Acta Orthopaedica最新文献

{"title":"Letter to the Editor: Machine learning-based prediction of short- and long-term mortality for shared decision-making in older hip fracture patients.","authors":"Eda Yildirim","doi":"10.2340/17453674.2026.45362","DOIUrl":"10.2340/17453674.2026.45362","url":null,"abstract":"","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"240"},"PeriodicalIF":2.4,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13063104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147637617","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":"Effect of an in-consult patient decision aid on decisional quality and involvement for patients with severe hip or knee osteoarthritis: a multicenter, cluster randomized controlled trial.","authors":"Trine Ahlmann Pedersen, Martin Lindberg-Larsen, Charlotte Myhre Jensen, Karina Dahl Steffensen, Claus Varnum","doi":"10.2340/17453674.2026.45697","DOIUrl":"10.2340/17453674.2026.45697","url":null,"abstract":"<p><strong>Background and purpose: </strong>Shared decision-making (SDM) is important in managing patients with severe hip and knee osteoarthritis, where treatment decisions often depend on patient preferences and values. We aimed to evaluate the effectiveness of an in-consult patient decision aid in improving decision quality and patient involvement compared with usual care.</p><p><strong>Methods: </strong>In a cluster-randomized controlled trial, surgeons from 2 Danish orthopedic departments were randomized to use in-consult patient decision aids or provide usual care. The primary outcome was decision quality assessed using the Hip/Knee OA Decision Quality Instrument (HK-DQI). Patients who were well informed and received their preferred treatment received an Informed Patient-Centered (IPC) score of 1, indicating good decisional quality; all others scored 0. Secondary outcomes included patient-experienced engagement and involvement in decision-making, assessed using CollaboRATE and the decision-process domain of the Hip/Knee OA Decision Quality Instrument and consultation duration. Relative risks (RR) and mean differences (MD) with 95% confidence intervals (CIs) were estimated using multilevel regression models.</p><p><strong>Results: </strong>20 surgeons were randomized to either use in-consult patient decision aids (n = 10) or provide usual care (n = 10). Of the 1,038 patients screened for severe hip or knee osteoarthritis, 581 were included in the study. Decision quality was similar between groups, with a score of 43 (36-51) in the intervention group and 44 (37-52) in the usual care group (RR 0.9, CI 0.7-1.2; P = 0.8), likewise, patient-experienced engagement assessed with CollaboRATE (RR 1.1, CI 0.8-1.4; P = 0.6). Consultations were longer in the intervention group, with a mean difference of 3.9 minutes (CI 0.1-7.7; P = 0.04).</p><p><strong>Conclusion: </strong>Decision quality and patient-reported engagement were similar between groups, while consultation time was longer with in-consult patient decision aids use. In the absence of prespecified minimal important differences, the clinical relevance of these findings remains uncertain.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"232-239"},"PeriodicalIF":2.4,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13084220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147637591","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":"Denosumab and bone loss in uncemented total hip arthroplasty: a secondary 5-year follow-up of a randomized controlled trial.","authors":"Caroline Sköld, Nils P Hailer, Hans Mallmin","doi":"10.2340/17453674.2026.45695","DOIUrl":"10.2340/17453674.2026.45695","url":null,"abstract":"<p><strong>Background and purpose: </strong>Denosumab may preserve periprosthetic bone mineral density (pBMD) around uncemented total hip arthroplasty (THA) components. This exploratory analysis of a previously published randomized controlled trial (RCT) aimed to assess the effects of denosumab on BMD 5 years after treatment cessation.</p><p><strong>Methods: </strong>64 non-osteoporotic patients undergoing uncemented THA were enrolled in a randomized, double-blind, placebo-controlled phase-2 trial and received either 2 doses of denosumab or placebo. The primary outcome was pBMD at 12 months, measured by dual-energy X-ray absorptiometry (DEXA). At a mean follow-up of 5.6 years (range 4.3-7.3), 54 patients remained for clinical assessment, DEXA, and plain radiography. The study was registered on ClinicalTrials.gov (NCT01630941).