Bone & Joint Journal最新文献

{"title":"Effect of prior rotator cuff repair technique and timing on clinical outcomes of reverse shoulder arthroplasty.","authors":"Kara E Holt, Kevin A Hao, Victoria E Bindi, Andrew H A Kaiser, Keegan M Hones, Jonathan O Wright, Thomas W Wright, Aimee M Struk, Bradley S Schoch, Joseph J King","doi":"10.1302/0301-620X.108B7.BJJ-2025-1393.R1","DOIUrl":"10.1302/0301-620X.108B7.BJJ-2025-1393.R1","url":null,"abstract":"<p><strong>Aims: </strong>Reverse shoulder arthroplasty (RSA) after prior rotator cuff repair (RCR) is commonly performed for recurrence of pain and arthritic progression; however, the influence of prior RCR timing and technique on outcomes of RSA has not been adequately explored. Our primary aim was to evaluate the relationship between the postoperative American Shoulder and Elbow Surgeons (ASES) score, whether prior RCR was performed open or arthroscopic, and the time interval between RSA and prior RCR. Secondary outcomes were forward elevation (FE) and external rotation (ER).</p><p><strong>Methods: </strong>A prospectively collected single-institution shoulder arthroplasty database was queried to identify patients undergoing primary RSA after prior RCR between 2004 and 2022 for non-tumour and non-fracture indications with minimum two-year follow-up. We evaluated the relationship between the postoperative ASES score, FE, and ER stratified by prior RCR approach (open vs arthroscopic) and time between RSA and RCR. Multivariable analysis was used to adjust for potential confounders.</p><p><strong>Results: </strong>We included 104 RSAs (99 patients) with a mean 8.8 years (SD 7.3) after RCR and a mean age of 68 years (SD 8.3). Prior RCR was performed arthroscopically in 40 RSAs (38%). Mean follow-up was 4.8 years (SD 2.8). On multivariable analysis, arthroscopic RCR was independently associated with a 13-point greater postoperative ASES score (p = 0.008), 14° greater forward elevation (p = 0.011), and 8° greater external rotation (p = 0.018) compared with open RCR. A ten-year increase in time between RCR and RSA was associated with a seven-point greater postoperative ASES score (p = 0.029) and 5° greater external rotation (p = 0.015).</p><p><strong>Conclusion: </strong>A greater time interval between prior RCR and RSA, as well as arthroscopic techniques, is associated with improved outcomes after primary RSA in patients with prior RCR.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 7","pages":"928-935"},"PeriodicalIF":4.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148363157","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":"Robotic arm-assisted bi-unicompartmental knee arthroplasty compared with conventional total knee arthroplasty : five-year clinical outcomes of a randomized controlled trial.","authors":"William D Foxcroft, James Doonan, Angus D MacLean, Bryn G Jones, Philip Rowe, Mark J G Blyth","doi":"10.1302/0301-620X.108B7.BJJ-2025-0359.R3","DOIUrl":"10.1302/0301-620X.108B7.BJJ-2025-0359.R3","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to compare the outcomes between constitutionally aligned, robotic arm-assisted bi-unicompartmental knee arthroplasty (RA-bi-UKA) and conventional, mechanically aligned total knee arthroplasty (TKA) at five years' follow-up. The results at one-year follow-up have previously been reported.</p><p><strong>Methods: </strong>This was a prospective, randomized, single-centre study comparing the clinical outcomes of RA-bi-UKA with conventional TKA in patients with medial and lateral osteoarthritis (OA) of the knee. A total of 80 patients were initially randomized to receive either a cemented, fixed-bearing RA-bi-UKA or a cemented, posterior-stabilized, mechanically aligned TKA using conventional instrumentation over a three-year recruitment period. The data which were collected included patient-reported outcome measures (PROMs) and complications. The patients were reviewed at three months, one, two, and five years.