The Bone & Joint Journal最新文献

{"title":"Ten-year insert wear and the migration of uncemented tibial and femoral components with either conventional polyethylene or sequentially annealed highly crosslinked polyethylene: a blinded randomized controlled trial using radiostereometric analysis","authors":"Ruud de Ridder,Bart L. Kaptein,Bart G. Pijls,Rob G. H. H. Nelissen,Jantsje H. Pasma,Rianne Oomen,Herman H. Kaptijn","doi":"10.1302/0301-620x.108b10.bjj-2026-0426.r1","DOIUrl":"https://doi.org/10.1302/0301-620x.108b10.bjj-2026-0426.r1","url":null,"abstract":"Aims The aims of this randomized controlled trial (RCT) was to compare the long-term insert wear and migration of the tibial and femoral components between highly crosslinked polyethylene (HXLPE) inserts and conventional polyethylene (PE) inserts in an uncemented Triathlon fixed insert cruciate-retaining total knee arthroplasty (TKA). Methods A double-blinded RCT was conducted including 96 TKAs. The wear of the insert, and migration of both the tibial and femoral components, was measured with model-based radiostereometric analysis up to ten years postoperatively. Patient-reported outcome measures (PROMs) were collected preoperatively and at follow-up. Results There was no progression of (medial) wear (from 0.15 mm at five years to 0.13 mm at ten years) for the HXLPE group after five years, whereas the wear rate increased for the PE group (from 0.22 mm at five years to 0.46 mm at ten years). There was no clinically relevant difference in terms of migration of the tibial and femoral component or PROMs between the HXLPE and PE groups at ten years. Migration of the tibial component (maximal total point motion; MTPM) after the ten-year follow-up for the HXLPE group was 0.99 mm (95% CI 0.83 to 1.18), and for the PE group, was 1.05 mm (95% CI 0.87 to 1.24). Migration of the femoral component (MTPM) after the ten-year follow-up for the HXLPE group was 1.16 mm (95% CI 0.99 to 1.35), and for the PE group, MTPM was 1.04 mm (95% CI 0.87 to 1.22). Conclusion There was no discernible increased wear for the HXLPE group after five years, whereas the wear for the PE group continued. After the initial migration, the uncemented TKA components remain stable at the ten-year follow-up. The use of HXLPE inserts are safe, when used in uncemented TKA, when considering wear and component migration. Cite this article: Bone Joint J  2026;108-B(10):1247–1254.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"8 1","pages":"1247-1254"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149092040","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":"Robotic-assisted surgery and functional alignment in total knee arthroplasty: the RASKAL registry-nested 2 × 2 factorial randomized trial.","authors":"Samuel J MacDessi,Gregory C Wernecke,Khashayar Ghadirinejad,Jil A Wood,Carl Holder,Michelle Lorimer,Ian A Harris, ,Durga Bastiras,Richard Boyle,Darren B Chen,Peiyao Du,Brett Fritsch,Maurice Guzman,George Kirsh,John Limbers,Peter McEwen,Stephen McMahon,Jonathan Mulford,Helena Oakey,David Penn,Julian Yu","doi":"10.1302/0301-620x.108b.bjj-2025-1472.r2","DOIUrl":"https://doi.org/10.1302/0301-620x.108b.bjj-2025-1472.r2","url":null,"abstract":"AimsRobotic-assisted surgery and functional alignment are increasingly being adopted in total knee arthroplasty (TKA). This study assessed the individual and combined effectiveness of robotic-assisted surgery and functional alignment in improving outcomes in TKA, compared with computer-assisted surgery and mechanical alignment, respectively.MethodsA registry-nested, multicentre, blinded, 2 × 2 factorial, randomized trial was performed with 303 TKA patients randomized to robotic-assisted or computer-assisted surgery, and functional or mechanical alignment. The primary outcome was the between-group differences in postoperative change over two years in the mean Knee Injury and Osteoarthritis Outcome Score (KOOS-12). Secondary outcomes included knee-specific and general patient-reported outcome measures (PROMs), operative and functional outcomes, and adverse events. Primary modified intention-to-treat and secondary per-protocol analyses were performed.ResultsThere were no differences comparing robotic-assisted with computer-assisted surgery in KOOS-12 at three months, six months, one year, and two years (mean two-year difference -2.8; 95% CI -6.4 to 0.9; p = 0.137), and no differences comparing functional with mechanical alignment at