Bone & Joint Open最新文献

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.

Aims: This study compares health-related quality of life (HRQoL) between patients undergoing primary total hip arthroplasty (THA) for osteoarthritis (OA) and a propensity-matched general population cohort. We also aimed to clarify the relationship between BMI and postoperative improvements, mediated via preoperative HRQoL.

Methods: In this retrospective study using the Edinburgh Arthroplasty database (1 January 2013 to 31 December 2022; n = 3,495) and Health Survey for England data (2010 to 2012; n = 25,320), propensity score matching (1:1) was performed based on age, sex, and BMI. The primary outcome was EuroQol five-dimension three-level questionnaire (EQ-5D-3L) index score. Secondary outcomes included EuroQol-visual analogue scale (EQ-VAS) and mediation analysis examining how preoperative EQ-5D-3L mediated the relationship between BMI and postoperative improvement.

Results: Preoperatively, THA patients had significantly lower EQ-5D-3L scores compared with matched general population (median difference: 0.280, bootstrapped 95% CIs; 0.258 to 0.306; p < 0.001). At one-year follow-up, THA patients exceeded population norms (THA median: 0.814 vs general population: 0.796, p = 0.014). Patients aged > 85 years showed the greatest magnitude of improvements, restoring EQ-5D-3L scores equivalent with their age-matched general population peers (preoperative: 0.189 vs postoperative: 0.796, general population: 0.696). Mediation analysis revealed that BMI's negative direct effect on improvements in EQ-5D-3L was counterbalanced by stronger indirect effects transmitted through preoperative scores (indirect effects: obesity I (30 to 34.9 kg/m²): β = 0.038, p < 0.001; obesity II (35 to 39.9 kg/m²): β = 0.086, p < 0.001; obesity III (≥ 40 kg/m²): β = 0.123, p < 0.001).

Conclusion: THA was shown to restore HRQoL to that expected of a matched normal population, but in younger patients this was less than expected. Patients aged > 85 years had the greatest magnitude of restoration. Postoperative HRQoL improvement was predominantly influenced by preoperative functional status, rather than BMI alone. These findings challenge current BMI-based eligibility thresholds and support surgical prioritization based on functional impairment severity.

Aims: Radiofrequency ablation (RFA) is the gold standard for treating symptomatic osteoid osteoma (OO), yet risk factors for recurrence and complications remain poorly understood. This study aims to identify predictors of recurrence and local complications following RFA.

Methods: A retrospective cohort study of OO patients treated with RFA at two academic medical centres between January 2010 and December 2024 was conducted. Primary outcomes were recurrence, defined as the return of symptoms with radiological confirmation, and post-procedural complications. Secondary outcomes included clinical success (complete pain resolution) and technical success (procedure done according to protocol). Descriptive, univariable, multivariable, and survival analyses were performed, with a sub-analysis of anterior tibial lesions.

Results: A total of 272 patients were included. The median age was 20 years (IQR 16 to 26), and 189 of patients were male (69.5%). The most common locations for OO were the femur (41.9%, n = 114), tibia (26.5%, n = 72), and foot (11.4%, n = 31). The median tumour size was 7 mm (IQR 6 to 10) . Recurrence occurred in 5.5% (n = 15) of cases, with spinal location as a risk factor (odds ratio (OR) 6.22; p = 0.048). Complications were observed in 4% (n = 11) of patients, with increased risk in females (OR 5.17; p = 0.014) and those with tibial lesions (OR 13.23; p = 0.018). In tibial lesions, an anterior approach with the RFA probe was associated with a higher rate of wound infection (100% vs 0%; p = 0.028).

Conclusion: RFA is a highly effective treatment for OO, with low rates of recurrence and complications. The identified risk factors underscore the need for tailored treatment plans. Furthermore, the anterior tibial approach should consistently incorporate a soft-tissue buffer to minimize the risk of wound infection.

Aims: Newer disease-modifying agents (DMA) targeting the involved survival motor neurone genes (SMN1 and SMN2) associated with spinal muscular atrophy (SMA) have improved gross motor function, but their impact on postoperative outcomes after scoliosis correction remains unclear. This study aimed to evaluate postoperative outcomes following scoliosis surgery, specifically analyzing the impact of functional level, genetic severity, and DMA use.

Methods: This retrospective cohort study evaluated patients with SMA (all types) who underwent scoliosis correction (growing rods (GR) or posterior spinal fusion (PSF)), with a minimum two-year postoperative follow-up. The primary outcome was 90-day postoperative complications by Clavien-Dindo (CD) grading. Secondary outcomes included age at surgery, SMA type, SMN2 copy number, Hammersmith Functional Motor Scale-Expanded, forced vital capacity, DMA treatment (> one year duration, nusinersen/risdiplam/onosemnogene abeparvovec), intensive care unit (ICU)/hospital length of stay (LOS), days intubated, and curve correction.

