Bone & Joint Journal最新文献

{"title":"Cobalt toxicity from third-body wear following revision of fractured ceramic-on-ceramic hip bearings with a metal articulation : the fractured ceramic syndrome.","authors":"E Bailey Terhune, E Grant Sutter, Rishi Balkissoon, Graham Pallante, Lawrence M Specht, Jerrold Leikin, Young-Min Kwon, David G Lewallen, Tad L Gerlinger, Joshua J Jacobs","doi":"10.1302/0301-620X.107B6.BJJ-2024-1114.R1","DOIUrl":"10.1302/0301-620X.107B6.BJJ-2024-1114.R1","url":null,"abstract":"<p><strong>Aims: </strong>Ceramic-on-ceramic (CoC) articulations in total hip arthroplasty (THA) have the advantage of low wear but the unique risk of fracture. After revision for CoC-bearing fracture, third-body ceramic particles can lead to massive wear of cobalt-chrome (CoCr) bearings, causing extremely elevated blood cobalt. We present a multicentre series of five cases where patients sustained fractures of ceramic liners, were revised using a CoCr articulation, and rapidly developed severe cobalt toxicity.</p><p><strong>Methods: </strong>We identified five cases of cobalt toxicity after fractured CoC THA treated with revision to CoCr on polyethylene bearings. Mean follow-up was three years (5 to 72 months) after re-revision to remove the CoCr bearing.</p><p><strong>Results: </strong>Symptoms of cobalt toxicity occurred at a mean ten months (6 to 12) after revision for ceramic fracture. All patients developed vision and hearing loss, balance difficulties, and peripheral neuropathy. Several had cardiomyopathy, endocrine abnormalities, and local skin discolouration. Only two reported hip pain. Repeat revision for recognized cobalt toxicity occurred at a mean 22 months after revision for ceramic fracture. Mean serum cobalt level at re-revision was 991 ng/ml (normal value < 1 ng/ml; 734 to 1,302). All CoCr femoral heads exhibited massive wear, and deep tissues showed prominent metal staining. Treatment consisted of debridement and revision to a ceramic femoral head with highly cross-linked polyethylene (HXLPE) liner. Serum cobalt improved to a mean 25 μg/l (1 to 76) at final follow-up. All patients reported partial improvement in vision and hearing, however their peripheral neuropathy and balance difficulties did not recover.</p><p><strong>Conclusion: </strong>Systemic cobalt toxicity is a devastating complication of ceramic-bearing fracture in THA treated with CoCr bearings, which may not present with hip symptoms. The diagnosis of this syndrome of systemic cobalt toxicity was significantly delayed following systemic symptoms in this series. Debridement and re-revision to a ceramic-on-HXLPE bearing leads to improvement, but not full resolution, of cobalt toxicity complications.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 6 Supple B","pages":"92-100"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192407","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":"Association between preoperative glycaemic control (HbA1c) and early outcomes following primary hip and knee arthroplasty.","authors":"Richard James Holleyman, Michael Clarkson, Amy Shenfine, Kate Martin, James Prentis, Mark Bowditch, Gerry Rayman, Andrew Judge, Mike R Reed","doi":"10.1302/0301-620X.107B6.BJJ-2024-1136.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.107B6.BJJ-2024-1136.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study investigates the relationship between diabetes mellitus (DM), glycated haemoglobin (HbA1c), and postoperative outcomes among patients undergoing hip and knee arthroplasty.</p><p><strong>Methods: </strong>We conducted a single-centre cohort study of patients who underwent primary hip or knee arthroplasty between June 2008 and December 2019 and for whom preoperative HbA1c had been recorded. Cases were categorized by preoperative HbA1c as 'diabetes' (≥ 48 mmol/mol), 'prediabetes' (≥ 42 mmol/mol and < 48 mmol/mol), 'no diabetes' (< 42 mmol/mol), or in 'remission' (preoperative HbA1c < 42 mmol/mol but having a historic HbA1c result ≥ 42 mmol/mol). Multivariable logistic regression and restricted cubic splines were used to examine the association between diabetes status, HbA1c, and early postoperative outcomes.