659","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 screening for developmental dysplasia of the hip in children born in England and Wales.","authors":"Catrin O Plumpton, Daniel C Perry","doi":"10.1302/0301-620X.108B8.BJJ-2025-0847.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.108B8.BJJ-2025-0847.R1","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to evaluate the cost-effectiveness of screening programmes for identifying developmental hip dysplasia (DDH) in children born in England and Wales.</p><p><strong>Methods: </strong>The costs and quality-adjusted life-years (QALYs) associated with DDH screening programmes were estimated using a decision-analytic model. Six programmes were modelled from an NHS perspective: 1) Current practice - 'selective' screening: clinical examination with later ultrasound screening (USS) for those with an abnormal examination or specific risk factors (breech birth, first degree family history of DDH); 2) No hip screening: no clinical examination or risk factor assessment; 3) Clinical examination: treatment decisions based solely upon a positive Barlow or Ortolani manoeuvre; 4) Universal USS at birth: USS in the neonatal period in addition to a postnatal check; 5) Universal USS at six weeks: USS in addition to the six-week postnatal check; 6) Sex-stratified screening: clinical examination with selective USS for males and universal USS in the neonatal period for females. The incremental net monetary benefit (INMB) was estimated at a cost-effectiveness threshold of £20,000 per QALY gained. Whether the result was robust to assumptions was assessed using analyses of uncertainty. Secondary outcomes included an estimate of the value of reducing the uncertainty of the decisions.</p><p><strong>Results: </strong>Universal USS (including stratification by sex) was more clinically effective, but at significant additional cost. Current practice was the most cost-effective screening programme in 96% of modelled simulations. Differences in INMB were statistically significant. The reconfiguration of service so that USS does not require additional hospital visits would reduce marginal losses and introduce uncertainty to the conclusion. The benefit of generating better evidence about a reconfigured USS service was valued at £1.91 per live birth, equating to £11 million over ten years.</p><p><strong>Conclusion: </strong>Clinical examination with USS for those with an abnormal examination, or specific risk factors, is likely to be the most cost-effective DDH screening programme in the UK. Further research focused on the costs and efficacy of screening programmes could add value for informing future policy decisions.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 8","pages":"1068-1074"},"PeriodicalIF":4.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649709","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}