Archives of Orthopaedic and Trauma Surgery最新文献

{"title":"Research progress on debridement, antibiotics, and implant retention (DAIR) for the treatment of periprosthetic joint infection after artificial joint replacement","authors":"Wenguang Feng,&nbsp;Zhichao Zhang,&nbsp;Ribusurong Pu,&nbsp;Haibin Wang,&nbsp;Rui Liu,&nbsp;Yanhong Sun,&nbsp;Guoliang Zhang","doi":"10.1007/s00402-026-06368-3","DOIUrl":"10.1007/s00402-026-06368-3","url":null,"abstract":"<div><p>Periprosthetic joint infection (PJI) is one of the most serious complications following artificial joint replacement, posing significant treatment challenges and a heavy clinical burden. Debridement, antibiotics, and implant retention (DAIR) has become the preferred treatment strategy for acute PJI due to its advantages of minimal invasiveness, functional preservation, and cost-effectiveness. This article reviews the latest advances in optimizing the indications, timing of intervention, key technical details, and multimodal anti-infection strategies for DAIR. It focuses on discussing patient selection models (e.g., KLIC score), the impact of modular component exchange on biofilm eradication, the synergistic role of chemical debridement, and the central position of biofilm-active therapy in penetrating biofilms. Furthermore, this article proposes that future efforts should integrate molecular diagnostics, intelligent antimicrobial materials, and artificial intelligence prediction models to achieve individualized precision therapy for PJI, providing a theoretical basis for clinical decision-making.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06368-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148380551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tranexamic acid in high-risk shoulder arthroplasty patients: safety across thromboembolic, cardiac, renal, and neurologic risk profiles","authors":"Tarishi Parmar,&nbsp;Akin Adio,&nbsp;Asim Handy,&nbsp;Mohammad Daher,&nbsp;Alec Kellish,&nbsp;Adam Khan,&nbsp;Joseph Abboud","doi":"10.1007/s00402-026-06406-0","DOIUrl":"10.1007/s00402-026-06406-0","url":null,"abstract":"<div><h3>Introduction</h3><p>Tranexamic acid (TXA) effectively reduces blood loss and transfusion requirements in shoulder arthroplasty. However, concerns regarding thromboembolic, neurologic, cardiac, and renal complications have limited its use in medically high-risk patients. This study evaluated temporal trends and the safety of TXA in high-risk patients undergoing total shoulder arthroplasty (TSA).</p><h3>Methods</h3><p>A retrospective cohort study was conducted using TriNetX, identifying patients who underwent shoulder arthroplasty (2012–2025). Patients were stratified by preexisting high-risk conditions, including prior thromboembolism, renal failure, atrial fibrillation, seizure disorders, and visual disturbances. Within each subgroup, patients receiving TXA were propensity score–matched to those who did not. Perioperative TXA utilization trends were assessed. Ninety-day postoperative outcomes were compared, including transfusion requirements, thromboembolic events, cardiac complications, renal failure, neurologic events, infections, readmissions, emergency department visits, and mortality. Outcomes were reported as odds ratios (ORs) with 95% confidence intervals (CIs).</p><h3>Results</h3><p>Reported perioperative TXA use began in 2012 and increased through 2025, with over 70% of patients in both standard- and high-risk cohorts receiving TXA. TXA use was associated with significantly lower transfusion rates (OR range 0.53–0.62) and readmissions (OR range 0.63–0.75) across all high-risk cohorts (all <i>p</i> ≤ 0.01). TXA use was not associated with increased risk of deep vein thrombosis, pulmonary embolism, stroke, or postoperative seizures in any subgroup. Notably, TXA demonstrated a protective association against myocardial infarction, cardiac ischemia, acute renal failure, and mortality in select high-risk populations. No increase in infection-related complications was observed.</p><h3>Conclusions</h3><p>In patients undergoing shoulder arthroplasty, TXA use was safe across multiple high-risk medical populations and was consistently associated with lower transfusion and readmission rates, with reduced mortality in select cohorts. These findings support the broader use of TXA for blood conservation in shoulder arthroplasty, even among patients with traditionally high-risk comorbidities, while underscoring the need for future prospective, shoulder-specific safety studies.</p><h3>Level of evidence</h3><p>III, Retrospective Cohort Study</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06406-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated screw fixation of posterior wall fractures","authors":"Jan-Dierk Clausen,&nbsp;Hür Özbek,&nbsp;Tarek Omar-Pacha,&nbsp;Stephan Sehmisch,&nbsp;Axel Gänsslen","doi":"10.1007/s00402-026-06408-y","DOIUrl":"10.1007/s00402-026-06408-y","url":null,"abstract":"<div><h3>Introduction</h3><p>Posterior wall (PW) fractures are common acetabular fractures and are most often treated by open reduction and internal fixation. The gold-standard of surgical stabilization is screw fixation of large wall fragments with additional buttress plating. Some reports focussed on screw fixation alone presenting adequate results.