</p><p><strong>Results: </strong>Analysis of 9,454 procedures (18.4% diabetes, 23.5% prediabetes, 49.7% no diabetes, 8.4% in remission) revealed that DM was associated with a 50% greater likelihood of experiencing one or more postoperative complications (odds ratio (OR) 1.47 (95% CI 1.26 to 1.71)), a 60% greater risk of acute kidney injury or electrolyte abnormality (OR 1.57 (95% CI 1.33 to 1.87)), and more than double the risk of postoperative urinary tract infection (OR 2.25 (95% CI 1.15 to 4.52)) and deep surgical site infection (OR 2.03 (95% CI 1.05 to 3.86)) compared to individuals without diabetes. There was a substantial increase in complication risk as HbA1c entered prediabetes range with no evidence of a plateau or threshold effect, and a profound reduction in the risk of almost all recorded complications for patients in remission from previously elevated HbA1c.</p><p><strong>Conclusion: </strong>DM was associated with an increased risk of almost all measured early postoperative complications. Interventions to reduce elevated HbA1c, to any degree, may benefit patient outcomes, however these must be balanced with the risk of iatrogenic harm.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 6","pages":"615-624"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192399","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":"Does CT improve the accuracy of predicting implant fixation status for periprosthetic fractures around uncemented femoral components?","authors":"Reese Courington, Rogerio Ferreira, M Kareem Shaath, Cody Green, Joshua Langford, George John Haidukewych","doi":"10.1302/0301-620X.107B6.BJJ-2024-0829.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.107B6.BJJ-2024-0829.R1","url":null,"abstract":"<p><strong>Aims: </strong>Periprosthetic femoral fractures (PPFFs) around total hip arthroplasty (THA) stems are challenging. Typically, loose stems are revised, while well-fixed implants undergo fracture open reduction and internal fixation. Determining implant fixation status preoperatively is important. The purpose of this study was to define the accuracy of predicting the status of preoperative stem fixation using radiography and CT.</p><p><strong>Methods: </strong>A total of 24 patients with Vancouver B-type PPFF with preoperative radiography and CT scans were included. Patients with obviously loose implants (detached or subsided stem), fractures that occurred within 90 days of index THA, and cemented femoral components were excluded. Two fellowship-trained adult reconstruction surgeons and two traumatologists reviewed radiographs and predicted stem fixation status. They then evaluated CT scans, and fixation status was reassessed. Each surgeon undertook two evaluations one month apart. The correct response was determined by intraoperative findings. Interobserver and intraobserver reliability values were calculated, as well as validity.</p><p><strong>Results: </strong>Overall, 15 implants (62.5%) were well-fixed and nine (37.5%) were loose. Radiography alone predicted correct fixation status in 53.1% of cases (102/192). When adding CT, correct predictions improved to 54.7% (105/192). Fixation status predictions were changed in 18.2% of cases (35/192) after reviewing CT scans: 8.3% (16/192) from correct to incorrect, and 9.9% (19/192) from incorrect to correct. Interobserver reliability ranged from poor to moderate agreement, and intraobserver reliability demonstrated moderate agreement for all raters. No difference in accuracy was noted between adult reconstruction or trauma surgeons.</p><p><strong>Conclusion: </strong>The ability to predict fixation status for PPFFs around uncemented femoral components remains challenging. The addition of preoperative CT did not significantly improve accuracy. Intraoperative testing of femoral component fixation status is essential to determine if revision or fixation is appropriate. Preoperative CT for Vancouver B PPFF does not significantly improve accuracy in assessing stem fixation status compared with plain radiography.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 6 Supple B","pages":"42-46"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192408","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":"Reconstruction of the hip abductor function with a deep muscle-sparing vastus lateralis to gluteus medius translational transfer/transposition : early results of a multidisciplinary team approach.","authors":"Gayatri Caplash, Lucian B Solomon, Douglas Copson, Abi Ehrlich, Yugesh Caplash, Dominic Thewlis, Boopalan Ramasamy","doi":"10.1302/0301-620X.107B6.BJJ-2024-1169.