three months, six months, one year, and two years (mean two-year difference 0.3 (95% CI -3.4 to 4.0); p = 0.867). No differences were found in Oxford Knee Score, Forgotten Joint Score, EuroQol five-dimension five-level visual analogue scale, patient satisfaction, joint-related improvement, and pain comparing technology or alignment groups at three months, six months, one year, and two years. Robotic-assisted surgery had a shorter mean operating time by 11.5 minutes (95% CI 7.3 to 15.9; p < 0.001) and better mean posterior cruciate ligament macroscopic soft-tissue injury score (mean difference 0.7 (95% CI 0.3 to 1.1); p = 0.001) compared with computer-assisted surgery. Mechanical alignment had a higher soft-tissue release rate compared with functional alignment (44.8% vs 8.1%; OR 9.2 (95% CI 4.6 to 18.3); p < 0.001). In most cases, surgeons preferred the use of robotics and functional alignment.ConclusionRobotic-assisted surgery and functional alignment were not superior to computer-assisted surgery and mechanical alignment, respectively, in improving clinical and functional outcomes up to two years post-TKA.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"3 1","pages":"xxx"},"PeriodicalIF":0.0,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147625948","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":"Outcomes of total knee arthroplasty, with revision surgery as an endpoint, following previous periarticular osteotomy or unicompartmental knee arthroplasty : a New Zealand Joint Registry study.","authors":"Jessica Leary,Douglas Stewart Hancock,Ritwik Kejriwal,Christopher Frampton","doi":"10.1302/0301-620x.108b4.bjj-2025-0569.r1","DOIUrl":"https://doi.org/10.1302/0301-620x.108b4.bjj-2025-0569.r1","url":null,"abstract":"AimsThis study evaluates the risk of revision of total knee arthroplasty (TKA) in patients with a history of previous periarticular osteotomy compared with those with a history of unicompartmental knee arthroplasty (UKA). Understanding the differences in TKA outcome following these procedures is important for informed decision-making and patient counselling when considering osteotomy or UKA in the management of single-compartment osteoarthritis in young, high-demand patients.MethodsWe conducted a retrospective analysis using data from the New Zealand Joint Registry, identifying 1,895 TKAs performed after prior osteotomy and 1,391 after previous UKA. We compared TKA revision rates and patient-reported outcome using the Oxford Knee Score (OKS), between the two groups at six months. Adjusted hazard ratios (HRs) were calculated to account for differences in demographic details.ResultsThe revision rate for TKA following osteotomy was significantly lower than TKA following UKA with rates of 0.88 per 100 component years (95% CI 0.74 to 1.03) versus 1.38 per 100 component years (95% CI 1.15 to 1.19), respectively. Adjusted HR calculations indicated that previous UKA more than doubled the risk of revision of TKA compared with previous osteotomy (HR 2.29, 95% CI 1.66 to 3.17; p < 0.001). In patients aged under 55 years, the risk of revision for TKA was nearly 2.5-fold for those with previous UKA compared with those with previous osteotomy (1.32, 95% CI 1.01 to 1.71 vs 3.25, 95% CI 2.01 to 4.97; p < 0.001). The mean-adjusted OKS scores at six months demonstrated a significant difference between the two groups, with improved OKS in the previous osteotomy group (34.85 (SD 0.36) vs 36.64 (SD 0.48); p < 0.001). However, this did not reach the minimal important clinical level of difference for the OKS.ConclusionPatients undergoing TKA after periarticular osteotomy exhibit a lower risk of revision compared to those with previous UKA, particularly in younger patients. Our study enhances the understanding of the risk of revision of a TKA following previous procedures, and confirms that TKA after osteotomy performs significantly better compared with previous unicompartmental arthroplasty.