Pub Date : 2025-02-01DOI: 10.1302/0301-620X.107B2.BJJ-2024-0749.R2
Codrin Popa, Marie Le Baron, Émile Dobelle, Xavier Flecher, Solène Prost, Matthieu Ollivier, Jean-Noel Argenson, Christophe Jacquet
Aims: The aim of this study was to assess the necessity of revising the acetabular component in revision total hip arthroplasty (THA) in patients with a Vancouver type B2 periprosthetic femoral fracture (PFF) who require revision of the femoral component. The hypothesis was that revision of both the acetabular and femoral components and using a dual-mobility acetabular component would provide a lower postoperative risk of dislocation, without increasing perioperative morbidity and mortality.
Methods: Data were retrospectively analyzed from a continuously gathered database. We included 150 revisions, performed between January 2015 and December 2022, in 150 patients, with 81 revisions limited to only the femoral component and 69 involving revision of both components. This resulted, after surgery, in 60 patients having a simple-mobility acetabular component and 90 having a dual-mobility component. The mean age of the patients was 79.7 years (SD 10.1), and 98 were female (65.3%). The mean follow-up was 31 months (SD 2.3).
Results: There were no significant differences between those in whom only the femoral component was revised and those in whom both components were revised with the use of a dual-mobility acetabular component for the rate of intraoperative complications, postoperative mortality, blood loss, the requirement of a blood transfusion, medical complications, dislocation (11/81 in the femoral component-only group vs 6/69 in the femoral + acetabular component revision group) or the overall need for reoperation at the final follow-up. Patients were at a significantly higher risk for dislocation when a simple-mobility component was retained (18.3% (n = 11) vs 6.7% (n = 6) for dual-mobility implants; p = 0.036). The revision rate prompted by postoperative instability was significantly higher in patients in whom a simple-mobility acetabular component was retained at revision (10% (n = 6) vs 0%; p = 0.002).
Conclusion: Based on these results, concurrent revision of the acetabular component was not associated with a higher rate of mortality or increased morbidity and patients in whom a dual-mobility acetabular component was used were significantly less prone to dislocation. We thus recommend routine revision of the acetabular component in favour of a dual-mobility component for patients sustaining a Vancouver B2 PFF requiring revision of the femoral component if their initial THA included a simple-mobility acetabular component.
{"title":"The impact of acetabular revision in revision total hip arthroplasty for a Vancouver B2 fracture requiring a change of femoral component.","authors":"Codrin Popa, Marie Le Baron, Émile Dobelle, Xavier Flecher, Solène Prost, Matthieu Ollivier, Jean-Noel Argenson, Christophe Jacquet","doi":"10.1302/0301-620X.107B2.BJJ-2024-0749.R2","DOIUrl":"https://doi.org/10.1302/0301-620X.107B2.BJJ-2024-0749.R2","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to assess the necessity of revising the acetabular component in revision total hip arthroplasty (THA) in patients with a Vancouver type B2 periprosthetic femoral fracture (PFF) who require revision of the femoral component. The hypothesis was that revision of both the acetabular and femoral components and using a dual-mobility acetabular component would provide a lower postoperative risk of dislocation, without increasing perioperative morbidity and mortality.</p><p><strong>Methods: </strong>Data were retrospectively analyzed from a continuously gathered database. We included 150 revisions, performed between January 2015 and December 2022, in 150 patients, with 81 revisions limited to only the femoral component and 69 involving revision of both components. This resulted, after surgery, in 60 patients having a simple-mobility acetabular component and 90 having a dual-mobility component. The mean age of the patients was 79.7 years (SD 10.1), and 98 were female (65.3%). The mean follow-up was 31 months (SD 2.3).</p><p><strong>Results: </strong>There were no significant differences between those in whom only the femoral component was revised and those in whom both components were revised with the use of a dual-mobility acetabular component for the rate of intraoperative complications, postoperative mortality, blood loss, the requirement of a blood transfusion, medical complications, dislocation (11/81 in the femoral component-only group vs 6/69 in the femoral + acetabular component revision group) or the overall need for reoperation at the final follow-up. Patients were at a significantly higher risk for dislocation when a simple-mobility component was retained (18.3% (n = 11) vs 6.7% (n = 6) for dual-mobility implants; p = 0.036). The revision rate prompted by postoperative instability was significantly higher in patients in whom a simple-mobility acetabular component was retained at revision (10% (n = 6) vs 0%; p = 0.002).</p><p><strong>Conclusion: </strong>Based on these results, concurrent revision of the acetabular component was not associated with a higher rate of mortality or increased morbidity and patients in whom a dual-mobility acetabular component was used were significantly less prone to dislocation. We thus recommend routine revision of the acetabular component in favour of a dual-mobility component for patients sustaining a Vancouver B2 PFF requiring revision of the femoral component if their initial THA included a simple-mobility acetabular component.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 2","pages":"164-172"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1302/0301-620X.107B2.BJJ-2024-0160.R3
Rald V M Groven, Ümit Mert, Johannes Greven, Klemens Horst, Virginie Joris, Lara Bini, Martijn Poeze, Taco J Blokhuis, Markus Huber-Lang, Frank Hildebrand, Martijn van Griensven
Aims: The aims of this study, using a porcine model of multiple trauma, were to investigate the expression of microRNAs at the fracture site, in the fracture haematoma (fxH) and in the fractured bone, compared with a remote unfractured long bone, to characterize the patterns of expression of circulating microRNAs in plasma, and identify and validate messenger RNA (mRNA) targets of the microRNAs.
