Bone & Joint Open最新文献

Aims: The objective of this study was to perform a long-term comparative analysis of patients who underwent total hip arthroplasty (THA) with a history of previous ipsilateral hip arthroscopy (PA) to a propensity-score matched control group of primary THA with no prior hip arthroscopy (NPA).

Methods: Data were analyzed from patients who underwent primary THA for symptomatic hip osteoarthritis between November 2010 and November 2013. Patients included had completed a minimum of ten years of patient-reported outcome measure questionnaires. The PA group was propensity-score matched 1:1 based on age at THA, BMI, sex, robotic assistance, approach, and laterality to the NPA group. Clinical hip arthroplasty outcome thresholds, complications, and revision surgery rates were compared between cohorts. A Kaplan-Meier analysis was performed to assess survivorship.

Results: A total of 108 patients were included, 54 in each group. The groups displayed comparable outcomes at minimum ten-year follow-up, for modified Harris Hip Score (mHHS) (p = 0.370), Harris Hip Score (HHS) (p = 0.370), Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR) (p = 0.380), Forgotten Joint Score (FJS) (p = 0.250), visual analogue scale (VAS; p = 0.150), and patient satisfaction (p = 0.310). The two groups reached Patient Acceptable Symptom State (PASS) for FJS, HHS, and HOOS-JR at similar rates (p > 0.05). The PA group exhibited a significantly higher complication rate, with 11 major complications compared to two in the NPA group, translating to a relative risk of 2.8 (p < 0.033). Among the major complications in the PA group, nine required revision surgery, resulting in a relative risk of 4.5 (p < 0.047).

Conclusion: Patients undergoing primary THA with a history of prior hip arthroscopy achieve similar long-term functional outcomes compared to a propensity-matched control group. However, they face a 2.8-fold increased risk of complications and a 4.5-fold higher risk of major complications requiring revision THA.

Aims: Postoperative periprosthetic femoral fractures (POPFFs) following hip arthroplasty pose complex challenges, with differences in management and outcomes across healthcare facilities. However, there is limited published literature on such variability to inform improvement initiatives. This study aims to quantify the between-hospital variations in surgical management and short-term outcomes.

Methods: Administrative hospitalizations data from all 177 NHS hospital Trusts in England were analyzed for patients aged 18 years and above with a primary diagnosis of POPFF between April 2016 and December 2022. Patient demographic characteristics, comorbidities, procedures, length of stay, in-hospital mortality, 30-day total mortality (in or out of hospital), and emergency 30-day all-cause readmissions were extracted. Multilevel models with random intercepts for hospitals and funnel plots assessed the non-random variations between hospitals in procedures and outcomes.

Results: Among 39,035 hospitalized patients, 66% were female (n = 25,720), with a median age of 82 years (IQR 73 to 88). Hospital variation existed in treatment outcomes, with adjusted intraclass correlation coefficients for fixation without revision, revision, and no surgical procedure of 4.0%, 3.8%, and 2.4%, respectively. Funnel plots revealed hospital outliers for procedure choice after adjusting for age, sex, and number of comorbidities - among 177 hospitals, nine (5.1%) exceeded the upper 95% control limit for fixation and 17 (9.6%) did so for revision; outlier proportions were 14.1% for length of stay, 3.9% for emergency 30-day readmission, and 1.1% for mortality.

Conclusion: Inter-hospital variation exists for the management and short-term outcomes following POPFFs in England. This warrants further explanation to better understand the reasons for this.

Aims: The epidemiology of proximal humerus fractures (PHFs) has been described in terms of incidence, fracture complexity, and general time trends, but current literature on time trends in PHF complexity is limited. This study aims to explore possible time trends in PHF complexity and report the distribution of different types of PHF from January 1944 to December 2020.

Methods: The city of Malmö, Sweden, has one emergency hospital where acute fractures are treated, and radiographs have been saved for almost a century. One author reviewed and classified relevant radiological examinations in individuals aged ≥ 18 years with a PHF during 17 sample years from 1944 to 2020 in Malmö using the Neer and AO classifications.

Results: Of the 3,031 identified PHFs, 2,216 (73%) were sustained by women (mean age 69 years (SD 14)) and 815 (27%) by men (mean age 59 years (SD 17)). We saw no obvious time trend in fracture complexity overall, for men and women separately, or for different age groups. Fracture complexity according to AO was higher in older than younger age groups, which was true also with the Neer classification for women. However, for men, according to the Neer classification, the fracture complexity was higher in younger than older age groups.

