Bone & Joint Journal最新文献

{"title":"Periprosthetic joint infection : lessons from the INFORM research programme.","authors":"Andrew J Moore, Andrew D Beswick, Michael R Whitehouse, Ashley W Blom","doi":"10.1302/0301-620X.108B8.BJJ-2025-1476.R1","DOIUrl":"10.1302/0301-620X.108B8.BJJ-2025-1476.R1","url":null,"abstract":"<p><p>Infection is one of the most devastating complications following arthroplasty. The National Institute for Health and Care Research (NIHR) funded the multinational INFection ORthopaedic Management (INFORM) research programme to study this problem comprehensively, and then funded INFORM: Evidence into Practice to translate findings into the INFORM guidelines. This annotation outlines the key findings with particular emphasis on hip and knee arthroplasty, including risk factors, impact, diagnosis, and treatment, and suggests guidelines underpinned by high-quality evidence from the programme. Finally, future directions for research are discussed.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 8","pages":"979-985"},"PeriodicalIF":4.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649738","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 importance of axial rotation of the lower limb : a systematic review of measurement methods.","authors":"Barbara Favier, Antoine Acker, Jonathan Miles, Cesar de Cesar Netto, Arne Burssens, Andrew Goldberg","doi":"10.1302/0301-620X.108B7.BJJ-2025-0854.R2","DOIUrl":"https://doi.org/10.1302/0301-620X.108B7.BJJ-2025-0854.R2","url":null,"abstract":"<p><strong>Aims: </strong>Assessment of lower limb alignment is a cornerstone of orthopaedics. Few studies look at rotational alignment in the axial plane as measured by femoral version (FV) and tibial torsion (TT), both of which have implications for hip, knee, and ankle pathology. This review provides an overview of the axial rotation and evaluates CT-based measurement methods for FV and TT to identify the most reliable and reproducible techniques for use in clinical practice.</p><p><strong>Methods: </strong>A systematic PRISMA-guided review assessed original CT-based methods, examining inter- and intraobserver reliability (intraclass correlation coefficient (ICC)), frequency of use, and validation.</p><p><strong>Results: </strong>Seven FV and nine TT CT-based techniques were identified. FV had a weighted mean of 17.8° anteversion (-9° to 60°). TT had a weighted mean of 30.8° (2° to 82°). ICCs ranged from good to excellent. The Murphy method (FV) and Goutallier method (TT) had the highest reliability and clinical utility.</p><p><strong>Conclusion: </strong>Lower limb axial rotational profile plays an important role in the management of hip, knee, and ankle arthroplasty surgery as well as many other orthopaedic pathologies. The Murphy and Goutallier methods should be adopted as standard for measuring FV and TT. Their high reproducibility and validation make them ideal for consistent clinical and research use.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 7","pages":"871-879"},"PeriodicalIF":4.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148363308","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":"Erratum.","authors":"Fares S Haddad","doi":"10.1302/0301-620X.108B7.BJJ-2025-00064","DOIUrl":"https://doi.org/10.1302/0301-620X.108B7.BJJ-2025-00064","url":null,"abstract":"","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 7","pages":"971"},"PeriodicalIF":4.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148363175","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":"Incidence of medical and surgical complications, and subsequent mortality, after hip fracture surgery : a nationwide cohort study from 2010 to 2021.","authors":"Katrine G Haugen, Cecilia M Hansen, Simon Storgaard Jensen, Alma B Pedersen","doi":"10.1302/0301-620X.108B7.BJJ-2025-1672.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.108B7.BJJ-2025-1672.R1","url":null,"abstract":"<p><strong>Aims: </strong>Hip fracture patients are at high risk of complications affecting their treatment, recovery, and survival. Previous studies report considerable variation in complication rates, and comprehensive data are limited. We examined the cumulative incidences of 20 medical and surgical complications after hip fracture surgery and their association with mortality.</p><p><strong>Methods: </strong>Using Danish nationwide registries, we identified 72,693 hip fracture patients aged ≥ 65 years who underwent surgery (2010 to 2021). Primary outcome was 30-day cumulative incidence of hospital-treated registered complications. The analysis was conducted overall and stratified by age, sex, and comorbidity. Secondary outcome was mortality within 31 to 60 days after surgery in patients with and without each specific complication.