Methods: Two multiple trauma treatment strategies were compared: early total care (ETC) and damage control orthopaedics (DCO). For this study, fxH, fractured bone, unfractured control bone, plasma, lung, and liver samples were harvested. MicroRNAs were analyzed using quantitative real-time polymerase chain reaction arrays, and the identified mRNA targets were validated in vivo in the bone, fxH, lung, and liver tissue.
Results: MicroRNA expression was associated with the trauma treatment strategy and differed depending on the type of sample. In the ETC group, a more advanced fracture healing response, as reflected by the expression of osteogenic microRNAs, was seen compared with the DCO group. DCO treatment resulted in a more balanced immune response in the systemic circulation as represented by significant upregulations of several anti-inflammatory microRNAs. The in vivo validation of the abundance of putative mRNA targets reflected the levels of microRNAs which were identified.
Conclusion: Local and systemic microRNA patterns of expression were identified, specific for the treatment strategy in multiple trauma, which corresponded with the expression of mRNA at the fracture site and in target organs. These findings match clinical observations and offer insights into the cellular communication which may underlie the effects of using different surgical strategies in patients with multiple trauma, both locally and systemically. We also identified a systemic involvement of microRNAs in multiple trauma which may include distant cellular communication between injured tissues. Further research may further describe the temporospatial role of circulating microRNAs after multiple trauma, their potential role in communication between organs, and prospective therapeutic applications.
{"title":"Early total care and damage control orthopaedics result in partially contrasting patterns of microRNA expression at the fracture site and in the systemic circulation : an animal study.","authors":"Rald V M Groven, Ümit Mert, Johannes Greven, Klemens Horst, Virginie Joris, Lara Bini, Martijn Poeze, Taco J Blokhuis, Markus Huber-Lang, Frank Hildebrand, Martijn van Griensven","doi":"10.1302/0301-620X.107B2.BJJ-2024-0160.R3","DOIUrl":"https://doi.org/10.1302/0301-620X.107B2.BJJ-2024-0160.R3","url":null,"abstract":"<p><strong>Aims: </strong>The aims of this study, using a porcine model of multiple trauma, were to investigate the expression of microRNAs at the fracture site, in the fracture haematoma (fxH) and in the fractured bone, compared with a remote unfractured long bone, to characterize the patterns of expression of circulating microRNAs in plasma, and identify and validate messenger RNA (mRNA) targets of the microRNAs.</p><p><strong>Methods: </strong>Two multiple trauma treatment strategies were compared: early total care (ETC) and damage control orthopaedics (DCO). For this study, fxH, fractured bone, unfractured control bone, plasma, lung, and liver samples were harvested. MicroRNAs were analyzed using quantitative real-time polymerase chain reaction arrays, and the identified mRNA targets were validated in vivo in the bone, fxH, lung, and liver tissue.</p><p><strong>Results: </strong>MicroRNA expression was associated with the trauma treatment strategy and differed depending on the type of sample. In the ETC group, a more advanced fracture healing response, as reflected by the expression of osteogenic microRNAs, was seen compared with the DCO group. DCO treatment resulted in a more balanced immune response in the systemic circulation as represented by significant upregulations of several anti-inflammatory microRNAs. The in vivo validation of the abundance of putative mRNA targets reflected the levels of microRNAs which were identified.</p><p><strong>Conclusion: </strong>Local and systemic microRNA patterns of expression were identified, specific for the treatment strategy in multiple trauma, which corresponded with the expression of mRNA at the fracture site and in target organs. These findings match clinical observations and offer insights into the cellular communication which may underlie the effects of using different surgical strategies in patients with multiple trauma, both locally and systemically. We also identified a systemic involvement of microRNAs in multiple trauma which may include distant cellular communication between injured tissues. Further research may further describe the temporospatial role of circulating microRNAs after multiple trauma, their potential role in communication between organs, and prospective therapeutic applications.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 2","pages":"193-203"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1302/0301-620X.107B2.BJJ-2024-1123.R1
Hugo Barret, Joris Tiercelin, Arnaud Godenèche, Christophe Charousset, Stephane Audebert, Yves Lefebvre, David Gallinet, Johannes Barth, Nicolas Bonnevialle
Aims: Loosening of the glenoid component in the long term remains an important complication of the anatomical total shoulder arthroplasty (aTSA). The aim of this study was to explore the bony integration of a hybrid glenoid component based on an analysis of CT scans.
Methods: In a prospective multicentre study, patients who underwent primary aTSA, whose hybrid design of glenoid component included a fully-polyethylene flanged upper peg and a porous-coated titanium lower peg, and who were reviewed with CT scans between 12 and 24 months postoperatively, were included. Two independent observers reviewed the scans. Bony integration of the upper peg was scored as described by Arnold et al, and integration of the lower peg was scored as described by Gulotta et al. Perforation of the glenoid vault in any plane was also assessed.
