Bone & Joint Journal最新文献

{"title":"Medium-term recovery of patients with complex lower limb fractures : follow-up study of fracture types in the Wound Healing in Surgery for Trauma (WHIST) trial.","authors":"En Lin Goh, M Sofia Massa, Juul Achten, Matthew L Costa","doi":"10.1302/0301-620X.108B5.BJJ-2025-0948.R1","DOIUrl":"10.1302/0301-620X.108B5.BJJ-2025-0948.R1","url":null,"abstract":"<p><strong>Aims: </strong>Complex fractures of the lower limb are serious injuries, but little is known about longer-term recovery. The aim of this study was to report disability, pain, and health-related quality of life (HRQoL) of patients with different fracture types up to five years after operative treatment for complex lower limb fractures.</p><p><strong>Methods: </strong>This study involved secondary analysis of fracture types in the follow-up study of the Wound Healing in Surgery for Trauma (WHIST) trial population. Adults aged ≥ 16 years with complex fractures of the lower limb who received operative treatment at 24 hospitals in the UK were followed up for five years after surgery. The primary outcome was the Disability Rating Index (DRI). Secondary outcomes were HRQoL (EuroQol five-dimension five-level (EQ-5D-5L) questionnaire), and the incidence of neuropathic pain using the Doleur Neuropathique Questionnaire (DN4).</p><p><strong>Results: </strong>The study cohort comprised 868 patients who completed at least one set of outcome data of the long-term follow-up study and had fracture type data available. The fracture distribution of the study cohort was acetabulum n = 67 (7.8%), hip n = 249 (28.7%), femur diaphysis n = 119 (13.7%), distal femur n = 72 (8.3%), tibia diaphysis n = 82 (9.4%), proximal tibia n = 193 (22.2%), distal tibia n = 40 (4.6%), and tibia plafond n = 46 (5.3%). There were marked improvements in DRI and EQ-5D-5L across all fractures at one year, but little improvement thereafter. Almost all patients who reported neuropathic pain at one year continued to experience persistent pain at five years.</p><p><strong>Conclusion: </strong>In this secondary analysis of the five-year follow-up study, we observed a similar pattern of recovery across all lower limb fractures. The high levels of disability and lower QoL experienced by patients in the year after their injury are persistent, and patients are unlikely to return to their preinjury health state in the medium term.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"681-687"},"PeriodicalIF":4.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822604","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":"Risk factors for idiopathic cubital tunnel syndrome : development and surgical intervention from a nationwide population-based cohort study.","authors":"Jung Il Lee, Jong Woong Park, Chan Mi Park, Seokjin Kong, Duk Hee Lee","doi":"10.1302/0301-620X.108B5.BJJ-2025-0884.R2","DOIUrl":"10.1302/0301-620X.108B5.BJJ-2025-0884.R2","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this nationwide population-based cohort study was to identify the risk factors associated with the development of idiopathic cubital tunnel syndrome (CuTS), and the factors which influence the requirement for surgery in these patients.</p><p><strong>Methods: </strong>We analyzed data from 43,189 patients newly diagnosed with idiopathic CuTS between January 2009 and December 2021, using the Korean National Health Insurance Service database. They were identified using diagnostic codes, procedural codes for surgery, and/or electrodiagnostic study codes. Patients with cervical radiculopathy, brachial plexopathy, polyneuropathy, previous CuTS and recent fracture, dislocation, or arthroplasty of the elbow were excluded. Age- and sex-matched controls were selected at a 1:5 ratio. Logistic regression identified risk factors for the development of CuTS, and Cox proportional hazards regression determined factors associated with surgical treatment. A false discovery rate-adjusted p-value < 0.05 was considered significant.</p><p><strong>Results: </strong>Risk factors for the development of CuTS included carpal tunnel syndrome (CTS), arthritis of the elbow, rheumatoid arthritis (RA), gout, depression, dyslipidaemia, hypertension, obesity, metabolic syndrome, diabetes, current smoking, anaemia, and hazardous alcohol drinking, in decreasing order of odds ratios. A total of 7,810 patients (18%) underwent surgery. Factors associated with surgery included CTS, arthritis of the elbow, RA, hypertension, obesity, metabolic syndrome, diabetes, current smoking, and hazardous alcohol drinking, in decreasing order of hazard ratios. Regular exercise significantly reduced the risk of both the development of CuTS and the requirement for surgery.