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"1 1","pages":"463-468"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147583780","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":"Aspirin prophylaxis is safe and effective for venous thromboembolism prophylaxis in low-risk patients undergoing aseptic revision total knee arthroplasty : evidence from a national cohort.","authors":"Billy I Kim,Brian P Chalmers,Fred D Cushner,Peter K Sculco,Alejandro Gonzalez Della Valle,Gwo-Chin Lee","doi":"10.1302/0301-620x.108b4.bjj-2025-1111.r1","DOIUrl":"https://doi.org/10.1302/0301-620x.108b4.bjj-2025-1111.r1","url":null,"abstract":"AimsWhile aspirin has been widely adopted as an effective method for deep vein thrombosis (DVT) prevention following primary total knee arthroplasty (TKA), concerns remain with regard to its efficacy in the setting of revision TKA (rTKA). However, the risk for thromboembolic events must be weighed against the increased potential for bleeding with more potent anticoagulants. This study aimed to compare venous thromboembolism (VTE) and transfusion rates between patients receiving aspirin with non-aspirin anticoagulation following aseptic rTKA.MethodsWe identified patients undergoing aseptic rTKA from 1 January 2016 to 30 April 2023 in a national database. Those with infection, fracture, prior VTE, coagulopathy, or preoperative anticoagulant use were excluded. Patients were grouped by postoperative prophylaxis: aspirin alone or non-aspirin anticoagulants. Patients were allocated to one of two categorical treatment groups. Crossover between groups was permitted where clinically indicated. Propensity score matching (1:1) was performed on demographic details, insurance, comorbidities, postoperative home health use, hospital length of stay ≤ one day, surgery year, and Current Procedural Terminology (CPT) code, yielding 4,585 patients per group. Outcomes included 30- and 90-day DVT, pulmonary embolism (PE), overall VTE, and transfusion.ResultsIn the matched cohort, aspirin use was associated with lower 90-day DVT (0.8% (n = 38) vs 2.1% (n = 96)), PE (0.6% (n = 26) vs 2.2% (n = 102)), and VTE (1.1% (n = 51) vs 3.3% (n = 152); all p < 0.001). Transfusion was also lower in the aspirin group at 30 days (0.6% (n = 28) vs 1.2% (n = 56); p = 0.003) and 90 days (0.7% (n = 33) vs 1.4% (n = 65); p = 0.002). DVT ultrasound use within 30 days was significantly higher in the non-aspirin group (7.1%; n = 326) compared with aspirin (5.1%; n = 235); p < 0.001), which may partly account for the higher VTE detection. Regression controlling for CPT code confirmed reduced odds of VTE with aspirin.ConclusionAspirin is a safe, effective, and noninferior option for VTE prophylaxis following aseptic rTKA in appropriately selected patients.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"16 1","pages":"490-497"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147583985","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":"Primary total knee arthroplasty for primary and secondary osteonecrosis : reliable outcomes at 15 years.","authors":"Nils Meissner,Matthew T Weintraub,Dirk R Larson,Rafael J Sierra,Mark W Pagnano,Charles P Hannon,Nicholas A Bedard,Matthew P Abdel","doi":"10.1302/0301-620x.108b4.bjj-2025-0627.r2","DOIUrl":"https://doi.org/10.1302/0301-620x.108b4.bjj-2025-0627.r2","url":null,"abstract":"AimsTotal knee arthroplasty (TKA) for end-stage osteonecrosis has historically been associated with concerns regarding aseptic loosening, and long-term data are limited. The purpose of this study was to update and expand our previous series with long-term follow-up, with specific emphasis on implant survivorship, risk factors for failure, complications, and clinical outcomes in a consecutive cohort of TKAs performed for primary and secondary osteonecrosis.MethodsWe retrospectively identified 295 consecutive TKAs in 266 patients for osteonecrosis performed at a single tertiary care academic institution from January 2002 to July 2022. Of these, 207 TKAs (70%) were performed for primary osteonecrosis, and 88 (30%) for secondary osteonecrosis. The predominant cause of secondary osteonecrosis was steroid use (59%; n = 52), followed by post-traumatic (25%; n = 22), radiation-induced (9%; n = 8), and alcohol-induced (7%; n = 6) osteonecrosis. Implant survivorship was analyzed as a time-to-event outcome using Kaplan-Meier estimation. The mean age was 61 years (18 to 93), with 67% being female (n = 197). The mean follow-up was nine years (2 to 20).ResultsThe 15-year survivorship free of any revision for the entire cohort was 92% (95% CI 87 to 97), with similar rates between primary and secondary osteonecrosis (92% (95% CI 87 to 98) vs 93% (95% CI 87 to 100), respectively; p = 0.459). Varus-valgus constraint implant designs (HR 10.8 (95% CI 2.7 to 43.4); p < 0.001) and tibial stem use (HR 12.0 (95% CI 4.1 to 35.1); p < 0.001) were associated with an increased risk of any revision. The 15-year survivorship free of aseptic loosening was 97% (95% CI 93 to 100) for the entire cohort. Age under 65 years (HR 2.7 (95% CI 1.4 to 5.4); p = 0.005) and secondary osteonecrosis (HR 1.9 (95% CI 1.0 to 3.4); p = 0.044) were associated with an increased risk of any reoperation at 15 years.ConclusionTKA is a durable and reliable option for primary osteonecrosis at long-term follow-up. However, TKAs performed for secondary osteonecrosis carry a higher reoperation risk.