Results: From an initial group of 120 aTSAs in 116 patients, 104 CT scans were analyzed in 100 patients (four bilateral shoulders, mean age 66 years (SD 11), 62 female and 38 male). Osteolysis around the upper peg was found in 32 patients (32 aTSAs; 31%). Of the remaining patients, 72 had a mean Arnold score of 5.6 points (SD 0.9), and 70 (67%) had perfect integration. The lower peg had a mean Gulotta score of 6.5 points (SD 1.4). There was perfect integration of the lower peg in 70 patients (70 aTSAs; 67%). A total of nine patients (nine aTSAs; 9%) had no bony integration at either peg. There was perforation of the glenoid in an anterior or posterior direction at the level of the upper peg in three and 28 patients, respectively. This occurred at the level of the lower peg in 11 and 18 patients, respectively. The inter- and intraobserver reliability was good (k = 0.782 and 0.86, respectively). No implant breakage occurred at a mean follow-up of 16 months (12 to 24). The clinical outcome was satisfactory at a mean follow-up of 32 months (24 to 35), as assessed by a visual analogue scale score for pain, the Constant-Murley score, Subjective Shoulder Value, and American Shoulder and Elbow Surgeons score.
Conclusion: Short-term CT scan analysis of a new hybrid anatomical glenoid component found perfect bony integration around the lower porous coated titanium peg in 90% of patients. The upper polyethylene flanged peg had bony integration in 70 patients (70 aTSAs; 67%). Longer follow-up is needed to analyze the rate of survival of this component. The short-term clinical outcome was satisfactory.
{"title":"Bony integration of a hybrid glenoid component in anatomical shoulder arthroplasty : short-term CT scan analysis.","authors":"Hugo Barret, Joris Tiercelin, Arnaud Godenèche, Christophe Charousset, Stephane Audebert, Yves Lefebvre, David Gallinet, Johannes Barth, Nicolas Bonnevialle","doi":"10.1302/0301-620X.107B2.BJJ-2024-1123.R1","DOIUrl":"10.1302/0301-620X.107B2.BJJ-2024-1123.R1","url":null,"abstract":"<p><strong>Aims: </strong>Loosening of the glenoid component in the long term remains an important complication of the anatomical total shoulder arthroplasty (aTSA). The aim of this study was to explore the bony integration of a hybrid glenoid component based on an analysis of CT scans.</p><p><strong>Methods: </strong>In a prospective multicentre study, patients who underwent primary aTSA, whose hybrid design of glenoid component included a fully-polyethylene flanged upper peg and a porous-coated titanium lower peg, and who were reviewed with CT scans between 12 and 24 months postoperatively, were included. Two independent observers reviewed the scans. Bony integration of the upper peg was scored as described by Arnold et al, and integration of the lower peg was scored as described by Gulotta et al. Perforation of the glenoid vault in any plane was also assessed.</p><p><strong>Results: </strong>From an initial group of 120 aTSAs in 116 patients, 104 CT scans were analyzed in 100 patients (four bilateral shoulders, mean age 66 years (SD 11), 62 female and 38 male). Osteolysis around the upper peg was found in 32 patients (32 aTSAs; 31%). Of the remaining patients, 72 had a mean Arnold score of 5.6 points (SD 0.9), and 70 (67%) had perfect integration. The lower peg had a mean Gulotta score of 6.5 points (SD 1.4). There was perfect integration of the lower peg in 70 patients (70 aTSAs; 67%). A total of nine patients (nine aTSAs; 9%) had no bony integration at either peg. There was perforation of the glenoid in an anterior or posterior direction at the level of the upper peg in three and 28 patients, respectively. This occurred at the level of the lower peg in 11 and 18 patients, respectively. The inter- and intraobserver reliability was good (k = 0.782 and 0.86, respectively). No implant breakage occurred at a mean follow-up of 16 months (12 to 24). The clinical outcome was satisfactory at a mean follow-up of 32 months (24 to 35), as assessed by a visual analogue scale score for pain, the Constant-Murley score, Subjective Shoulder Value, and American Shoulder and Elbow Surgeons score.</p><p><strong>Conclusion: </strong>Short-term CT scan analysis of a new hybrid anatomical glenoid component found perfect bony integration around the lower porous coated titanium peg in 90% of patients. The upper polyethylene flanged peg had bony integration in 70 patients (70 aTSAs; 67%). Longer follow-up is needed to analyze the rate of survival of this component. The short-term clinical outcome was satisfactory.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 2","pages":"181-187"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1302/0301-620X.107B2.BJJ-2024-0213.R1
Paula L Hedley, Ulrik Lausten-Thomsen, Kristin M Conway, Klaus Hindsø, Paul A Romitti, Michael Christiansen
Aims: In this study, we aimed to evaluate incidence trends and potential risk factors associated with Perthes' disease in Denmark, using publicly available data.
Methods: Our population-based case-control study used data from the Danish National Patient Register and Danish Civil Registration System, accessed through the publicly available Danish Biobank Register, to identify 1,924,292 infants born between 1985 and 2016. We estimated age-specific incidence rates for four birth periods of equal duration (1985 to 1992, 1993 to 2000, 2001 to 2008, and 2009 to 2016) and investigated associations with perinatal conditions, congenital malformations, coagulation defects, autism spectrum disorders (ASD), and attention deficit hyperactivity disorders (ADHD).
Results: We identified 2,374 (81.6% male) diagnosed with Perthes' disease aged between two and 12 years, corresponding to an overall incidence of 12.1 per 100,000 live births relative to the year of birth. The incidence declined across all four birth periods, irrespective of sex or age at diagnosis. Several perinatal conditions were associated with higher Perthes' disease risk. Children with reported birth injuries (vs no reported injuries) exhibited the highest risk (relative risk (RR) 7.48 (95% CI 3.37 to 16.63)) followed by those with versus without coagulation defects (RR 4.77 (95% CI 1.79 to 12.69)). Children diagnosed with syndromic (RR 2.90 (95% CI 2.08 to 4.04)) or non-syndromic major congenital malformations (RR 1.86 (95% CI 1.55 to 2.23)) (vs those with no malformation diagnosis) were also associated with higher Perthes' disease risk. The development of Perthes' disease was positively associated with several ASD and ADHD diagnoses. However, once adjusting for the sex of the child and period of birth, the associations with ASD and ADHD were no longer significant.