</p><p><strong>Results: </strong>The cumulative incidence of any medical complication was 23% (n = 14,404), while the incidence of any surgical complication was 4% (n = 2,708). The most frequent medical complications were pneumonia (6%; n = 4,364), urinary tract infection (5%; n = 3,943), gastrointestinal complication (3%; n = 1,893), delirium (2%; n = 1,454), and dehydration (2%; n = 1,301), and the most common surgical complications were major reoperations (2%; n = 1,655) and prosthesis dislocation (2%; n = 1,053). The cumulative incidence of any medical complication was higher in patients aged > 85 years compared with those aged 65 to 75 years (27% (n = 7,140) vs 18% (n = 3,221)), for males compared with females (26% (n = 5,931) vs 21% (n = 10,475)), and in patients with compared with without comorbidities (24% (n = 13,417) vs 18% (n = 3,022). Overall crude mortality was 3% (n = 1,667) for patients without any complication, compared with 11% (n = 1,584) after any medical or 11% (n = 298) after any surgical complication.</p><p><strong>Conclusion: </strong>Medical and surgical complications occurred in 23% and 4% of hip fracture patients, with infections being most common. Mortality was threefold higher among patients who experienced a complication. Early detection of complications to improve personalized clinical pathways and treatment is essential to reducing the associated high mortality.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 7","pages":"961-970"},"PeriodicalIF":4.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148363170","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":"Hospital costs attributable to further fracture, reoperation, and death during the first year following hip fracture in England : a nationwide cohort study.","authors":"Petra Baji, Celia L Gregson, Rita Patel, Andrew Judge, Tim Chesser, Xavier L Griffin, Yoav Ben-Shlomo, Antony Johansen, Elsa M R Marques, Jill Griffin, Muhammad K Javaid","doi":"10.1302/0301-620X.108B7.BJJ-2025-1758.R1","DOIUrl":"10.1302/0301-620X.108B7.BJJ-2025-1758.R1","url":null,"abstract":"<p><strong>Aims: </strong>Within one year after hip fracture in older adults living in England, this study aimed to estimate the inpatient hospital costs associated with subsequent complications, including further fractures, reoperations, and death.</p><p><strong>Methods: </strong>The study linked national datasets to identify all patients aged ≥ 60 years who underwent an index hip fracture operation in all hospitals in England between 1 April 2016 and 31 March 2019, with one-year follow-up. Patients were categorized into eight mutually exclusive groups based on combinations of further fracture (after 30 days from index hip fracture, at any skeletal site, excluding facial, digit, and skull fractures), reoperation, and death in the year after hip fracture. Inpatient costs were valued using 2019/20 NHS reference costs. Marginal cost differences over patients with no complications were estimated using generalized linear models.</p><p><strong>Results: </strong>Among 164,691 patients (70.8% female (n = 116,534); mean age 82.7 years (SD 8.7)), across 159 hospitals, the mean one-year inpatient cost was £14,581 (SD 8,583). Further fracture (£24,306 (SD 11,635); n = 11,226) and reoperation (£23,923 (SD 13,537); n = 7,522) were each associated with approximately twice the cost of patients without complications (£12,859 (SD 7,097); n = 107,638). Additional costs, adjusted for prefracture costs, fracture type, and patient case-mix variables, were highest for patients with further fracture and reoperation who died within one year (+£16,971 (95% CI 15,914 to 18,028); n = 541), closely followed by patients with both further fracture and reoperation who survived (+£13,562 (95% CI 13,065 to 14,059); n = 2,348), compared with adjusted cost of patients who survived with no complications (mean £13,159 (95% CI 13,118 to 13,201)). Nationally, annual inpatient expenditure for hip fracture care was estimated to £647 million in 2018/19. Of this, £265 million was attributable to patients with a complication (35% of all patients).</p><p><strong>Conclusion: </strong>Nearly half of total national inpatient expenditure on hip fracture care is concentrated among patients who experienced complications or died. Further fracture and reoperation markedly increase inpatient expenditure, highlighting the importance of preventing complications and refractures.