Results: In total, 87 patients (60% female), SMA types 1 (29, 33%), 2 (47, 54%), and 3 (11, 13%), were included; follow-up duration was 6.8 years (SD 4.5). PSF was performed for 62 (71%) and GR for 23 (26%) at ages 12.0 (SD 2.4) and 6.2 (SD 2.9) years, respectively. For those with DMA treatment preoperatively, postoperative complications were less severe compared with no DMA use (CD 1 to 2/CD 3 to 5: 24 (100%)/0 (0%) vs 39 (65%)/21 (35%), respectively, p = 0.005) and ICU LOS (3.0 (SD 1.2) vs 4.7 (SD 4.7) days; p = 0.048), total hospital LOS (5.0 (SD 3.4) vs 7.8 (SD 4.8) days; p < 0.001), and days intubated (0.1 (SD 0.3) vs 1.8 (SD 2.3) days; p < 0.001) were less. DMA use was associated with no deterioration in pulmonary function (p = 0.094) compared with untreated patients (p < 0.001).

Conclusion: Postoperative complications were less severe (CD 1 to 2) with preoperative DMA treatment. Coupled with DMA use, pulmonary function was stabilized after scoliosis surgery at almost seven years' follow-up. Improvements in hospital LOS and days intubated postoperatively are potential benefits of preoperative DMA treatment, serving to increase confidence to offering these major orthopaedic surgeries for patients with SMA. Improvements in outcomes may also reflect advances in surgical techniques and perioperative care over the study period. Further comparative studies are warranted to better isolate the specific impacts of DMA treatment.

Aims: To compare the outcomes of robotic arm-assisted (rUKA) and manual unicompartmental knee arthroplasty (mUKA) during the learning phases of a single surgeon. Previous comparisons have not accounted for the recognized learning curve of mUKA.

Methods: This retrospective study included 109 patients (n = 37 rUKA, n = 72 mUKA) treated by a single surgeon during their learning curve at two centres during the same period. Inclusion criteria encompassed isolated medial compartment osteoarthritis with correctable deformities. Outcomes included patient-reported outcome measures (PROMs), implant positioning accuracy and precision, operating time, complications, and implant survival. Learning curves for both groups were analyzed using cumulative sum (CUSUM) analysis and breakpoint detection using piecewise linear regression.

Results: There were no differences in baseline characteristics between groups, except for American Society of Anesthesiologists (ASA) grade I, which was more prevalent in the rUKA group (p = 0.017). While both groups achieved similar PROMs postoperatively, the rUKA group showed greater improvement in Oxford Knee Score, being significantly more likely to achieve the minimal important change and/or patient-acceptable symptom state (p = 0.014). No learning curve was seen for PROMs in either group. The learning curve to competency for operating time was shorter for rUKA (13 cases) compared with mUKA (45 cases). rUKA demonstrated significantly higher accuracy and precision across all radiological planes (p ≤ 0.005) with no observable learning curve, whereas the mUKA group had a learning phase for implant positioning that took 25 cases, and competency was not reached until case 55. Tibial overhang occurred in eight mUKA cases and none in rUKA (p = 0.033). At a median follow-up of over six years, all four revisions occurred in the mUKA group, however this was not statistically significant (p = 0.141).

Conclusion: rUKA demonstrated a greater likelihood of achieving clinically meaningful outcomes, a shorter learning curve, and improved implant positioning accuracy and precision, compared with mUKA, when performed during the surgeon's learning phase.

Aims: High-quality clinical trials in adolescent idiopathic scoliosis (AIS) are needed to guide decision-making but progress is hindered by suboptimal selection of outcome measures. Identifying meaningful outcomes for consistent measurement across clinical trials and routine practice is critical. However, there is currently no understanding of which treatment outcome domains are considered important by adolescents, their parents, and healthcare professionals (HCPs). This study is the first to address this gap internationally.

Methods: This study represents the first stage of core outcome set (COS) development, following gold-standard guidance. A cross-sectional qualitative interview study with 40 participants (adolescents with AIS, their parents, and HCPs) was conducted. Semi-structured interviews were analyzed to identify and categorize important AIS treatment outcomes. Analytical rigour was ensured through coder agreement and stakeholder consultation.

Results: A total of 91 important outcome domains were identified; 53 outcome domains applying to both bracing and surgery, with 15 additional outcome domains for bracing only, and 23 additional outcome domains for surgery only. Of the 91 outcome domains, more than three-quarters (71/91, 78%) related to life impact, with smaller proportions relating to physiological/clinical outcomes (13/91, 14%), resource use (4/91, 4%), and adverse events (1/91, 1%).