Conclusion: Using publicly available data, we observed a declining incidence of Perthes' disease in Denmark over a 32-year study period. Our findings also confirm positive associations between Perthes' disease and various perinatal conditions, coagulation defects, and congenital malformations, highlighting potential aetiological pathways for further investigation.
{"title":"Incidence trends and risk factors for Perthes' disease in children born between 1985 and 2016 : a Danish nationwide register-based study.","authors":"Paula L Hedley, Ulrik Lausten-Thomsen, Kristin M Conway, Klaus Hindsø, Paul A Romitti, Michael Christiansen","doi":"10.1302/0301-620X.107B2.BJJ-2024-0213.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.107B2.BJJ-2024-0213.R1","url":null,"abstract":"<p><strong>Aims: </strong>In this study, we aimed to evaluate incidence trends and potential risk factors associated with Perthes' disease in Denmark, using publicly available data.</p><p><strong>Methods: </strong>Our population-based case-control study used data from the Danish National Patient Register and Danish Civil Registration System, accessed through the publicly available Danish Biobank Register, to identify 1,924,292 infants born between 1985 and 2016. We estimated age-specific incidence rates for four birth periods of equal duration (1985 to 1992, 1993 to 2000, 2001 to 2008, and 2009 to 2016) and investigated associations with perinatal conditions, congenital malformations, coagulation defects, autism spectrum disorders (ASD), and attention deficit hyperactivity disorders (ADHD).</p><p><strong>Results: </strong>We identified 2,374 (81.6% male) diagnosed with Perthes' disease aged between two and 12 years, corresponding to an overall incidence of 12.1 per 100,000 live births relative to the year of birth. The incidence declined across all four birth periods, irrespective of sex or age at diagnosis. Several perinatal conditions were associated with higher Perthes' disease risk. Children with reported birth injuries (vs no reported injuries) exhibited the highest risk (relative risk (RR) 7.48 (95% CI 3.37 to 16.63)) followed by those with versus without coagulation defects (RR 4.77 (95% CI 1.79 to 12.69)). Children diagnosed with syndromic (RR 2.90 (95% CI 2.08 to 4.04)) or non-syndromic major congenital malformations (RR 1.86 (95% CI 1.55 to 2.23)) (vs those with no malformation diagnosis) were also associated with higher Perthes' disease risk. The development of Perthes' disease was positively associated with several ASD and ADHD diagnoses. However, once adjusting for the sex of the child and period of birth, the associations with ASD and ADHD were no longer significant.</p><p><strong>Conclusion: </strong>Using publicly available data, we observed a declining incidence of Perthes' disease in Denmark over a 32-year study period. Our findings also confirm positive associations between Perthes' disease and various perinatal conditions, coagulation defects, and congenital malformations, highlighting potential aetiological pathways for further investigation.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 2","pages":"268-276"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1302/0301-620X.107B1.BJJ-2024-0644.R1
Jonathan Bennett, Neal Patel, Nakulan Nantha-Kumar, Veronica Phillips, Sandeep K Nayar, Niel Kang
Aims: Frozen shoulder is a common and debilitating condition characterized by pain and restricted movement at the glenohumeral joint. Various treatment methods have been explored to alleviate symptoms, with suprascapular nerve block (SSNB) emerging as a promising intervention. This meta-analysis aimed to assess the effectiveness of SSNB in treating frozen shoulder.
Methods: The study protocol was registered with PROSPERO (CRD42023475851). We searched the MEDLINE, Embase, and Cochrane Library databases in November 2023. Randomized controlled trials (RCTs) comparing SSNB against other interventions were included. The primary outcome was any functional patient-reported outcome measure. Secondary outcomes were the visual analogue scale (VAS) for pain, range of motion (ROM), and complications. Risk of bias was assessed using the Cochrane risk of bias v. 2.0 tool.
Results: A total of 12 RCTs were identified (702 patients; mean age 55 years (30 to 72)). Eight RCTs were deemed "low" risk-of-bias and four raised "some concerns". Comparator interventions included intra-articular steroid injection (IAI), hydrodistension, physiotherapy, and placebo injection with 0.9% saline. Seven studies compared SSNB to IAI, with SSNB resulting in greater improvement in the Shoulder and Pain Disability Index (mean difference -4.75 (95% CI -8.11 to -1.39); p = 0.006) and external rotation (mean difference 11.64 (95% CI -0.05 to 23.33); p = 0.050). In three studies, SSNB demonstrated better VAS (mean difference -0.31 (95% CI -0.53 to 1.79); p = 0.004) compared to physiotherapy (with or without placebo injection). One study favoured hydrodistension over SSNB in improving ROM and VAS. There was no significant difference in outcomes between SSNB administered under ultrasound guidance or using a landmark technique.
Conclusion: SSNB can be administered in the outpatient clinic with promising outcomes compared to IAI or physiotherapy based on level I evidence. It can therefore be considered as a first-line treatment option.
