Bone & Joint Open最新文献

Aims: The Mako system is one of the most widely used systems for robotic arm-assisted total hip arthroplasty (THA). Two workflows for femoral preparation exists for this system - the enhanced and the express workflow.

Methods: We performed a retrospective cohort study comparing the accuracy of each workflow in restoring the patient's combined offset and correcting the hip length discrepancy. The Mako derived values were compared against measured values and assessed with Bland-Altman plots and Theil's median slope. Secondary outcomes of interest included comparison of the measured combined offset and hip length discrepancy, surgical time, incidence of postoperative instability/dislocation, as well as pin-site related complications between the two groups.

Results: A total of 81 patients were identified from our database: 61 in the enhanced group and 20 in the express workflow group. Bland-Altman plots demonstrated agreement between the measurements for both hip length discrepancy and combined offset. There was no significant difference in the measurement of hip length discrepancy or combined offset difference between the two groups; however, the magnitude of the latter was better in the enhanced (median 1.50 mm) compared with the express workflow group (median 3.13 mm). There was no significant difference in measured combined offset (p = 0.254), hip length discrepancy (p = 0.425), or surgical time (p = 0.548). Lastly, there were no patients with postoperative instability/dislocation nor pin-site related complications in either group.

Conclusion: Both techniques provide excellent outcomes with minimal risk of complications when performing a Mako robotic arm-assisted THA.

Aims: The purpose of this study was to assess the effect of combined preoperative benzoyl peroxide application and subcutaneous povidone-iodine (PV-I) disinfection, in addition to standard PV-I disinfection of the skin, on intraoperative cultures of Cutibacterium acnes.

Methods: All patients undergoing arthroscopic or open shoulder surgery were eligible for inclusion. Patients were randomized into one of three groups: control (standard disinfection of the skin with PV-I), double prevention (disinfection of the skin and subcutaneous tissue with PV-I after incision for 60 seconds), and triple prevention (application of benzoyl peroxide during the three days before surgery, disinfection of the skin with PV-I, and disinfection of the subcutaneous tissue with PV-I after incision for 60 seconds). Cultures were taken of the tissue layers, equipment, and the surgeon's gloves. A sample size of 156 patients was calculated. Culture positivity was compared between the groups, with the intra-articular and deep muscular culture as the primary outcome.

Results: A total of 156 patients (median age 58 years (IQR 20 to 85), with 61 patients (39%) being female) were included. The intra-articular cultures were positive in 16 patients (32%) in the control group, 11 (21%) in the double prevention group, and five (10%) in the triple prevention group (p = 0.031). C. acnes presence in the muscular layer was 21 (42%) in the control group, 17 (33%) in the double prevention group, and seven (13%) in the triple prevention group (p = 0.0052). The median number of positive cultures was one in the control group (IQR 0 to 5), one in the double prevention group (IQR 0 to 3.75), and zero in the triple prevention group (IQR 0 to 2; p = 0.082).

Conclusion: Combining disinfection of the subcutaneous tissue after incision with preoperative application of benzoyl peroxide reduced the presence of C. acnes during surgery. These results suggest that the triple prevention protocol may be effective in reducing C. acnes infections after both arthroscopic and open surgery.

Aims: Fragility distal femur fractures have comparable mortality outcomes to fragility hip fractures. Increasing scrutiny is being placed on the perioperative management of these injuries to improve mortality and morbidity outcomes. A key pillar of preoperative consent is the explanation of adverse events associated with the underlying pathology and/or suggested treatment course. The Nottingham Hip Fracture Score (NHFS) is a validated tool used to predict mortality after a fragility hip fracture and has been shown to be predictive of mortality after fragility odontoid peg fractures. This study aims to assess the utility of the NHFS in predicting 30-day and one-year mortality after distal femur fragility fractures.

Methods: A retrospective cohort study of all consecutive fragility distal femur fractures treated surgically over an 86-month period at six units managing acute fragility fractures was performed. NHFS were calculated, with 30-day and one-year mortality ascertained from local hospital and primary care records. Patients were grouped as 'high-risk' of mortality with a NHFS > 5.

