The Bone & Joint Journal最新文献

{"title":"Evaluation of the clicky hip as a screening tool in the diagnosis of developmental dysplasia of the hip","authors":"Arwel T. Poacher,Muslim Bilal,Amy Smith,Lily Scourfield,Ella Hawes,Max Ross,Tariq Yasin,Eleanor C. Carpenter","doi":"10.1302/0301-620x.108b10.bjj-2025-1367.r1","DOIUrl":"https://doi.org/10.1302/0301-620x.108b10.bjj-2025-1367.r1","url":null,"abstract":"Aims The early diagnosis of developmental dysplasia of the hip (DDH) is important because treatment in early infancy is usually nonoperative. A consensus statement from the British Society for Children’s Orthopaedic Surgery identified ongoing uncertainty regarding the predictive value of a documented clicky hip. The aim of this study was to evaluate the association between a clicky hip at the newborn or six- to eight-week examination and pathological DDH requiring treatment in a selective screening programme in the UK. Methods This was a retrospective analysis of prospectively collected registry data for all live births in the catchment area of a single tertiary centre between January 2016 and December 2023. Infants underwent examination at birth and again at six to eight weeks, with ultrasound screening offered for those with primary risk factors or abnormal findings on examination, including a clicky hip. The primary outcome was pathological DDH requiring treatment. Multivariable logistic regression was used to estimate the adjusted odds ratios (ORs) for DDH. Positive predictive value (PPV), risk difference (RD), and the number needed to screen (NNS) were calculated as programme-level measures. Results Of 42,338 infants who were analyzed, 7,564 (17.9%) underwent ultrasound screening. Pathological DDH requiring treatment was identified in 245 (5.8 per 1,000 live births). A clicky hip was recorded in 1,125 infants, of whom 40 (3.56%) had DDH requiring treatment. Clicky hip was independently associated with DDH (adjusted OR 4.68 (95% CI 3.11 to 7.03); p < 0.001). Within the selective screening pathway, the RD was 3.86% (95% CI 2.65 to 5.07), the PPV was 3.56% and the NNS was 26. Conclusion In this large UK cohort within a selective screening programme, a clicky hip was independently associated with DDH requiring treatment. Although limited by differential ascertainment inherent to selective screening, these findings support the prospective evaluation of an isolated documented clicky hip as an indication for referral in selective screening pathways for DDH. Cite this article: Bone Joint J  2026;108-B(10):1273–1277.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"74 1","pages":"1273-1277"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of changing Coronal Plane Alignment of the Knee classification on early functional outcomes after primary robotic-assisted total knee arthroplasty","authors":"Faseeh Zaidi,Craig M. Goplen,Massoud Akbarshahi,Samuel J. MacDessi,Josh Petterwood,Peter McEwen,Jacob T. Munro,A. Paul Monk","doi":"10.1302/0301-620x.108b10.bjj-2025-1378.r2","DOIUrl":"https://doi.org/10.1302/0301-620x.108b10.bjj-2025-1378.r2","url":null,"abstract":"Aims We aimed to determine the impact of changing a patient’s Coronal Plane Alignment of the Knee (CPAK) phenotype on early functional outcomes after robotic-assisted total knee arthroplasty (RA-TKA). Methods We conducted a retrospective multicentre cohort study of 297 patients undergoing primary RA-TKA. Standardized pre- and postoperative long-leg radiographs were obtained. Radiological measures included the lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA). Pre- and postoperative CPAK classification was derived by determining the arithmetic hip-knee-ankle (HKA) angle and joint line obliquity (JLO). Oxford Knee Scores (OKSs) were assessed at preoperative baseline and at three months, six months, and one year postoperatively. We also investigated the isolated impact of changes in LDFA and MPTA on OKS. Results Preoperatively, the most common classification was CPAK type II (30.0%; n = 89), followed by type I (27.6%; n = 82). Postoperatively, the majority of patients were CPAK type V (30.0%; n = 89), followed by type IV and type II. Overall, 30.6% (n = 91) of patients remained in the same preoperative CPAK classification, while 62.3% (n = 185) shifted by one CPAK classification and 6.4% (n = 19) moved two phenotypes following RA-TKA. Patients who moved across two CPAK phenotypes after RA-TKA demonstrated significantly smaller improvements in OKS at three months (p = 0.008) and six months (p = 0.036) compared with those who remained in the same CPAK phenotype. Patients with LDFA changes in excess of 4° from the native value demonstrated the smallest improvement in mean three-month (7.14 (SD 9.9)) and six-month (10.95 (SD 7.0)) OKS compared with all other groups. Conclusion In this exploratory analysis, altering coronal alignment across two CPAK classifications after RA-TKA was associated with lower early functional outcomes as measured by OKS at three months and six months, though this finding was based on a small subgroup (n = 19) and warrants further investigation in larger cohorts. Furthermore, femoral coronal deviation in excess of 4° from native alignment appears to have a greater negative impact on functional outcomes than equivalent tibial changes. Cite this article: Bone Joint J  2026;108-B(10):1238–1246.