</p><p><strong>Results: </strong>No differences in pBMD in the acetabular Digas zones or femoral Gruen zones were found between the groups at 5 years. The estimated mean difference in the sum of all zones around the cup was 0.042 g/cm² (95% confidence interval [CI] -0.31 to 0.35; P = 0.8), and for the sum of all Gruen zones -0.06 g/cm² (CI -0.55 to 0.43; P = 0.8). No statistically significant differences were observed in patient-reported outcome measures or the incidence of heterotopic ossification. A gradual decline in pBMD was evident.</p><p><strong>Conclusion: </strong>At 5 years, the adjusted between-group difference and its 95% confidence interval showed no statistically or clinically relevant effect of denosumab. Whether longer treatment duration or a sequential post-denosumab regimen could influence long-term periprosthetic bone preservation is unknown.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"217-224"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13044700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147589122","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":"Long-term implant retention after impacted elastic stable intramedullary nailing in pediatric diaphyseal forearm fractures: a retrospective cohort study.","authors":"Jan Egil Brattgjerd, Christer Aasheim, Astrid Rosenberg, Christoffer Fotland, Vera Halvorsen","doi":"10.2340/17453674.2026.45693","DOIUrl":"10.2340/17453674.2026.45693","url":null,"abstract":"<p><strong>Background and purpose: </strong>In elastic stable intramedullary nailing (ESIN) for forearm fractures, nail protrusion may cause irritation-related implant removal. The primary aim was to evaluate implant retention after nail impaction, and secondarily to assess secondary procedures, complications, and protrusion as a predictor of removal.</p><p><strong>Methods: </strong>We analyzed a retrospective cohort of children with diaphyseal forearm fractures treated with impacted ESIN between 2017 and 2024. Implant retention was defined as no nail removal at record review. Secondary procedures were unplanned operations, while complications were adverse events managed conservatively. Radiographic nail protrusion was measured as extraosseous nail length and evaluated using receiver operating characteristic analysis to predict irritation-related implant removal.</p><p><strong>Results: </strong>160 children with diaphyseal forearm fractures were included. At a mean observation time of 5 years, 132/160 children retained their implants (83%, 95% confidence interval [CI] 76-88). Secondary procedures occurred in 30/160 patients (19%, CI 13-26), most commonly irritation-related implant removal (10%, CI 6-16) and refracture (6%, CI 3-10). Complications occurred in 19/160 patients (12%, CI 7-18), including superficial radial nerve symptoms (7/160; 4.4%) and irritation without implant removal (6/160; 3.8%). A protrusion threshold of 3.3 mm predicted irritation-related implant removal (AUC 0.79, CI 0.71-0.86; sensitivity 100%, CI 83-100; specificity 55%, CI 49-61). No irritation-related removals occurred below this threshold.</p><p><strong>Conclusion: </strong>Impacted ESIN was associated with high long-term implant retention, although secondary procedures and complications occurred in about one-third of the patients. A protrusion threshold of 3 mm was linked to irritation-related removal and may guide implant retention.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"225-231"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13044701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147589177","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":"Combating orthopedic implant biofilms - SABER (Study on Agitation for Biofilm Eradication and Reduction) evaluates mechanical, sonication, and radiofrequency approaches: a preclinical in vitro study.","authors":"Timothy Greeley McManus, Michael W Fort, Kaitlyn E Barrack, Gabrielle S Ray, Michael B Sparks, Kevin J McGuire, George A O'Toole O'Toole","doi":"10.2340/17453674.2026.45569","DOIUrl":"10.2340/17453674.2026.45569","url":null,"abstract":"<p><strong>Background and purpose: </strong>Medical devices commonly employed in orthopedic surgery continue to be susceptible to challenging and costly biofilm bacterial infections. We aimed to evaluate the impact of mechanical brushing with sonication and radiofrequency on biofilms grown on 3 metallic alloys commonly utilized in orthopedic implants: titanium, stainless steel, and cobalt-chromium.</p><p><strong>Methods: </strong>Biofilms of 4 common bacteria encountered in orthopedic infections were grown on 540 metal chips for 3 metal alloy cohorts. The biofilms were treated with sterile saline irrigation, sonication brushing, or radiofrequency sonication brushing to compare against untreated control. Biofilm burden was evaluated both qualitatively and quantitatively with scanning electron microscopy imaging and crystal violet (CV) staining optical density or colony-forming unit measurements, respectively. Parametric, nonparametric, and linear regression analyses for quantitative data were performed.