Results: Overall, 30-day mortality was 7.1% in the high-risk cohort (16/225), with no deaths identified in the low-risk cohort. Across both groups one-year mortality rate was 24.9%, with a 6.4% one-year mortality in the low-risk cohort (10/157) compared with 37.8% (85/225) in the high-risk cohort. Area under the curve analysis of receiver operator characteristic curves for 30-day mortality was 0.854 and 0.779 for one-year mortality. This demonstrated excellent predictive power at 30 days, diminishing slightly at one year.

Conclusion: The NHFS is an excellent predictor of 30-day mortality with reliability reducing at one year. A NHFS of 5 or more is associated with a deleterious outcome and can be used to inform discussions with patients and/or relatives regarding adverse outcomes. It can also identify patients with high mortality risk allowing for modifiable risk factors such as time to theatre to be further optimized.

Aims: With increasing demand for knee arthroplasties, innovative approaches like virtual consultations are gaining traction. This study assesses the feasibility of using virtual consultation as arthroplasty for in-person consultations in patients undergoing total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA).

Methods: This single-centre cohort study evaluated patients receiving virtual consultations as their primary contact and followed patients scheduled for primary TKA or medial UKA after virtual consultations as their sole preoperative contact between 1 January 2023 and 30 June 2023. Visitation criteria for virtual consultation were severe radiologically confirmed osteoarthritis (Kellgren-Lawrence grade ≥ 3 and American Society of Anesthesiologists grade ≤ 2). Outcomes measured included the proportion of patients scheduled for surgery directly after virtual consultation and those requiring additional in-person consultations. Secondary outcomes included the completion of scheduled surgeries, conversion rates from UKA to TKA, and the proportion of patients successfully completing outpatient surgery.

Results: A total of 303 patients received virtual consultations, and 97 (32%) were directly scheduled for surgery. Overall, 123 patients (41%) required in-person consultations, while 83 patients (27%) were managed directly after virtual consultation without surgery. Among the directly scheduled surgeries, 82 (85%) proceeded without changes to the planned course. No perioperative conversions from UKA to TKA occurred. In total, 57 patients (70%) were eligible for outpatient surgery, and 41 of these (72%) successfully completed the course and were discharged on the day of surgery.

Conclusion: This study found it feasible to use virtual consultations as replacement for in-person consultations prior to knee arthroplasty surgery for a selected group of patients. Future research should explore patient safety and patient-reported outcomes to validate these findings.

Aims: While trochlear dysplasia is recognized as a key factor in patellar instability, its association with specific patellar fracture patterns remains unclear. This study investigates the relationship between trochlear dysplasia and patellar fractures through morphological analysis.

Methods: In this prospective cohort study of 318 patients with acute patellar fractures (January to June 2021), preoperative CT scans were analyzed for trochlear dysplasia parameters: sulcus angle, trochlear depth, and lateral trochlear inclination. Fractures were classified using AO/Orthopaedic Trauma Association (OTA) criteria with emphasis on inferior pole involvement. Multivariable logistic regression was used to identify morphological predictors of fracture type.

Results: Trochlear dysplasia was identified in 152 (47.80%) of patients, with a mean sulcus angle of 144.44° (SD 11.16°), trochlear depth of 4.43 mm (SD 1.33), and lateral trochlear inclination of 18.25° (SD 4.89°). Fractures classified as AO/OTA types A and C1.3 were more prevalent in patients with trochlear dysplasia. Logistic regression analysis showed that the sulcus angle significantly influenced the occurrence of the distal fractures (p < 0.001, odds ratio (OR) = 1.15, 95% CI 1.111 to 1.187).

Conclusion: Trochlear dysplasia, particularly manifested by an increased sulcus angle, is significantly associated with distal patellar fractures. These findings highlight the importance of preoperative morphological assessment in predicting fracture patterns and tailoring clinical management.