</p><p><strong>Results: </strong>After randomization, 80 patients were enrolled in the study (42 in the RA-bi-UKA group and 38 in the TKA group). At five-year follow-up, there were no significant differences between the PROMs including the Oxford Knee Score, Forgotten Joint Score, EuroQol five-dimension three-level questionnaire (EQ-5D-3L), University of California, Los Angeles (UCLA), New Knee Society Score, and Pain or Stiffness visual analogue scale scores, in the two groups. There were significant improvements in all outcomes in both groups. Both groups had simliar complication and adverse event profiles and there were no differences in re-intervention or revision rates.</p><p><strong>Conclusion: </strong>The outcomes from patients with advanced medial and lateral OA of the knee who were treated with constitutionally aligned, RA-bi-UKA were not significantly different from those who were treated with TKA, with similar outcomes and complication rates at mid-term follow-up. Although the specific indications for bi-UKA remain inconclusive, the technique offers a viable alternative to TKA.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 7","pages":"898-905"},"PeriodicalIF":4.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148363292","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":"Lower septic revision rates following cementless compared with cemented robotic-assisted total knee arthroplasty using a single implant design : a five-year survivorship analysis.","authors":"Carmelo Burgio, Harold I Salmons, Karlos E Zepeda, Fernando J Quevedo Gonzalez, David J Mayman, Seth A Jerabek, Eytan M Debbi, Jonathan M Vigdorchik","doi":"10.1302/0301-620X.108B7.BJJ-2025-1654.R1","DOIUrl":"10.1302/0301-620X.108B7.BJJ-2025-1654.R1","url":null,"abstract":"<p><strong>Aims: </strong>The choice of fixation for total knee arthroplasty (TKA) remains controversial. Cementless designs incorporating highly porous titanium surfaces may achieve durable biological fixation and mitigate cement-related complications. However, little has been written comparing the methods of fixation for robotic-assisted (RA) TKA. The aim of this study was to compare the implant survival and complication rates between cemented and cementless RA-TKA using a single robotic system and uniform implant design.</p><p><strong>Methods: </strong>This retrospective review involved 2,647 consecutive primary RA-TKAs undertaken by 27 surgeons at a high-volume academic centre, between 2016 and 2024, using a single CT-based robotic platform and implant design (Triathlon). Patients aged > 18 years with primary osteoarthritis and at least one year of follow-up were included. The method of fixation was determined by the operating surgeon. This resulted in 1,289 cemented and 1,358 cementless RA-TKAs. The mean follow-up was 3.5 years (SD 2.1). Outcomes included Kaplan-Meier survival free from revision (overall, septic, and aseptic), all-cause further surgery, and 90-day readmissions and nonoperative complications. Multivariable Cox regression analysis adjusted for age, BMI, sex, race, ethnicity, and operating time was performed to identify independent predictors.</p><p><strong>Results: </strong>The five-year revision-free survival was 98.0% (95% CI 97.1 to 98.9) and 98.5% (95% CI 97.4 to 99.6) for cemented and cementless fixation, respectively (p = 0.137, log-rank test). Cementless fixation was associated with a significantly decreased risk of septic revision (hazard ratio 0.21 (95% CI 0.03 to 0.71); p = 0.021), whereas there were no differences between the groups for aseptic revision. The five-year survival free from any reoperation was 96.6% (95% CI 95.5 to 97.7) in the cemented group and 97.1% (95% CI 95.9 to 98.4) in the cementless group (p = 0.472, log-rank test). The most common indication for reoperation was stiffness, followed by periprosthetic joint infection. The 90-day readmission and nonoperative complication rates were similar between the groups (p = 0.999 and p = 0.290, respectively).</p><p><strong>Conclusion: </strong>Cementless RA-TKA showed excellent five-year survival with a significantly decreased risk of septic revision compared with cemented RA-TKA. These findings suggest a decreased infection-related risk of failure with cementless fixation, without compromising the short-term implant survival.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 7","pages":"906-912"},"PeriodicalIF":4.