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.107B6.BJJ-2024-1169.R1","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study is to describe a deep muscle-sparing vastus lateralis (VL) flap to gluteus medius (Gmed) transfer to address severe hip abductor function deficiency, and present the early results achieved through a multidisciplinary team (MDT) approach.</p><p><strong>Methods: </strong>Seven patients, with and without previous total hip arthroplasty, with severe abductor deficiency of the hip (Medical Research Council ≤ 2/5), and requiring walking aids, underwent a deep muscle-sparing VL translation flap to Gmed as part of a new orthopaedic and plastic MDT approach, and had more than 12 months' follow-up. The fatty infiltration of the glutei had a median Goutallier scale of 4 (IQR 1 to 4). Five patients had prior revision surgery, two involving a proximal femoral arthroplasty. Patients underwent pre- and postoperative evaluations with clinical examination, instrumented gait analysis, surface electromyography (EMG), and MRI.</p><p><strong>Results: </strong>All patients were satisfied with the result and could walk without support by six months after surgery. The abductor power improved to 3 to 5 out of 5 and continued to improve beyond one year after surgery. Knee extension power was not affected. EMG demonstrated that the transferred VL activated synchronously with Gmed three months postoperatively, suggesting adaptation to its new function. MRI demonstrated no fatty infiltration of the flap or the residual VL.</p><p><strong>Conclusion: </strong>The MDT approach to hip abductor function reconstruction with VL to Gmed transfer has demonstrated potential for success, with good functional outcomes and no functional donor-site morbidity recorded to date.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 6 Supple B","pages":"84-91"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192414","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 acetabular reconstruction in revision total hip arthroplasty : a clinical study with minimum two-year follow-up.","authors":"Wang Deng, Xiangdong Wu, Hongyi Shao, Hao Tang, Yong Huang, Zhaolun Wang, Dejin Yang, Yixin Zhou","doi":"10.1302/0301-620X.107B4.BJJ-2024-0982.R1","DOIUrl":"10.1302/0301-620X.107B4.BJJ-2024-0982.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to report the surgical techniques and early clinical results of robotic arm-assisted acetabular reconstruction in revision total hip arthroplasty (THA).</p><p><strong>Methods: </strong>Between October 2019 and May 2021, we used the Mako robotic system to perform 62 revision THAs at our hospital. This study included 54 patients who underwent robotic arm-assisted revision THA for acetabular reconstruction. Surgical techniques using the robotic system to reconstruct the acetabulum, including preoperative planning, intraoperative registration, and the accuracy of different registration methods, are reported. The accuracy between the target acetabular component orientation and final orientation was evaluated. The latest follow-up Harris Hip Score (HHS) and radiographs were analyzed.</p><p><strong>Results: </strong>Among the 54 hips included, four types of intraoperative registration methods with different surfaces were developed and registered 65 times. The overall success rate of the registration process was 98.5%. The mean accuracy of successful registration was 0.38 mm (0.2 to 0.5). The median difference between the target and final acetabular component orientations assessed by Mako was 1.0° (-2.0° to 0.0°) for inclination and 0.0° (-1.0° to 1.0°) for anteversion. Four hips were classified as outliers for acetabular component orientation. The reconstructed centres of rotation (CORs) were slightly lower than the anatomical CORs by a mean 4.72 mm (SD 4.71), and shifted laterally by 3.92 mm (SD 4.62) on postoperative radiographs. The median HHS improved significantly from 46.0 (IQR 33.0 to 58.3) preoperatively to 89.0 (IQR 78.3 to 93.0) postoperatively (p < 0.001). The overall satisfaction rate was 86.0% (n = 50). There were no radiological failures at the latest follow-up.</p><p><strong>Conclusion: </strong>Robotic arm-assisted revision THA provides valuable information for the analysis of bone defects to guide reconstructive strategies. Robotic arm-assisted reaming and acetabular component or augment positioning facilitates accurate component position and orientation. The radiological and preliminary clinical results of this cohort were satisfactory.