Aims: The aims of this study are to identify the causes and independent risk factors for failure following revision total hip arthroplasty (RTHA).

Methods: We conducted a retrospective multicentre cohort study involving 963 patients who underwent RTHA between January 2016 and December 2021 across three French university hospitals, with a minimum follow-up of two years. Data collected included demographic details, revision rank (R1= first revision, R2= second revision, R ≥ 3=third or subsequent revision), surgical variables, complications, reoperations, re-revisions, and mortality. RTHA failure was defined as any reoperation or re-revision. Multivariate logistic regression was used to determine independent risk factors for failure.

Results: The mean patient age was 72 years (14 to 104), with 55% of patients being female. The most common indications for RTHA were aseptic loosening (35.6%), periprosthetic fracture (32.0%), periprosthetic joint infection (PJI; 15.2%), and dislocation (5.7%). Failure occurred in 135 patients (14.0%), most frequently due to PJI (53%), of which 61% were new infections. Among patients revised for dislocation, recurrent instability accounted for 43.7% of failures. Most failures (70%) occurred within one year of revision. Independent risk factors included age ≥ 75 years (odds ratio (OR) 0.61), revision rank ≥ 3 (OR 1.96), PJI (OR 2.0), dislocation (OR 2.86), use of revision (OR 2.38), and constrained acetabular cups (OR 5.38).

Conclusion: Aseptic loosening remains the leading indication for revision surgery, while PJI is the principal cause of failure following RTHA, both as a new infection and as iterative failure. Recurrent dislocation continues to pose a complex challenge despite modern implant strategies, underscoring the need for meticulous surgical planning in high-risk patients.

Aims: Total hip arthroplasty (THA) in the setting of proximal femoral defects and poor bone stock often necessitates distal fixation using specialized implants, such as monolithic tapered, fluted titanium stems (TFTSs), to ensure adequate stability. This study evaluates the mid-term outcomes of TFTS in both primary and revision THA.

Methods: This was a multi-institutional retrospective review of patients who received monolithic TFTS between July 2016 and June 2020 during either complex primary THA or revision THA. Outcomes included pre-, intra- and postoperative characteristics, as well as five-year all-cause, septic and aseptic revisions, and Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS, JR) at different postoperative timepoints.

Results: A total of 115 patients with a mean follow-up of 6.3 years (SD 1.2) were included. Femoral component survivorship free from aseptic revisions was 99.1% (95% CI 97.3 to 100) at 5.1 years after TFTS. Aseptic revision occurred in a single patient (0.9%) due to periprosthetic acetabular fracture that necessitated femoral component removal for exposure 60.6 months following TFTS. Survivorship from septic revisions was 93.2% (95% CI 91.5 to 99.9) at 5.3 years. Septic revisions included debridement, irrigation and exchange of modular components (n = 3, 2.6%), and two-stage revision arthroplasties (n = 4, 3.5%) at a mean of 27.7 months after surgery (1.5 to 63.9). All-cause survivorship from any revision was 92.4% (95% CI 90.5 to 100) at 5.3 years after TFTS. HOOS, JR scores improved from preoperative to five-year follow-up (46.1 (SD 20.8) to 83.8 (SD 19.0), respectively).

Conclusion: The TFTS demonstrates excellent mid-term survivorship (99.1% at five years) and significant clinical improvement in complex primary and revision THA. These outcomes suggest that the TFTS can be considered a valuable option in this challenging patient population.

Aims: Predictive modelling studies are increasingly popular, but the reporting quality in developing and validating these models remains suboptimal. This review aimed to evaluate the methodological quality of predictive models for patient-reported outcomes following total hip arthroplasty (THA) and total knee arthroplasty (TKA), identifying gaps in reporting and biases.

Methods: The review followed PRISMA guidelines, appraising studies that developed and/or validated multivariate predictive models. Methodological quality was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST) tool, and reporting quality was evaluated using Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) guidelines. An electronic search was conducted across MEDLINE, EMBASE, and CINAHL up to 29 May 2025 and several studies from expert recommendation. Studies involving adults (aged ≥ 18 years) undergoing elective primary or revision THA or TKA were included, while univariate analyses and literature reviews were excluded.