</p><h3>Material and methods</h3><p>From a total of 208 PW-fracture treated between 1972 and 2008, 57 patients were identified with open reduction and internal fixation (ORIF) using isolated screw fixation. These patients were analyzed regarding demographical data (patient age, sex), type of accident, injury mechanism, Injury Severity Score (ISS), concomitant pelvic ring injuries, associated injuries, perioperative parameters and long-term results.</p><h3>Results</h3><p>44 patients were male and 13 were female with a mean age of 36.8 years. More than 90% sustained high-energy trauma with 34 sustaining multiple injuries or polytrauma. The mean Injury Severity Score was 11.5 points. All patients had fracture dislocations, which were reduced within 24 h after admission except one patient with secondary transfer. 11 patients presented with an initial sciatic nerve deficit. 29 patients had a single PW-fragment, 16 presented with two PW-fragments and in 12 patients marginal impactions were present. Surgery was performed in average after 7 days using the Kocher-Langenbeck approach. 24.6% femoral head lesions and 19.3% acetabular lesions were detected. All hips could be reconstructed anatomically. One patient died after severe head injury. 41 patients had follow-up of at least 12 months: 80.5% reported none or slight pain and 90.2% had good to excellent clinical results. 78% had no post-traumatic hip joint changes.</p><h3>Conclusion</h3><p>Screw fixation alone can be considered as a rare but adequate treatment modality in selected posterior wall fractures, especially minor comminuted fractures with predominantly a large single posterior wall fragment.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06408-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148380421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gait speed recovery after iliofemoral ligament-preserving hip arthroscopy for femoroacetabular impingement: associations with early postoperative gait kinematics","authors":"Satoshi Machida,&nbsp;Masahiro Tsutsumi,&nbsp;Hajime Utsunomiya,&nbsp;Shintarou Kudo","doi":"10.1007/s00402-026-06399-w","DOIUrl":"10.1007/s00402-026-06399-w","url":null,"abstract":"<div><h3>Introduction</h3><p>Whether iliofemoral ligament-preserving hip arthroscopy facilitates recovery of gait speed—an indicator of functional recovery following hip arthroscopy in patients with femoroacetabular impingement—remains unclear. We investigated whether gait speed improved after iliofemoral ligament-preserving hip arthroscopy and examined whether pelvic jerk, defined as the time derivative of acceleration and assessed using inertial sensors at 1 month postoperatively (1M), was associated with gait speed at 6 months (6M).</p><h3>Materials and methods</h3><p>Eighteen patients who underwent primary hip arthroscopy for femoroacetabular impingement were included. Gait speed and pelvic jerk were assessed during a 10-m walk at a self-selected speed, using an inertial sensor positioned at the third lumbar level. Peak pelvic jerks during the 1st and 2nd halves of the stance phase (1st - and 2nd -peak pelvic jerks) were calculated. Measurements were obtained preoperatively and at 1M and 6M. Gait parameters were compared across time points using a linear mixed model. Bayesian regression was used to compare the observed change in gait speed from preoperatively to 6M with previously reported values. Associations between gait variables at 1M and gait speed at 6M were also examined.</p><h3>Results</h3><p>Gait speed was significantly higher at 6M than that pre surgery (preoperative, 1.15 [95% confidence interval, 1.08–1.21] m/s, 6M, 1.24 [95% confidence interval, 1.17–1.30] m/s, <i>P</i> = 0.013). Bayesian analysis indicated that the improved gait speed (posterior mean, 0.09 m/s; 95% credible interval, 0.04–0.14) was comparable with previously reported values. The 2nd -peak pelvic jerk at 1M was significantly associated with gait speed at 6M (β = 0.63, <i>P</i> = 0.02).</p><h3>Conclusions</h3><p>Iliofemoral ligament-preserving hip arthroscopy was associated with a significant improvement in gait speed at 6M. Early postoperative gait kinematics during the latter half of the stance phase, reflected by the 2nd -peak pelvic jerk, may be associated with subsequent gait speed recovery.