</p><p><strong>Conclusion: </strong>In this large cohort study, we identified risk factors for the development of idiopathic CuTS and its surgical treatment, many of which parallel those for CTS. These findings may guide clinicians in risk stratification, prevention, and management of patients with idiopathic CuTS, and provide insights into the shared aetiology.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"657-662"},"PeriodicalIF":4.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between tibial slope and posterior tibial tilting, not wear, in uncemented total knee arthroplasty : a secondary analysis of a five-year radiostereometry study.","authors":"Ruud de Ridder, Bart L Kaptein, Bart G Pijls, Rob G H H Nelissen, Herman H Kaptijn","doi":"10.1302/0301-620X.108B5.BJJ-2025-1092.R1","DOIUrl":"10.1302/0301-620X.108B5.BJJ-2025-1092.R1","url":null,"abstract":"<p><strong>Aims: </strong>The primary objective of this study was to evaluate the influence of postoperative slope on the five-year tibial component migration and wear following uncemented cruciate-retaining condylar-stabilized total knee arthroplasty (TKA). Secondary objectives included the association between postoperative slope and clinical and functional outcomes.</p><p><strong>Methods: </strong>This observational study was a secondary analysis of a randomized controlled trial of 93 TKAs on insert materials. Tibial component migration and insert wear were measured across three postoperative slope groups (small (≤ 5°), intermediate (6° to 9°), and large (≥ 10°)) using radiostereometric analysis at three, six, 12, 24, and 60 months postoperatively. Patient-reported outcome measures were collected preoperatively and at all follow-up timepoints.</p><p><strong>Results: </strong>There was an association between tibial component migration and postoperative tibial slope: the group with the largest postoperative tibial slope showed the largest posterior tilting. At five years, there was no difference in insert wear between the small, intermediate, and large slope groups. There was also no association between postoperative slope and functional or patient-reported outcomes.</p><p><strong>Conclusion: </strong>TKA implanted with more than 10° of slope showed increased tibial component migration and posterior tilting, independent of the native slope. At five years, there was no influence of slope on wear or functional outcomes.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"634-642"},"PeriodicalIF":4.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822609","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":"Wrong-level spinal surgery : a multicentre analysis of 34,544 consecutive cases.","authors":"Masayuki Furuya, Takahito Fujimori, Shota Takenaka, Yukitaka Nagamoto, Tomiya Matsumoto, Yoshifumi Takahashi, Motoki Iwasaki, Seiji Okada","doi":"10.1302/0301-620X.108B5.BJJ-2025-1129.R2","DOIUrl":"10.1302/0301-620X.108B5.BJJ-2025-1129.R2","url":null,"abstract":"<p><strong>Aims: </strong>Wrong-level spinal surgery (WLSS) is a rare but serious event. Previous studies have been constrained by small sample sizes and voluntary survey methodologies, resulting in variable incidence rates and insufficient data. This study aimed, first, to determine accurately the incidence of WLSS in different regions of the spine; second, to identify high-risk situations and causative mechanisms; and third, to analyze event characteristics in detail, including the timing of recognition, corrective management, and patient-surgeon conflicts.</p><p><strong>Methods: </strong>This study was a retrospective analysis of a prospectively collected multicentre registry, involving 34,544 consecutive patients who had undergone spinal surgery for degenerative disorders at 27 affiliated hospitals between January 2012 and December 2022. WLSS data were collected, and lumbar WLSS cases were investigated for method of level identification, causative mechanisms, timing of error recognition, corrective actions, and patient-surgeon conflicts.