Bone & Joint Journal最新文献

{"title":"The National Joint Registry Data Quality Audit of elbow arthroplasty.","authors":"Zaid Hamoodi, Joanne Shapiro, Adrian Sayers, Michael R Whitehouse, Adam C Watts, Jennifer Abbott, Sarah Abbott, Oliver Adebayo, Kashif Ahmad, Philip Ahrens, Michael Akinfala, Nawfal Al-Hadithy, Majed Al-Najjar, Rouin Amirfeyz, Sudhi Ankarath, Fiona Ashton, Kelly Aulton, Sunil Auplish, Jane Austin, Segun Ayeko, Raja Azhar, Rish Bahia, Steven Baines, Marisol Baldomir, Sneha Barai, Benjamin Barkham, Emily Barrett, Timothy Batten, Luckshman Bavan, Jonathan Baxter, Sera Beaumont, James Bentley, Gev Bhabra, Mahendar Bhat, Ankit Bhatt, Mahmoud Bhingraj, Aqeel Bhutta, Samuel Bingham, Jenny Blastland, David Boardman, Michael Boateng, Kasia Bojarska, Khalis Boksh, Simon Booker, Sebastian Borreshi, Michael Bould, Lesley Boulton, Linda Brannan, Zarina Breidaka, Rachel Brereton, Mark Brinsden, Joanne Brooker, Sabine Brookes, Cheryl Broux, Elke Brown, Jacqueline Browne, Richard Bryant, James Buchanan, Lisa Buck, Karen Burnett, Melanie Burrows, Jill Burt, David Burton, Usman Butt, Barry Campaner, Jaime Candal-Couto, Hannah Carvell, Jagannath Chakravarthy, Somashree Chatterji, Salma Chaudhury, Govind S Chauhan, Adrian Chojnowski, Janani Cittambalam, David Clark, Malgorzata Gosia Clarke, Ben Clarke, Andrew Clelland, Roz Cochrane, Karen Colbridge, Hayley Cook, Becky Cooper, Elizabeth Correa, Joanna Craven, Jason Crawford, Sherri Curtis, Rory Cuthbert, Jeremy Dainton, Lisa Dale, Sammy Davies, Joanne Davis, Vicky Davis, Ben Dean, Tom Dehler, Sonu Dennis, Jacob Der Tavitian, Aravind Desai, Sukhraj S Dhillon, Richard Dias, Graham Dickinson, Margo Dirckx, Oliver Dixon, Charles Docker, Ronald Dodenhoff, Peter Domos, Kingsleypaul Draviaraj, Steven Drew, Caroline Duff, Sarah Duffin, Paula Durham, Kirstie Earnshaw, Jefin Edakalathur, Michelle Edwards, Zain Elahi, Samantha Else, Moustafa Emara, Khemerin Eng, Alireza Esfandiari, Colin Esler, Jon Evans, Alicia Everall, Alistair Eyre-Brook, Muhamed Farhan-Alanie, Simon Federer, Sharon Ferdinandus, Marie Finch, Jochen Fischer, Catherine Flood, Christine Forde, Justin Forder, Lisa Fowler, Marieta Franklin, Hamez Gacaferi, David Gamble, Sunil Garg, Vicki Gill, Jean Ginley, Emma Glancey, Gemma Glanville, Aimen Gmati, Karen Goddard, Jay Goel, Carly Goldsmith, Ben Gooding, Fiona Goodwin, Benjamin Goring, Will Goude, Paul Guyver, Samuel Haines, Aziz Haque, Thomas Hardley, Susan Haritonow, Louise Harnett, Joanna Harris, Margaret Harris, Jane Harrison, Isabelle Hauffe, Archie Hawken, Dave Hawkes, Stuart Hay, Mia Haywood, Siddhant Hedge, Susan Hickey, Anne Hickinson, Deborah Higgs, Richard Hill, Sharyn Hill, Jamie Hind, Maria Hitchcock, Terry Holdcroft, Emily Holdcroft, Ann Holliday, Siobhan Hudson, Hazel Hughes, Rabia Imtiaz, Sheeraz Iqbal, Yamen Jabr, Crystal Jackson, Jackie Jameson, Odette Jayme, Andrew Jennings, Cara Jenvey, Elizabeth Jewitt, Andreea Jimenez, John Joby, Adrian Jones, Neil Jones, Jadranka Jovanovic, Vanessa Kabala, Niel Kang, Gulnaz Kausor, Sarah Kaynes, Conal Keane, Lauren Keen, Gaynor Kelly, Matthew Kent, Jonathan Kent, Carla Kerr, Julie Kerr, Christina King, Anthony Kinnair, Gemma Kinsley, Alastair Konarski, Jacqueline Kord, Hari Kumar, Sachin Kumar, Rebecca Lafferty, Patrick Lancaster, William Levitt, Alexandria Lewin, Yueyang Li, Ignatius Liew, Martin Yizhe Lim, Stephen Lipscombe, Edith Lynch, Scott MacInnes, Paula Madden, Nick Maddocks, Ravindra Mahajan, Rachel Mahoney, Sheraz Malik, Syed Mannan, Alexandros Maris, Michael Markey, Christy Martin, Rebecca Martin, Stanley Masunda, George Mazis, Anne-Marie Mcauliffe, Tim McBride, Amy McGowan, Nicolee Mckeown, George McLauchlan, Debbie McNally, Joel Melton, Jane Miller, Cathy Millyard, Claire Mitchell, Foad Mohamed, Abdalla Mohamed, Helen Charlotte Montgomery, Darren Munn, John Mutimer, Rajesh Nanda, Daniel Neen, Lynne Newton, Ashley Newton, Aly Nicholl, Jessica Nightingale, Emma Ogden, Peter Orton, Lynda Oswald, Kelly Page, Maria Paius, Madhavan Papanna, Neelam Patel, Claudia Paul, Chris Peach, Derek Pegg, Sue Penfold, Eleanore Phillips, Greg Pickering, Christos Plakogiannis, Julie Platt, Craig Pole, Richard Potter, Kate Povall, Riten Pradhan, Ganesh Prasad, Karen Price, Julie Pride, Afnan Prins, Layth Qazzaz, Ajay Radhakrishnan, Ashwanth Ramesh, Adil Rashid, Abbas Rashid, Damir Rasidovic, Emily Ratford, Jan Rayner, Jae Rhee, Matthew Rice-Evans, Martha