目的:肩周炎是一种常见的使人衰弱的疾病,其特征是肩关节疼痛和活动受限。各种治疗方法已被探索以减轻症状,肩胛上神经阻滞(SSNB)成为一种有希望的干预措施。本荟萃分析旨在评估SSNB治疗肩周炎的有效性。方法:研究方案在PROSPERO注册(CRD42023475851)。我们于2023年11月检索了MEDLINE、Embase和Cochrane图书馆数据库。纳入比较SSNB与其他干预措施的随机对照试验(rct)。主要终点是任何功能性患者报告的终点测量。次要结果是疼痛的视觉模拟评分(VAS)、活动范围(ROM)和并发症。使用Cochrane偏倚风险v. 2.0工具评估偏倚风险。结果:共纳入12项随机对照试验(702例;平均年龄55岁(30 ~ 72岁)。8项随机对照试验被认为是“低”偏倚风险,4项提出了“一些担忧”。比较干预措施包括关节内类固醇注射(IAI)、水膨胀、物理治疗和0.9%生理盐水安慰剂注射。七项研究比较了SSNB与IAI, SSNB对肩部和疼痛残疾指数的改善更大(平均差异-4.75 (95% CI -8.11至-1.39);p = 0.006)和外旋(平均差异11.64 (95% CI -0.05 ~ 23.33);P = 0.050)。在三项研究中,SSNB表现出更好的VAS(平均差异-0.31 (95% CI -0.53至1.79);P = 0.004)与物理治疗(注射或不注射安慰剂)相比。一项研究在改善ROM和VAS方面优于SSNB。在超声引导下进行SSNB或使用里程碑式技术进行SSNB的结果无显著差异。结论:基于I级证据,与IAI或物理治疗相比,SSNB可在门诊应用,效果良好。因此,它可以被视为一线治疗方案。
{"title":"Assessing the effectiveness of suprascapular nerve block in the treatment of frozen shoulder.","authors":"Jonathan Bennett, Neal Patel, Nakulan Nantha-Kumar, Veronica Phillips, Sandeep K Nayar, Niel Kang","doi":"10.1302/0301-620X.107B1.BJJ-2024-0644.R1","DOIUrl":"10.1302/0301-620X.107B1.BJJ-2024-0644.R1","url":null,"abstract":"<p><strong>Aims: </strong>Frozen shoulder is a common and debilitating condition characterized by pain and restricted movement at the glenohumeral joint. Various treatment methods have been explored to alleviate symptoms, with suprascapular nerve block (SSNB) emerging as a promising intervention. This meta-analysis aimed to assess the effectiveness of SSNB in treating frozen shoulder.</p><p><strong>Methods: </strong>The study protocol was registered with PROSPERO (CRD42023475851). We searched the MEDLINE, Embase, and Cochrane Library databases in November 2023. Randomized controlled trials (RCTs) comparing SSNB against other interventions were included. The primary outcome was any functional patient-reported outcome measure. Secondary outcomes were the visual analogue scale (VAS) for pain, range of motion (ROM), and complications. Risk of bias was assessed using the Cochrane risk of bias v. 2.0 tool.</p><p><strong>Results: </strong>A total of 12 RCTs were identified (702 patients; mean age 55 years (30 to 72)). Eight RCTs were deemed \"low\" risk-of-bias and four raised \"some concerns\". Comparator interventions included intra-articular steroid injection (IAI), hydrodistension, physiotherapy, and placebo injection with 0.9% saline. Seven studies compared SSNB to IAI, with SSNB resulting in greater improvement in the Shoulder and Pain Disability Index (mean difference -4.75 (95% CI -8.11 to -1.39); p = 0.006) and external rotation (mean difference 11.64 (95% CI -0.05 to 23.33); p = 0.050). In three studies, SSNB demonstrated better VAS (mean difference -0.31 (95% CI -0.53 to 1.79); p = 0.004) compared to physiotherapy (with or without placebo injection). One study favoured hydrodistension over SSNB in improving ROM and VAS. There was no significant difference in outcomes between SSNB administered under ultrasound guidance or using a landmark technique.</p><p><strong>Conclusion: </strong>SSNB can be administered in the outpatient clinic with promising outcomes compared to IAI or physiotherapy based on level I evidence. It can therefore be considered as a first-line treatment option.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 1","pages":"19-26"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142910967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1302/0301-620X.107B1.BJJ-2024-0444.R1
Hong J Kim, Pil W Yoon, Euihwan Cho, Inyong Jung, Jun-Ki Moon
Aims: We evaluated the national and regional trends from 2013 to 2022, in the prevalence of Perthes' disease among adolescent males in South Korea.
Methods: This retrospective, nationwide, population-based study included a total of 3,166,669 Korean adolescent males examined at regional Military Manpower Administration (MMA) offices over ten years. Data from the MMA were retrospectively collected to measure the national and regional prevalence per 100,000 and 95% CI of Perthes' disease according to the year (1 January 2013 to 31 December 2022) and history of pelvic and/or femoral osteotomy in South Korea. Spearman's correlation analysis was performed to assess the relationship between the Perthes' disease prevalence and several related factors.
Results: The prevalence of Perthes' disease showed a gradually increasing trend for a ten-year follow-up period from 2013 to 2022 with a mean of 71.17 (95% CI 61.82 to 80.52) per 100,000, ranging from 56.02 (95% CI 48.34 to 63.71) in 2013 to 77.53 (95% CI 67.94 to 87.11) in 2019. The proportion of patients with a Stulberg classification ≥ III ranged from 50.57% in 2015 to 80.08% in 2019, showing a gradually increasing trend. Following the trend for Perthes' disease, an increase in the proportion of pelvic and/or femoral osteotomies was observed, whereas conservative treatment decreased in adolescent males. For a ten-year follow-up period, the prevalence of Perthes' disease was highest in provinces, followed by the metropolitan area and Seoul.