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"36 1","pages":"1238-1246"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From bowing to fracture","authors":"Shuhong Zhang,Tao Wang,Lingrong Zeng,Baohui Xiao,HaiBo Mei,Xinzhan Mao,Qian Tan,Ge Yang","doi":"10.1302/0301-620x.108b10.bjj-2025-1847.r1","DOIUrl":"https://doi.org/10.1302/0301-620x.108b10.bjj-2025-1847.r1","url":null,"abstract":"Aims Congenital anterolateral bowing of the tibia represents the prefracture stage of congenital pseudarthrosis of the tibia. However, specific radiological factors which are predictive of fracture remain poorly defined. The aim of this study, therefore, was to investigate whether the presence of radiolucent lines could serve as a predictive factor for the development of a fracture in patients with Crawford types I to III congenital pseudarthrosis of the tibia. Methods We retrospectively reviewed 251 children with congenital pseudarthrosis of the tibia who were treated between 2015 and 2020. Demographic, clinical, and radiological data were collected, and the presence and extent of radiolucent lines were systematically assessed. Inter- and intraobserver agreement were evaluated using κ coefficients. Group comparisons used the independent-samples t -test, chi-squared test, or Fisher’s exact test, as appropriate. Independent predictive factors of fracture were identified with multivariable logistic regression. Fracture-free survival was evaluated using Kaplan-Meier analysis. Results A total of 142 children with Crawford types I to III congenital pseudarthrosis of the tibia met the inclusion criteria. The assessment of radiolucent lines showed high inter- and intraobserver agreement. Radiolucent lines were strongly associated with the occurrence of a fracture. The risk of fracture differed significantly across Crawford sub-types (p = 0.002) and the extent of radiolucent lines (quantified by the r-value) (p = 0.037). Crawford types II and III were associated with a significantly higher risk of fracture than type I (both adjusted p < 0.05). Similarly, patients with r ≥ 2/3 had a higher risk of fracture than those with r < 1/3 (adjusted p < 0.05). Multivariable logistic regression identified radiolucent lines and Crawford type as independent risk factors for fracture. A significantly reduced fracture-free survival in patients with radiolucent lines, both in the overall cohort and within the individual Crawford types I to III (p < 0.0001 for types I to III, type I, and type II; p = 0.0002 for type III), was shown in the Kaplan-Meier analysis. Conclusion Radiolucent lines may represent a new radiological predictive factor of fracture in patients with Crawford types I to III congenital pseudarthrosis of the tibia. Their prognostic value for predicting the time to fracture appears to vary across Crawford types. Combining the assessment of radiolucent lines with the Crawford classification could improve the stratification of the risk of fracture, providing a more precise framework for surveillance and timely intervention in these patients. Cite this article: Bone Joint J  2026;108-B(10):1278–1286.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"13 1","pages":"1278-1286"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Higher femoral periprosthetic fracture rate with dual-mobility compared with single-mobility total hip arthroplasty","authors":"Mehdi Komat,Liam Sabot,Filip Simion,Dylan Lechien,Harkirat Bhogal,Eyal Gan El,Soufiane Diaby,Jacques Hernigou","doi":"10.1302/0301-620x.108b10.bjj-2025-1810.r2","DOIUrl":"https://doi.org/10.1302/0301-620x.108b10.bjj-2025-1810.r2","url":null,"abstract":"Aims Dual-mobility implants have reduced dislocation rates in total hip arthroplasty (THA), particularly in high-risk populations. However, under conditions of high stress, such as a fall or forced range of motion, the energy that would otherwise cause dislocation is instead transmitted distally along the femoral component and into the surrounding bone. Therefore, concerns remain regarding their potential impact on the risk of periprosthetic fracture (PPF). Methods In a single-centre study, we retrospectively analyzed 1,415 patients who underwent uncemented THA with either a dual-mobility (DM-THA; 425 hips) or ceramic-on-ceramic (CoC-THA; 990 hips) bearing between January 2017 and December 2024. Propensity score matching (PSM) was performed for age, sex, BMI, and surgical