</p><p><strong>Results: </strong>Qualitatively and quantitatively, all interventions showed a strong reduction in biofilm burden of all microbes on all metals. There was a significant decrease in CV-stained biofilms for brushing interventions compared with irrigation alone and controls. Biofilm burden was significantly reduced in all experiments. The untreated control represented 100% biofilm. Irrigation alone reduced biofilm to 44%, while sonication further decreased biofilm to 25%. The most effective method, sonication with radiofrequency, reduced biofilm to 20%.</p><p><strong>Conclusion: </strong>Our data shows consistent qualitative and quantitative reduction in biofilm burden with brushing interventions compared with irrigation and control. While further study is warranted, our data suggest that mechanical brushing with sonication and radiofrequency may be beneficial tools in reducing biofilm burden on orthopedic metal implants.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"209-216"},"PeriodicalIF":2.4,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13037461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580249","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":"National rates of pediatric extremity fractures over a 20-year timespan in Denmark: a population-based descriptive cohort study.","authors":"Anja Rønnov Lund, Christian Færgemann, Per Gundtoft, Bjarke Viberg","doi":"10.2340/17453674.2026.45511","DOIUrl":"10.2340/17453674.2026.45511","url":null,"abstract":"<p><strong>Background and purpose: </strong>Previous reports on incidences rates of Scandinavian pediatric extremity fractures have varied, as they are often anatomically specific and based on institution-specific findings. To gain knowledge of current and future burden on the healthcare system, a national cohort assessment is necessary. We aimed to assess the proportion and incidence within anatomical distributions of pediatric extremity fractures in relation to age, sex, and time trends.</p><p><strong>Methods: </strong>We retrieved a 20-year population-based cohort from the Danish National Patient Registry 1999-2018. We included all children aged 0-15 years with an extremity fracture diagnosis (ICD-10). We estimated fracture proportions and incidence rates (IRs) in different anatomical regions stratified by sex, age groups, and periods. IRs were estimated based on national population counts.</p><p><strong>Results: </strong>We included 668,595 pediatric fractures corresponding to an overall IR of 3,164 (95% confidence interval 3,157-3,172) per 100,000 persons/year. The highest proportion and IR were in the lower arm, but the proportions differed within the age groups. The IR increased with age and was higher in boys. The overall IR increased during the study period. In upper and lower leg fractures a decrease was seen, with all other anatomical sites increasing.</p><p><strong>Conclusion: </strong>We found an increased IR during the study period for all fractures except for the upper and lower leg. The study gives important knowledge to the healthcare system when coordinating the right resources.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"204-208"},"PeriodicalIF":2.4,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13019125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147508740","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":"An Acta Orthopaedica educational article: Treatment of adult patients with a humeral shaft fracture.","authors":"Thomas Ibounig, Olof Wolf, William M Oliver, Dennis Karimi, Bjarke Viberg, Maire Ratasvuori, Antti P Launonen, Tuomas Lähdeoja, Jeppe V Rasmussen, Lasse Rämö","doi":"10.2340/17453674.2026.45597","DOIUrl":"10.2340/17453674.2026.45597","url":null,"abstract":"<p><p>This educational review outlines the core principles of humeral shaft fracture (HSF) management and is designed for orthopedic trainees, general orthopedic surgeons, emergency physicians, and allied health professionals who participate in the acute or postoperative care of patients with HSFs. The content integrates the authors' expert opinion with the current evidence. Humeral shaft fractures account for 1-3% of adult fractures, most often resulting from low-energy falls in older adults or high-energy trauma in younger patients. Although open fractures and neurovascular injuries are rare, primary radial nerve palsy (RNP) occurs in about 10% of cases. Diagnosis relies primarily on clinical evaluation and standard radiographs, with CT or MRI reserved for complex