Ricketts, Deborah Roach, Eve R Waters, Simon Robinson, Paul Robinson, Samantha Rodgers, Emma Rogers, Aaron Rooney, Dan Rossouw, Bibhas Roy, Maseh Sadiqi, Markus Sagmeister, David Samy, Paige Sanders, Kelly Sanderson, Dilraj Sandher, Nastaran Sargazi, Mark Saunders, Nicky Saunders, Kim Savage, Seif Sawalha, Melissa Schouw, Gareth Scott, Gunther Selzer, Lucia Sepesiova, Sohan Shah, Shantanu Shahane, Grant Shaw, Suzani Shrestha, John Shutt, Nashat Siddiqui, Sijin Sidharthan, Adrian Simons, Vera Simpson, Pierre Sinclair, Paul Siney, Jagwant Singh, Bijayendra Singh, Harvinder Singh, Apurv Sinha, Callum Smith, Christopher Smith, Kerry Smith, Brinda Somanchi, Muhab Soufan, Cynthia Southgate, Jeremy Southgate, Nicola Spearpoint, Rebecca Stainer, Richard Stevens, Batya Stimler, Andrew Stone, Danielle Suter, Charlie Talbot, Tareq Tareef, Kanthan Theivendran, Beverely Thomas, William Thomas, Andrew Thompson, Jackie Thompson, Elizabeth Thornhill, Andrew Titchener, Michael Townley, Tina Tozer, Jennie Truman, Adam Truss, Rob Turner, Lee Van Rensburg, Vinayak Venugopal, Sam Vollans, Louise Waller, Anna Walsh, Aleena Waraich, Nicholas Wei, William James White, Mark Wilkinson, Daniel Williams, Philip Williams, Nicola Williams, Stephanie Wilson, David Wood, Shirley Yadu, Tejas Yarashi, Julian Zeolla, Nasri H Zreik, Ben Ollivere","doi":"10.1302/0301-620X.106B12.BJJ-2023-1372.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.106B12.BJJ-2023-1372.R1","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this audit was to assess and improve the completeness and accuracy of the National Joint Registry (NJR) dataset for arthroplasty of the elbow.</p><p><strong>Methods: </strong>It was performed in two phases. In Phase 1, the completeness was assessed by comparing the NJR elbow dataset with the NHS England Hospital Episode Statistics (HES) data between April 2012 and April 2020. In order to assess the accuracy of the data, the components of each arthroplasty recorded in the NJR were compared to the type of arthroplasty which was recorded. In Phase 2, a national collaborative audit was undertaken to evaluate the reasons for unmatched data, add missing arthroplasties, and evaluate the reasons for the recording of inaccurate arthroplasties and correct them.</p><p><strong>Results: </strong>Phase 1 identified 5,539 arthroplasties in HES which did not match an arthroplasty on the NJR, and 448 inaccurate arthroplasties from 254 hospitals. Most mismatched procedures (3,960 procedures; 71%) were radial head arthroplasties (RHAs). In Phase 2, 142 NHS hospitals with 3,640 (66%) mismatched and 314 (69%) inaccurate arthroplasties volunteered to assess their records. A large proportion of the unmatched data (3,000 arthroplasties; 82%) were confirmed as being missing from the NJR. The overall rate of completeness of the NJR elbow dataset improved from 63% to 83% following phase 2, and the completeness of total elbow arthroplasty data improved to 93%. Missing RHAs had the biggest impact on the overall completeness, but through the audit the number of RHAs in the NJR nearly doubled and completeness increased from 35% to 70%. The accuracy of data was 94% and improved to 98% after correcting 212 of the 448 inaccurately recorded arthroplasties.</p><p><strong>Conclusion: </strong>The rate of completeness of the NJR total elbow arthroplasty dataset is currently 93% and the accuracy is 98%. This audit identified challenges of data capture with regard to RHAs. Collaboration with a trauma and orthopaedic trainees through the British Orthopaedic Trainee Association improved the completeness and accuracy of the NJR elbow dataset, which will improve the validity of the reports and of the associated research.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 12","pages":"1461-1468"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774018","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":"Cutibacterium acnes periprosthetic joint infections.","authors":"Christopher N Warne, Sean Ryan, Elizabeth Yu, Douglas R Osmon, Daniel J Berry, Matthew P Abdel","doi":"10.1302/0301-620X.106B12.BJJ-2024-0437.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.106B12.BJJ-2024-0437.R1","url":null,"abstract":"<p><strong>Aims: </strong><i>Cutibacterium acnes</i> (<i>C. acnes</i>; previously known as <i>Propionibacterium acnes</i> or <i>P. acnes</i>) periprosthetic hip and knee infections are under-reported. While culture contamination with <i>C. acnes</i> occurs, true infections are important to recognize and treat. We sought to describe the demographics and treatment outcomes of patients with <i>C. acnes</i> periprosthetic joint infections (PJIs) of the hip and knee.