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148363282","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 alignment and risk of proximal junctional failure : a framework for upper instrumented vertebra selection in adult spinal deformity.","authors":"Jeffrey Hills, Lawrence G Lenke, Justin S Smith, Christopher I Shaffrey, Virginie Lafage, Renaud Lafage, Shay Bess, Michael P Kelly, Jay Turner, Juan Uribe, Alan Daniels, Bassel Diebo, Lawrence G Lenke, Dean Chou, Christopher I Shaffrey, Peter G Passias, Richard Hostin, Han Jo Kim, Khaled Kebaish, Sang Lee, Douglas C Burton, Brandon Carlson, Joshua Bunch, Frank J Schwab, Virginie Lafage, Renaud Lafage, Themistocles S Protopsaltis, Darryl Lau, Shay Bess, Breton Line, Michael P Kelly, Gregory M Mundis, Robert K Eastlack, Eric O Klineberg, Christopher P Ames, Praveen Mumanneni, Alekos Theologis, Nima Alan, Jon Yoon, Alex Soroceanu, Jeffrey L Gum, Kojo Hamilton, David Okonkwo, Thomas Buell, Stephen Lewis, Justin S Smith, Munish C Gupta, Jacob Greenberg, Neel Anand, Justin Scheer, Kai-Ming Fu, Paul Park, Yashar Javidan, Michael Wang, Byron Stephens, Scott Zuckerman","doi":"10.1302/0301-620X.108B7.BJJ-2025-1405.R1","DOIUrl":"10.1302/0301-620X.108B7.BJJ-2025-1405.R1","url":null,"abstract":"<p><strong>Aims: </strong>Proximal junctional kyphosis (PJK) remains a major complication after surgery for adult spinal deformity (ASD). While postoperative alignment is a recognized modifiable risk factor, objective methods for selecting the upper instrumented vertebra (UIV), a key modifiable factor, are lacking. We aimed to determine whether preoperative sagittal alignment, specifically cervicothoracic alignment, predicts the risk of PJK, and whether this risk can be mitigated by UIV selection, focusing on factors available at the time of surgical planning.</p><p><strong>Methods: </strong>From a multicentre, prospective ASD registry, we identified patients who had undergone fusion to the sacrum or pelvis and had an upper (T1-T5) or lower thoracic (T9-L1) UIV, with a two-year or more radiological follow-up, excluding those with a previous fusion over more than four levels. The primary outcome was PJK within two years. Multivariable logistic regression modelled the risk of PJK by UIV region, preoperative C2-T9 pelvic angle (PA), age, sex, and pelvic incidence, testing for interaction between UIV region and C2-T9 PA. Adjusted absolute risk reduction (ARR) and number needed to be exposed (NNEB) were calculated. Multivariable linear regression estimated two-year patient-reported outcome measures, adjusting for baseline scores, age, UIV, and PJK.</p><p><strong>Results: </strong>A total of 627 patients across 20 centres were included (median age 66 years (IQR 59 to 70); 483 (77%) female). The UIV was lower thoracic in 380 (61%) and upper thoracic in 247 (39%) patients. PJK occurred in 149 (39%) lower thoracic and 38 (15%) upper thoracic UIV patients. There was a significant interaction (p = 0.028) between preoperative C2-T9 PA and UIV region. At a preoperative C2-T9 PA of 14° (cohort median), an upper thoracic UIV had an adjusted ARR of 36% and NNEB was 2.8. Females had an adjusted odds ratio of 1.62 (95% CI 1.03 to 2.59; p = 0.042) for PJK.</p><p><strong>Conclusion: </strong>Worse preoperative sagittal malalignment, measured by C2-T9 PA, was associated with a higher risk of PJK and depended on UIV region. An upper thoracic UIV in patients with high preoperative C2-T9 PA may reduce PJK.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 7","pages":"943-951"},"PeriodicalIF":4.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148363234","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":"Primary total hip arthroplasty after prior osteosynthesis versus osteotomy : distinct risk profiles and the modifying effect of femoral fixation.","authors":"Nele Wagener, Yinan Wu, Carsten Perka, Sebastian Hardt","doi":"10.1302/0301-620X.108B7.BJJ-2025-1635.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.108B7.BJJ-2025-1635.R1","url":null,"abstract":"<p><strong>Aims: </strong>To compare outcomes after primary total hip arthroplasty (THA) following prior ipsilateral osteosynthesis with prior ipsilateral osteotomy, and to assess whether femoral fixation modifies risk.