</p><p><strong>Results: </strong>A total of 40 cases of WLSS were identified, giving an overall incidence of 0.12% (95% CI 0.09 to 0.16). Regional incidence varied significantly: thoracic 0.42% (95% CI 0.16 to 1.08), lumbar 0.13% (95% CI 0.09 to 0.18), and cervical 0.05% (95% CI 0.02 to 0.12; p = 0.004). Of the lumbar procedures, extracanal disc herniation had a significantly higher risk than intracanal herniation (3.41% (95% CI 1.17 to 9.558) vs 0.16% (95% CI 0.07 to 0.35); p < 0.001). Causative mechanisms were categorized as intraoperative disorientation (81.3%) or image misinterpretation (18.8%). Intraoperative disorientation occurred exclusively at levels involving L4/5 or L5/S1. Errors were recognized before patient extubation in 84.4% of cases: all underwent corrective surgery before the reversal of anaesthesia. However, patient-surgeon conflicts still arose in 18.8% of lumbar cases, including 18.5% of those who had undergone reoperation under the same anaesthetic.</p><p><strong>Conclusion: </strong>The incidence of WLSS varies significantly by spinal region, with thoracic surgery and extracanal disc herniation being at highest risk. Intraoperative disorientation, particularly at the lower lumbar levels, was the primary reason. Patient-surgeon conflicts can occur even when errors are recognized and corrected immediately.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"673-680"},"PeriodicalIF":4.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822518","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":"Isolated hamstring tendon autograft should be avoided in high-risk patients undergoing anterior cruciate ligament reconstruction : a New Zealand ACL Registry study.","authors":"Richard Rahardja, Hamish Love, Mark G Clatworthy, Simon W Young","doi":"10.1302/0301-620X.108B5.BJJ-2025-0181.R4","DOIUrl":"10.1302/0301-620X.108B5.BJJ-2025-0181.R4","url":null,"abstract":"<p><strong>Aims: </strong>Younger patients are at the highest risk of repeat injury after anterior cruciate ligament (ACL) reconstruction. The hamstring tendon autograft remains the most popular choice of graft in the world, but its use in these high-risk patients is controversial. The aim of this study was to compare revision rates between the bone-patellar tendon-bone (BTB) and hamstring tendon autografts in a high-risk patient population.</p><p><strong>Methods: </strong>Prospective data recorded in the New Zealand ACL Registry were analyzed. Primary ACL reconstructions performed between April 2014 and March 2022 were included, allowing for a minimum follow-up of two years. High-risk patients were analyzed using the following criteria: age between 14 and 25 years, ACL rupture during sporting activity, time from injury to surgery within 12 months, grade 2 pivot shift, and a minimum preinjury Marx activity score of 8. The rate of revision was compared between the BTB and hamstring tendon autografts using a univariate chi-squared test and multivariable Cox regression survival analysis to calculate hazard ratios (HRs) with 95% CIs.</p><p><strong>Results: </strong>A total of 3,482 high-risk primary ACL reconstructions were analyzed. A lateral extra-articular procedure was performed in 175 cases with no revisions performed during the study period. The rate of revision was 11.4% (238/2,091) with the hamstring tendon autograft versus 4.3% (60/1,391) with the BTB autograft (p < 0.001). The hamstring tendon autograft had a 2.5-times higher risk of revision compared with the BTB autograft (adjusted HR 2.5 (95% CI 1.9 to 3.3); p < 0.001). The number needed to treat with a BTB autograft to prevent one revision was 14 patients.</p><p><strong>Conclusion: </strong>Isolated hamstring tendon autograft has a high rate of revision and should be avoided in high-risk patients undergoing ACL reconstruction.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"616-621"},"PeriodicalIF":4.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822578","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":"Superior compared with anteroinferior plating for mid-shaft fractures of the clavicle : a meta-analysis.","authors":"Marc Boutros, Guy Awad, Akin Adio, Jad Lawand, Peter Boufadel, Adam Z Khan, Brian W Hill, John G Horneff, Joseph A Abboud","doi":"10.1302/0301-620X.108B5.BJJ-2025-1271.R1","DOIUrl":"10.1302/0301-620X.108B5.BJJ-2025-1271.R1","url":null,"abstract":"<p><strong>Aims: </strong>Superior plating has long been the routine surgical approach for mid-shaft fractures of the clavicle. However, concerns about the prominence of the plate and neurological risk have led to an increased interest in anteroinferior plating. Whether anteroinferior plating offers comparable or improved outcomes without compromising the stability of fixation has been investigated in several studies. The aim of this meta-analysis was to evaluate the clinical outcomes, complications, and complication-related outcomes following superior compared with anteroinferior plating of mid-shaft fractures of the clavicle.