Acta Orthopaedica最新文献

{"title":"No difference in patient-reported outcome measures between private and public hospitals in the Netherlands: a cross-sectional analysis based on 170,150 hip and knee arthroplasties from the Dutch Arthroplasty Register.","authors":"Marije Carlijn Vink, Pelle Bos, Bart-Jan Van Dooren, Rinne M Peters, Liza N Van Steenbergen, Enrico De Visser, J Martijn Brinkman, B Willem Schreurs, Wierd P Zijlstra","doi":"10.2340/17453674.2026.45891","DOIUrl":"https://doi.org/10.2340/17453674.2026.45891","url":null,"abstract":"<p><strong>Background and purpose: </strong> Private hospitals have become more frequent healthcare providers for arthroplasty surgery in the Netherlands. The aim of our study was to assess patient-reported outcome measures (PROMs) in patients who received primary total hip arthroplasty (THA), total knee arthroplasty (TKA), and unicompartmental knee arthroplasty (UKA) in private hospitals compared with patients from public hospitals, and to assess access to care based on mean travel distance to the healthcare facility.</p><p><strong>Methods: </strong> Patients operated on between 2014 and 2023 were included. Patient characteristics, preoperative, 3- or 6-, and 12 months postoperative PROMs (Numeric Pain Rating Scale [NRS] pain, EuroQoL 5-Dimensions [EQ-5D-5L], Hip disability and Osteoarthritis Outcome Score [HOOS-PS], Knee Injury and Osteoarthritis Outcome Score [KOOS-PS], Oxford Hip Score [OHS], and Oxford Knee Score [OKS]) were retrieved from the LROI. For analysis, repeated measurements were performed, using mixed-effect models adjusted for confounders. Primary endpoints for inference were NRS pain during activity, HOOS/KOOS-PS, and OHS/OKS at 3 months follow-up. Mean travel distance to the hospital was compared, as measure for access to care.</p><p><strong>Results: </strong> 146,303 primary THAs, TKAs, and UKAs performed in public hospitals and 23,847 in private hospitals were included. Patients undergoing arthroplasty in private hospitals were generally younger and had a higher socioeconomic status and lower body mass index and American Society of Anesthesiologists Physical Status class. Both patients from private and public hospitals improved similarly and significantly after surgery. At 3-month follow-up, public hospitals showed marginal but statistically significant advantages in HOOS/KOOS-PS for THA, TKA, and UKA (mean differences 0.5 [95% confidence interval (CI) 0.1-0.9], 0.5 [CI 0.1-0.9], and 1.3 [CI 0.5-2.1], respectively). OKS favored public hospitals for TKA and UKA (-0.4 [CI -0.6 to -0.2] and -0.6 [CI -1.0 to -0.1]). NRS pain during activity favored private hospitals for TKA (-0.2 [CI -0.3 to -0.1]). All absolute differences were small and without statistical significance. Mean travel distance was significantly shorter for patients treated in public hospitals.</p><p><strong>Conclusion: </strong> There is no difference in PROMs between public and private hospitals after primary THA, TKA and UKA in the Netherlands. Based on mean travel distance, access to care was not compromised for high-risk patients.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"301-307"},"PeriodicalIF":2.4,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147863340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased all-cause mortality following distal radius fractures in Danish adults: a register-based matched cohort study.","authors":"Cecilie Rud Budtz, Antti P Launonen, Bakir O Sumrein, Stig Brorson, Helle K Østergaard, Merete N Madsen","doi":"10.2340/17453674.2026.45786","DOIUrl":"https://doi.org/10.2340/17453674.2026.45786","url":null,"abstract":"<p><strong>Background and purpose: </strong>Distal radius fractures (DRFs) are common in older adults and are associated with osteoporosis and underlying frailty. While hip and spine fractures are associated with increased mortality, the association between DRFs and all-cause mortality remains less clear. We aimed to assess all-cause mortality risk following DRF in Denmark compared with age- and sex-matched controls.</p><p><strong>Methods: </strong> We conducted a nationwide, register-based matched cohort study using data from the Danish National Patient Register and Civil Registration System (1998-2018). Adults (≥ 18 years) with a DRF were matched 1:5 to controls by sex and birthdate ± 30 days. Mortality rates per 103 persons and mortality rate ratios with 95% confidence intervals (CIs) were calculated at 30, 90, 365, and 730 days after the fracture.