The Bone & Joint Journal最新文献

{"title":"Clear cell sarcoma : a retrospective review from a tertiary orthopaedic sarcoma unit.","authors":"Natalie Green,James E Archer,Charles A E Baird,Scott Evans","doi":"10.1302/0301-620x.108b2.bjj-2025-0526.r1","DOIUrl":"https://doi.org/10.1302/0301-620x.108b2.bjj-2025-0526.r1","url":null,"abstract":"AimsThe aim of this study was to assess the presentation, investigation and management of patients with a clear cell sarcoma within a single-centre, tertiary bone tumour unit, reporting the rates of survival, local recurrence, and metastases.MethodsThe study involved a retrospective review of a prospectively maintained oncology database, from which we identified and included 47 patients who were referred and treated for a clear cell soft-tissue sarcoma at our unit between January 1996 and January 2024. The median follow-up was 28 months (IQR 13.5 to 71.5). The primary outcome measure was survival and secondary outcomes included the rates of local recurrence and the development of metastases.ResultsThe overall survival for all patients was 61.9% at two years (95% CI 49.1 to 78.1), 45.7% at five years (95% CI 32.6 to 64.1), and 37.4% at ten years (95% CI 24.1 to 57.9). The median survival was 40 months. At the time of presentation, metastases were found in 13 patients (28%), in whom radionuclide imaging with positron emission tomography (PET) CT allowed better identification. More than half of the patients who were referred from elsewhere had prviously undergone an unplanned excision, although this did not seem to influence the mortality outcomes. Excision of the tumour and/or local disease was the primary treatment, with curative intent in 37 patients (78.7%). Local recurrence and metastases after the primary treatment was noted in seven (19%) and 16 (43%) patients, respectively, with a wide range of timing (1 to 73 months). Primary excision with disease-free margins gave the best chance of cure.ConclusionClear cell sarcoma is an aggressive tumour. The rate of survival remains modest. The early identification of metastases using PET CT allowed for more focused treatment. The local follow-up protocol must appreciate the wide variations in the time to recurrence. Targeted immunological systemic treatments may improve the outcomes in the future.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"30 1","pages":"234-240"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146095493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age, glenoid bone fragment, and glenoid bone loss increase recurrence risk after arthroscopic bony Bankart repair.","authors":"Petar Golijanin,Paolo Spinello,Fabrizio Brindisino,Nicola de Gasperis,Leonardo Moreno Rodriguez,Matthew T Provencher,Giovanni Di Giacomo","doi":"10.1302/0301-620x.108b2.bjj-2024-1360.r3","DOIUrl":"https://doi.org/10.1302/0301-620x.108b2.bjj-2024-1360.r3","url":null,"abstract":"AimsNumerous studies have identified risk factors for recurrent anterior shoulder dislocation, but the exact impact of each remains unclear. This study analyzes outcomes after arthroscopic bony Bankart repair (ABBR) and evaluates how time to surgery, number of preoperative instability events, age, glenoid bone loss (GBL), glenoid bone fragment (GBF), age at surgery, and preoperative Western Ontario Shoulder Instability (WOSI) scores influence recurrence.MethodsA retrospective review was conducted of patients who underwent ABBR between January 2008 and December 2018. Data included demographic details, number of instability episodes, time to surgery, age at first dislocation, GBL, GBF size, WOSI scores, and recurrence rates.ResultsA total of 243 patients with bony Bankart lesions were included. The mean age was 25.4 years (17 to 46). Recurrence occurred in 24 patients (9.9%). Compared with the non-recurrence group, patients with recurrence had smaller GBF (6.5% (SD 4.2) vs 8.8% (SD 5.6); p = 0.049), longer elapsed time since initial instability (20.0 months vs 13.2 months; p < 0.001), younger age at initial instability (21.9 years (SD 6.9) vs 25.6 years (SD 5.2); p = 0.002), and more preoperative instability events (5.7 (SD 3.1) vs 3.8 (SD 