</p><p><strong>Methods: </strong>Using the German Arthroplasty Registry (EPRD; 2012 to 2024), two 1:1 matched analyses were performed: prior osteosynthesis versus no prior surgery (8,643 pairs) and prior osteotomy versus no prior surgery (5,569 pairs), matched on age, sex, BMI category, and Elixhauser score. Kaplan-Meier and Cox regression were used, censoring at death, with adjustment for femoral fixation (cemented, cementless, hybrid, reverse-hybrid).</p><p><strong>Results: </strong>After prior osteosynthesis, hazards were higher for revision (HR 6.93 (95% CI 6.07 to 7.92), periprosthetic femoral fracture (PFF; HR 17.22 (95% CI 12.28 to 24.15)), and infection (HR 3.87 (95% CI 3.05 to 4.91)) compared with controls (all p < 0.001); cemented and hybrid fixation had lower revision and PFF hazards than cementless fixation. After prior osteotomy, revision (HR 2.30 (95% CI 1.89 to 2.80)) and dislocation (HR 9.43 (95% CI 4.55 to 19.56)) hazards were higher; PFF and infection were not significant. Reverse-hybrid fixation was associated with higher revision (HR 2.01 (95% CI 1.27 to 3.19)) and infection (HR 3.71 (95% CI 1.71 to 8.06)) hazards than cementless fixation.</p><p><strong>Conclusion: </strong>Prior osteosynthesis denotes a high-risk, conversion-type THA scenario; cemented-based constructs were associated with lower PPF and revision hazards than cementless fixation. Prior osteotomy confers an intermediate risk profile, mainly driven by revision, dislocation, and loosening. Osteosynthesis and osteotomy histories should not be pooled in preoperative risk assessment before THA.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 7","pages":"880-888"},"PeriodicalIF":4.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148363305","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":"Single-use surgical gowns are associated with an increased rate of periprosthetic joint infection : analysis of 9,239 primary hip and knee arthroplasties from a single centre.","authors":"Amy Marie Firth, Ross Sian, Jessica Nightingale, Bernard H van Duren, Mark Higgins, Andrew R J Manktelow, Benjamin V Bloch","doi":"10.1302/0301-620X.108B7.BJJ-2025-0996.R2","DOIUrl":"https://doi.org/10.1302/0301-620X.108B7.BJJ-2025-0996.R2","url":null,"abstract":"<p><strong>Aims: </strong>Periprosthetic joint infection (PJI) remains a serious complication of arthroplasty, associated with increased morbidity, mortality, and healthcare costs. While patient-related and procedural risk factors are well established, the effect of surgical gown type on infection risk is unclear. Single-use surgical gowns are often used due to their perceived superior sterility in the absence of clear evidence. The purpose of this study was to determine the effect of single-use compared with reusable gown use on the incidence of PJI in the 12 months following primary hip and knee arthroplasty.</p><p><strong>Methods: </strong>Between January 2015 and September 2023, 9,239 consecutive primary elective hip and knee arthroplasties were performed at our institution. Data were obtained from a prospectively maintained local registry aligned with the UK Health Security Agency Surgical Site Infection database and National Joint Registry, and combined with surgeon gown preference data. A retrospective logistic regression was undertaken to evaluate the association between gown type and PJI in the 12 months after surgery, adjusting for age, sex, BMI, diabetes, and chronic obstructive pulmonary disease (COPD).</p><p><strong>Results: </strong>A total of 76 infections (0.82%) were identified, comprising 49/5,024 knees (0.98%) and 27/4,215 hips (0.64%). Infection occurred more frequently in the single-use gown group (n = 4,314; 1.0%) than in the reusable gown group (n = 4,925; 0.6%; p = 0.017). Single-use gowns were associated with higher odds of infection (adjusted odds ratio (OR) 1.73 (95% CI 1.09 to 2.76); p = 0.020).</p><p><strong>Conclusion: </strong>Use of single-use surgical gowns was independently associated with an increased odds of PJI following primary hip and knee arthroplasty in the 12 months after surgery in our institution. This finding highlights the need for further studies exploring the causal factors contributing to this outcome.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 7","pages":"913-919"},"PeriodicalIF":4.