</p><p><strong>Methods: </strong>Patients with <i>C. acnes</i> PJI between January 2005 and December 2018 were retrospectively reviewed utilizing the institutional total joint registry. Patients with monomicrobial PJI and two or more positive cultures were considered to have true <i>C. acnes</i> PJI. Patients with polymicrobial infection or with only one positive culture were excluded. This resulted in 35 PJIs (21 hips and 14 knees); the patients' mean age was 63 years (35 to 84) and 15 (43%) were female. Mean follow-up was five years (1 to 14).</p><p><strong>Results: </strong>The median time to positive culture was five days (IQR 5 to 6) and median synovial fluid cell count was 22,583 cells (IQR 15,200 to 53,231). The median ESR was 25 mm/hr (IQR 7 to 37), and CRP was 15 mg/l (IQR 3 to 29). Of the 35 PJIs, 18 (51%) were treated with chronic antibiotic suppression without surgical intervention, and the remainder were treated with two-stage exchange arthroplasty. The two-year survival free of any revision was 94%. Four patients failed treatment due to symptomatic infection, with three treated with two-stage exchange and one treated with irrigation and debridement with modular component exchange for a survival rate of 89% and 83% at two and five years, respectively.</p><p><strong>Conclusion: </strong>Laboratory evidence of <i>C. acnes</i> PJI in this cohort was typical compared to more conventional organisms. Cultures grew more quickly than previously thought in patients with <i>C. acnes</i> PJI. Treatment with two-stage exchange or chronic antibiotic suppression alone both had few treatment failures at mid-term follow-up.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 12","pages":"1426-1430"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773991","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":"Acetabular rim syndrome revisited.","authors":"William Z Morris, Shamrez Haider, Sean T Hinds, David Podeszwa, Henry Ellis, Lauren Osborne, Nicholas Anable, Daniel Sucato","doi":"10.1302/0301-620X.106B12.BJJ-2024-0164.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.106B12.BJJ-2024-0164.R1","url":null,"abstract":"<p><strong>Aims: </strong>There has been limited literature regarding outcomes of acetabular rim syndrome (ARS) with persistent acetabular os in the setting of acetabular dysplasia. The purpose of this study was to characterize a cohort of adolescent and young adult patients with ARS with persistent os and compare their radiological and clinical outcomes to patients with acetabular dysplasia without an os.</p><p><strong>Methods: </strong>We reviewed a prospective database of patients undergoing periacetabular osteotomy (PAO) for symptomatic acetabular dysplasia between January 1999 and December 2021 to identify hips with preoperative os acetabuli, defined as a closed triradiate cartilage but persistence of a superolateral os acetabulum. A total of 14 hips in 12 patients with persistent os acetabuli (ARS cohort) were compared to 50 randomly selected 'control' hips without persistent os acetabuli. Preoperative and postoperative radiographs were measured for markers of dysplasia: lateral centre-edge angle, anterior centre-edge angle, acetabular inclination, and migration index. Union of the os was determined in patients with ≥ six months' follow-up. Patient-reported outcome measures (PROMs) included the University of California, Los Angeles (UCLA) activity score and modified Harris Hip Score (mHHS, maximum score 80) completed at one year postoperatively.</p><p><strong>Results: </strong>There was no significant difference between the ARS and control cohorts with regard to sex distribution (p = 0.270), age at surgery (p = 0.186), or BMI (p = 0.442). Preoperatively, the ARS cohort had more severe dysplasia, including lower lateral centre-edge angle (-9.3° (SD 12.5°) vs 7.6° (SD 10.7°); p < 0.001) and greater acetabular inclination (33.9° (SD 8.2°) vs 21.8° (SD 8.7°); p < 0.001). Postoperatively, 6/13 (46%) hips with ≥ six months of radiological follow up demonstrated union of the os. There was no difference between the ARS and control cohorts at one year in UCLA score (9.1 (SD 1.5) vs 8.2 (SD 1.9); p = 0.167) or mHHS (73.4 (SD 9.5) vs 69.9 (SD 8.8); p = 0.312).