2.0); p < 0.001). Postoperative WOSI scores improved in both groups but were not significantly different (447 (SD 141) vs 381 (SD 98)). Regression analysis showed that older age, larger GBF, and lower GBL were independently associated with reduced recurrence risk.ConclusionPatients without recurrence were generally older, had shorter delay from the initial instability event, fewer preoperative instability events, and larger GBF for incorporation in the repair. In younger patients, smaller GBF and greater GBL were strongly associated with recurrence. These findings indicate that the longer the elapsed time, the greater the reabsorption of the glenoid bone fragment and, consequently, the greater the glenoid bone loss. Therefore, strategies aimed at preserving fragment size, potentially through timely surgical intervention, may help reduce recurrence. In patients aged over 40 years, GBL and GBF did not confer the same recurrence risk. Further studies are needed to clarify the thresholds for elapsed time and number of instability events that significantly affect recurrence after ABBR.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"93 1","pages":"202-208"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146095495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between ten complications and mortality : insights from the Dutch Hip Fracture Audit.","authors":"Hanne-Eva van Bremen,Lotta J Seppala,Nathalie van der Velde,Johannes H Hegeman,Hanna C Willems, , ,Wilco P Achterberg,Frank Malgo,Agneta H Calf-de Bruin,Pim W van Egmond,Elvira R Flikweert,Martin J Heetveld,Johannes H Hegeman,Bernard G Schutte,Marijke C Trappenburg,Stijn C Voeten,Frans J G Wijdicks,Franka S Würdemann,Cornelis L P van de Ree, ,G De Klerk,C Stevens,J Snoek,H A F Luning,D Van der Velde,E J Verleisdonk,A H P Niggebrugge,M Regtuijt,F Wurdemann","doi":"10.1302/0301-620x.108b2.bjj-2025-0629.r1","DOIUrl":"https://doi.org/10.1302/0301-620x.108b2.bjj-2025-0629.r1","url":null,"abstract":"AimsThis study examined the association between post-admission complications and 120-day mortality using data from a national hip fracture registry. A sub-analysis explored the impact of improved complication registration on these associations.MethodsWe conducted a cohort study including patients (1 January 2018 to 31 December 2023) from the Dutch Hip Fracture Audit (DHFA). Ten complications (anaemia, delirium, fall incident, heart failure, pneumonia, pressure ulcer, pulmonary embolism (PE), renal dysfunction, urinary tract infection, wound infection) were assessed. From 2018 to 2019, seven hospitals were recruited for additional data collection for the DHFA to improve and develop quality indicators. A multivariate Cox regression model was used to calculate the hazard ratio (HR) between complications and mortality at 30, 60, and 120 days. Subgroup analysis assessed the effect of better registration.ResultsA total of 86,524 patients were included, with a median age of 81 years (IQR 72 to 87). The overall complication rate was 25.7% (n = 22,210), anaemia was the most common complication (n = 8,027; 9.3%), followed by delirium (n = 7,836; 9.1%). In subgroup analysis, project hospitals had a higher overall complications rate (38.8% vs 27.4%; p < 0.001). After adjustment for confounders, at 30 days, heart failure (HR 2.45 (95% CI 2.15 to 2.75)), delirium (HR 1.28 (95% CI 1.19 to 1.38)), PE (HR 2.62 (95% CI 2.11 to 3.27)), renal dysfunction (HR 2.20 (95% CI 1.96 to 2.47)), and pneumonia (HR 2.35 (95% CI 2.15 to 2.56)) were significantly associated with an increased hazard of death. In the subgroup analysis, fewer complications were associated with an increased hazard of death in the project hospitals in comparison to the non-project hospitals.ConclusionFive complications were significantly associated with an increased risk of mortality at 30 and 60 days. These findings highlight the importance of closely monitoring and managing complications. Improved registration practices in project hospitals were linked to fewer complications that showed a relation with mortality. Complications without a clear association with mortality may be more suitable for short-cycle in-hospital feedback rather than a national audit.