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148363264","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":"From surgical backlog to opioid burden : the case for opioid stewardship in arthroplasty pathways.","authors":"Najwa Jamal, Nick D Clement, Andrew D Duckworth, Catherine V Collinson","doi":"10.1302/0301-620X.108B7.BJJ-2025-1765.R1","DOIUrl":"10.1302/0301-620X.108B7.BJJ-2025-1765.R1","url":null,"abstract":"<p><p>The prolonged waiting times for hip and knee arthroplasty have resulted in numerous negative effects for patients being reported, with none more important than increasing opioid reliance due to chronic musculoskeletal pain. Opioid use prior to surgery is a factor associated with prolonged use postoperatively, and while opioids remain a valuable resource in the management of acute surgical pain, ongoing use carries substantial clinical, psychological, and societal risks. Recent Medicines and Healthcare products Regulatory Agency (MHRA) guidance and the 2024 UK consensus statement have resulted in a shift for perioperative pain management, moving away from routine modified release opioid use towards individualized care. To address these issues and changes, interventions need to be focused both preoperatively and postoperatively using improved risk stratification, patient education, and community engagement. This annotation discusses these issues and emphasizes the importance of opioid stewardship as a unifying framework to embed principles across the arthroplasty pathway, with the aims of reducing harm, improving outcomes, and supporting safer sustainable care.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 7","pages":"853-858"},"PeriodicalIF":4.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148363210","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":"Coronal alignment parameters of the knee predict osteoarthritis development : a Coronal Plane Alignment of the Knee classification-based analysis using the Multicenter Osteoarthritis Study data.","authors":"Ji-Sahn Kim, Samuel J MacDessi, Do Weon Lee, Du Hyun Ro","doi":"10.1302/0301-620X.108B7.BJJ-2025-0687.R2","DOIUrl":"10.1302/0301-620X.108B7.BJJ-2025-0687.R2","url":null,"abstract":"<p><strong>Aims: </strong>Mechanical varus or valgus alignment measures have been demonstrated to be closely related to knee osteoarthritis (KOA) development, but few attempts have been made to correlate the Coronal Plane Alignment of the Knee (CPAK) classification and disease development. This study hypothesized that certain CPAK types or deviations in CPAK parameters might enhance the risk of KOA development.</p><p><strong>Methods: </strong>KOA was defined as a Kellgren-Lawrence grade of 2 or higher. Data from 2,541 knees without KOA at baseline from the Multicenter Osteoarthritis Study (MOST) over five years of follow-up were examined. Differences in baseline CPAK types and parameters were analyzed between knees that developed KOA and those that did not. The association of CPAK type, arithmetic hip-knee-ankle angle (aHKA), and joint line obliquity (JLO) with the risk of disease development and joint line convergence angle (JLCA) changes were assessed.</p><p><strong>Results: </strong>Knees that developed KOA (480 knees; 18.9%) had significantly lower JLO (p = 0.022) and aHKA (p = 0.008) values than those that did not (2,061 knees; 81.1%). JLO was significantly associated with KOA development (odds ratio 1.048 (95% CI 1.001 to 1.098)). For knees with JLO values under the cut-off value of 171.6°, the risk of KOA development was 1.36 times higher than for those with values over the cut-off value (95% CI 1.053 to 1.770). aHKA showed a significant negative correlation with JLCA change (regression coefficient -0.139 (95% CI -0.241 to -0.036); p = 0.008). However, CPAK type itself showed no significant correlation with KOA development.</p><p><strong>Conclusion: </strong>CPAK parameters, rather than types, were significantly associated with KOA development. Importantly, significant obliquity to the constitutional joint line might be as impactful as lower limb alignment. By potentially adjusting cut-off values, CPAK classification might be applied for predicting KOA development and investigating alignment-related aspects of KOA pathophysiology.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 7","pages":"889-897"},"PeriodicalIF":4.