Conclusion: We found no obvious time trend in fracture complexity with the Neer or AO classification systems from 1944 to 2020.

Aims: The primary aim of this trial is to investigate whether two novel robotic-assisted tendon-sparing posterior approaches to total hip arthroplasty (THA) surgery, the piriformis-sparing posterior approach (PSPA) and the spare piriformis and internus, repair externus technique (SPAIRE), improve early patient outcomes in THA compared with a robotic-assisted standard posterior approach (PA).

Methods: HIP Surgical Techniques to Enhance Rehabilitation (HIPSTER) is a single-centre, double-blind, parallel three-arm, individually randomized, controlled, superiority trial. A total of 309 participants aged over 18 years who have been listed for an elective THA will be recruited. Participants will be randomized in a 1:1:1 ratio to SPAIRE:PSPA:PA, using minimization (with a random element) on sex (males; females), age (< 50 years; ≥ 50 years), and BMI (< 30 kg/m²; ≥ 30 kg/m²). The primary outcome is the patient-reported outcome of Oxford Arthroplasty Early Recovery Score (OARS), assessed six weeks after surgery. Secondary outcome measures include blood biomarkers, activity monitoring, and patient-reported outcome measures.

Conclusion: The trial will assess whether the two novel robotic-assisted tendon-sparing posterior approaches to THA surgery, the PSPA and SPAIRE, improve patient outcomes in THA compared with a robotic-assisted standard PA. If successful, it is anticipated that the results of this trial will provide the evidence necessary to plan a future multicentre, randomized-controlled trial to compare the best-performing tendon-sparing approach (PSPA or SPAIRE) identified in this efficacy trial with the gold standard PA, to assess whether the efficacy results are generalizable across the NHS. At the time of the submission, the trial is currently completing recruitment, and the follow-up will be completed in 2026.

Aims: The Oxford Knee Score (OKS) is an established and validated outcome measure of knee arthroplasty (KA), but it is not clear how responses to each of the 12 questions relate to satisfaction. The aim was to assess which of 12 OKS questions were associated with patient satisfaction after KA.

Methods: This single-centre retrospective cohort study was conducted over an eight-year period from January 2014 to December 2021. A total of 3,361 patients completed preoperative and six months postoperative OKS. The mean age was 69.9 years (34 to 94, SD 9.3), and 1,792 were female (55.0%). Patient satisfaction with their KA was assessed at six months, which was categorized into satisfied (satisfied, very satisfied) and dissatisfied (neutral, dissatisfied, very dissatisfied).

Results: All 12 questions demonstrated significant improvements postoperatively (p < 0.001), with moderate (q2/3/7) to large (q1/4/5/6/8/9/10/11/12) effect sizes. There were 2,704 patients (82.9%) who were satisfied with their KA at six months. Satisfied patients had significantly greater improvements (p < 0.001) in each of the OKS questions, with the greatest differences found in questions 6 (limping; mean difference (MD) 1.41 (95% CI 1.29 to 1.53)) and 1 (pain; MD 1.32 (95% CI 1.22 to 1.42)). Preoperative responses to each of the OKS questions demonstrated poor discriminatory ability to predict patient satisfaction (area under the curve < 0.70). Improvement in questions 1 (pain; odds ratio (OR) 1.72 (95% CI 1.51 to 1.96), p < 0.001), 6 (limping; OR 1.28 (95% CI 1.16 to 1.41), p < 0.001), 7 (kneeling; OR 1.20 (95% CI 1.06 to 1.35), p = 0.003), 8 (night pain; OR 1.11 (95% CI 1.01 to 1.23), p = 0.038), 9 (working; OR 1.21 (95% CI 1.05 to 1.39), p = 0.015), and 12 (stairs; OR 1.42 (95% CI 1.25 to 1.63), p < 0.001) were independently associated with satisfaction.

Conclusion: Improvements in six of the 12 OKS questions were independently associated with patient satisfaction; these could be prioritized as areas to be addressed following KA, and modification of related patient expectations may improve satisfaction with surgery.

Aims: Leg-length discrepancy (LLD) following total hip arthroplasty (THA) is a source of patient dissatisfaction and morbidity. The objectives of this study were to characterize LLD following revision THA (rTHA) and evaluate the difference in LLD between navigated and non-navigated rTHA.

Methods: This retrospective cohort study included 202 patients treated with rTHA performed between 2017 and 2021. An a priori power analysis determined that 101 patients in each group were required. Navigated and non-navigated rTHA were compared with regard to LLD (absolute value), re-revision rate, and patient-reported outcome measures (PROMs).