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"8 1","pages":"216-225"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146095509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A review and summary of the National Institute for Health and Care Excellence early value assessment of robotic-assisted surgery for orthopaedic procedures.","authors":"Nick D Clement,Fares S Haddad","doi":"10.1302/0301-620x.108b2.bjj-2025-1438","DOIUrl":"https://doi.org/10.1302/0301-620x.108b2.bjj-2025-1438","url":null,"abstract":"Robotic-assisted systems are being increasingly integrated into orthopaedic surgery, offering potential improvements in precision, reproducibility, and patient-reported outcome measures (PROMs) for unicompartmental knee arthroplasty (UKA), total knee arthroplasty (TKA), and total hip arthroplasty (THA). A review and summary of the early value assessment (EVA) undertaken by the National Institute for Health and Care Excellence (NICE) to evaluate the clinical effectiveness, cost-effectiveness, and implementation considerations of these technologies is presented. The EVA includes a review of the literature, an evidence gap analysis, and an evidence generation plan. Evidence from 28 studies and two registries suggested that robotic-assisted surgery was noninferior to conventional approaches in key outcomes, including PROMs, complications, hospital stay, and revisions, but it was associated with enhanced implant alignment. Short-term PROMs showed modest improvements, although most differences fell below currently defined clinically meaningful thresholds. Revision data were limited in follow-up, and ergonomic benefits for surgeons were uncertain. Economic evaluations suggested potential cost-effectiveness, particularly for THA, but assumptions regarding utilities, resource use, procedure volume, and implant costs introduced substantial uncertainty. The EVA highlighted the importance of training, equitable access, and national coordination for implementation. Evidence gaps were identified in long-term revision rates, health-related quality of life outcomes, productivity, sub-group effects, surgical team benefits, and learning curves. NICE recommended conditional adoption of six robotic platforms (ApolloKnee (Corin, UK), CORI (Smith & Nephew, UK), Mako (Stryker, USA), ROSA (Zimmer Biomet, USA), SkyWalker (MicroPort, China), and VELYS (DePuy Synthes, USA)) over a three-year evidence generation period, requiring annual reporting and adherence to regulatory standards. While robotic-assisted arthroplasty offers technical advantages, definitive clinical and economic benefits remain unproven. Surgeons, healthcare systems, and industry partners will need to work collaboratively to provide the required evidence in the next three years. A UK robotic registry could help address the evidence gaps more rapidly than individual centres by capturing large-scale national data.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"78 1","pages":"147-152"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146095486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of cartilage regeneration in initial and second-look arthroscopy following low tibial osteotomy for varus osteoarthritis of the ankle.","authors":"Dan Moriwaki,Tomoyuki Nakasa,Yasunari Ikuta,Akinori Nekomoto,Shingo Kawabata,Satoru Sakurai,Saori Ishibashi,Nobuo Adachi","doi":"10.1302/0301-620x.108b2.bjj-2025-0194.r2","DOIUrl":"https://doi.org/10.1302/0301-620x.108b2.bjj-2025-0194.r2","url":null,"abstract":"AimsThe cover of cartilaginous defects in patients with varus osteoarthritis (OA) of the ankle in the medial compartment (medial gutter, talar dome, and tibial plafond) after low tibial osteotomy has only been reported in a few studies. There has also been little description of the distribution of the defects and the risk factors for persistent defects after surgery. The aim of this study was to report the degree and distribution of cartilage repair after low tibial osteotomy, and their association with postoperative outcomes in these patients.MethodsWe retrospectively reviewed 24 patients (27 ankles) who underwent low tibial osteotomy for OA of the ankle. There were eight males and 16 females. Their mean age was 70.8 years (55 to 79), and the mean follow-up was 29.1 months (14 to 60). Clinical assessments included the Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale score and a visual analogue scale (VAS) score for pain. Radiological assessments included the Takakura-Tanaka classification, tibial anterior surface angle, talar tilt angle, tibiomedial malleolar angle (TMMA), tibial lateral surface angle, and mechanical ankle joint axis point. The condition of the cartilage was evaluated using the modified Outerbridge classification at the initial and second-look arthroscopies.ResultsThe mean JSSF scale and VAS sores and all radiological parameters improved significantly postoperatively. At the initial arthroscopy, grade 4 cartilage defects were most common in the medial gutter (26 of 27 ankles; 96%), followed by the anteromedial talar dome (talar zone 1) (20 of 27 ankles; 74%). At the second-look arthroscopy, grade 4 defects were absent in the medial gutter but remained in ten of 20 ankles (50%) of those initially in talar zone 1. The modified Outerbridge grade in talar zone 1 at second-look arthroscopy correlated positively with postoperative VAS (R = 0.48). Pre- and postoperative TMMA (cutoff values: 43.1° and 31.4°) and postoperative VAS scores were significantly higher in patients in whom there was not cartilage repair in talar zone 1 than in those in whom there was cartilage repair (preoperative TMMA, p = 0.004; postoperative TMMA, p = 0.015; postoperative VAS score, p = 0.026), while the postoperative mechanical ankle joint axis point (cutoff value: 80.7%) was significantly smaller (p = 0.041).ConclusionSecond-look arthroscopy after low tibial osteotomy revealed good cartilage repair in the medial gutter, but it was poor in the anteromedial talar dome and associated with persistent postoperative pain. A large pre- and postoperative TMMA and medial deviation of the postoperative axis of loading may inhibit cartilage repair in these patients.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"8 1","pages":"185-194"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146095497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoprosthetic reconstruction of the diaphysis for segmental bone defects after bone tumour resection : a mid- and long-term retrospective study of 112 cases.","authors":"Leming Mou,Jinwei Liu,Chuanhao Guo,Jing-Yu Zhang,Yancheng Liu,Xiaokang Gao,Deng-Xing Lun,Yongcheng Hu","doi":"10.1302/0301-620x.108b2.bjj-2025-0342.r1","DOIUrl":"https://doi.org/10.1302/0301-620x.108b2.bjj-2025-0342.r1","url":null,"abstract":"AimsThis study evaluated the clinical outcome, complications, and overall efficacy of diaphyseal endoprosthetic reconstruction after tumour resection, with the aim of providing a comprehensive insight into the role of diaphyseal prostheses in managing segmental bone defects after resection of a bone tumour.MethodsA retrospective analysis was carried out of 112 patients treated at two centres. Resection length, intramedullary stem length, and fixation type were recorded. Clinical outcomes were assessed with Musculoskeletal Tumor Society (MSTS) scores, while survival rates were calculated using Kaplan-Meier analysis. Complications were classified according to the Henderson system.ResultsThe mean duration of follow-up was 27.2 months (3 to 159), the mean operating time 142.4 minutes (SD 44.1), and the mean blood loss 658.8 ml (SD 437.3). The mean resection length was 106.8 mm (SD 33.3), and the mean intramedullary stem length 96.1 mm (SD 34.1). Cemented fixation was used in 90.2% of cases (101 of 112), and auxiliary plates in 63.4% (71 of 112). The mean MSTS score was 24.3 (SD 3.3). Kaplan-Meier analysis revealed three-, five-, and ten-year survival rates of 42.9% (95% CI 33.4 to 55.1), 34.6% (95% CI 24.8 to 48.3), and 25.2% (95% CI 14.5 to 43.9) for patients, and 91.6% (95% CI 86.1 to 97.5), 82% (95% CI 69.4 to 96.8), and 82% (95% CI 69.4 to 96.8) for prostheses, respectively, with a significant difference between the two (p < 0.001). Medium- to