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148363218","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 modified Delphi consensus on tenosynovial giant cell tumour and giant cell tumour of bone : a report from the Birmingham Orthopaedic Oncology Meeting (BOOM).","authors":"Lee M Jeys, Eduardo Botello, Richard Boyle, Walid Ebeid, Thomas Hilton, Matthew T Houdek, Keith Hosking, Vineet J Kurisunkal, Maritz Laubscher, Guy V Morris, Ajay Puri, Pietro Ruggieri, Minna K Laitinen, Yunus Abdul Bari, Ahmed Abood, John A Abraham, Marthelena Acosta Marin, Manish Agarwal, Rishi Agarwal, Marcela Aguirre, Vivek Ajit Singh, Toru Akiyama, Humaid Al Farii, Motaz Alaqeel, Abdulrahman Alaseem, Omar Aldosari, Kate Alexander, Patricio Alfaro, Wazzan Aljuhani, Daniel C Allison, Mohammed Almashahedi, Abdullah Alotaibi, Bugra Alpan, Ibrahim S Alshaygy, Turki Althunayan, Lorenzo Andreani, Dimosthenis Andreou, Andriandi Andriandi, Lucas Annabelle, Luis Aponte-Tinao, Melanie Ardelt, Selma Armas, William Aston, Osman Emre Aycan, Thomas Baad-Hansen, Pablo Baeza, Charles Baird, Tessa Balach, Xavier Banse, Juan Barriga, Janie Barry, Georges Basile, Stefano Bastoni, Mohammad Hardian Basuki, Henrik C Bauer, Semay Baydar, Lee Bayliss, Ricardo Becker, Angad Bedi, Joseph Benevenia, Francisco Bengoa, Christina Berger, Nicholas Bernthal, Odion Binitie, Justin Bird, Abdulrahman Bobseit, Caitlin Bodian, Michele Boffano, Patricia Bonilla Huertas, Jos Bramer, Matthew Broadhead, Demien Broekhuis, Samuel Earl Broida, Danielle Brown, Alessandro Bruschi, Tymoteusz Budny, Mirka Buist, Zachary Burke, Tilmann Busse, Jorge Cabrolier, Jose Antonio Calvo-Haro, Domenico A Campanacci, Rodrigo Cardoso, Richard Carey Smith, María G Carrasco, Nicolas Casales, Ashley Castan, Oscar Ceballos, Chung Ming Chan, Lester Chan, Liang Zhen Chang, Chris Charoenlap, Juan Fernando Chaustre Florez, Janet Chin, Peter Choong, Adam Chrobok, Yang-Guk Chung, Dawid Ciechanowicz, Miguel Angel Clara-Altamirano, Luis Alfonso Consuegra Guzman, Olivier Cornu, Laurent Coubeau, Louis Courtot, Brooke Crawford, Gillian Cribb, Carlos Eduardo Cuervo-Lozano, Dietmar Dammerer, Pablo de la Rosa, Daniela de Lima Corvino, Massimiliano De Paolis, Francisco Javier De Santos de la Fuente, Marieke de Vaal, Julian M Deisenhofer, Javier Delgado Obando, Eren Demir, Shaneel Deo, Niklas Deventer, Claudia Di Bella, Edwin Dierselhuis, Pierre-Louis Docquier, Gregory Domson, Davide M Donati, Arpan Doshi, Myléne J C Duivenvoorden, Rodolfo Duran-Ciarrochi, Hans Roland Dürr, Pierre J Ehlers, Ahmed Mohamed El Ghoneimy, Alessandro El Motassime, Fabio Fernando Eloi Pinto, Makoto Endo, Gadi Epstein, Levent Eralp, Mahmoud Etaiwi, Will Eward, Nicola Fabbri, Martina Faimali, Ullah Farman, Arbab Farooq, Khalil Farooque, Clayton Farris, Peter Ferguson, Nando Ferreira, Fabrice Fiorenza, Michael Flint, Jonathan A Forsberg, Daniel Franks, Joao Paolo Freitas, Bruno Fuchs, Tomohiro Fujiwara, Philipp T Funovics, Edward Fuzy, Marcos Galli Serra, Zakareya Gamie, Maria Garcia-Carrasco, Gabriel García-Huidobro, Czar Louie Gaston, Aaron Gazendam, Basile Georges, Michelle Ghert, Kanishka Milton Ghosh, Fabio Luca Giardina, C Parker Gibbs, Yanina Golovina, Luis Carlos Gomez Mier, Anne Gomez-Mascard, Maria Antonia Gomez-Sierra, Catalina González-Browne, Juan Gonzalez-Saldivar, Alejandro González-Motta, Yair Gortzak, Georg Gosheger, Francois Gouin, Krista Goulding, Isidro Gracia, Andrew Graydon, Natalie Green, Anthony Griffin, Alex Guedes, Ashish Gulia, Sanjay Gupta, Maurice Guzman, Jendrik Hardes, Yusuf O Hasan, Ahmad Munir Hashim, Hel Havard, Rex Haydon, Prateek Hegde, Adriana Hernandez Lopez, David Herrera, Amr Hesham, Asle Hesla, Matthew Hess, Adam Hirschmann, Gerhard Hobusch, Anna Hohensteiner, Chindanai Hongsaprabhas, Francis Hornicek, Megan Hsu, Oluwaseyi K Idowu, Mujaddid Idulhaq, Bright Igbinoba, Joseph A Ippolito, Shintaro Iwata, Jakub Jagiello, Muhammad P Johan, Luke Johnson, Andy Johnston, Min Wook Joo, David Joyce, Beatrice Jung, Christiane Jungels, Paul Jutte, Willem Jutte, Anna-Stina Jääskeläinen, Kadri Kaldas, Bilal Kapanci, Mustafa Onur Karaca, Akira Kawai, Alysia Kemp, Adyb-Adrian Khal, Zeeshan Khan, Zainab Aqeel Khan, Nader Khaouam, Han-Soo Kim, Schalk Klopper, Eisuke Kobayashi, Hiroshi Kobayashi, Vasileios Kontogeorgakos, Daniel Kotrych, Gitte G J Krebbekx, Anjan Venkataraman