</p><p><strong>Results: </strong> We included 190,513 patients with DRF and 952,565 controls (70% female, mean age 59 years). Mortality rates were higher for patients with DRF compared with controls across all age categories, particularly in men and within the first 30 days. Among men, mortality rates ranged from 0.36 to 52.9 per 1,000 persons in patients with DRF and from 0.07 to 20.0 per 1,000 persons in controls. Among women, mortality ranged from 0.16 to 26.3 per 1,000 persons in patients with DRF and from 0.04 to 15.9 per 1,000 persons in controls. Mortality rate ratios were highest for the 50-59 age category (male: 4.60, CI 3.95-5.35, female 3.08, CI 2.80-3.39), decreasing with higher age. Mortality rate ratios stabilized after 365 and 730 days.</p><p><strong>Conclusion: </strong> This nationwide study shows increased all-cause mortality among patients with DRF compared with sex and age-matched controls, with the highest mortality rate within the first 30 days after the fracture. The mortality rate ratio was consistently higher in the age-group 50-59 and among males.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"294-300"},"PeriodicalIF":2.4,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147863380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaccination is associated with reduced mortality rates after surgery for hip fractures in the setting of recent COVID-19 infection: an observational study from the Kaiser Permanente Northern California Database.","authors":"Aidan T Morrell, Ryland P Kagan, Mackenzie Kelly, Graham J Dekeyser, Andrew L Avins, Lusine X Gigoyan, John S Cox","doi":"10.2340/17453674.2026.45696","DOIUrl":"10.2340/17453674.2026.45696","url":null,"abstract":"<p><strong>Background and purpose: </strong> Limited data exist on mortality and venous thromboembolism (VTE) risk in hip-fracture patients with recent COVID-19 infection. We aimed to examine (i) the association between vaccination status and mortality risk, (ii) whether infection timing is associated with mortality risk, and (iii) whether recent infection is associated with an increase in postoperative VTE risk.</p><p><strong>Methods: </strong> Adult Kaiser Permanente Northern California members undergoing hip-fracture surgery (2020-2022) were identified. Patients with varying vaccination statuses and SARS-CoV-2 infection histories within 6 months preoperatively were analyzed. Multivariable regression models were adjusted for demographics, comorbidities, and COVID-19 status to calculate risk ratios. The primary outcome was 90-day mortality; the secondary outcome was 90-day VTE.</p><p><strong>Results: </strong> 3,674 patients were included. Unvaccinated or partially vaccinated patients with COVID-19 within 6 months preoperatively had a 4.49-fold higher 90-day mortality risk than fully vaccinated patients (95% confidence interval [CI] 3.72-5.42). Among COVID-positive patients, shortening of the interval from infection to surgery from 6 months to 6 weeks was associated with increased 90-day mortality risk of approximately 53% (CI 1.29-1.97). Additionally, more recent infection (within 6 months) was associated with a 3.14-fold higher postoperative VTE risk (CI 1.10-8.98).</p><p><strong>Conclusion: </strong> COVID-19 vaccination is associated with a reduction in the mortality risk among hip-fracture patients with recent infection. Shorter infection-to-surgery intervals are associated with increased mortality risk, and recent infection is associated with higher VTE risk.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"286-293"},"PeriodicalIF":2.4,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13154000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147831484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychological factors associated with trial participation among patients eligible for total knee arthroplasty with a non-surgical treatment arm: a comparative cross-sectional study.","authors":"Nina Jullum Kise, Siri Eliassen, Caryl L Gay, Anners Lerdal, Maren Falch Lindberg, Tor Kjetil Nerhus, Turid Rognsvåg, Arild Aamodt, Stig Heir","doi":"10.2340/17453674.2026.45869","DOIUrl":"10.2340/17453674.2026.45869","url":null,"abstract":"<p><strong>Background and purpose: </strong> Knowledge of psychological factors' influence on patients' decisions to participate in randomized controlled trials (RCTs) is scarce. We aimed to compare levels of psychological factors in patients with knee osteoarthritis (OA) eligible for total knee arthroplasty in those who agree to participate in an RCT with those who declined.