indication, yielding a matched cohort of 260 DM-THA and 520 CoC-THA patients. Incidences of PPF, dislocation, and mortality were compared. Results PPF occurred significantly more frequently in the DM-THA group than in the CoC-THA group (4.0% (17/425) vs 0.8% (8/990); odds ratio (OR) 4.8 (95% CI 1.86 to 12.4); p = 0.001), a finding confirmed after PSM (OR 3.5 (95% CI 1.3 to 8.6); p = 0.007). Femoral neck fracture (FNF) as the surgical indication was independently associated with an increased risk of PPF in both the overall and matched cohorts. In contrast, DM-THA was associated with a significantly lower dislocation rate compared with CoC-THA after PSM (0.4% (1/260) vs 4.0% (21/520); OR 0.09 (95% CI 0.02 to 0.49); p = 0.005). FNF was also associated with a higher risk of dislocation. No significant interaction was observed between bearing type and surgical indication for either PPF or dislocation. Conclusion While DM-THA effectively reduces dislocation risk, it may be associated with a higher incidence of PPF compared with standard constructs in patients undergoing THA for FNF. These findings underscore the need to carefully weigh the risks and benefits of dual-mobility bearings. Cite this article: Bone Joint J  2026;108-B(10):1231–1237.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"5 1","pages":"1231-1237"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New guidelines for the prevention of periprosthetic joint infection","authors":"Augusto Ferrini,Mincong He,Rocco Papalia,Wei He,Thorsten Gehrke,Javad Parvizi","doi":"10.1302/0301-620x.108b10.bjj-2025-1731.r1","DOIUrl":"https://doi.org/10.1302/0301-620x.108b10.bjj-2025-1731.r1","url":null,"abstract":"Periprosthetic joint infection (PJI) remains one of the most serious complications of arthroplasty. Since the publication of major guidelines, several aspects of the prevention of PJI have been refined, although high-quality evidence remains limited in many areas. The aim of this annotation was to provide an updated overview of current preventive strategies, and to summarize the latest recommendations in perioperative practice. Cite this article: Bone Joint J  2026;108-B(10):1208–1215.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"53 1","pages":"1208-1215"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative clinical and imaging factors associated with arthroscopically confirmed occult syndesmotic instability in patients undergoing surgery for osteochondral lesions of the talus","authors":"Shenghong Jia,Ke Fu,Zi Li,Cheng Hao,Zhenhua Fang","doi":"10.1302/0301-620x.108b10.bjj-2026-0040.r1","DOIUrl":"https://doi.org/10.1302/0301-620x.108b10.bjj-2026-0040.r1","url":null,"abstract":"Aims Osteochondral lesions of the talus (OLTs) are common ankle disorders. Recent clinical observations suggest that a subset of patients with OLTs also exhibit occult syndesmotic instability (OSI) intraoperatively, implying a potential association between the two conditions. This study aimed to investigate the potential clinical association between OLTs and OSI, and to identify preoperative factors associated with OSI in patients with OLTs. Methods A retrospective review was performed on patients diagnosed with OLTs who underwent ankle arthroscopy between January 2021 and June 2023. Based on arthroscopic probe assessment of distal tibiofibular stability, patients were divided into an OLT with OSI group and an OLT without OSI group. Demographic characteristics, arthroscopic findings, imaging results, physical examination outcomes, and preoperative American Orthopaedic Foot and Ankle Society ankle-hindfoot and visual analogue scale scores were compared between groups. Univariate and multivariate logistic regression analyses were performed to identify independent predictors, and receiver operating characteristic analysis determined diagnostic cut-off values. Results Among 175 patients with OLTs, 36 (20.6%) demonstrated OSI. Univariate analysis showed that BMI, symptom duration, height of syndesmotic fluid, lesion size, presence of osteophytes, and Bassett’s ligament hypertrophy were significantly associated with OSI. Multivariate analysis identified higher BMI (odds ratio (OR) 1.811 (95% CI 1.418 to 2.312); p < 0.001), presence of osteophytes (OR 0.260 (95% CI 0.087 to 0.775); p = 0.016), and Bassett’s ligament hypertrophy (OR 0.108 (95% CI 0.030 to 0.387); p = 0.001) as independent associated factors for OSI. Conclusion In patients with OLTs, BMI above 25.6 kg/m 2 , presence of osteophytes, and Bassett’s ligament hypertrophy were associated with intraoperative OSI, although these exploratory findings warrant further prospective investigation and external validation. Cite this article: Bone Joint J  2026;108-B(10):1265–1272.