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"1 1","pages":"455-462"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584187","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":"Scaphoid fractures and associated ligament injury : five-year follow-up of the SWIFFT trial.","authors":"Nick A Johnson,Roshni Francis,Surabhi Choudhary,Kanagaratnam Jeyapalan,Joseph J Dias","doi":"10.1302/0301-620x.108b4.bjj-2025-0876.r1","DOIUrl":"https://doi.org/10.1302/0301-620x.108b4.bjj-2025-0876.r1","url":null,"abstract":"AimsThe association between scaphoid fractures and ligament injuries is uncertain, and the clinical relevance is not well established. The aim of this study was to undertake a secondary analysis of data from the Scaphoid Waist Internal Fixation for Fractures Trial (SWIFFT) to evaluate the incidence of concurrent ligament injuries in patients with a scaphoid waist fracture displaced by ≤ 2 mm, explore the radiological changes between one and five years after the injury, and assess whether there is an association between the characteristics of the fracture and ligament injury.MethodsAll 439 patients from the SWIFFT had baseline measurements available from plain radiographs and CT scans. Further follow-up measurements were undertaken from CT scans in 292 patients at 52 weeks and 239 patients at five years. A total of 345 patients had radiographs suitable for assessment of the scapholunate (SL) and lunotriquetral (LT) intervals at 52 weeks and/or five years.ResultsOnly 12 patients (2.8%) had widening of the SL gap by > 3 mm on initial imaging. There was no progression of these gaps at five years, and no patient had widening of the LT gap.ConclusionInjury to the interosseous intercarpal ligaments causing diastasis of carpal bones is rare in patients with a scaphoid waist fracture displaced by ≤ 2 mm. Treatment of the fracture with a cast or surgical fixation, without additional imaging or intervention for a potential ligament injury, appears adequate for most fractures. If there are ligament injuries not identified with standard imaging, they do not seem to progress.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"34 1","pages":"538-543"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584227","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":"Achieving normative quadriceps strength after total knee arthroplasty : associations with satisfaction, function, and a predictive nomogram.","authors":"Yoshinori Hiyama,Ryuichi Sawa,Moeka Yokoyama,Shosuke Ohtera,Osamu Wada,Kiyonori Mizuno","doi":"10.1302/0301-620x.108b4.bjj-2025-0859.r2","DOIUrl":"https://doi.org/10.1302/0301-620x.108b4.bjj-2025-0859.r2","url":null,"abstract":"AimsThis study quantified the contribution of contralateral quadriceps strength to achieving a normative quadriceps strength benchmark one year after total knee arthroplasty (TKA). We also evaluated whether achieving this benchmark was associated with patient satisfaction and function, and developed a nomogram for individualized goal setting.MethodsIn this retrospective cohort study, 1,341 patients (1,475 knees) who underwent primary TKA at a single orthopaedic centre between January 2018 and December 2023, and 240 knees from 120 older adults without knee osteoarthritis (OA), were analyzed. Patients were divided into development and validation cohorts. Quadriceps strength was measured preoperatively and at one year postoperatively using a standardized protocol with a handheld dynamometer, and values were normalized to body weight. The primary outcome was achieving strength equal to or greater than tenth percentile of the reference group. Associations with one-year 2011 Knee Society Score (KSS) domains, preoperative surgical side strength, and pre- and postoperative contralateral strength were examined using generalized estimating equations. A nomogram (a graphical prediction tool) was constructed and validated to provide an individualized prediction of strength