Results: The search identified 6,194 results, with 3,793 unique articles. A total of 58 studies were screened, and 41 were included. TRIPOD compliance ranged from 58% to 68%. Overall, 98% of studies had a low risk of bias in participant selection, but 83% showed a high risk of bias in analysis. Applicability concerns were low in 93% of studies.

Conclusion: The review reveals significant methodological limitations in predictive models for THA and TKA outcomes, especially in analysis. Improving adherence to reporting guidelines is essential for enhancing transparency and reliability, ultimately supporting better clinical decision-making and patient outcomes.

Aims: Adolescent idiopathic scoliosis affects 0.2% to 0.5% of adolescents, often requiring bracing to reduce the risk of curve progression. While bracing is typically discontinued at skeletal maturity, significant curve progression can occur afterwards, potentially necessitating surgery. The Bracing AdoleScent Idiopathic Scoliosis (BASIS) 2 study, nested within the larger BASIS trial, aims to evaluate the efficacy of prolonged full-time and night-time bracing beyond skeletal maturity in reducing curve progression. The aim is to determine if six months of additional bracing at normal prescription, after skeletal maturity, significantly reduces curve progression and is acceptable to patients with adolescent idiopathic scoliosis who were successfully treated with bracing.

Methods: This multicentre, prospective, parallel group, pragmatic, open-label, randomized controlled superiority trial will recruit participants from the BASIS study who reach skeletal maturity with a curve < 50°. Participants will be randomized 1:1 to either continue bracing for six months or cease bracing immediately.

Outcomes: The primary outcome is curve progression from baseline to two years post-skeletal maturity. Secondary outcomes include radiological measures, patient bracing experience and any preferences, and cost-effectiveness. The sample size is estimated at 228 participants. Results will be disseminated through peer-reviewed publications, conference presentations, and to study participants.

Aims: Clubfoot (congenital talipes equinovarus) is a significant cause of childhood disability globally, with the highest burden in low- and middle-income countries, particularly in Africa. The Ponseti method has emerged as the gold standard for treating clubfoot; however, evidence on its treatment outcomes across African nations remains scattered. We conducted a systematic review and meta-analysis to evaluate the overall and regional outcomes of the Ponseti method in Africa, focusing on success rate, relapse, treatment failure, brace non-compliance, and loss to follow-up.

Methods: A comprehensive search was conducted in PubMed, Scopus, Hinari, Lens.org, and Google Scholar from inception to 31 May 2025. Additional studies were identified through citation tracking using Citation Chaser. Studies reporting clinical outcomes of the Ponseti method in African populations were included. Quality assessment was conducted using the Joanna Briggs Institute (JBI) checklist. A random-effects model was used to calculate pooled estimates. Subgroup and sensitivity analyses were also performed, and heterogeneity was assessed using I² statistics and p-values.

Results: A total of 47 institution-based studies from 15 African countries involving 7,214 participants and 8,135 feet met the inclusion criteria. The overall success rate was 84.8% (95% CI 78.7 to 91.0) by participants and 83.5% (95% CI 78.9 to 88.2) by feet. Relapse was reported in 11.7% (95% CI 7.8 to 15.7) of participants and 12.6% (95% CI 9.3 to 15.9) of feet. Tenotomy was performed in 65.6% of participants and 59.5% of feet. Treatment failure affected 5.1% of feet. Loss to follow-up was 17.4%, and brace non-compliance occurred in 9.2% of patients. Subgroup analysis showed the highest success rate in West Africa (90%) and the lowest in East Africa (73%). Heterogeneity was substantial (I² > 85%).

Conclusion: The Ponseti method shows high effectiveness in African settings. However, relapse and follow-up issues remain key challenges. Hence, region-specific strategies are needed to improve long-term outcomes.