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 4","pages":"404-412"},"PeriodicalIF":4.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755384","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":"Functional alignment restores native kinematics more consistently than mechanical axis alignment in total knee arthroplasty.","authors":"Jonathan R Manara, Rick Steer, Sarah L Whitehouse, Dermot Collopy, Gavin W Clark","doi":"10.1302/0301-620X.107B4.BJJ-2024-0956.R1","DOIUrl":"10.1302/0301-620X.107B4.BJJ-2024-0956.R1","url":null,"abstract":"<p><strong>Aims: </strong>Functional alignment (FA) and adjusted mechanical alignment (aMA) are recognized techniques for performing total knee arthroplasty (TKA). The native femur rolls back further on the lateral tibial plateau than the medial side during flexion, resulting in a medial pivot pattern of movement. We have assessed whether an individualized alignment technique affects the kinematic pattern observed and the clinical outcomes, when compared to a systematic alignment technique in TKA.</p><p><strong>Methods: </strong>A total of 60 consecutive patients were randomized to a robotically assisted TKA with either FA (n = 29) or aMA (n = 31), using a cruciate-retaining (CR) implant. After definitive implantation of the prostheses, a trial pressure monitor was inserted recording contact points between the femoral component and monitor in the medial and lateral compartments as the knee was taken through a range of motion. The kinematic pattern was observed, contact pressures measured, and patient-reported outcome measures (PROMs) assessed at 12 months.</p><p><strong>Results: </strong>The FA-TKA group produced a medial pivot in 58.6% of cases (17/29), symmetrical rollback in 37.9% (11/29), and a lateral pivot in 3.4% (1/29). The aMA-TKA group produced a medial pivot in 19.4% of cases (6/31), symmetrical rollback in 45.2% (14/31), and a lateral pivot in 35.5% (11/31) (p < 0.001). No differences in knee balance were recorded between the two alignment groups at any flexion point. Patients with a medial pivot kinematic pattern had superior one-year PROMs in some measures. Patients producing a lateral pivot had lower Kujala scores.</p><p><strong>Conclusion: </strong>FA CR-TKA generates an intraoperative medial pivot kinematic pattern through soft-tissue balance more often than those that use aMA. Lateral pivot kinematic patterns are more commonly found with aMA. These intraoperative kinematic patterns are related to clinical outcomes, with knees producing a medial pivot performing better than those with lateral pivot.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 4","pages":"423-431"},"PeriodicalIF":4.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755289","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 and characteristics of noise generation in total hip arthroplasty with ceramic-on-ceramic bearings : a comparison between robotic-assisted surgery and conventional methods.","authors":"Xianzuo Zhang, Mo Chen, Tao Zhang, Haining Zhang, Bo Yang, Chen Zhu","doi":"10.1302/0301-620X.107B4.BJJ-2024-0506.R2","DOIUrl":"10.1302/0301-620X.107B4.BJJ-2024-0506.R2","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate the impact and risk factors of robotic-assisted surgery (RAS) on noise generation in total hip arthroplasty (THA) with ceramic-on-ceramic (CoC) bearings in comparison to conventional (CON) manual methods.</p><p><strong>Methods: </strong>A secondary analysis of a prospective multicentre randomized controlled trial - conducted from June 2021 to July 2022 - included 74 patients with CoC bearings, equally divided between RAS and CON groups. Noise incidence, characteristics, and duration were documented. Radiological assessments and logistic regression analysis were performed to identify predictors of noise or squeaking.