</p><p><strong>Conclusion: </strong>ARS with persistent acetabular os may occur in more severe dysplasia. Union occurs in 50% cases following corrective PAO.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 12","pages":"1393-1398"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773854","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":"Acute Lisfranc injury management.","authors":"Freideriki Poutoglidou, Bart van Groningen, Louise McMenemy, Robin Elliot, Daniel Marsland","doi":"10.1302/0301-620X.106B12.BJJ-2024-0581.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.106B12.BJJ-2024-0581.R1","url":null,"abstract":"<p><p>Lisfranc injuries were previously described as fracture-dislocations of the tarsometatarsal joints. With advancements in modern imaging, subtle Lisfranc injuries are now more frequently recognized, revealing that their true incidence is much higher than previously thought. Injury patterns can vary widely in severity and anatomy. Early diagnosis and treatment are essential to achieve good outcomes. The original classification systems were anatomy-based, and limited as tools for guiding treatment. The current review, using the best available evidence, instead introduces a stability-based classification system, with weightbearing radiographs and CT serving as key diagnostic tools. Stable injuries generally have good outcomes with nonoperative management, most reliably treated with immobilization and non-weightbearing for six weeks. Displaced or comminuted injuries require surgical intervention, with open reduction and internal fixation (ORIF) being the most common approach, with a consensus towards bridge plating. While ORIF generally achieves satisfactory results, its effectiveness can vary, particularly in high-energy injuries. Primary arthrodesis remains niche for the treatment of acute injuries, but may offer benefits such as lower rates of post-traumatic arthritis and hardware removal. Novel fixation techniques, including suture button fixation, aim to provide flexible stabilization, which theoretically could improve midfoot biomechanics and reduce complications. Early findings suggest promising functional outcomes, but further studies are required to validate this method compared with established techniques. Future research should focus on refining stability-based classification systems, validation of weightbearing CT, improving rehabilitation protocols, and optimizing surgical techniques for various injury patterns to ultimately enhance patient outcomes.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 12","pages":"1431-1442"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773867","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":"Failed radial head arthroplasty treated by removal of the implant.","authors":"Juan Ameztoy Gallego, Blanca Diez Sanchez, Afonso Vaquero-Picado, Samuel Antuña, Raul Barco","doi":"10.1302/0301-620X.106B11.BJJ-2024-0330.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.106B11.BJJ-2024-0330.R1","url":null,"abstract":"<p><strong>Aims: </strong>In patients with a failed radial head arthroplasty (RHA), simple removal of the implant is an option. However, there is little information in the literature about the outcome of this procedure. The aim of this study was to review the mid-term clinical and radiological results, and the rate of complications and removal of the implant, in patients whose initial RHA was undertaken acutely for trauma involving the elbow.</p><p><strong>Methods: </strong>A total of 11 patients in whom removal of a RHA without reimplantation was undertaken as a revision procedure were reviewed at a mean follow-up of 8.4 years (6 to 11). The range of motion (ROM) and stability of the elbow were recorded. Pain was assessed using a visual analogue scale (VAS). The functional outcome was assessed using the Mayo Elbow Performance Score (MEPS), the Oxford Elbow Score (OES), and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Radiological examination included the assessment of heterotopic ossification (HO), implant loosening, capitellar erosion, overlengthening, and osteoarthritis. Complications and the rate of further surgery were also recorded.