Krishnamurthy, Toshiyuki Kunisada, Richard Kyte, Valérie Lacroix, Alexander Lazarides, Louis-Romee Le Nail, Francis Y Lee, Jewoo Lee, Minpyo Lee, Pawel Legosz, Burkhard Lehner, Andreas Leithner, Gianpaolo Leone, Douglas Letson, Valerae O Lewis, Binghao Li, Hanna Liikanen, Peng Lin, Zwelithini Linda, Sarah Lindsay, Santiago Lozano Calderon, Mark Lutomia Lumbasi, Jonathan Macdonald, Pau Machado, Edgar Majirija, Mario Malina, Roman Malyk, Leonard Marais, Eric Mascard, Jean Camille Mattei, Louise McCullough, Samuel McMahon, Manuel Ricardo Medellin Rincon, Lydia Mediavilla Santos, Diederik Meijer, Johannes Gerard Meijer, Benjamin Miller, Allan Molloy, Diego Jesus Moriel Garcesco, Carol D Morris, Ashlyn Morse-Sanyal, Sophie Mottard, Phakamani G Mthethwa, Carlos Muñoz-Montecinos, Miguel Murcia, Michelle Müller, Robert Nakayama, Prashant Narhari, Ali Nasar, Prakash Nayak, Johannes Neugebauer, Jyrki Nieminen, Philani Ntombela, Lukas Nystrom, Sarah O'Reilly-Harbidge, Gary O'Toole, Koichi Ogura, Made Dolly Oktayana, Vania Oliveira, André Olivier, Daniel Olson, Opeyemi Olusunmade, Mohamed Omar, Yusuf Omran Hasan, Eduardo J Ortiz-Cruz, Shuhei Ozaki, Toshifumi Ozaki, Korhan Ozkan, Elisa Pala, Emanuela Palmerini, Yogesh Panchwagh, Grant Pang, Panayiotis Papagelopoulos, Dimitra P Papagelopoulos, Giovanni Paraliticci, Walter Parizzia, Michael Parry, Matthew Pate, Ana Peiró, Jonathan Perera, Michael M Petersen, Oatile Phakathi, Rapin Phimolsarnti, Tshepang Phiri, Rafael Pinheiro, Nicolas Pinto Santander, Joris Ploegmakers, Robin Pollock, Gerard Powell, Yuni Prabowo, Manish Pruthi, Mark Puhaindran, Julia Quirion, Camila Quirland, Eden Rabin, Anna Rachbauer, Sanjeevan Radhakrishnan, Anand Raja, Rohit Rajalbandi, Rajiv Rajani, Raja Bhaskara Rajasekaran, Shanmuganthan Rajasekaran, Stanislav Rajkovic, Maria Teresa Ramirez, Dipak B Ramkumar, Kenneth S Rankin, Alejandro Ras El Abiad, Kumaran Rasappan, Malena Redl, Arianna Rizzo, Peter S Rose, Andrew Rosenberg, Michael Russell, German Salcedo Rodriguez, Ahmad Saleh, Andrea Sambri, Ahmed Samy, Maria Sánchez-Maldonado, Rhyan Darma Saputra, Roberto Scanferla, Tom Scharschmidt, Thomas Schubert, Guido Scoccianti, Florencio Segura, Simen Sellevold, Ahmad Shehadeh, Bhim Shreemal, Félix Shumelinsky, Ather M Siddiqi, Claudio Silveri, Friedl Sinnaeve, Maria A Smolle, Franz Snyman, Michael Solomons, Scott Sommerville, Sahil Sood Sood, Mariel E Spense, Christian Spiegel, Andre Spiguel, Eric L Staals, Nikolaos A Stavropoulos, Peter Steadman, Sydney Stern, Jonathan Stevenson, Pablo Stoppiello, Chris Stubbe, Mikaela H Sullivan, Nathalia Sundin, Felipe Martín Suntaxi Basantes, Bartlomiej Szostakowski, Bartek Szostakowski, Nikhil Tandon, Xiaodong Tang, Sarah Tepper, Bruno Terrarossa, Pushpa B Thippeswamy, Joachim Thorkildsen, Kaspar Tootsi, Ferran Torner-Rubies, Koray Tosyali, Frank Traub, Jonathan Trent, Chanonta Triganjananun, Ioannis Trikoupis, Laura Trullols, Panagiotis Tsagkozis, Kim Tsoi, Pakjai Tuntarattanapong, Marisa N Ulrich, Veli-Matti Vainio, Juan D Valencia, Michiel van de Sande, Ingrid van der Geest, Robert Jp van der Wal, Kirsten van Langevelde, Roberto Velez, Léonie Verbeke, Floortje G M Verspoor, Anne Versteeg, George Vicatos, Jagandeep Singh Virk, Julia Visgauss, Oleg Vyrva, Hazem Wafa, Wan Ismail Wan Faisham, Patrick Qi Wang, Ran Wei, David Wennergren, Joel Werier, Wolfram Weschenfelder, Nadine Williams, Jay Wunder, Huseyin Yusuf Yildiz, Eduardo S Yonamine, Hirotaka Yonezawa, Maitham Yousuf, Ahmed Zaghloul, Suraya Zainul-Abidin, Tomas Zamora, Lee Zuckerman, Juan Pablo Zumarraga, Harzem Özger","doi":"10.1302/0301-620X.108B.BJJ-2026-0394","DOIUrl":"10.1302/0301-620X.108B.BJJ-2026-0394","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to achieve consensus on important topics related to tenosynovial giant cell tumour (TGCT) and giant cell tumour of bone (GCTB), and to identify areas for future research.</p><p><strong>Methods: </strong>In January 2026, a consensus meeting, The Birmingham Orthopaedic Oncology Meeting (BOOM), held in Cape Town, South Africa, gathered 314 delegates from 59 countries to debate 21 consensus statements on tenosynovial giant cell tumour (TGCT) and giant cell tumour of bone (GCTB) through a modified Delphi process.