achievement.ResultsAt one year postoperatively, 254 knees (45.0%) achieved the tenth percentile threshold of quadriceps strength observed in older adults without knee OA. The achievement was associated with higher satisfaction (mean difference (MD) 3.12 (95% CI 1.76 to 4.48)) and functional activities scores (MD 5.82 (95% CI 3.03 to 8.61)). Additionally, this achievement was associated with preoperative surgical-side quadriceps strength (risk ratio (RR) 1.66 (95% CI 1.18 to 2.33)) and postoperative contralateral strength (RR 4.83 (95% CI 3.56 to 6.56)). The nomogram demonstrated excellent discrimination (area under the curve (AUC) 0.900 (95% CI 0.850 to 0.950) in the development cohort; AUC 0.888 (95% CI 0.847 to 0.931) in the validation cohort) and acceptable calibration.ConclusionAchieving quadriceps strength within the distribution of older adults without knee OA following TKA is associated with clinically meaningful differences in satisfaction and functional activities. Preoperative and contralateral strength are key factors. The validated nomogram provides a practical tool for individualized rehabilitation goal setting.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"275 1","pages":"469-477"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584188","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":"Functional assessment of ceramic-on-ceramic hip resurfacing arthroplasty : improvement in gait at 12 months.","authors":"Amy Maslivec,Natasha Allott,Brogan Guest,Camilla Halewood,Justin P Cobb","doi":"10.1302/0301-620x.108b4.bjj-2025-0885.r1","DOIUrl":"https://doi.org/10.1302/0301-620x.108b4.bjj-2025-0885.r1","url":null,"abstract":"AimsA ceramic-on-ceramic hip resurfacing implant (cHRA) was developed and introduced in a Medicines and Healthcare products Regulatory Agency (MHRA)-approved clinical investigation. This study aimed to examine function and physical activity levels of patients with a cHRA implant using subjective and objective measures, both preoperatively and 12 months postoperatively.MethodsA total of 82 unilateral cHRA patients consented to this study as part of the larger MHRA-approved clinical investigation. In addition to their patient-reported outcome measures (PROMs), self-reported measures of physical activity and gait analysis were undertaken preoperatively (median 1.7 weeks (IQR 0.6 to 4.2)) and postoperatively (median 52.1 weeks (IQR 50.0 to 53.9)). These data were then compared with data from a group of 43 age-, sex-, and BMI-matched healthy controls. Kinetics and kinematics were recorded using an instrumented treadmill and 3D motion capture. Statistical parametric mapping was used for analysis.ResultscHRA improved PROMs and self-reported physical activity from preoperative levels. cHRA improved top walking speed (5.75 km/hr (SD 1.04) vs 7.27 km/hr (SD 0.71)), achieved a more symmetrical ground reaction force profile (symmetry index value: 10.6% (SD 9.4) vs 0.9% (SD 2.1)), and increased hip range of motion (31.7° (SD 6.2°) vs 45.9° (SD 5.3°)) from preoperative levels. Postoperative data were not statistically distinguishable from the healthy controls in any domain.ConclusionThese short-term results of cHRA appear promising, with the potential to restore a near-normal gait pattern and overall quality of life.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"15 1","pages":"447-454"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584224","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":"Outcomes of soft-tissue reconstruction for isolated type III internal hemipelvectomy.","authors":"Brooke E Willborg,Cristina A Salinas,Matthew M Rode,Barbara L Mullen,Peter S Rose,Samuel E Broida,Steven L Moran,Matthew T Houdek","doi":"10.1302/0301-620x.108b4.bjj-2025-0889.r1","DOIUrl":"https://doi.org/10.1302/0301-620x.108b4.bjj-2025-0889.r1","url":null,"abstract":"AimsA type III internal hemipelvectomy includes resection of the pubic rami. Although bony reconstruction is not necessary, the integrity of the abdominal wall is deficient following resection. The aim of this study was to report the outcome of soft-tissue reconstruction following these resections.MethodsWe retrospectively reviewed all isolated type III internal hemipelvectomies which were undertaken at the Mayo Clinic (Rochester, USA) between January 2002 and December 2022. The group included 25 patients, of whom 14 (56%) were male. Their median age was 45 years (IQR 61 to 31) at the time of surgery. Most