Results: Mean postoperative LLD was 4.3 mm (SD 4.6) in all patients. In navigated rTHA, mean postoperative LLD of 3.7 mm (SD 4.7) was lower than preoperative LLD (7.5 mm (SD 6.1); p < 0.001). In non-navigated rTHA, postoperative LLD of 4.9 mm (SD 4.3) was lower than preoperative LLD (7.8 mm (SD 6.6); p < 0.001). Postoperative LLD was significantly lower in navigated compared with non-navigated rTHA in all patients and in sub-groups with preoperative LLD < 5 mm (1.7 mm vs 3.5 mm), < 10 mm (2.8 mm vs 3.9 mm), < 15 mm (3.0 mm vs 4.1 mm), and < 20 mm (3.3 mm vs 4.7 mm), respectively (p < 0.05). Based on revision type, postoperative LLD was significantly lower in navigated rTHA compared to non-navigated rTHA in those with both-component and acetabular component-only revisions (p < 0.05). Subsequent re-revision was required in three navigated rTHAs (3%) and eight non-navigated rTHAs (8%, p = 0.121). Changes in patient-reported Hip injury and Osteoarthritis Outcome Score Joint Replacement, Lower Extremity Activity Scale, and pain were not significantly different between navigated and non-navigated patients.

Conclusion: Postoperative LLD was improved relative to preoperative LLD in rTHA with and without the use of navigation. Postoperative LLD was significantly lower in navigated rTHA compared with non-navigated rTHA. There was no significant difference in PROMs between groups. Based on these results, computer-assisted navigation seems to optimize leg-length correction and should be considered for use in rTHA involving the acetabular component, including both-component and acetabular component-only revisions. Of note, the present study was not designed to validate all aspects of all parameters of computer navigation; rather, it was specifically designed to assess LLDs when using navigation. Therefore, the present results only cover the topic of LLD when using navigation in comparison with manual techniques.

Aims: To systematically review published evidence of outcomes reported in trials of knee injuries in children and adolescents.

Methods: We searched the following databases from inception to 29 July 2024: OVID MEDLINE, Embase, Cochrane CENTRAL, Clinicaltrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). In total, 13,146 studies were identified; after removing duplicates, 9,796 studies were yielded for screening following PRISMA guidelines. Data extraction was performed by two researchers, and 15 trials were included in the final analysis. Outcomes reported by trials were mapped to the domains within the WHO International Classification of Function framework (ICF), comprising four main categories: Body functions (b), Activities and participation (d), Environmental factors (e), and Body structure (s).

Results: A total of 83 outcomes were identified from 15 trials, representing 35 WHO domains. The most common domain reported mapped to the ICF framework was structure of the lower limb (s750; 93.3%), followed by sensation of pain (b280; 86.7%), mobility of joint function (b710; 86.7%), and function of the joints and bones (b729; 86.7%). Patient satisfaction was reported in two trials (13.3%) trials. Primary outcomes were not reported in seven trials (46.6%). Pedi-International Knee Documentation Committee (IKDC) was the most common patient-reported outcome measure in seven trials (46.6%).

Conclusion: Outcome measure tools reported in children and adolescent knee injuries are highly variable and inconsistent. Currently, there are no core outcome sets (COS) for these injuries, highlighting an urgent need to improve standardization and consistency in trial reporting. A key recommendation for the COS development is accounting for pathology-specific subcategories, given the difference in emphasis on WHO ICF domains across various knee injuries. In the future, these approaches will ensure the COS has comprehensive yet unique priorities for each condition.

Aims: Periprosthetic femoral fractures (PFF) around hip arthroplasty implants are increasingly common, often occurring in frail elderly patients. Polished taper-slip (PTS) cemented femoral components are commonly used and have been associated with increased PFF rates compared with other cemented femoral component types. In managing Unified Classification System (UCS) type B fractures around PTS stems, surgical treatment options include open reduction and internal fixation (ORIF) and revision arthroplasty (RA), but there is limited evidence comparing these.

Methods: A systematic review and meta-analysis was undertaken. Results from database searching were screened and data were extracted by two authors independently. Reoperation was the primary outcome measure, and the secondary outcome measures included mortality, blood transfusion requirements, and length of stay.