</p><p><strong>Methods: </strong>A comprehensive search was conducted in PubMed, Scopus, Cochrane Library, and Google Scholar until 22 August 2025. Randomized controlled trials and observational studies comparing superior and anteroinferior plating techniques for mid-shaft clavicular fractures in adults were included. A total of 13 studies met the inclusion criteria, including 1,433 adult patients with these fractures. The outcomes which were assessed included the Constant-Murley score (shoulder function), Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, neurological injury, implant removal, postoperative pain (visual analogue scale), time to union, the rates of nonunion and infection, and operating time.</p><p><strong>Results: </strong>Anteroinferior plating yielded significantly higher Constant-Murley scores compared with superior plating (mean difference -1.91 (95% CI -3.25 to -0.57); p = 0.005). Anteroinferior plating was also associated with a significantly lower risk of minor neurological injury compared with superior plating, with a risk ratio of 3.69 (95% CI 1.03 to 13.25; p = 0.050). There were no significant differences in the mean DASH score (p = 0.110), implant removal (p = 0.350), postoperative pain (p = 0.620), nonunion rate (p = 0.250), infection rate (p = 0.600), time to union (p = 0.520), or operating time (p = 0.580) between the groups.</p><p><strong>Conclusion: </strong>Anteroinferior plating provides significantly better shoulder function with a significantly reduced risk of minor neurological injury compared with traditional superior plating. These findings support the growing adoption of anteroinferior plating as a safe and effective alternative for the surgical treatment of mid-shaft fractures of the clavicle.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"578-587"},"PeriodicalIF":4.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The prognostic accuracy of three classification systems used for periprosthetic joint infection : a comparative study of the McPherson, PJI-TNM, and JS-BACH classifications.","authors":"João de Sousa Seixas, Laís Simonato Altoé, Ana Cláudia Santos, Ana Ribau, Daniel Esteves Soares, Andre Dias Carvalho, Miguel Abreu, Ricardo Sousa","doi":"10.1302/0301-620X.108B5.BJJ-2025-1141.R1","DOIUrl":"10.1302/0301-620X.108B5.BJJ-2025-1141.R1","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to evaluate and compare the prognostic value of three classification systems for periprosthetic joint infection (PJI) - McPherson, PJI-TNM, and JS-BACH - by analyzing their association with three key clinical outcomes: recurrence of infection after the initial treatment, final PJI status, and PJI-related mortality.</p><p><strong>Methods: </strong>This was a retrospective cohort study using a prospectively maintained institutional database. All patients who underwent surgery for PJI of the hip or knee between January 2011 and December 2022 were included, provided that they had a minimum of two years of follow-up, unless they had earlier recurrence of infection or had died. Each case was classified according to the three systems and grouped into three levels of severity (A: less severe; B: intermediate; C: most severe) to allow direct comparison. Associations between the variables of the classification systems and outcomes were examined using chi-squared and Fisher's exact tests. Discriminative ability was assessed using receiver operating characteristic (ROC) curve analysis and the area under the curve was calculated for each outcome.