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 7","pages":"952-960"},"PeriodicalIF":4.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148363215","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":"Time-course changes in bone mineral density after anatomical and reverse total shoulder arthroplasty : a dual-energy X-ray absorptiometry-based study.","authors":"Katsumasa Nakazawa, Tomoya Manaka, Yoichi Ito, Yoshihiro Hirakawa, Rei Nishiura, Naoki Oi, Hidetomi Terai","doi":"10.1302/0301-620X.108B7.BJJ-2025-1462.R1","DOIUrl":"10.1302/0301-620X.108B7.BJJ-2025-1462.R1","url":null,"abstract":"<p><strong>Aims: </strong>Bone resorption around cementless short humeral stems is increasingly recognized after shoulder arthroplasty, but quantitative longitudinal data are lacking. We measured bone mineral density (BMD) around the humeral component after anatomical total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (RSA) using dual-energy X-ray absorptiometry (DEXA) and evaluated the time-course changes over two postoperative years. Additionally, we investigated the association between osteoporosis and clinical outcomes.</p><p><strong>Methods: </strong>The subjects were patients who underwent aTSA or RSA, and for whom DEXA evaluation was available at three weeks, six months, one year, and two years postoperatively. The area around the humeral component was divided into five zones, and the BMD of each zone was measured. To evaluate clinical outcomes, we investigated their association with osteoporosis and measured the postoperative American Shoulder and Elbow Surgeons (ASES) score using the minimal clinically important difference (MCID) as the reference. Overall, 94 RSAs and 43 aTSAs were observed.</p><p><strong>Results: </strong>In RSA, BMD decreased significantly over time in zones 3 and 5 (both p < 0.05). In aTSA, BMD decreased in zones 2, 3, and 4 from three weeks to six months, with little sustained decrease thereafter. Additionally, in RSA, a decrease in zone 3 BMD was significantly associated with osteoporosis (both p < 0.05). Failure to achieve the MCID for the ASES score was also significantly associated with both zone 3 BMD loss and osteoporosis (both p < 0.05).</p><p><strong>Conclusion: </strong>Time-course changes in BMD around cementless short humeral components differed between aTSA and RSA. In RSA, BMD decreased over time in zones 3 and 5. Zone 3 BMD loss was significantly associated with osteoporosis, and both zone 3 BMD loss and osteoporosis were linked to failure to achieve the MCID for the ASES score. These findings suggest that patients undergoing RSA with osteoporosis may benefit from careful postoperative follow-up, including monitoring of periprosthetic bone loss and optimization of osteoporosis management.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 7","pages":"936-942"},"PeriodicalIF":4.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148363260","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 management of distal humeral fractures in older patients.","authors":"Andrel W H Yoong, Jonathan T Super, Gerald J S Tan, Adam C Watts, Benjamin J Ollivere, Andrew D Duckworth","doi":"10.1302/0301-620X.108B7.BJJ-2026-0141.R1","DOIUrl":"10.1302/0301-620X.108B7.BJJ-2026-0141.R1","url":null,"abstract":"<p><p>The number of fractures of the distal humerus in older adults is rising due to an ageing population and an increasing incidence of fragility fractures. The management is based on the patient's preference, the pattern of the fracture, the quality of the bone and soft-tissue, the patient's comorbidities and potential for rehabilitation, as well as balancing the risk of complications such as infection, nonunion, instability, or loosening. Nonoperative treatment remains appropriate for a few low-demand or medically unfit patients. Open reduction and internal fixation (ORIF) or arthroplasty, either hemiarthroplasty (HA) of the elbow or total elbow arthroplasty (TEA), provide good outcomes when appropriately selected. An increase in the use of arthroplasty for trauma is shown in registry data, although the indications and survival remain controversial with few robust comparative and long-term data. Similar short- to mid-term functional outcomes between ORIF and TEA have been reported in recent comparative studies, with a trend towards an increased reoperation rate after ORIF, but the evidence is derived largely from small retrospective observational studies. HA of the elbow may be a viable alternative for active older patients, particularly when stable fixation is not achievable, although instability and conversion to TEA may be required. The aim of this review was to synthesize the current evidence dealing with the indications, techniques, and outcomes for nonoperative management, ORIF and arthroplasty in older patients with a distal humeral fracture.