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06399-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computed tomography findings in 11,504 adult patients with traumatic brain injury: a large real-world cohort study with a S100B subgroup analysis","authors":"Clemens Clar,&nbsp;Paul Puchwein,&nbsp;Maximilian Moshammer,&nbsp;Patrick Sadoghi,&nbsp;Diether Kramer,&nbsp;Andreas Leithner,&nbsp;Patrick Reinbacher","doi":"10.1007/s00402-026-06397-y","DOIUrl":"10.1007/s00402-026-06397-y","url":null,"abstract":"<div><h3>Objective</h3><p>The aim of this study was to characterize acute cranial CT findings in a large cohort of adult patients with traumatic brain injury and to explore the diagnostic performance of S100B in a selected subgroup. The hypothesis was that most cranial CT scans in adult patients with traumatic brain injury would not demonstrate acute traumatic abnormalities, and that, within a selected subgroup, negative S100B levels would be associated with the absence of such findings on CT.</p><h3>Methods</h3><p>This retrospective cohort study included 11,504 adult patients presenting with traumatic brain injury to a level I trauma center between 04/2016 and 05/2024. All patients underwent cranial CT, while serum S100B measurements were available in a selected subset. CT findings were classified as normal or showing acute traumatic abnormalities. In the S100B subgroup, biomarker levels were analyzed in relation to CT findings to assess their diagnostic performance for excluding acute pathology.</p><h3>Results</h3><p>A total of 11,504 adult patients with traumatic brain injury were included; 27.4% were inpatients and 72.6% outpatients. Overall, 81.9% of CT scans showed no acute pathology, while 10.7% demonstrated abnormalities. 7.4% of all cases were excluded. Acute TBI-related interventions were rare (3.7% of inpatients vs. 0.3% of outpatients). In patients with dementia and those receiving anticoagulation, CT scans remained normal in 81.7% and 81.9%, respectively. S100B was available in 483 patients (4.2%); negative values were associated with absence of CT pathology, with higher negative predictive value in outpatients (98%) than in inpatients (73%) (<i>p</i> &lt; 0.001).</p><h3>Conclusion</h3><p>In this large retrospective cohort of adult patients with traumatic brain injury, most cranial CT examinations were negative for acute pathology. In a selected subgroup, negative S100B levels were associated with the absence of CT abnormalities, with substantially lower performance in inpatients. These findings suggest a potential adjunctive role of S100B in selected low-risk patients, however further prospective studies with standardized testing protocols are required to define the diagnostic utility and clinical applicability of S100B more precisely in the evaluation of traumatic brain injury.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06397-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148350408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early post-operative CRP is a better predictor of DAIR failure than pre-operative CRP in total knee PJI","authors":"Harrison Beadel,&nbsp;Ryan Chaffey,&nbsp;Katy Kim,&nbsp;Mark Zhu,&nbsp;Brendan Coleman","doi":"10.1007/s00402-026-06369-2","DOIUrl":"10.1007/s00402-026-06369-2","url":null,"abstract":"<div><h3>Introduction</h3><p>Debridement, antibiotics and implant retention (DAIR) surgery is often performed as a first-line treatment for periprosthetic joint infection (PJI), however, success rates are variable. This study aimed to determine whether post-operative C-reactive protein (CRP) levels predict DAIR failure.</p><h3>Materials and methods</h3><p>A multi-centre retrospective cohort study was performed over a 15-year period. All total knee arthroplasty (TKA) patients undergoing DAIR for first episode PJI were included. CRP was measured at admission and for 6 weeks post-operatively. Treatment success was defined as implant retention without the need for revision surgery or long-term suppressive antibiotics. Trends in CRP were compared between two groups: failed and successful DAIR. Receiver operating characteristic (ROC) curves were analysed.</p><h3>Results</h3><p>189 DAIR procedures were included, of which 49% (92) failed and 51% (97) were successful. Mean follow-up was 7.5 years. Overall, CRP trended down following surgery. Mean CRP was significantly higher in the failed DAIR group at all time points. The greatest difference was at week one post-operatively (mean 76 vs. 101, <i>P</i> &lt; 0.01). This remained significant when patients experiencing DAIR failure within 90 days were excluded (mean 76 vs. 107, <i>P</i> &lt; 0.01). CRP was most accurate as a predictor of failure at week one post-operatively, with an area under the curve (AUC) of 0.71. Optimal balance of specificity and sensitivity was achieved with a CRP cutoff of 89. This yielded a sensitivity of 74% and specificity of 66%. CRP at week one post-operatively more accurately predicted DAIR failure than admission CRP.