</p><p><strong>Results: </strong>Of the 186 patients who were included, recurrence after initial treatment occurred in 50 (26.9%) and PJI-related mortality in 19 patients (10.2%). Among the sub-categories of the classifications, host-related variables consistently correlated with most outcomes across all systems. Local extremity grade/soft-tissues also correlated with recurrence after initial treatment throughout. The JS-BACH classification was significantly associated with all three outcomes: recurrence (p = 0.002), final PJI status (p = 0.008), and mortality (p < 0.001). It also showed the best discriminative ability on ROC analysis. PJI-TNM was significantly associated with the final status (p = 0.004) and mortality (p = 0.002), but not with recurrence of infection. The McPherson classification was only significantly associated with the final PJI status (p = 0.039). Patients classified as 'limited options' in JS-BACH had a 28.6% mortality rate, while none in the 'uncomplicated' group died or required suppressive antibiotic treatment.</p><p><strong>Conclusion: </strong>The JS-BACH classification system showed the best prognostic performance, correlating with all the outcomes which were evaluated and offering a balanced combination of simplicity, clinical use, and predictive value. The host status remained a critical predictor regardless of which classification system was used.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"643-649"},"PeriodicalIF":4.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822590","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":"Recovery trajectory and patient-specific predictors following periacetabular osteotomy : a 24-month prospective study.","authors":"Vincent Justus Leopold, Stéphane Poitras, John C Clohisy, Ira Zaltz, Ernest L Sink, Sasha Carsen, Etienne Belzile, Paul E Beaulé","doi":"10.1302/0301-620X.108B5.BJJ-2025-1450.R1","DOIUrl":"10.1302/0301-620X.108B5.BJJ-2025-1450.R1","url":null,"abstract":"<p><strong>Aims: </strong>Periacetabular osteotomy (PAO) is the gold-standard treatment for symptomatic hip dysplasia. While long-term joint preservation and functional improvement are documented, early postoperative recovery trajectories and predictors of meaningful improvement remain unclear.</p><p><strong>Methods: </strong>This prospective multicentre cohort study is a secondary analysis of a randomized trial including 218 patients (mean age 27.1 years (SD 7.7); 83.2% female (181/218)) undergoing PAO with or without hip arthroscopy. We aimed to 1) determine the timing and proportion of patients achieving minimal clinically important difference (MCID, + 26), substantial clinical benefit (SCB, + 42), and patient-acceptable symptom state (PASS, ≥ 65) on the 33-item International Hip Outcome Tool (iHOT-33) within 24 months; and 2) identify predictors of threshold achievement. Correction was assessed by lateral centre-edge angle (LCEA) and acetabular index. Logistic regression evaluated patient- and surgery-specific factors.</p><p><strong>Results: </strong>Radiological parameters improved significantly (mean LCEA 18.7° (SD 8.4°) to 32.2° (SD 5.7°); acetabular index 12.8° (SD 7.6°) to 1.6 (SD 6.3°), both p < 0.001). iHOT-33 improved from 34.2 (SD 16.4) preoperatively to 61.4 (SD 24.0) at six months, 72.8 (SD 22.0) at 12 months, and 78.0 (SD 21.0) at 24 months (p < 0.001). At six, 12, and 24 months, MCID was achieved by 70.2%, 71.5%, and 80.3% of patients; SCB by 52.8%, 64.6%, and 74.6%; and PASS by 56.3%, 73.5%, and 79.6%. Most recovery occurred within the first year, with continued gains thereafter. Multivariable analysis identified higher BMI as negative predictor for MCID, SCB, and PASS at 12 months (OR 0.88 to 0.89; p = 0.015 to 0.019). Residual undercorrection, reflected by higher postoperative acetabular index, reduced odds of MCID at 12 months (OR ~ 0.80 (95% CI 0.67 to 0.95); p = 0.011). Older age lowered the likelihood of PASS (OR 0.94 (95% CI 0.89 to 0.999); p = 0.047). Labral repair was negatively associated with PASS at six months (OR 0.27 (95% CI 0.09 to 0.89); p = 0.031), but not thereafter.</p><p><strong>Conclusion: </strong>Most patients achieve clinically meaningful improvement within the first postoperative year, with further recovery into the second. Elevated BMI, older age, and residual undercorrection reduce the likelihood of reaching thresholds, while concomitant labral repair may temporarily delay early symptom acceptability.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"607-615"},"PeriodicalIF":4.