</p><p><strong>Results: </strong>The indications for removal of the implant were stiffness in five patients, aseptic loosening in five, and pain attributed to the RHA in three. The mean time interval between RHA for trauma to removal was ten months (7 to 21). Preoperatively, three patients had overlengthening of the implant, three had capitellar erosion, six had HO, and four had radiological evidence of loosening. At the final follow-up, the mean the flexion-extension arc improved significantly by 38.2° (95% CI 20 to 59; p = 0.002) and the mean arc of prono-supination improved significantly by 20° (95% CI 0 to 72.5; p = 0.035). The mean pain VAS score improved significantly by 3.5 (95% CI 2 to 5.5; p = 0.004). The mean MEPS improved significantly by 27.5 (95% CI 17.5 to 42.5; p = 0.002). The mean OES improved significantly by 9 (95% CI 2.5 to 14; p = 0.012), and the mean DASH score improved significantly by 23.5 (95% CI 7.5 to 31.6; p = 0.012). Ten patients (91%) had HO and osteoarthritis. Two patients underwent further surgery due to stiffness and pain, respectively.</p><p><strong>Conclusion: </strong>Simple removal of the implant at revision surgery following a failed RHA introduced following trauma provides satisfactory mid-term results with an acceptable risk of complications. Osteoarthritis, instability, and radioulnar impingement were not problems in this series.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 11","pages":"1327-1332"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Core Outcome Domains for Elbow Replacement (CODER).","authors":"Adam C Watts, Catriona McDaid, Catherine Hewitt, Marcus Bateman, Jonathan P Evans, Deborah Higgs, Ben Hughes, Toni Luokkala, Chris Smith, Elaine Uppal","doi":"10.1302/0301-620X.106B11.BJJ-2024-0352.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.106B11.BJJ-2024-0352.R1","url":null,"abstract":"<p><strong>Aims: </strong>A review of the literature on elbow replacement found no consistency in the clinical outcome measures which are used to assess the effectiveness of interventions. The aim of this study was to define core outcome domains for elbow replacement.</p><p><strong>Methods: </strong>A real-time Delphi survey was conducted over four weeks using outcomes from a scoping review of 362 studies on elbow replacement published between January 1990 and February 2021. A total of 583 outcome descriptors were rationalized to 139 unique outcomes. The survey consisted of 139 outcomes divided into 18 domains. The readability and clarity of the survey was determined by an advisory group including a patient representative. Participants were able to view aggregated responses from other participants in real time and to revisit their responses as many times as they wished during the study period. Participants were able to propose additional items for inclusion. A Patient and Public Inclusion and Engagement (PPIE) panel considered the consensus findings.</p><p><strong>Results: </strong>A total of 45 respondents completed the survey. Nine core mandatory domains were identified: 'return to work or normal daily role'; delivery of care was measured in the domains 'patient satisfaction with the outcome of surgery' and 'would the patient have the same operation again'; 'pain'; 'revision'; 'elbow function'; 'independence in activities of daily living'; 'health-related quality of life'; and 'adverse events'. 'Elbow range of motion' was identified as important by consensus but was felt to be less relevant by the PPIE panel. The PPIE panel unanimously stated that pain should be used as the primary outcome domain.</p><p><strong>Conclusion: </strong>This study defined core domains for the clinical outcomes of elbow replacement obtained by consensus from patients, carers, and healthcare professionals. Pain may be used as the primary outcome in future studies, where appropriate. Further work is required to define the instruments that should be used.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 11","pages":"1306-1311"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed fixation of distal radial fractures beyond three weeks after initial failed closed reduction increases the odds of reoperation.","authors":"Lauren L Nowak, Joel Moktar, Patrick Henry, Taylor Dejong, Michael D McKee, Emil H Schemitsch","doi":"10.1302/0301-620X.106B11.BJJ-2023-1349.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.106B11.BJJ-2023-1349.R1","url":null,"abstract":"<p><strong>Aims: </strong>We aimed to compare reoperations following distal radial fractures (DRFs) managed with early fixation versus delayed fixation following initial closed reduction (CR).