Conclusion: The current study highlights treatment outcomes considered important by adolescents with AIS, their parents, and HCPs. These findings will inform outcome selection in clinical trials and routine practice, as well as facilitating an ongoing programme of research to develop a COS for evaluating treatment of AIS.

Aims: Fragility hip fractures are a growing concern, increasing year on year by just over 1%. These injuries carry high mortality rates and often result in poor functional outcomes, especially in frail patients. Early mobilization after surgery has been linked to better survival and shorter hospital stays. While Enhanced Recovery After Surgery (ERAS) protocols are well established in elective orthopaedics, their application in hip fracture care remains limited due to the frailty of this patient group.

Methods: The Cardiac Chair Position (CCP), originally used in cardiac surgery, may support early mobilization by helping patients transition from supine to standing. This study evaluated the impact of incorporating CCP into day 1 rehabilitation for hip fracture patients. This observational cohort study compared two six-month periods: June to November 2019 (standard care) and June to November 2021 (standard care plus CCP). A total of 270 patients aged 65 years and older with neck of femur fractures from low-energy trauma were included.

Results: Patients were divided into two groups: those who received standard bed exercises, and those who also used the CCP. Researchers collected data on day 1 mobility, postural hypotension, inpatient mortality, 30-day survival, length of hospital stay, and discharge destination. No significant differences were observed in postural hypotension, mortality, length of stay, or discharge destination. However, the CCP group showed significantly improved day 1 mobility with an increased proportion of patients demonstrating the ability to push-off the bed, stand and step, transfer to a chair, and walk.

Conclusion: Although CCP did not affect survival or hospital stay, it did enhance day 1 mobility. Given its simplicity, CCP is a promising addition to hip fracture rehabilitation. Further studies, including randomized trials and cost-effectiveness assessments, are needed to confirm its broader benefits. This research underscores the importance of early mobilization in elderly patients with fragility fractures.

Aims: Perthes' disease is a childhood hip condition that requires prolonged management, which often includes physiotherapy and education. Families and clinicians have highlighted a need for optimized self-management. The NON-STOP app was developed as a digital self-management intervention. The app incorporates exercises, educational content, and a reward system including a customisable avatar to motivate children to engage. This study assessed the usability and acceptability of the NON-STOP app in preparation for a definitive clinical trial.

Methods: A mixed-methods study was undertaken, involving an observational before-and-after study, with a nested focus group study. Children with Perthes' disease from three UK NHS centres were recruited and used the Non-Surgical Treatment of Perthes' (NON-STOP) app for six weeks. Quantitative data included app engagement metrics, quality of life and function (for follow-up completion rates), physical activity levels (Children's Physical Activity Questionnaire), and app-usability (Health Information Technology Usability Evaluation Scale (Health ITUES)). Following this, focus groups with participating families explored their experiences to explore usability and acceptability in more detail and also inform refinement of the app.

Results: A total of 31 children were recruited, 20 of whom completed post-trial data. Health ITUES scores demonstrated high usability, with particularly high scores in 'perceived ease of use' and 'usefulness'. Engagement was highest in the first three weeks, with a decline thereafter. Focus group participants described the app as more engaging than previous self-management tools (e.g. paper handouts), citing rewards, avatars, and a user-friendly layout as positive elements. Suggested improvements included further personalization and inclusion of videos in the education section of the app.

Conclusion: The NON-STOP app was found to be both usable and acceptable by children with Perthes' disease and their families. Insights from this study have informed further refinements to the app in preparation for its integration in Op NON-STOP trial, the first randomized clinical trial comparing surgical and non-surgical treatment in Perthes' disease.

Aims: Obesity is associated with increased surgical complexity and poorer postoperative outcomes after primary total hip arthroplasty (THA), yet its impact on revision THA remains unclear. This study evaluates the relationship between BMI and outcomes following revision THA.

Methods: We analyzed prospectively collected data from patients who consented to participation in the Perioperative Quality Improvement Programme (PQIP) research study. All patients undergoing revision THA from May 2018 to December 2022 were included. Patients were stratified into BMI categories, and outcomes were assessed using the EuroQol five-dimension five-level questionnaire (EQ-5D-5L) at baseline, six, and 12 months postoperatively. Statistical comparisons were performed to evaluate differences in health-related quality of life (HRQoL) between BMI groups.

Results: Higher BMI was associated with lower preoperative EQ-5D scores. However, all BMI groups demonstrated significant postoperative improvement, with the greatest gains observed in patients with a BMI > 40 kg/m². At six and 12 months, HRQoL improvements were comparable across BMI groups, with no significant difference in long-term outcomes between those living with and without obesity.

Conclusion: Despite potentially increased intraoperative risks, high BMI patients experience meaningful functional improvement following revision THA. These findings challenge the rationale for BMI-based surgical restrictions, suggesting that high BMI alone should not be a contraindication for revision THA.