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822545","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":"Total hip arthroplasty compared with conservative treatment with a self-directed exercise programme in moderate-to-severe hip osteoarthritis: a randomized controlled trial.","authors":"Aapo Talonpoika, Lauri Karttunen, Antti Jaroma, Toni Rikkonen, Joonas Sirola, Jussi Mäki, Jukka Huopio, Sarang Qazi, Tuomas Selander, Jari Arokoski, Heikki Kröger","doi":"10.1302/0301-620X.108B5.BJJ-2025-0858.R2","DOIUrl":"10.1302/0301-620X.108B5.BJJ-2025-0858.R2","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to compare clinical, performance-based, and patient-reported outcomes between patients with moderate-to-severe hip osteoarthritis (OA) who were treated with total hip arthroplasty (THA) or conservative treatment with a self-directed exercise programme.</p><p><strong>Methods: </strong>We conducted a single-centre, randomized controlled trial including 120 participants with radiologically confirmed moderate-to-severe hip OA (Kellgren-Lawrence grades 2 to 4). Participants were randomly allocated (1:1) to receive either THA combined with postoperative rehabilitation or a self-directed exercise programme. The primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Harris Hip Score (HHS) at 12 months. Minimal clinically important differences (MCIDs) were predefined as 11 points for WOMAC and 15.9 points for HHS. Secondary outcomes included WOMAC at six months, as well as WOMAC subscales, health-related quality of life (HRQoL) RAND 36-Item Health Survey 1.0 (RAND-36) domains, and physical performance tests (chair stand, 40 m walk, and stair climb).</p><p><strong>Results: </strong>At 12 months, the THA group demonstrated significantly greater improvements than the conservative group in WOMAC total score (-30.9 (95% CI -34.9 to -27.0) vs -3.7 (95% CI -8.2 to 0.9; between-group difference -27.1 points (95% CI -32.4 to -21.8)) and HHS (29.8 (95% CI 25.8 to 33.9) vs 5.7 (95% CI 2.4 to 9.0); difference 24.1 (95% CI 19.6 to 28.7)), both exceeding MCID thresholds. Overall, 23 participants (38%) in the conservative group underwent THA during the study; two participants in the THA group declined surgery. The THA group also showed superior gains across all performance-based tests and most RAND-36 domains.</p><p><strong>Conclusion: </strong>In patients with moderate-to-severe hip OA, THA combined with postoperative rehabilitation provides clinically meaningful improvements in pain, function, and HRQoL compared with a self-directed exercise programme alone. These findings reinforce THA as the preferred option for eligible patients.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"588-596"},"PeriodicalIF":4.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822582","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 components and additive manufacturing: does it all add up? : a literature review of the current themes around the use of additive manufacturing in orthopaedic acetabular implants.","authors":"Jack Hurst, Richard O C Oreffo, Douglas G Dunlop","doi":"10.1302/0301-620X.108B5.BJJ-2025-0710.R2","DOIUrl":"10.1302/0301-620X.108B5.BJJ-2025-0710.R2","url":null,"abstract":"<p><p>Advances in 3D printing, known as additive manufacturing (AM), have allowed for the production of highly porous trabecular metals (TMs) that aim to 'mimic' human bone and facilitate bony ingrowth. AM is increasingly being used to produce acetabular implants which incorporate TMs to varying degrees, to try and create a well-fixed acetabular component and, as a result, reduce the rate of aseptic loosening. This review details the history of uncemented acetabular implants and the developmental milestones towards these novel 3D-printed components, highlighting key steps in the complex design rationale of these intricate designs and why they are thought to be beneficial. To date, there has been no clear consensus on the optimum structural design or even manufacturing technique for acetabular implants, despite the plethora of AM implants already widely available on the market. Further evaluation of the manufacturing literature, as summarized, displays a paucity of preclinical studies or appropriate biological models that account for the dynamic stresses seen across a newly implanted acetabular component and the implications for a clinical setting. This review evaluates the differences seen across previous studies and implants which are currently commercially available. We highlight the need for further comparisons and evaluation of this rapidly evolving area of orthopaedics, together with suggestions to advance the field.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"570-577"},"PeriodicalIF":4.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822435","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}