</p><p><strong>Methods: </strong>We used administrative databases in Ontario, Canada, to identify DRF patients aged 18 years or older from 2003 to 2016. We used procedural and fee codes within 30 days to determine which patients underwent early fixation (≤ seven days) or delayed fixation following CR. We grouped patients in the delayed group by their time to definitive fixation (eight to 14 days, 15 to 21 days, and 22 to 30 days). We used intervention and diagnostic codes to identify reoperations within two years. We used multivariable regression to compare the association between early versus delayed fixation and reoperation for all patients and stratified by age (18 to 60 years and > 60 years).</p><p><strong>Results: </strong>We identified 14,960 DRF patients, 8,339 (55.7%) of whom underwent early surgical fixation (mean 2.9 days (SD 1.8)). In contrast, 4,042 patients (27.0%) underwent delayed fixation between eight and 14 days (mean 10.2 days (SD 2.2)), 1,892 (12.7%) between 14 and 21 days (mean 17.5 days (SD 1.9)) and 687 (4.6%) > 21 days (mean 24.8 days (SD 2.4)) post-fracture. Patients who underwent delayed fixation > 21 days post-fracture had a higher odds of reoperation (odds ratio (OR) 1.33 (95% CI 1.11 to 1.79) vs early fixation). This worsened for patients aged > 60 years (OR 1.69 (95% CI 1.11 to 2.79)). We found no difference in the odds of reoperation for patients who underwent delayed fixation within eight to 14 or 15 to 21 days post-fracture (vs early fixation).</p><p><strong>Conclusion: </strong>These data suggest that DRF patients with fractures with unacceptable reduction following CR should be managed within three weeks to avoid detrimental outcomes. Prospective studies are required to confirm these findings.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 11","pages":"1257-1262"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"UK Foot and Ankle Thromboembolism (UK-FATE).","authors":"Jitendra Mangwani, Linzy Houchen-Wolloff, Karan Malhotra, Sarah Booth, Aiden Smith, Lucy Teece, Lyndon W Mason, Rabia Shaikh, Wilam Alfred, Imobhio Okhifun, Ece Cinar, Nelson Bua, Krishna Vemulapalli, Ashok Acharya, Richard Gadd, John Money-Taylor, Rohit Kantharaju, Abhijit Bhosale, Suchita Bahri, Rosie Broadbent, Isabella Drummond, Neil Jones, Savan Shah, Thuwarahan Ravindrarjah, Zaid Yasen, Kunjshri Singh, Ruqaiya Al-Habs, Lucky Jeyaseelan, Abdullah Habbiba, Thomas Walker, Maximilian Dewhurst, Nisha Glasgow, Dominic Eze, Gary Carter, Praveen Rajan, Vijay Patil, Omer Amer, Kalim Malik, Pranavan Pavanerathan, Arijit Mallick, Ilias Seferiadis, Verity Currall, Preetha Sadasivan, Sunil Kumar, Shahrukh R Sanjani, Maria Ciaccio, Brijesh Ayyaswamy, Pradeepsyam Prasad, Mr Anand, Dr Sunilraj, Suzanne Lane, Swetha Prathap, Raghubir Kankate, Ioannis Aktselis, Kinner Davda, Arvind Vijapur, Mohammed Tayyem, Jackie Chau, Muhammad S Azhar, Simon Sturdee, Halima Hussain, Sarah Sonde, Muhammad Q Luqman, Rahy Farooq, Gareth Wells, Aneil Shenolikar, Michiel Simons, Paul Hodgson, Rhys Thomas, Sam Stevens, Yahya Elhassan, Adebowale Adeniyi, Will Aspinall, Vinay Joseph, Miriam Day, Aureola Tong, Claire Joyner, Muhammed Alzaranky, Osman Elhassan, Kishor Chhantyal, Abhishek Arora, Zain Abiddin, Robert Kucharski, Irfan Ahmad, Junaid Zeb, Usman Ishaq, Jija Thomas, Kowshik Jain, Rupinderbir Deol, Rad Faroug, Karan Johal, Simon Mordecai, Miltiadis Argyropouos, Amit Chawla, Mohamed Ibrahim, Marta Pereira, Lynne Barr, Elda Julies, Francesca Hill, Smriti Kapoor, James Bailey, Ishani Mukhopadhyay, Sarina Rana, Hamza Tarig, Mahdi Qualaghassi, Sheena Seewoonarian, Barry Rose, Georgina Crate, Sarah Abbott, Christopher Fenner, Ryan Geleit, Sohail Yousaf, Nimra Akram, Zahra Al-Hubeshy, Bhavi Patel, Mohamed Hussein, Callum Clark, Jasdeep Giddie, Raman Dega, Kishore Dasari, Gurbinder Nandhara, Pritesh Kumar, Prateek Gupta, Hope Poole, Pamela Zace, Farhan Alvi, Jagan Jacob, Raji Reddy, Vaishnav Sateesh, Andrea Gledhill, James Craven, Matt Cichero, Ben Yates, Ayla Newton, John Grice, Nicholas Fawcett, Hossam Fraig, Farouk Hamad, Daniel Marsland, Robin Elliot, Yaser Ghani, Suresh Chandrashekhar, Ravi K Millan, Andrew Clark, Kashed Rahman, Mark Sykes, Zoe Little, Jawaad Saleem, Lewis Jolly, Aman Jain, Ansar Qadri, Sophy Rymaruk, Avadhut Kulkarni, Mohanrao