</p><p><strong>Results: </strong>The incidence of overall noise complaints was higher in the CON group compared to the RAS group, with a statistically significant difference observed at the early postoperative stage. Specifically, at 14 days post-surgery, 5.4% of patients in the RAS group and 32.4% in the CON group reported noises (p = 0.008), while at 24 weeks, the rates were 5.4% and 21.6%, respectively, with no statistically significant difference (p = 0.089). RAS showed superior alignment and precision in component placement. Logistic regression analysis identified conventional surgery as a significant predictor of noise complaints (odds ratio 7.10 (95% CI 1.51 to 33.33); p = 0.013). Additionally, the probability distributions of different acetabular alignment and abduction angles were plotted and analyzed. No differences in functional status or patient-reported outcomes were found between groups.</p><p><strong>Conclusion: </strong>RAS in THA with CoC bearings reduces the incidence and severity of noise-related complications, and is likely due to more precise and appropriate component placement, which may improve outcomes.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 4","pages":"391-403"},"PeriodicalIF":4.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755413","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":"Mid-term outcomes of the fixed-bearing lateral Oxford unicompartmental knee arthroplasty.","authors":"Lachlan W Arthur, Cathy Jenkins, Christopher A F Dodd, Andrew J Price, William F M Jackson, Nicholas Bottomley, Abtin Alvand, David W Murray","doi":"10.1302/0301-620X.107B4.BJJ-2024-0977.R1","DOIUrl":"10.1302/0301-620X.107B4.BJJ-2024-0977.R1","url":null,"abstract":"<p><strong>Aims: </strong>Mixed clinical results have been reported following the use of lateral unicompartmental knee arthroplasty (UKA) in patients with isolated lateral compartment osteoarthritis (OA) of the knee. Although this procedure may be appropriate for use in about 10% of knees needing arthroplasty, it is only used in about 1%. The aim of this study was to determine the medium-term results for the Fixed Lateral Oxford (FLO) UKA.</p><p><strong>Methods: </strong>We report the clinical results and survival for 305 consecutive FLO UKAs implanted in 279 patients between July 2015 and August 2022. A total of 283 knees (93%) satisfied the recommended surgical indications. The mean age of the patients was 70.8 years (SD 11), their mean BMI was 28.4 kg/m² (SD 5.4), and 219 (72%) were female. Isolated lateral compartment OA was the indication for 298 operations (98%). The mean follow-up was 4.3 years (1 to 8). The Oxford Knee Score (OKS) was recorded pre- and postoperatively. The revision status of all knees was known.</p><p><strong>Results: </strong>There were four revisions (1%): two were conversions to a total knee arthroplasty (TKA) for instability and progressive OA and two had the addition of a medial UKA for medial compartment OA. Three other UKAs required a reoperation. At the last follow-up, the mean OKS was 40.9 (SD 7.8), a mean increase of 20 points from the preoperative score. The cumulative rate of survival with any reoperation, including revision, as the endpoint, at seven years, was 96% (95% CI 91 to 100), with revision as the endpoint was 98% (95% CI 94 to 100) and with revision to a TKA as the endpoint was 99% (95% CI 96 to 100). No revisions required revision TKA components. When those who underwent surgery for indications which were outside the recommended indications were excluded, there were only two revisions, both with the addition of a medial UKA for progressive OA, resulting in a seven-year cumulative survival with revision as the endpoint of 99% (95% CI 93 to 100).</p><p><strong>Conclusion: </strong>This study involved the largest published cohort of fixed-bearing lateral UKAs. The good clinical outcomes and medium-term survival of the FLO UKA, particularly in patients satisfying the recommended indications, suggest that it is an excellent alternative to TKA for the treatment of patients with isolated OA of the lateral compartment of the knee.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 4","pages":"432-439"},"PeriodicalIF":4.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755380","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":"Periprosthetic joint infection : development of a core outcome set.","authors":"Ian W Kennedy, Fares S Haddad, Matthew P Abdel, Donald S Garbuz, Vanya Gant, R M D Meek, Carsten Perka, Chloe E H Scott, Bryan D Springer, Sam Oussedik, Michael R Whitehouse","doi":"10.1302/0301-620X.107B4.BJJ-2024-1727","DOIUrl":"10.1302/0301-620X.107B4.BJJ-2024-1727","url":null,"abstract":"<p><strong>Aims: </strong>Periprosthetic joint infection (PJI) is a devastating complication of arthroplasty, with substantial morbidity, mortality, and healthcare costs. Despite advances in diagnosis and treatment, inconsistencies in outcome reporting have hindered evidence synthesis, limiting progress in understanding and management. This study aimed to develop a core outcome set (COS) for PJI to standardize outcome reporting in the literature.