or pathological cases. Functional bracing has traditionally been the mainstay of nonsurgical treatment, achieving good long-term results but with nonunion rates up to 25%. Surgical fixation methods-including open reduction and internal fixation, minimally invasive plate osteosynthesis, and intramedullary nailing-allow earlier mobilization and more predictable fracture union but carry risks of iatrogenic RNP and infection. Management of primary RNP remains largely nonsurgical, with over 90% recovering spontaneously. Nonunion is frequently symptomatic and managed most often with compression plating. Surgery offers faster early recovery and lower nonunion rates, although long-term outcomes converge with successful bracing. Cost-effectiveness analyses suggest surgery may be more economical when productivity loss is considered, particularly for working-age patients. Optimal treatment selection depends on patient age, activity level, fracture characteristics, and patient preference, emphasizing shared decision-making.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"194-203"},"PeriodicalIF":2.4,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12994134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147472301","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":"Assessing the value for money of a registry: an exploratory analysis of the Dutch Arthroplasty Register.","authors":"Mirthe H W Van Veghel, Gerjon Hannink, B Willem Schreurs, Janneke P C Grutters","doi":"10.2340/17453674.2026.45553","DOIUrl":"10.2340/17453674.2026.45553","url":null,"abstract":"<p><strong>Background and purpose: </strong>It is unclear whether arthroplasty registries provide value for money. We aimed to provide insight into this value for money by relating the costs of the Dutch Arthroplasty Register (LROI) to potential benefits from preventing revisions.</p><p><strong>Methods: </strong>We included all primary total hip (n = 276,252) and knee (n = 217,901) arthroplasties (THA/TKA), and all first revisions of these THAs (n = 8,604) and TKAs (n = 8,745) from the LROI between 2014 and 2022. Threshold analyses estimated at which number of prevented revisions the benefits (i.e., savings and increased quality of life) outweighed the LROI costs. Scenario analyses explored whether the required revision reductions were feasible, including the minimum revision reduction required per hospital, revision reduction at outlier hospitals only, and the potential impact of temporal changes in national 1-year revision rates.</p><p><strong>Results: </strong>The LROI costs were €5,697,120 for THA registration and €4,532,920 for TKA registration between 2014 and 2022. Preventing 119 to 145 THA revisions and 106 to 134 TKA revisions would be required in the current patient population over 30 years for the benefits to outweigh these LROI costs between 2014 and 2022, depending on revision costs. Each Dutch hospital should prevent 1.2 to 1.5 THA revisions and 1.1 to 1.3 TKA revisions to achieve the required revision reduction. Moreover, 306 THA revisions and 140 TKA revisions could be prevented if outlier hospitals improved their 1-year overall revision rate to the upper 99% control limit. Compared with the calendar years showing the highest revision rates, applying 2022 1-year revision rates to 2023 procedure volumes resulted in reductions of 1.5% for THAs and 0.3% for TKAs.</p><p><strong>Conclusion: </strong>Preventing approximately 1-2 revisions per hospital over 30 years would offset the LROI's registration costs. Although causality cannot be established, these findings suggest that national arthroplasty registries may provide good value for money when actively used to reduce revision rates.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"177-184"},"PeriodicalIF":2.4,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12976591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429972","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":"Machine learning and logistic regression in estimating survival in patients with high-malignant deep-seated soft tissue sarcomas: development and analysis based on a population-based retrospective cohort.","authors":"Andrea Thorn, Jessica A Lavery, Thomas Baad-Hansen, Jonathan A Forsberg, Michael Mørk Petersen, Christina Enciso Holm","doi":"10.2340/17453674.2026.45509","DOIUrl":"10.2340/17453674.2026.45509","url":null,"abstract":"<p><strong>Background and purpose: </strong>Soft tissue sarcomas are a heterogeneous group of malignant tumors with a high risk of metastasis, primarily to the lungs, making accurate survival prediction an essential part of long-term planning. No machine learning (ML) survival prediction models have been developed using a modern, population-based dataset from Scandinavia. We aimed to develop and compare ML models with logistic regression in predicting 5-year survival in soft tissue sarcoma patients and identify key predictive variables.