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"218 1","pages":"1265-1272"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indications for revision following Birmingham Hip Resurfacing","authors":"Ahmed A. H. H. Nasser,Inderpal Samra,Ronan B. C. Treacy,Shakir Hussain","doi":"10.1302/0301-620x.108b10.bjj-2026-0344.r1","DOIUrl":"https://doi.org/10.1302/0301-620x.108b10.bjj-2026-0344.r1","url":null,"abstract":"Aims The literature reports excellent medium- to long-term results of Birmingham Hip Resurfacing (BHR). However, revision risks after hip resurfacing vary across implant types, particularly as a result of variations in adverse reactions to metal debris (ARMD). We aimed to characterize the indications for BHR revision and to identify factors associated with specific failure modes. Methods We identified all patients who underwent a BHR at our institution between July 1997 and July 2022. Patients were categorized by sex, age, and BHR head size. Indications for revision were grouped into consensus clinical categories, and Kaplan-Meier survival analysis was performed. Results Out of a total of 4,513 BHR cases over 25 years, 392 (8.7%) were revised. Overall implant survival in males was 95.3%. A total of 4.7% (n = 148) of males were revised compared with 17.8% (n = 244) of females (p < 0.001). The most common indication for revision was aseptic loosening (n = 98; 2.2%). A total of 92 patients (2.0%) underwent a revision for adverse reaction to metal debris (ARMD). Female sex was significantly associated with revision for ARMD (p < 0.001). Revision for periprosthetic fractures occurred early while revision for ARMD occurred late (median 0.6 years (IQR 0.1 to 5.6) vs 10.5 (IQR 8.1 to 14.0), respectively; p < 0.001). Revision rates in femoral heads < 50 mm were significantly higher compared with ≥ 50 mm (17.4% (n = 247) vs. 4.7% (n = 145), respectively; p < 0.001). Revision for ARMD in males with heads ≥ 50 mm was 0.4% (n = 13) over 25 years. Conclusion This 25-year BHR institutional analysis represents the largest series reported to date and demonstrates that the indication for revision is associated with patient and implant factors. Revision rates for males are low and compare favourably to the best results of total hip arthroplasties. These results legitimize the continued use of metal-on-metal resurfacing in selected groups and form a basis for evaluation of all new resurfacing designs using different material combinations. Cite this article: Bone Joint J  2026;108-B(10):1224–1230.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"58 1","pages":"1224-1230"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diaphyseal zonal fixation in revision total knee arthroplasty","authors":"Peter K. Sculco,Mohammed El-Hassan,Ittai Shichman,Eugenia Lee,Rhidian Morgan-Jones,Fares S. Haddad","doi":"10.1302/0301-620x.108b10.bjj-2026-0245.r1","DOIUrl":"https://doi.org/10.1302/0301-620x.108b10.bjj-2026-0245.r1","url":null,"abstract":"The concept of zonal fixation for the distal femur and proximal tibia has revolutionized our understanding of how to best achieve durable fixation in revision total knee arthroplasty. However, the diaphyseal zone covers most of the femur, and achieving durable diaphyseal fixation is essential for optimizing outcomes for patients undergoing multiple revisions and distal femoral replacements (DFRs), since this may be the only anatomical area available for fixation. Therefore, we detail a standardized methodology that divides the diaphysis into three diaphyseal zones: the distal diaphysis, the isthmus, and the proximal diaphysis. This new classification, which expands on the principles of zonal fixation, and further defines the regions of the diaphysis, could offer a more comprehensive approach to preoperatively plan and analyze diaphyseal fixation, and evaluate how it relates to complex revision and DFR implant survivorship. Cite this article: Bone Joint J  2026;108-B(10):1202–1207.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"34 1","pages":"1202-1207"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In vivo 3D hip kinematics during racket swinging after total hip arthroplasty","authors":"Yuki Nakao,Satoshi Hamai,Koji Murakami,Satoru Harada,Shinya Kawahara,Satoru Ikebe,Hidehiko Higaki†,Yasuharu Nakashima","doi":"10.1302/0301-620x.108b10.bjj-2026-0030.r1","DOIUrl":"https://doi.org/10.1302/0301-620x.108b10.bjj-2026-0030.r1","url":null,"abstract":"Aims Interest in sports participation after total hip arthroplasty (THA) has grown, and some patients return to playing racket sports after THA. However, dynamic hip kinematics and the risk of liner-to-neck contact during racket swinging remain unclear. This study aimed to evaluate in vivo, 3D dynamic hip kinematics during racket swinging after THA, and to identify factors associated with reduced liner-to-neck clearance, which may indicate an increased risk of liner-to-neck contact. Methods A total of 19 patients (24 hips) who were playing racket sports after primary THA were evaluated. Dynamic radiological