Results: There were 4,640 unique results, and four comparative studies were included in the final analysis. These were published between 2015 to 2023, totalling 539 patients, with 339 treated with ORIF and 200 treated with RA. There was a signal for a clinically large, but not statistically significant, benefit of ORIF compared with RA in reoperation risk (risk ratio (RR) 0.444; 95% CI 0.162 to 1.218; p = 0.115), with an absolute risk reduction of 9.15%. There was also a non-significant signal for increased mortality in the ORIF group at both 90 days and one year. ORIF was associated with a significant decrease in blood transfusion requirements (RR 0.65; 95% CI 0.482 to 0.876; p = 0.005), with an absolute risk reduction of 14.07%. There was also a significant decrease in length of stay following ORIF (mean reduction 2.45 days; 95% CI 0.09 to 4.82; p = 0.042).

Conclusion: Fixation alone is associated with significantly reduced length of stay and blood transfusion, and also with a trend towards reduced reoperation and increased mortality, which may reflect a frailer patient group that receive this treatment, but neither of these findings reached statistical significance. Fixation may have benefits when applied in suitable cases.

Aims: Extendable endoprostheses are utilized to reconstruct segmental defects following resection of bone sarcomas in skeletally immature children. However, there remains a paucity of data regarding long-term functional and quality of life outcomes.

Methods: We conducted a retrospective, multicentre study and reviewed 45 children who underwent cementless minimally invasive extendable endoprosthetic replacement. Anatomical sites included the distal femur (n = 29), proximal femur (n = 4), proximal tibia (n = 11), and total femur (n = 1). The mean follow-up period was 12 years. The mean age at extendable endoprosthetic replacement was ten years (5 to 15). Most patients (96%, 43/45) had reached skeletal maturity at the final follow-up.

Results: The ten-year endoprosthetic failure-free survival rate was 60%. Of the 45 patients, 25 (56%) had 42 complications which were frequently related to structural failure (45%, 19/42), with extension mechanism jamming being the most common (n = 7, 17%). Excluding lengthening procedures, 20 patients (44%) underwent additional surgery with a mean of two surgeries per patient. The mean limb-length discrepancy at the final follow-up was 2.3 cm. Limb salvage was achieved in 44 (98%) patients. The mean Musculoskeletal Tumor Society (MSTS) scores, Toronto Extremity Salvage Score (TESS), and EuroQol five-dimension five-level questionnaire (EQ-5D-5L) were 78%, 92%, and 92% at the last follow-up, respectively. Multiple additional surgeries (≥ 2 times) for complications were associated with worse MSTS scores compared with those without multiple additional surgeries (p = 0.009). Moreover, limb-length discrepancy > 3 cm showed significantly worse MSTS scores compared with those ≤ 3 cm (p = 0.019).

Conclusion: Extendable endoprostheses were associated with a high complication rate and need for additional surgeries over time, especially for structural-related complications. Despite this, successful limb salvage with reasonable function/quality of life and small limb-length discrepancy were achievable in the long term. Patients' function in the long term depended on the experience of postoperative complications and limb-length discrepancy.

Aims: To conduct a scoping review into the use of allograft in primary anterior cruciate ligament (ACL) reconstruction, and to ascertain the variability in reporting outcomes in the literature.

Methods: The study was conducted in line with the Preferred Reporting Items for Systematic reviews and Meta-Analayses (PRISMA), and also used Arksey and O'Malley's established five-stage process for scoping reviews in order to map the literature for allograft use in primary ACL reconstruction. Following screening to identify eligible studies, data were extracted and mapped to provide a descriptive and thematic analysis.

Results: A total of 421 studies were identified from the initial search, with 77 studies eligible for final scoping review published from January 1993 to December 2024. The majority of studies were published from the USA and China (56/77, 72.3%). Nine studies (9/77, 11.7%) were level1 evidence. Key variables such as graft diameter (27/77, 33.8%), graft processing (27/77, 35.1%), and cost of graft (3/77, 3.9%) were significantly under-reported. For clinical outcomes, the Lachman score (45/77, 57.1%), pivot shift grade (45/77, 58.4%), and graft re-rupture rate (42/77, 54.5%) were highest reported. For functional outcomes, two predominant scores were recorded, the International Knee Documentation Committee score (52/77, 67.5%) and the Tegner-Lysholm knee score (48/77, 62.3%). A total of 30 functional outcomes were recorded, spanning all studies.

Conclusion: This scoping review identified 77 studies which analyzed allografts in primary ACL reconstruction. There is great variability in the reporting standards, with significant under-reporting of important variables. Further research is required to develop standardized reporting criteria in order to accurately reflect the outcomes of allografts in primary ACL reconstruction.