</p><p><strong>Methods: </strong> We compared anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), pain-related fear of movement (Fear-Avoidance Belief Questionnaire [FABQ]), catastrophizing (Pain Catastrophizing Scale [PCS]), knee symptoms (Knee Osteoarthritis and Outcome Scale [KOOS]), and knee awareness (Forgotten Joint Score [FJS]), in patients in the Multidisciplinary Intervention in Total Knee Arthroplasty (MultiKnee) trial (n = 280) and in patients who declined (n = 373). Simple and multiple logistic regression models explored associations between psychological factors and patients' willingness to participate.</p><p><strong>Results: </strong> Patients declining participation had more fear avoidance (FABQ 1.6 points higher, 95% confidence interval [CI] 0.6-2.6), more knee awareness (FJS 4.0 points lower, CI 1.9-6.1), and worse KOOS scores (ranging from 3.4, CI 0.6-6.1 to 5.6 points, CI 3.1-8.2). In simple regression analysis, each 1-point increase in FABQ-Physical activity score was associated with a 3.9% decrease in odds of participating (OR 0.96, CI 0.94-0.99), and in adjusted analyses, a 3.0% decrease in odds (OR 0.97, CI 0.94-1.0). When considering a clinically meaningful difference of 4 points, this corresponds to a 14.7% reduction in crude odds and a 11.5% reduction in adjusted odds of study participation. Each 1-point increase in HADS Anxiety score was associated with a 5.4% increase in odds of participating (OR 1.05, CI 1.00-1.11). HADS Depression and PCS were not associated with RCT participation.</p><p><strong>Conclusion: </strong> Patients with higher fear avoidance of physical activity were less willing to participate in the RCT, while patients with higher anxiety were more willing. These findings may weaken the generalizability of the findings from the RCT.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"272-278"},"PeriodicalIF":2.4,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13153999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147831532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"1-year results after surgery for flexible adult-acquired flatfoot deformity: a cohort study based on 190 patients from the Swedish Foot and Ankle Surgery Register.","authors":"Ida Karin Johanna Osbeck, Maria Cöster, Isam Atroshi","doi":"10.2340/17453674.2026.45942","DOIUrl":"10.2340/17453674.2026.45942","url":null,"abstract":"<p><strong>Background and purpose: </strong> Surgical outcomes in patients with flexible adult-acquired flatfoot deformity (AAFD) have not been evaluated in large prospective register studies. Calcaneal osteotomy and hindfoot arthrodesis are commonly used. We aimed to compare the results of these 2 procedures using preoperative and 1-year postoperative patient-reported outcome data from the Swedish Quality Register for Foot and Ankle Surgery (Swefoot).</p><p><strong>Methods: </strong>We analyzed data regarding feet that had primary surgery for flexible (grade II) AAFD between 2017 and 2022 in Sweden. The primary outcome was the Self-Reported Foot and Ankle Score (SEFAS), range 0-48 (minimal important difference 5). Secondary outcomes were EQ-5D and satisfaction.</p><p><strong>Results: </strong> 190 feet (63% women, median age 62 years, interquartile range 54-68) were surgically treated during the study period. Mean improvement in SEFAS score was 12 (95% confidence interval [CI] 10-13) in grade IIa and 10 (CI 8-12) in grade IIb, and in the EQ-5D index 0.27 (CI 0.20-0.34) and 0.23 (CI 0.15-0.31), respectively. Compared with preoperatively a higher percentage of patients were satisfied with postoperative foot appearance (77% vs 39%) and foot strength (66% vs 23%). The mean SEFAS score improvement was 11 (CI 10-13) in the osteotomy group and 10 (CI 5-15) in the arthrodesis group; adjusted mean difference was 2.7 (CI -1.2 to 6.5).</p><p><strong>Conclusion: </strong> Surgical treatment of flexible AAFD significantly improves function and quality of life at 1 year postoperatively. No differences in postoperative patient-reported outcomes were observed between patients who underwent calcaneal osteotomy compared with hindfoot arthrodesis.