Garabadi, Meraj Akhtar, Munier Hossain, Shamael Yunus, Maleeha Saleem, Joanna Fong, Amirul Islam, Ben Nusir, James Chapman, David Holmes, Neville Mamoowala, Kieran Almond, Claire Wright, Ethan Caruana, Thomas Watson, Georgia Allison, Anand Pillai, Imad Madhi, Mazin Alsalihy, Khadija Elamin, Chee Rong Yip, Lucy Tew, Rohan Dahiya, Thomas Goff, Oliver Bagshaw, Henry Slade, Paul Andrzejowski, Ayoub Gomati, Chris Drake, Jamie Hind, Rebecca Morgan, Ahmed Khalaf, Adeel Ditta, Arul Ramasamy, Joshua McIntyre, Calum Blacklock, Scott Middleton, Robert Clayton, Alex Hrycaiczuk, Christopher Thornhill, Gowsikan Jeyakumar, Delani Vaithilingam, Kate Potter, Bilal Jamal/Pete Chan, Muyed Mohamed, Debbie Fraser, Ahmed Elhalawany, James Beastall, Gerard Cousins, Perrico Nunag, David Loveday, Akshdeep Bawa, Rebecca Gilmore, Kerstin Schankat, Andrew Walls, Nicole Corin, Peter Robinson, Steve Hepple, William Harries, Andrew Riddick, Ian Winson, Luke Marsh, Muhammad A Bashir, Jigyasa Saini, Henry Atkinson, Rajiv Limaye, Sarah Johnson-Lynn, Mohit Sethi, George Flanagan, Akram Uddin, Ian Reilly, Rebecca Martin, Andrea Pujol-Nichol, Natalie Carroll, Alexander Boucher, Mustafa Alward, Yuland Myint, Katherine Butler, Adrian Kendal, Mark Bugeja, Justin Mooteeram, Farid Saedi, Togay Koc, Zeid Morcos, Gregory Robertson, Natal Holmes, Howard Tribe, Tim Pearkes, Ahmed Soliman, Anil Prasanna, Kar Teoh, Sanil Kamat, Abhijit Bajracharya, James Reeves, Mbori Ngwayi, Galal Imtiaz, Noah Blackmore, Benjamin Lau, Arjun Naik, Eleanor Tung, Siddhartha Murhekar, Robbie Ray, Shirley Lyle, Nilesh Makwana, Kahlan A Kaisi, Musab Al-Musabi, Mike Dean, Adrian Hughes, Kimberley Shuttlewood, Matthew Welck, Shelain Patel, Adam Sykes, Mahesh M Thibbaiah, Hosain Hadi, Anil Haldar, Amir G Ardakani, Priyanka Jani, Vladislav Kutuzov, James Gibbons, Daniel Trussler, Eve Hawley, Sabeen Akhtar, Harshadkumar D Rajgor, Basil Budair, Hari Prem, James Mckenzie, Daniel Thurston, Michael O'Sullivan, Mohammed Elmajee, Erika Pond, Wajiha Zahra, Catriona Heaver, Kueni Igbagiri, Andrew Gaukroger, Matthew Solan, Christian Peacock, Ka S Fan, Tristan Barton, Derek Robinson, Selina Graham, Julian Zeolla, Samuel Everett, Mohammad Iqbal, Lysander Gourbault, Shashwat Singh, Cary Tang, Mariam Tarhini, Shahrukh Khan, Satishkumar Balasubramanian, Caroline Lever, Vaibhav Bansod, Kartik Iyengar, Abdul Wadood, Lara McMillan, Eugene Toh, Stanley Masunda, Simon Federer, Faheem Ahmad, Ahmed Lashin, Ahmed Kaddah, Emmanuel Oladeji, Ed Dawe, Ciaran Nolan, Khalil El-Bayouk, Vivek Dhukaram, Anna Chapman, Laura Beddard, Alex Thomas, Vipul Garg, Heath Taylor, Nikki Kelsall, Charline Roslee, Nimra Akram, Hamish Lowdon, Ahmed Kamel-Sherif, Anette Jones, Alistair Best, Mate Zabaglo, Junaid Sayani, Olive Kyaw, Chan Khin, Ramla Ali, Yousufuddin Shaik, Natasha Hossain, Lucia Valente, Adam Ajis, Abhijit Guha, Melwyn Pereira, Atif Ayoub, Vlad Paraoan, Nayeem Hali, Charles Baird, Raj Kugan, Ahmad Abdallatif, Mark Blomfield, Gillian Jackson, James Craven, Anubhav Malhotra, Aileen Toner, Luke Render, Connor Ashley, Richard Limb, Robert Smith, Luke Hughes, Hannah Matthews, Fleur Shiers-Gelalis, Jason Ting, Stuart Place, Adam Budgen, James Stanley, Charlie Jowett","doi":"10.1302/0301-620X.106B11.BJJ-2024-0128.R1","DOIUrl":"10.1302/0301-620X.106B11.BJJ-2024-0128.R1","url":null,"abstract":"<p><strong>Aims: </strong>Venous thromboembolism (VTE) is a potential complication of foot and ankle surgery. There is a lack of agreement on contributing risk factors and chemical prophylaxis requirements. The primary outcome of this study was to analyze the 90-day incidence of symptomatic VTE and VTE-related mortality in patients undergoing foot and ankle surgery and Achilles tendon (TA) rupture. Secondary aims were to assess the variation in the provision of chemical prophylaxis and risk factors for VTE.</p><p><strong>Methods: </strong>This was a multicentre, prospective national collaborative audit with data collection over nine months for all patients undergoing foot and ankle surgery in an operating theatre or TA rupture treatment, within participating UK hospitals. The association between VTE and thromboprophylaxis was assessed with a univariable logistic regression model. A multivariable logistic regression model was used to identify key predictors for the risk of VTE.