</p><p><strong>Methods: </strong>A two-stage modified Delphi process was conducted to establish consensus across a range of domains. Stage 1 involved the identification of core outcomes in PJI research by an international expert panel. A patient group was also consulted to ensure that the domains were relevant to patient priorities. Stage 2 included a broader group of 55 stakeholders in an online consensus process to finalize the COS. Quantitative and qualitative data were collated to redefine the outcomes throughout the Delphi process.</p><p><strong>Results: </strong>Following the modified two-stage Delphi process, a high level of consensus was achieved for all outcomes. The final COS included 23 outcomes across the following four domains: patient demographics and baseline characteristics; infection characteristics; surgical and treatment details; and outcomes and follow-up.</p><p><strong>Conclusion: </strong>The developed COS provides a standardized framework for reporting outcomes in PJI research. By addressing variability and inconsistency in the literature, this COS aims to enhance comparability across studies, support robust evidence synthesis, and ultimately guide clinical decision-making.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 4","pages":"455-460"},"PeriodicalIF":4.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755382","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":"Kinematic alignment achieves a tibial joint line angle that is more parallel to the floor in single-leg stance than mechanical alignment : a radiological analysis of a randomized controlled trial.","authors":"Benjamin J Leong, James Corbett, Darren B Chen, George Kirsh, Anthony K L Leong, Jil A Wood, Ashish D Diwan, Gregory C Wernecke, Ian A Harris, Samuel J MacDessi","doi":"10.1302/0301-620X.107B4.BJJ-2024-0204.R3","DOIUrl":"10.1302/0301-620X.107B4.BJJ-2024-0204.R3","url":null,"abstract":"<p><strong>Aims: </strong>Previous research on knee kinematics has demonstrated that achieving a tibial joint line angle (TJLA) parallel to the floor in the single-leg stance phase of gait may restore native knee kinematics and optimize compartmental compressive loads in total knee arthroplasty (TKA). However, it is currently unclear which surgical alignment strategy best achieves this. Therefore, this study sought to determine whether kinematically aligned (KA) or mechanically aligned (MA) TKAs produce a TJLA closer to parallel.</p><p><strong>Methods: </strong>A total of 95 patients were randomized to KA (n = 46) or MA (n = 49). Constitutional joint line obliquity (JLO) was measured from preoperative radiographs; TJLA was measured from postoperative radiographs. The primary outcome was the mean difference in TJLA between KA and MA in single-leg stance. Secondary outcomes included differences in TJLA between apex distal and neutral JLO knees, the proportion of patients with TJLA within approximately 2° of neutral, and changes in constitutional JLO between alignment groups.</p><p><strong>Results: </strong>In single-leg stance, the mean TJLA was closer to parallel with KA (-2.0° (SD 2.6°)) than MA (-4.5° (SD 1.9°); p < 0.001). Similar mean differences were observed in patients with apex distal JLO (KA -1.4° (SD 2.1°); MA -4.9° (SD 1.8°); p < 0.001) but not neutral JLO (KA -3.7° (SD 2.8°); MA -3.7° (SD 1.9°); p = 0.776). More patients had a TJLA within 2° of parallel with KA (n = 24; 52.2%) than MA (n = 4; 8.2%; p < 0.001), and KA resulted in significantly less change to constitutional JLO.</p><p><strong>Conclusion: </strong>A TJLA parallel to the floor in single-leg stance is achieved more readily with KA than MA, but is dependent on constitutional JLO. A parallel TJLA during this phase of gait is more likely achieved when alignment is individualized to the patient's native anatomy.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 4","pages":"413-422"},"PeriodicalIF":4.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755379","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}