Conclusion: The prevalence of Perthes' disease in adolescent males increased over time from 2013 to 2022. In particular, the trend in the prevalence of Perthes' disease with incongruent hips was significantly associated with overweight and obesity rates among male adolescents with a very high level of correlation.
目的:我们评估了2013年至2022年韩国青少年男性珀尔塞斯病患病率的国家和地区趋势。方法:这项回顾性的、全国性的、以人群为基础的研究包括了3166669名韩国青少年男性,在地区军事人力管理局(MMA)办公室进行了10年的调查。回顾性收集MMA数据,根据年份(2013年1月1日至2022年12月31日)和韩国骨盆和/或股骨截骨史,测量Perthes病的全国和地区患病率(每10万人)和95% CI。采用Spearman相关分析评估Perthes病患病率与几个相关因素之间的关系。结果:在2013 - 2022年的10年随访期间,Perthes病的患病率呈逐渐上升趋势,平均为71.17 (95% CI 61.82 ~ 80.52) / 10万,从2013年的56.02 (95% CI 48.34 ~ 63.71)到2019年的77.53 (95% CI 67.94 ~ 87.11)。Stulberg分级≥III的患者比例从2015年的50.57%上升至2019年的80.08%,呈逐渐上升趋势。随着Perthes病的趋势,观察到骨盆和/或股骨截骨术的比例增加,而保守治疗在青少年男性中减少。在10年的随访期间,Perthes病的患病率在各省最高,其次是首都地区和首尔。结论:2013 - 2022年青少年男性Perthes病患病率呈上升趋势。特别是,珀尔塞斯病伴髋部不一致的流行趋势与男性青少年超重和肥胖率显著相关,且相关性非常高。
{"title":"National and regional trends in the prevalence of Perthes' disease among the male population in South Korea.","authors":"Hong J Kim, Pil W Yoon, Euihwan Cho, Inyong Jung, Jun-Ki Moon","doi":"10.1302/0301-620X.107B1.BJJ-2024-0444.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.107B1.BJJ-2024-0444.R1","url":null,"abstract":"<p><strong>Aims: </strong>We evaluated the national and regional trends from 2013 to 2022, in the prevalence of Perthes' disease among adolescent males in South Korea.</p><p><strong>Methods: </strong>This retrospective, nationwide, population-based study included a total of 3,166,669 Korean adolescent males examined at regional Military Manpower Administration (MMA) offices over ten years. Data from the MMA were retrospectively collected to measure the national and regional prevalence per 100,000 and 95% CI of Perthes' disease according to the year (1 January 2013 to 31 December 2022) and history of pelvic and/or femoral osteotomy in South Korea. Spearman's correlation analysis was performed to assess the relationship between the Perthes' disease prevalence and several related factors.</p><p><strong>Results: </strong>The prevalence of Perthes' disease showed a gradually increasing trend for a ten-year follow-up period from 2013 to 2022 with a mean of 71.17 (95% CI 61.82 to 80.52) per 100,000, ranging from 56.02 (95% CI 48.34 to 63.71) in 2013 to 77.53 (95% CI 67.94 to 87.11) in 2019. The proportion of patients with a Stulberg classification ≥ III ranged from 50.57% in 2015 to 80.08% in 2019, showing a gradually increasing trend. Following the trend for Perthes' disease, an increase in the proportion of pelvic and/or femoral osteotomies was observed, whereas conservative treatment decreased in adolescent males. For a ten-year follow-up period, the prevalence of Perthes' disease was highest in provinces, followed by the metropolitan area and Seoul.</p><p><strong>Conclusion: </strong>The prevalence of Perthes' disease in adolescent males increased over time from 2013 to 2022. In particular, the trend in the prevalence of Perthes' disease with incongruent hips was significantly associated with overweight and obesity rates among male adolescents with a very high level of correlation.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 1","pages":"42-49"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142910981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1302/0301-620X.107B1.BJJ-2024-0305.R1
Stephen Mc Donald, Andrel Yoong, Jonathan T Evans, Luke Farrow
Aims: The Exeter femoral stem has a cemented, polished taper-slip design, and an excellent track record. The current range includes short-length options for various offsets, but less is known about the performance of these stems. The aim of this study was to compare the survival of short-length stems with standard-length Exeter stems.
Methods: A systematic review of all studies reporting the use of short-length Exeter stems in primary total hip arthroplasty (THA) was undertaken. Survival data, the indication for revision, and patient-reported outcomes were gathered from observational and randomized studies. Studies based on registry data were analyzed separately.
Results: The review included nine studies which covered a total of 2,190 short stems. The mean follow-up was 6.4 years (2 to 12) with an all-cause survival of 95.4%. When revisions due to aseptic acetabular loosening were excluded, the survival was 97.7%. Four stems fractured (0.18%). The mean Oxford Hip Score improved from 18.29 (1.33 to 21.6) preoperatively to 41.59 (32.9 to 43.4) at final follow-up. Three studies used data from national registries. A total of 25,895 short stems (offset ≤ 35.5 mm) were used compared with 336,218 standard-length stems. In these studies, short stems had a hazard ratio (HR) for all-cause survival of 1.19 (95% CI 0.96 to 1.43) with a rate of revision per 1,000 component-years of 0.037 compared with 0.035 for standard-length stems. One study from the New Zealand Joint Registry divided short stems into standard and small offset groups. Standard offset short stems (≥ 37.5 mm) had a 0.84 HR (95% CI 0.38 to 1.88) while small offset short stems (≤ 35.5 mm) had a 1.6 HR compared with standard stems (95% CI 1.3 to 1.98).