</p><h3>Conclusions</h3><p>CRP measured at week one post-operatively demonstrated moderate prognostic value for predicting DAIR failure in the treatment of total knee PJI. While an elevated CRP may assist in identifying patients who require close monitoring, CRP alone is insufficient to guide decisions around revision surgery.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06369-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148323730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tuberosity refixation in reverse proximal humerus fracture arthroplasty: a prospective cohort study with two-year follow-up","authors":"Cornelia Hildegard Oberrauter,&nbsp;Florian Hess,&nbsp;JoEllen Welter,&nbsp;Hans-Christoph Pape,&nbsp;Saskia Mayer,&nbsp;Alexander Dullenkopf,&nbsp;Ruben Mazzucchelli,&nbsp;Ivan Marintschev","doi":"10.1007/s00402-026-06303-6","DOIUrl":"10.1007/s00402-026-06303-6","url":null,"abstract":"<div><h3>Introduction</h3><p>To evaluate the outcomes of a simplified tuberosity refixation technique using a two-suture construct in patients with complex proximal humerus fractures treated with reverse shoulder arthroplasty (RSA). The technique reduces the number of fixation sutures rather than the traditional four to five, aiming to decrease operative complexity while promoting greater tuberosity (GT) healing and improving the healing rate. A secondary exploratory analysis compared clinical and radiological outcomes between cemented and uncemented humeral stem fixation.</p><h3>Materials and methods</h3><p>This prospective study included 73 patients who underwent RSA (Global Unite Fracture Reverse System, DePuy Synthes, Warsaw, Indiana, USA). Clinical and radiological outcomes were assessed at two-year follow-up. Bone quality was evaluated using the Deltoid Tuberosity Index (DTI). Functional outcomes and GT healing were analyzed, and stem fixation type was assessed in a secondary subgroup analysis.</p><h3>Results</h3><p>The mean patient age was 79 ± 8 years (range 61–95), and 65 (89%) were female. Osteoporotic bone quality (DTI &lt; 1.4) was observed in 51 (70%) of cases. At two years, the median outcome scores were: Subjective Shoulder Value, 90 (IQR 80–95); Constant-Murley score, 76 (IQR 73–81); active forward flexion, 140° (IQR 120–160); abduction, 140° (IQR 120–160); external rotation, 8 (IQR 8–8); and internal rotation, 6 (IQR 6–8). GT healing occurred in 68 (93%) patients. Dislocation occurred in 5 (7%) patients. Complications occurred in 4 (5.5%) patients, and 1 (1.4%) required revision surgery. In the exploratory comparison, cemented stems demonstrated slightly greater forward flexion (<i>p</i> = 0.02) and abduction (<i>p</i> = 0.045), without clinically relevant differences between fixation types.</p><h3>Conclusions</h3><p>The simplified two-suture greater tuberosity refixation technique achieved high GT healing rates and favorable functional outcomes, supporting its use in RSA for complex proximal humerus fractures. Stem fixation method did not have a clinically relevant influence on outcomes.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06303-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148323719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is it time for a systematic and objective assessment of knee laxity? The impact of objective knee laxity after TKA on patient-reported outcomes: a comprehensive review","authors":"Hannes Vermue,&nbsp;Victor Klincke,&nbsp;Lenka Stroobant,&nbsp;Thomas Tampere,&nbsp;Jan Victor,&nbsp;Nele Arnout","doi":"10.1007/s00402-026-06387-0","DOIUrl":"10.1007/s00402-026-06387-0","url":null,"abstract":"<div><h3>Purpose</h3><p>Over the past decade, robot assistance has emerged as an innovative and rapidly advancing tool in total knee arthroplasty (TKA). Despite technological advancements, the evaluation of the soft-tissue envelope during TKA often relies on subjective and rudimentary assessments by the surgeon. This literature review explores the relationship between objective intraoperative and postoperative laxity measurements in the coronal and sagittal planes and patient-reported outcome measures (PROMs) following TKA.</p><h3>Methods</h3><p>A literature review was conducted using PubMed/MEDLINE and Embase to identify studies on intra- or postoperative laxity measurements in TKA and their correlation with PROMs. Inclusion criteria required studies on TKA patients with quantifiable coronal and/or sagittal laxity measurements and postoperative PROMs linked to these measurements.</p><h3>Results</h3><p>Thirty-four studies met inclusion criteria: ten on sagittal laxity, twenty-seven on coronal laxity, and three on both. Follow-up ranged from 1 month to over 8 years. Sagittal laxity thresholds of 5–10 mm under applied loads of 89–133 N were associated with better functional outcomes, whereas excessive (&gt; 10 mm) or overly tight (&lt; 5 mm) laxity correlated with reduced satisfaction. Medial laxity in the coronal plane was linked to lower PROMs, while the impact of lateral laxity on PROMs was less conclusive.