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"279-285"},"PeriodicalIF":2.4,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13154001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147831522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What aspects of pain and functional outcomes contribute to patient satisfaction 1 year after surgery within total hip and total knee arthroplasty populations? A registry-based cohort study.","authors":"Marys Revaz, Thomas Perneger, Christophe Barea, Hermes H Miozzari, Didier Hannouche, Anne Lübbeke","doi":"10.2340/17453674.2026.45732","DOIUrl":"https://doi.org/10.2340/17453674.2026.45732","url":null,"abstract":"<p><strong>Background and purpose: </strong> Patient satisfaction after total hip and knee arthroplasty (THA, TKA) is influenced by multiple factors, including patient-reported pain and function. We aimed to examine whether functional abilities or pain during specific activities are associated more than other aspects with satisfaction 1 year after THA and TKA.</p><p><strong>Methods: </strong> This cohort study included all primary elective THAs and TKAs performed between January 2012 and June 2022 at a tertiary care university hospital. Ordinal logistic regression models were used to assess associations between patient satisfaction and WOMAC Pain and Function summary scores and items, 1 year postoperatively.</p><p><strong>Results: </strong> 1,772 THAs and 1,323 TKAs were included. Individually, all scores and items were associated with satisfaction. However, multivariable models revealed differences in the strength of association. Global pain score (odds ratio [OR] THA: 2.80, 95% confidence interval [CI] 2.40-3.29; TKA: 3.61, CI 2.96-4.44), pain while walking on the flat (OR THA: 1.79, CI 1.45-2.22; TKA: 1.74, CI 1.43-2.11), and pain going up or down stairs (OR THA: 1.64, CI 1.37-1.96; TKA: 1.68, CI 1.44-1.97) showed the strongest associations in both populations. Among THAs, activities walking on the flat (OR 1.41, CI 1.17-1.68), putting on socks (OR 1.29, CI 1.12-1.48), and ascending stairs (OR 1.26, CI 1.08-1.46) contributed most to satisfaction, whereas among TKAs, walking on the flat (OR 1.41, CI 1.18-1.69), rising from sitting (OR 1.32, CI 1.11-1.58), and getting in or out of a car (OR 1.31, CI 1.10-1.57) did.</p><p><strong>Conclusion: </strong> After THA/TKA, patient satisfaction is associated with pain during basic daily tasks-especially walking and stair climbing. Key functional drivers differ by joint: socks and stairs matter for THA, rising from sitting and getting in/out of a car matter for TKA.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"265-271"},"PeriodicalIF":2.4,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147831495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Migration patterns of uncemented femoral stems in hip replacement: a systematic review and meta-analysis of clinical radiostereometric analysis cohort studies.","authors":"Lisa Van der Water, Christiaan H Righolt, Trevor Gascoyne, Bart L Kaptein, Rob G H H Nelissen, Bart G C W Pijls","doi":"10.2340/17453674.2026.45412","DOIUrl":"10.2340/17453674.2026.45412","url":null,"abstract":"<p><strong>Background and purpose: </strong>We conducted a systematic review and meta-analysis of radiostereometric analysis studies of primary uncemented femoral stems to investigate their subsidence and retroversion patterns and the migration patterns according to implant, patient, and study characteristics.</p><p><strong>Methods: </strong>A systematic search of PubMed, Web of Science, Cochrane, and Embase databases to identify all radiostereometric analysis studies on femoral stem migration following primary uncemented total hip replacement was performed. Clinical studies with 2 or more postoperative radiostereometric measurements within 2 years were included. Subsidence and retroversion at 6 weeks, 3 and 6 months, 1, 2, 5, and 10 years were included for analysis. Extracted implant characteristics included implant design, coating, and surgical approach. Data was analyzed using a random effects model.</p><p><strong>Results: </strong>73 studies on 120 cohorts and 2,970 uncemented stems were included. 