images of forehand and backhand swings were acquired using a flat panel detector. Hip joint kinematics were analyzed using a model-image registration technique. Liner-to-neck contact and clearance were assessed using postoperative CT data and kinematic analysis. Multivariable regression analyses identified factors associated with reduced posterior clearance. Results The mean total axial hip rotation during racket swinging was 32°, with the hip maintained in slight flexion and abduction throughout the motion. Liner-to-neck contact occurred in two of 24 hips (8%), all at the elevated rim during maximum external rotation (ER). No bone-to-bone contact was observed. Posterior clearance below 10°, indicating an increased risk of posterior contact, was observed in nine hips (20%) during both extension and external rotation. Multivariable regression analysis identified elevated liner use, greater acetabular component anteversion, and greater hip extension angle at maximum ER as significant factors associated with reduced posterior clearance. Conclusion In vivo racket swinging after THA was performed within a kinematically safe range of motion without excessive axial rotation. Although liner-to-neck contact was infrequent, elevated liners and excessive acetabular component anteversion were associated with reduced posterior clearance during maximum external rotation. While racket swinging appears generally permissible after THA, careful liner selection and implant orientation are important to minimize the risk of liner-to-neck contact. Cite this article: Bone Joint J  2026;108-B(10):1216–1223.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"1 1","pages":"1216-1223"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of the European Bone & Joint Infection Society recommendations for debridement, antibiotics, and implant retention in hip and knee periprosthetic joint infection","authors":"Andrew J. Hotchen,James Richards,Ruben P. Thumbadoo,Shawn Jia Hwang Tan,Paul Foster,Sefa W. Canbilen,Bhavi Patel,Antony Palmer,Athanasios Pollalis,Irene K. Sigmund,Martin McNally","doi":"10.1302/0301-620x.108b10.bjj-2026-0028.r1","DOIUrl":"https://doi.org/10.1302/0301-620x.108b10.bjj-2026-0028.r1","url":null,"abstract":"Aims The aim of this study was to externally validate the European Bone & Joint Infection Society (EBJIS) recommendations for the use of debridement, antibiotics, and implant retention (DAIR) in the treatment of periprosthetic joint infection (PJI), examining the independent associations of the selection of patients and the operative technique with failure after DAIR. Methods This was a multicentre retrospective cohort study involving seven UK hospitals and including adults with hip or knee PJI treated with DAIR. Patients were classified by EBJIS recommendations (DAIR-indicated, risk factors, or not recommended) and operative technique (exchange of components vs no exchange). The primary endpoint was the failure of treatment as defined by the need for further surgery for infection, long-term suppressive antibiotics, or death within 90 days, amputation, or arthrodesis. Sensitivity analyses were stratified by joint and repeated, excluding long-term suppressive antibiotics from the composite endpoint. Results A total of 411 patients (165 hips; 246 knees) were analyzed: 82 (20.0%) DAIR-indicated, 103 (25.1%) with risk factors, and 226 (55.0%) not recommended. Modular components were exchanged in 213 (51.8%). Over a median 2.1 years of follow-up (IQR 0.58 to 5.5), failure occurred in 193 patients (47.0%). Compared with the DAIR-indicated group, the DAIR not recommended group had a significantly higher risk of failure (hazard ratio (HR) 1.64 (95% CI 1.14 to 2.35); p = 0.007), whereas the risk factor group had a similar risk (HR 1.14 (95% CI 0.60 to 2.15); p = 0.689). DAIR without exchange of components was strongly significantly associated with failure of treatment (HR 2.40 (95% CI 1.89 to 3.06); p < 0.001). Joint-stratified and sensitivity analyses showed a similar direction of effect. Treatment was successful in 78.8% (26/33) in the most favourable scenario (DAIR-indicated with exchange of components) compared with 28.0% (26/93) in the least favourable scenario (DAIR not recommended without exchange of components). Conclusion In this external validation, both EBJIS patient selection and operative technique were associated with the outcomes after DAIR, with lack of exchange of components showing the strongest association with failure of treatment. The EBJIS framework is pragmatic and generalizable across specialist and non-specialist centres, and can support shared decision-making and the standardization of surgery in these patients. Cite this article: Bone Joint J  2026;108-B(10):1255–1264.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"57 1","pages":"1255-1264"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}