</p><p><strong>Methods: </strong>This retrospective cohort study included patients diagnosed with deep-seated, high-grade soft tissue sarcomas of the extremities and trunk wall in Denmark from 2000 to 2016. Logistic regression was compared with 4 developed ML models, including random forest. Performance was assessed using the area under the curve (AUC), sensitivity, specificity, and calibration metrics, with a 70:30 training-test split and 5-fold cross-validation to evaluate the models.</p><p><strong>Results: </strong>516 patients were included, of whom 226 (44%) died within 5 years following surgery. Random forest demonstrated the best ML performance on the training set and was compared with logistic regression on the test set. Logistic regression achieved an AUC of 0.74 (95% confidence interval [CI] 0.66-0.82), outperforming random forest's AUC of 0.65 (CI 0.56-0.74). Logistic regression also had higher sensitivity (0.65 vs 0.59) and specificity (0.72 vs 0.69), while random forest had a lower Brier score (0.38 vs 0.41).</p><p><strong>Conclusion: </strong>Although the developed random forest ML model performed well during training, logistic regression outperformed it after internal validation. Soft tissue sarcomas located in the trunk, grade 3 tumors, and chemotherapy within 3 months of surgery demonstrated the highest negative effect on survival, consistent with current treatment protocols in which patients with high-risk disease are managed with more aggressive multimodal therapy. Further external validation and assessment of clinical utility are required before potential clinical implementation.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"185-193"},"PeriodicalIF":2.4,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12976663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429945","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":"Associations between hospital characteristics, volume, and reasons for revision: a cohort study of 48,029 unicompartmental knee arthroplasties with 3,397 revisions from the Dutch Arthroplasty Register.","authors":"Hendrik W H De Raadt, Iris Koenraadt-van Oost, Anouk Nijs, Anneke Spekenbrink-Spooren, Leon Elmans, Rutger C I Van Geenen","doi":"10.2340/17453674.2025.44961","DOIUrl":"10.2340/17453674.2025.44961","url":null,"abstract":"<p><strong>Background and purpose: </strong>It remains debated whether high annual hospital volumes for unicompartmental knee arthroplasty (UKA) are associated with a low risk of revision, and what explanations may underlie this relationship. We aimed to analyze the association between specific hospital characteristics defined as volume, type, and referral for revision, and frequency and reasons for UKA revision.</p><p><strong>Methods: </strong>Data from primary UKAs (2007-2022) and their revisions were extracted from the Dutch Arthroplasty Register. Hospitals were categorized by type; academic, top clinical teaching, private, or other general hospitals. Hospitals were grouped by annual UKA volume: ≤24, 25-39, 40-79, and ≥80 procedures. Multiple linear regression assessed the relationship between the number of revisions with hospital volume and type, adjusted for confounders. Chi-squared tests were used to test for differences in revision reasons based on volume and referrals.</p><p><strong>Results: </strong>48,029 primary UKAs and 3,397 revisions were included. High-volume and top clinical teaching hospitals had a significantly lower risk of revision following primary UKA (P < 0.001). Cementless implants had a lower risk compared with cemented implants. Revision reasons varied by hospital volume and whether revision occurred after referral (P < 0.001). Loosening, progression of osteoarthritis, malalignment, and pain were less common in the highest volume hospitals. If revision occurred after referral, malalignment was more frequently registered as the reason for revision.</p><p><strong>Conclusion: </strong>High-volume and top clinical teaching hospitals were associated with lower risk of revision following primary UKA. Differences in revision reasons, with fewer cases of loosening, progression of osteoarthritis, malalignment, and pain, may explain the lower risk of revision at higher volume hospitals.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"164-170"},"PeriodicalIF":2.4,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12963959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363811","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}