</p><h3>Conclusions</h3><p>Objective laxity parameters correlate with PROMs, particularly a stable medial compartment throughout the range of motion, while the role of lateral laxity remains unclear. Systematic use of objective soft-tissue evaluations may enhance PROMs. While fixed-force assessments are standardized, personalized approaches with variable forces tailored to individual patients might be needed for optimal outcomes.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06387-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prioritisation of assessments, diagnostic classifications, and outcome measures in Perthes disease: a Delphi survey of international health professionals","authors":"Stephanie Ball,&nbsp;Luke M. Davies,&nbsp;Kelly Gray,&nbsp;Verity Pacey","doi":"10.1007/s00402-026-06392-3","DOIUrl":"10.1007/s00402-026-06392-3","url":null,"abstract":"<div><h3>Introduction</h3><p>The aim of this study is to reach consensus and prioritise the most clinically important assessments, diagnostic classifications, and outcome measures by an international panel of experts for Legg-Calve-Perthes disease.</p><h3>Materials and methods</h3><p>A three-round modified e-Delphi survey was conducted between April and May 2025. Participants rated the clinical importance of 14 clinical assessments, 26 radiological assessments, eight diagnostic classifications, and 26 outcome measures identified by a scoping review. Consensus was defined as ≥ 75% agreement. In the final round, items in each category were prioritised for overall condition and by specific age groups (&lt; 6 years, 6–8 years, &gt; 8 years).</p><h3>Results</h3><p>Thirty-eight health professionals, from nine countries participated in round 1. Thirty-four completed all three rounds, a retention rate of 89.5%. Consensus and prioritisation for clinical use were achieved for 10 clinical assessments, three radiological assessments, three diagnostic classifications, and three outcome measures.</p><h3>Conclusion</h3><p>Paediatric specialists have reached consensus and prioritised methods to evaluate and diagnose Legg-Calve-Perthes disease in clinical practice. These results represent an important step towards improving continuity of care and the foundation for future development of clinical practice guidelines.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06392-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Silver-impregnated occlusive dressing is associated with a lower rate of acute surgical site infection after direct anterior total hip arthroplasty","authors":"Yi-Yen Tsai,&nbsp;Pei-Hung Shen,&nbsp;Chia-Chun Wu,&nbsp;Ru-Yu Pan,&nbsp;Leou-Chyr Lin,&nbsp;Sheng-Hao Wang","doi":"10.1007/s00402-026-06393-2","DOIUrl":"10.1007/s00402-026-06393-2","url":null,"abstract":"<div><h3>Introduction</h3><p>The direct anterior approach (DAA) for total hip arthroplasty (THA) has gained increasing adoption in recent years; however, it has been associated with a higher risk of wound-related complications compared with other surgical approaches. Silver-impregnated occlusive dressings have demonstrated antimicrobial potential, though their role in DAA THA remains underexplored.</p><h3>Materials and methods</h3><p>We conducted a retrospective cohort study with a historical control group, reviewing 321 consecutive primary DAA THAs performed by a single surgeon (September 2020–December 2025). Standard sterile gauze was used before August 2021 (<i>n</i> = 76) and a silver-impregnated occlusive dressing (AQUACEL^® Ag SURGICAL; ConvaTec, Deeside, UK) thereafter (<i>n</i> = 245). Despite the chronological difference between cohorts, baseline demographic and clinical characteristics did not differ significantly between groups (Table 1). The primary endpoint was acute surgical site infection(SSI) within 30 days (CDC criteria); all patients had ≥ 3 months follow-up to capture early wound-related reoperations as secondary outcomes.</p><h3>Results</h3><p>Four acute SSI events occurred (1.25%). SSI incidence was 3.94% (3/76) with gauze versus 0.41% (1/245) with the silver-impregnated dressing (Fisher’s exact <i>p</i> = 0.043). This corresponds to an absolute risk reduction (ARR) of 3.54% (95% CI, 0.34–10.57) and a number needed to treat (NNT) of 29 (95% CI, 10–293). No deep PJI occurred. Given sparse events, adjusted analyses were considered exploratory; in a penalized (Firth) logistic model, silver dressing remained associated with lower odds of SSI, while higher BMI and diabetes were associated with higher odds.</p><h3>Conclusions</h3><p>In this retrospective historical-control cohort, silver-impregnated occlusive dressing use was associated with a lower 30-day SSI rate after DAA THA. Given the low event rate and potential temporal confounding, these findings should be interpreted cautiously and warrant confirmation in larger studies.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06393-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}