patients (n = 18; 72%) underwent resection for a sarcoma. Soft-tissue flaps were used in 21 patients (84%) and nine also had a mesh reconstruction.ResultsThe five-year disease-specific survival was 65% following surgery, with significantly worse survival in patients with locally advanced tumour (35% (95% CI 12 to 100) vs 76% (95% CI 59 to 99); p = 0.036). Complications were common, with 21 patients (84%) having at least one complication, and 12 (48%) having several complications. Most commonly, this included seroma or haematoma (44%), wound dehiscence (40%), and infection (40%). The use of a soft-tissue flap did not significantly reduce the risk of infection (hazard ratio (HR) 0.68 (95% CI 0.14 to 3.28); p = 0.638) or seroma or haematoma (HR 0.31 (95% CI 0.30 to 4.14); p = 0.088), but patients who did not have a soft-tissue flap were significantly more likely to develop a hernia (odds ratio 9.0 (95% CI 1.14 to 71.03); p = 0.027). A total of three of 21 patients (14%) whose reconstruction involved a flap had donor site complications.ConclusionSoft-tissue reconstruction following a type III internal hemipelvectomy reduces the risk of postoperative hernia formation, with a low rate of donor site complications. This additional procedure should be considered for all patients undergoing this type of resection.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"28 1","pages":"561-566"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584228","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 fate of comminuted extruded or devitalized fragments of bone in Gustilo type III open fractures and an innovative form of treating them.","authors":"Li Yu,Huaqi Liu,Yinyin Wang,Lei Deng,Zhida Shen,Nimra Ghafar Shah,Qi Zhang,Linglong Deng","doi":"10.1302/0301-620x.108b4.bjj-2025-0542.r1","DOIUrl":"https://doi.org/10.1302/0301-620x.108b4.bjj-2025-0542.r1","url":null,"abstract":"AimsThis prospective study investigated an innovative approach to the management of extruded or devitalized fragments of bone in patients with a Gustilo type III open fracture of the tibia, which enabled the efficient reconstruction of the bony defect while minimizing the requirement for iliac bone harvesting.MethodsA total of 12 patients with a Gustilo type III open fracture were enrolled into the study between June 2019 and June 2022. During initial emergency management, all patients were treated with radical debridement, the introduction of an antibiotic-loaded spacer, and stabilization of the fracture. Extruded or devitalized fragments, including detached and potentially contaminated segments, were collected and processed into autologous demineralized bone matrix (ADBM). In the second stage, after removal of the spacer, ADBM combined with iliac bone graft was implanted into the induced membrane cavity for reconstruction of the bony defect. The sterility of the ADBM specimens was assessed using microbiological culture. Volumetric analysis of iliac graft requirements was performed. Primary outcome measures including time to healing of the fracture and complications were recorded. The recovery of function was assessed using the Lower Extremity Functional Scale (LEFS) at final follow-up.ResultsThe mean follow-up was 32.5 months (24 to 48). No bacteria were detected in any ADBM implants. Complete reconstruction of the defect was achieved in all patients. Quantitative volume analysis revealed an autogenous bone-to-ADBM ratio of 1.36:1, reducing the autologous bone requirements. Radiological union occurred at a mean of seven months (5 to 10) after the second surgical stage. There were no complications such as rejection, infection, nonunion, or refracture. At the last follow-up, all patients had regained satisfactory function of the lower limb as recorded by a mean LEFS score of 72.2 (68 to 76).ConclusionThe processing of comminuted extruded or devitalized fragments of bone into ADBM represents a safe and effective strategy for managing severe open fractures of the tibia. When synergistically integrated with an induced membrane technique, this innovative approach considerably reduced the incidence of infection, diminished the need for iliac bone graft, and substantially enhanced the efficiency of reconstruction of the bony defect.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"105 1","pages":"544-552"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147583984","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}