Conclusion: Short Exeter stems perform well and are a safe femoral component in primary THA, according to the current literature. There does not appear to be an increased risk of implant fracture associated with these stems.
目的:Exeter股骨干具有胶结、抛光的锥形滑动设计,具有良好的跟踪记录。目前的范围包括各种偏移的短长度选项,但对这些茎的性能知之甚少。本研究的目的是比较短茎和标准长度埃克塞特茎的存活率。方法:系统回顾了所有报道在初次全髋关节置换术(THA)中使用短长度埃克塞特假体的研究。生存数据、修订适应症和患者报告的结果来自观察性和随机研究。基于注册表数据的研究分别进行分析。结果:该综述包括9项研究,共涉及2190个短茎。平均随访6.4年(2 ~ 12年),全因生存率为95.4%。当排除无菌性髋臼松动引起的翻修时,生存率为97.7%。4根茎断裂(0.18%)。平均牛津髋关节评分从术前的18.29(1.33 - 21.6)提高到最终随访时的41.59(32.9 - 43.4)。三项研究使用了国家登记处的数据。与336,218根标准长度茎相比,总共使用了25,895根短茎(偏移量≤35.5 mm)。在这些研究中,短茎的全因生存风险比(HR)为1.19 (95% CI 0.96至1.43),每1000个成分年的修正率为0.037,而标准长度茎的修正率为0.035。新西兰联合登记处的一项研究将短茎分为标准组和小组。标准偏置短茎(≥37.5 mm)的HR为0.84 (95% CI 0.38 ~ 1.88),而小偏置短茎(≤35.5 mm)的HR为1.6 (95% CI 1.3 ~ 1.98)。结论:根据目前的文献,短埃克塞特柄在原发性全髋关节置换术中表现良好,是一种安全的股骨假体。与这些柄相关的植入物骨折的风险似乎没有增加。
{"title":"A systematic review of short- compared with standard-length Exeter stems in primary total hip arthroplasty.","authors":"Stephen Mc Donald, Andrel Yoong, Jonathan T Evans, Luke Farrow","doi":"10.1302/0301-620X.107B1.BJJ-2024-0305.R1","DOIUrl":"10.1302/0301-620X.107B1.BJJ-2024-0305.R1","url":null,"abstract":"<p><strong>Aims: </strong>The Exeter femoral stem has a cemented, polished taper-slip design, and an excellent track record. The current range includes short-length options for various offsets, but less is known about the performance of these stems. The aim of this study was to compare the survival of short-length stems with standard-length Exeter stems.</p><p><strong>Methods: </strong>A systematic review of all studies reporting the use of short-length Exeter stems in primary total hip arthroplasty (THA) was undertaken. Survival data, the indication for revision, and patient-reported outcomes were gathered from observational and randomized studies. Studies based on registry data were analyzed separately.</p><p><strong>Results: </strong>The review included nine studies which covered a total of 2,190 short stems. The mean follow-up was 6.4 years (2 to 12) with an all-cause survival of 95.4%. When revisions due to aseptic acetabular loosening were excluded, the survival was 97.7%. Four stems fractured (0.18%). The mean Oxford Hip Score improved from 18.29 (1.33 to 21.6) preoperatively to 41.59 (32.9 to 43.4) at final follow-up. Three studies used data from national registries. A total of 25,895 short stems (offset ≤ 35.5 mm) were used compared with 336,218 standard-length stems. In these studies, short stems had a hazard ratio (HR) for all-cause survival of 1.19 (95% CI 0.96 to 1.43) with a rate of revision per 1,000 component-years of 0.037 compared with 0.035 for standard-length stems. One study from the New Zealand Joint Registry divided short stems into standard and small offset groups. Standard offset short stems (≥ 37.5 mm) had a 0.84 HR (95% CI 0.38 to 1.88) while small offset short stems (≤ 35.5 mm) had a 1.6 HR compared with standard stems (95% CI 1.3 to 1.98).</p><p><strong>Conclusion: </strong>Short Exeter stems perform well and are a safe femoral component in primary THA, according to the current literature. There does not appear to be an increased risk of implant fracture associated with these stems.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 1","pages":"27-33"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142910966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1302/0301-620X.107B1.BJJ-2024-1151
Yael Gelfer, Elizabeth Ashby, Daniel C Perry
{"title":"Paediatric orthopaedics.","authors":"Yael Gelfer, Elizabeth Ashby, Daniel C Perry","doi":"10.1302/0301-620X.107B1.BJJ-2024-1151","DOIUrl":"https://doi.org/10.1302/0301-620X.107B1.BJJ-2024-1151","url":null,"abstract":"","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 1","pages":"3-4"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142910983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1302/0301-620X.107B1.BJJ-2024-0611.R1
Yousef Hussein, Afrim Iljazi, Michala S Sørensen, Søren Overgaard, Michael M Petersen
Aims: Dislocation is a major concern following total hip arthroplasty (THA) for osteoarthritis (OA). Both dual-mobility components and standard acetabular components with large femoral heads are used to reduce the risk of dislocation. We investigated whether dual-mobility components are superior to standard components in reducing the two-year dislocation and revision risk in a propensity-matched sample from the Danish Hip Arthroplasty Register (DHR).