</p><p><strong>Results: </strong>A total of 13,569 patients were included from 68 sites. Overall, 11,363 patients were available for analysis: 44.79% were elective (n = 5,090), 42.16% were trauma excluding TA ruptures (n = 4,791), 3.50% were acute diabetic procedures (n = 398), 2.44% were TA ruptures undergoing surgery (n = 277), and 7.10% were TA ruptures treated nonoperatively (n = 807). In total, 11 chemical anticoagulants were recorded, with the most common agent being low-molecular-weight heparin (n = 6,303; 56.79%). A total of 32.71% received no chemical prophylaxis. There were 99 cases of VTE (incidence 0.87% (95% CI 0.71 to 1.06)). VTE-related mortality was 0.03% (95% CI 0.005 to 0.080). Univariable analysis showed that increased age and American Society of Anesthesiologists (ASA) grade had higher odds of VTE, as did having previous cancer, stroke, or history of VTE. On multivariable analysis, the strongest predictors for VTE were the type of foot and ankle procedure and ASA grade.</p><p><strong>Conclusion: </strong>The 90-day incidence of symptomatic VTE and mortality related to VTE is low in foot and ankle surgery and TA management. There was notable variability in the chemical prophylaxis used. The significant risk factors associated with 90-day symptomatic VTE were TA rupture and high ASA grade.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 11","pages":"1249-1256"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiolucent lines and revision risk in total knee arthroplasty using the conventional versus the Attune S+ tibial baseplate.","authors":"Maria A Smolle, Maximilian Keintzel, Kevin Staats, Christoph Böhler, Reinhard Windhager, Amir Koutp, Andreas Leithner, Stefanie Donner, Tobias Reiner, Tobias Renkawitz, Manuel-Paul Sava, Michael T Hirschmann, Patrick Sadoghi","doi":"10.1302/0301-620X.106B11.BJJ-2024-0084.R3","DOIUrl":"10.1302/0301-620X.106B11.BJJ-2024-0084.R3","url":null,"abstract":"<p><strong>Aims: </strong>This multicentre retrospective observational study's aims were to investigate whether there are differences in the occurrence of radiolucent lines (RLLs) following total knee arthroplasty (TKA) between the conventional Attune baseplate and its successor, the novel Attune S+, independent from other potentially influencing factors; and whether tibial baseplate design and presence of RLLs are associated with differing risk of revision.</p><p><strong>Methods: </strong>A total of 780 patients (39% male; median age 70.7 years (IQR 62.0 to 77.2)) underwent cemented TKA using the Attune Knee System) at five centres, and with the latest radiograph available for the evaluation of RLL at between six and 36 months from surgery. Univariate and multivariate logistic regression models were performed to assess associations between patient and implant-associated factors on the presence of tibial and femoral RLLs. Differences in revision risk depending on RLLs and tibial baseplate design were investigated with the log-rank test.</p><p><strong>Results: </strong>The conventional and novel Attune baseplates were used in 349 (45%) and 431 (55%) patients, respectively. At a median follow-up of 14 months (IQR 11 to 25), RLLs were present in 29% (n = 228/777) and 15% (n = 116/776) of the tibial and femoral components, respectively, and were more common in the conventional compared to the novel baseplate. The novel baseplate was independently associated with a lower incidence of tibial and femoral RLLs (both regardless of age, sex, BMI, and time to radiograph). One- and three-year revision risk was 1% (95% CI 0.4% to 1.9%)and 6% (95% CI 2.6% to 13.2%), respectively. There was no difference between baseplate design and the presence of RLLs on the the risk of revision at short-term follow-up.</p><p><strong>Conclusion: </strong>The overall incidence of RLLs, as well as the incidence of tibial and femoral RLLs, was lower with the novel compared to the conventional tibial Attune baseplate design, but higher than in the predecessor design and other commonly used TKA systems.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 11","pages":"1240-1248"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Old problems, new problems, and some solutions.","authors":"Fares S Haddad","doi":"10.1302/0301-620X.106B11.BJJ-2024-1050","DOIUrl":"https://doi.org/10.1302/0301-620X.106B11.BJJ-2024-1050","url":null,"abstract":"","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 11","pages":"1197-1198"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}