119 cohorts reported on subsidence and 91 on retroversion. The pooled subsidence at 3 months was 0.29 mm (95% confidence interval [CI] 0.19-0.39) and 0.32 mm (CI 0.21-0.43) at 2 years. The pooled retroversion at 3 months was 0.51° (CI 0.33-0.70) and 0.70° (CI 0.48-0.93) at 2 years. Hydroxyapatite-coated stems showed the least migration (subsidence 0.26 mm; CI 0.13-0.40; retroversion 0.51°; CI 0.22-0.80) among different coating types. The anterior approach showed more migration (subsidence 1.04 mm, CI 0.53-1.55; retroversion 1.52°, CI 1.08-1.95) than other surgical approaches.</p><p><strong>Conclusion: </strong>Our study shows that most subsidence and retroversion of uncemented femoral stems occurs during the first 3 months. Stabilization of subsidence occurred after 3 months, and retroversion stabilized after 2 years. Migration patterns differ based on stem type, coating, surgical approach, the time period when inclusion started, and timing of baseline measurement.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"247-254"},"PeriodicalIF":2.4,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13085547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Letter: Correlation between acetabular index at 3 and 12 months of age: a longitudinal radiographic study of 228 neonates treated for 6 or 12 weeks with the von Rosen splint for developmental dysplasia of the hip.","authors":"Adam Sand, Daniel Wenger, Henrik Düppe, Carl Johan Tiderius","doi":"10.2340/17453674.2026.45820","DOIUrl":"10.2340/17453674.2026.45820","url":null,"abstract":"","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"245-246"},"PeriodicalIF":2.4,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13085541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: Correlation between acetabular index at 3 and 12 months of age: a longitudinal radiographic study of 228 neonates treated for 6 or 12 weeks with the von Rosen splint for developmental dysplasia of the hip.","authors":"Soner Kocak","doi":"10.2340/17453674.2026.45783","DOIUrl":"10.2340/17453674.2026.45783","url":null,"abstract":"","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"243-244"},"PeriodicalIF":2.4,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13085542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147687373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative single-dose methadone significantly affects postoperative morphine consumption in older patients with a hip fracture: the MetaHip randomized controlled trial.","authors":"Kevin H Nygaard, Nikolaj H Schmidt, Lasse Eriksen, Sofie R Petersen, Thomas Strøm, Kirsten Specht, Jesper O Schønnemann","doi":"10.2340/17453674.2025.44754","DOIUrl":"10.2340/17453674.2025.44754","url":null,"abstract":"<p><strong>Background and purpose: </strong>Effective pain management in older patients with a hip fracture is critical for postoperative recovery. Our primary objective was to compare intraoperative methadone with placebo on postoperative morphine consumption over 72 hours.</p><p><strong>Methods: </strong>Patients aged ≥ 60 years with hip fractures were randomized to receive methadone (0.10 mg/kg) or placebo intraoperatively. The primary outcome was postoperative morphine consumption measured in 24-hour intervals over 72 hours. Secondary outcomes included pain scores, time to mobilization, and discharge. Harms were assessed as adverse and serious adverse events.</p><p><strong>Results: </strong>129 patients were included. The primary endpoint analysis demonstrated that postoperative morphine consumption over 72 hours differed significantly between groups (likelihood-ratio test, P = 0.02). Model-based estimates suggested lower morphine consumption in the methadone group at 0-24 hours (least square mean [LSM] 7.1 [SE 1.2] vs placebo 10.1 [SE 1.7] mg) and at 24-48 hours (4.1 [SE 0.8] vs placebo 5.3 [SE 0.9] mg). At 48-72 hours, the model suggested lower morphine consumption in the placebo group (3.2 [SE 0.6] vs methadone 4.6 [SE 0.9] mg). Secondary outcomes were similar between groups, except that time to hospital discharge was longer in the methadone group (LSM 5.6 vs 4.5 days; mean difference -1.3 days, 95% confidence interval -2.3 to -o.4; P < 0.01). Harms appeared comparable, although the low event rate precluded formal analysis.</p><p><strong>Conclusion: </strong>A single intraoperative dose of methadone significantly alters postoperative morphine consumption over 72 hours after hip fracture surgery, without major safety concerns.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"255-264"},"PeriodicalIF":2.4,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13093133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}