Methods: This population-based cohort study analyzed data from the DHR and the Danish National Patient Register. We included all patients undergoing primary THA for OA from January 2010 to December 2019 with either dual-mobility or standard acetabular components with metal-on-polyethylene or ceramic-on-polyethylene articulations with a 36 mm femoral head. The samples were propensity score-matched on patient and implant characteristics. The primary outcome was the difference in the absolute risk of dislocation within two years, with a secondary outcome of the difference in the absolute risk of revision surgery of any cause within the same timeframe. The cumulative incidence of dislocation was calculated using the Aalen-Johansen estimator, while the difference in absolute risk was estimated using absolute risk regression (ARR).
Results: We included 4,499 patients with dual-mobility components and 4,499 patients with standard components after propensity score-matching. Both groups had a mean age of 75 years (SD 8.5), included approximately 60% females, and had a two-year survival of 95.3% (95% CI 94.6 to 95.9). The dual-mobility group was 80% less likely to dislocate within two years (ARR 0.20 (95% CI 0.14 to 0.28); p < 0.001), with no significant difference in the risk of revision compared to standard components (ARR 1.15 (95% CI 0.89 to 1.48); p = 0.293).
Conclusion: Dual-mobility components are associated with a reduced risk of dislocation and with no significant difference in the risk of revision for any cause within two years of THA when compared to standard acetabular components with 36 mm femoral heads.
目的:脱位是骨关节炎(OA)全髋关节置换术(THA)后的主要问题。双活动假体和带大股骨头的标准髋臼假体均可用于降低脱位的风险。在丹麦髋关节置换术登记(DHR)的倾向匹配样本中,我们调查了双活动部件在降低两年脱位和翻修风险方面是否优于标准部件。方法:这项基于人群的队列研究分析了来自DHR和丹麦国家患者登记册的数据。我们纳入了2010年1月至2019年12月期间接受OA初级THA治疗的所有患者,这些患者采用双活动或标准髋臼假体,金属对聚乙烯或陶瓷对聚乙烯关节,股骨头为36 mm。样本在患者和种植体特征上的倾向评分匹配。主要结果是两年内脱位绝对风险的差异,次要结果是同一时间段内任何原因翻修手术绝对风险的差异。使用aallen - johansen估计器计算脱位的累积发生率,而使用绝对风险回归(ARR)估计绝对风险的差异。结果:在倾向评分匹配后,我们纳入了4499例双活动成分患者和4499例标准成分患者。两组患者的平均年龄为75岁(SD 8.5),其中约60%为女性,两年生存率为95.3% (95% CI 94.6 ~ 95.9)。双活动组两年内脱位的可能性降低80% (ARR 0.20 (95% CI 0.14 - 0.28);p < 0.001),与标准成分相比,修订风险无显著差异(ARR 1.15 (95% CI 0.89 ~ 1.48);P = 0.293)。结论:与36mm股骨头的标准髋臼假体相比,双活动假体与脱位风险降低有关,并且在THA术后两年内因任何原因翻修的风险没有显著差异。
{"title":"The risk of dislocation in dual-mobility versus 36 mm heads in primary total hip arthroplasty for osteoarthritis.","authors":"Yousef Hussein, Afrim Iljazi, Michala S Sørensen, Søren Overgaard, Michael M Petersen","doi":"10.1302/0301-620X.107B1.BJJ-2024-0611.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.107B1.BJJ-2024-0611.R1","url":null,"abstract":"<p><strong>Aims: </strong>Dislocation is a major concern following total hip arthroplasty (THA) for osteoarthritis (OA). Both dual-mobility components and standard acetabular components with large femoral heads are used to reduce the risk of dislocation. We investigated whether dual-mobility components are superior to standard components in reducing the two-year dislocation and revision risk in a propensity-matched sample from the Danish Hip Arthroplasty Register (DHR).</p><p><strong>Methods: </strong>This population-based cohort study analyzed data from the DHR and the Danish National Patient Register. We included all patients undergoing primary THA for OA from January 2010 to December 2019 with either dual-mobility or standard acetabular components with metal-on-polyethylene or ceramic-on-polyethylene articulations with a 36 mm femoral head. The samples were propensity score-matched on patient and implant characteristics. The primary outcome was the difference in the absolute risk of dislocation within two years, with a secondary outcome of the difference in the absolute risk of revision surgery of any cause within the same timeframe. The cumulative incidence of dislocation was calculated using the Aalen-Johansen estimator, while the difference in absolute risk was estimated using absolute risk regression (ARR).</p><p><strong>Results: </strong>We included 4,499 patients with dual-mobility components and 4,499 patients with standard components after propensity score-matching. Both groups had a mean age of 75 years (SD 8.5), included approximately 60% females, and had a two-year survival of 95.3% (95% CI 94.6 to 95.9). The dual-mobility group was 80% less likely to dislocate within two years (ARR 0.20 (95% CI 0.14 to 0.28); p < 0.001), with no significant difference in the risk of revision compared to standard components (ARR 1.15 (95% CI 0.89 to 1.48); p = 0.293).</p><p><strong>Conclusion: </strong>Dual-mobility components are associated with a reduced risk of dislocation and with no significant difference in the risk of revision for any cause within two years of THA when compared to standard acetabular components with 36 mm femoral heads.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 1","pages":"50-57"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142910390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}