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 7","pages":"859-870"},"PeriodicalIF":4.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148363290","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":"Comparison of the modified Broström-Gould procedure for chronic lateral ankle instability in adolescents with and without an os subfibulare : a propensity score-matched study.","authors":"Shikai Xiong, Yusheng Li, Ziming Liu, Feng Zhao, Dong Jiang, Yuelin Hu, Chen Jiao, Xing Xie, Qinwei Guo","doi":"10.1302/0301-620X.108B7.BJJ-2025-1558.R1","DOIUrl":"10.1302/0301-620X.108B7.BJJ-2025-1558.R1","url":null,"abstract":"<p><strong>Aims: </strong>An os subfibulare (OS) is frequently seen in adolescents with chronic lateral instability of the ankle, potentially impairing participation in sport and the quality of life. The aim of this study was to compare the clinical outcomes of the modified Broström-Gould procedure in adolescent patients with chronic lateral instability of the ankle with and without an OS.</p><p><strong>Methods: </strong>We retrospectively reviewed adolescent patients who underwent a modified Broström-Gould procedure for chronic instability of the ankle between August 2019 and July 2023. Propensity score matching (1:1) was undertaken based on age, sex, side, BMI, the duration of symptoms, pre-injury Tegner score, and joint hypermobility, yielding 82 matched cases (41 OS and 41 non-OS). Preoperative imaging parameters and intraoperative findings were recorded. Primary outcomes included patient-reported outcome measures (PROMs): a visual analogue scale (VAS) for pain, the Karlsson score, the Tegner score, and the Foot and Ankle Outcome Score (FAOS). Secondary outcomes included the incidence of re-sprain, the time to return to sport, satisfaction, and complications. Logistic regression analysis identified risk factors for re-sprain.</p><p><strong>Results: </strong>The mean follow-up was 47.8 months (SD 11.2) in the OS group and 47.9 months (SD 9.6) in the non-OS group (p = 0.949). Both groups had significant improvements in all PROMs, with no differences between the groups for the VAS, Karlsson score, Tegner score, or FAOS. Re-sprain occurred in five in the OS group (12.2%) and 12 in the non-OS group (29.3%) (p = 0.081). Multivariate analysis identified higher pre-injury Tegner score (p = 0.001) and concomitant calcaneofibular ligament injury (p = 0.028) as significant independent risk factors for re-sprain.</p><p><strong>Conclusion: </strong>In adolescent patients with chronic lateral instabilty of the ankle, the presence of an OS does not compromise the outcomes of a modified Broström-Gould procedure. Excision of the OS combined with ligamentous repair provides improvements which are comparable to those of an isolated repair, representing a safe and effective form of surgical treatment. Nonetheless, greater attention should be given to patients with high sporting demands or concomitant calcaneofibular ligament injury, due to their increased risk of re-sprain postoperatively.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 7","pages":"920-927"},"PeriodicalIF":4.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148363197","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":"Interesting data, but further corroborative studies are often needed.","authors":"Fares S Haddad","doi":"10.1302/0301-620X.108B7.BJJ-2026-0731","DOIUrl":"https://doi.org/10.1302/0301-620X.108B7.BJJ-2026-0731","url":null,"abstract":"","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 7","pages":"847-848"},"PeriodicalIF":4.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148363254","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":"Missing not at random : how much missing patient-reported outcome measure data is too much?","authors":"Thomas R Williamson, Nick D Clement, Liam Z Yapp, Andrew D Duckworth, Fares S Haddad, Chloe E H Scott","doi":"10.1302/0301-620X.108B7.BJJ-2026-0357.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.108B7.BJJ-2026-0357.R1","url":null,"abstract":"","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 7","pages":"849-852"},"PeriodicalIF":4.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148363231","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}