</p><p><strong>Results: </strong>Of the 21 statements, two achieved unanimous consensus, 18 strong consensus, and one moderate consensus. Unanimous consensus was reached for prioritizing joint-preserving intralesional curettage in GCTB when feasible, and for supporting non-surgical approaches in anatomically challenging cases, particularly sacral lesions. The statement addressing the role of denosumab in GCTB achieved only moderate consensus. The use of adjuvants in GCTB, as well as the management of recurrent and systemic GCTB, including long-term use of denosumab, reached strong consensus. Strong consensus was achieved in the surgical and non-surgical management for both primary and recurrent TGCT. Surveillance strategies for both TGCT and GCTB generated substantial discussion despite strong consensus, reflecting ongoing uncertainty and lack in evidence.</p><p><strong>Conclusion: </strong>This international consensus provides practical guidance for the management of TGCT and GCTB while identifying important gaps in evidence. Joint-preserving surgery remains central to the treatment of GCTB, with selective integration of systemic therapies and individualized surveillance. The consensus framework highlights priorities for future collaborative research in orthopaedic oncology.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B ","pages":"1045-1051"},"PeriodicalIF":4.8,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206678","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":"Revision after anatomical total shoulder arthroplasty : the influence of age on outcomes in a large nationwide registry study.","authors":"Nick Smeitink, Femke F Schröder, Oscar Dorrestijn, Anneke Spekenbrink-Spooren, Jari Dahmen, Arthur van Noort, Michel P J van den Bekerom, Egbert J D Veen","doi":"10.1302/0301-620X.108B6.BJJ-2025-1488.R1","DOIUrl":"10.1302/0301-620X.108B6.BJJ-2025-1488.R1","url":null,"abstract":"<p><strong>Aims: </strong>Primary anatomical total shoulder arthroplasty (aTSA) is generally the preferred treatment for active young patients with increased functional demands who need a shoulder arthroplasty. There is little information, however, about the survival of this implant in patients aged < 65 years. The aim of this study was to investigate the differences in revision rates after primary aTSA in patients aged < 65 years compared with those aged ≥ 65 years, within ten years, hypothesizing that younger patients would have higher revision rates due to increased functional demands and activity levels.</p><p><strong>Methods: </strong>Data on 3,622 primary aTSAs performed between January 2014 and January 2024 were extracted from the Dutch Arthroplasty Register. A total of 1,486 were performed in patients aged < 65 years, and 2,136 in those aged ≥ 65 years. Kaplan-Meier survival and multivariate Cox regression analyses were performed.</p><p><strong>Results: </strong>Within ten years of follow-up, 159 revisions (4%) were required. Significantly more revisions were performed in the younger group (89 (6%)) than in the older group (70 (3%); p < 0.001). The cumulative revision percentages were 11% (95% CI 8 to 14) and 6% (95% CI 4 to 7; p < 0.001), respectively. The most common indications for revision in both groups were cuff rupture, instability, and loosening of the glenoid component. In patients aged ≥ 65 years, both revisions for periprosthetic fracture (8 (11%) vs 2 (2%); p = 0.023) and total revisions were undertaken significantly more often (49 (71%) vs 49 (56%); p = 0.029). In the multivariate Cox regression model, age < 65 years was not associated with worse implant survival (hazard ratio (HR) 1.4 (95% CI 1.0 to 1.9); p = 0.069). Previous surgery on the affected shoulder was associated with significantly worse implant survival in all patients (HR 1.9 (95% CI 1.3 to 2.8); p = 0.002).</p><p><strong>Conclusion: </strong>Patients aged < 65 years had significantly higher revision rates after aTSA, but this was primarily explained by an increased prevalence of previous surgery to the shoulder. After adjustment, age itself was not associated with implant survival.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 6","pages":"793-798"},"PeriodicalIF":4.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139454","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}