long-term analysis showed that prosthesis survival, both for primary and metastatic tumours, exceeded patient survival. Additionally, cemented prostheses had significantly higher survival rates than uncemented prostheses (p = 0.006). Postoperative complications occurred in 16% of patients (18 of 112), with 6.3% (7 of 112) requiring reoperation.ConclusionDiaphyseal prostheses are a reliable solution for reconstructing segmental defects after resection of a bone tumour, with benefits such as early weightbearing, improved functional outcome, acceptable mid- to long-term failure rates, and effective local disease control for a variety of tumour types and anatomical locations.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"3 1","pages":"241-250"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146095490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival of the Exeter V40 hemiarthroplasty femoral component and associated complications : an eight-year review of 3,050 cases from a major trauma centre.","authors":"Matthew J Kennedy,Gopikrishnan Nair,Christopher McColm,Angus V Paterson,Phil J Walmsley,Nick D Clement,Jon V Clarke,Mark R J Jenkinson","doi":"10.1302/0301-620x.108b2.bjj-2025-0975.r1","DOIUrl":"https://doi.org/10.1302/0301-620x.108b2.bjj-2025-0975.r1","url":null,"abstract":"AimsPolished taper slip (PTS) designs are widely used in cemented hip hemiarthroplasty for displaced intracapsular native hip fractures (NHFs), though concerns persist regarding PTS association with higher postoperative periprosthetic femoral fracture (POPFF) risk. The aim of this study was to evaluate the performance of the Exeter V40 cemented femoral component in the management of NHFs. This study prioritized evaluating survival, reoperations of the index hip joint, and major complications including intraoperative periprosthetic femoral fracture (IOPFF), POPFF, infection, and dislocation.MethodsThis retrospective cohort study included consecutive patients who underwent hip hemiarthroplasty with the Exeter V40 PTS femoral component for NHF at a single hospital between 1 February 2016 and 30 June 2024. Patient demographic details, time to theatre, surgical and medical management, American Society of Anesthesiologists grade, and mortality were collected. Reoperation and mortality were calculated to final follow-up. Cox regression analysis was performed to identify independent associations with revision or fixation adjusted for confounders.ResultsA total of 3,050 hip hemiarthroplasties in 2,948 patients were identified (69% female, median age 83 years (IQR 76 to 88)). Overall, 75 patients (2.5%) required reoperation, yielding a prosthesis-time incidence rate per 1,000 prosthesis-years (PTIR) of 10.7 (95% CI 8.4 to 13.4), with POPFF PTIR 5.1 per 1,000 prosthesis-years, infection PTIR 3.43 (95% CI 2.20 to 5.10), and dislocation PTIR 3.28 (95% CI 2.08 to 4.93). Male sex was an independent predictor of poor survival, with an adjusted hazard ratio of 2.85 (95% CI 1.76 to 4.60). Intraoperative fracture incidence was 0.9%, with the majority occurring at trial reduction (0.6%). Survival of the Exeter V40 femoral component was 97.6% (95% CI 96.9 to 98.4) at three years.ConclusionThe Exeter V40 femoral component demonstrates acceptable performance in hip hemiarthroplasty for NHF, with low rates of POPFF and femoral component revision. Male sex is an independent risk factor for reoperation of the index hip joint. Surgeons should exercise caution during trial reduction to minimize intraoperative fracture risk. These findings support its continued use in hip hemiarthroplasty for elderly patients.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"42 1","pages":"226-233"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146095494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality after an infected total knee arthroplasty : a meta-analysis.","authors":"Michael S Ramos,Brian Benyamini,Varun Kompala,Shujaa T Khan,Kyle N Kunze,Anabelle Visperas,Peter A Surace,Nicolas S Piuzzi","doi":"10.1302/0301-620x.108b2.bjj-2025-0106.r1","DOIUrl":"https://doi.org/10.1302/0301-620x.108b2.bjj-2025-0106.r1","url":null,"abstract":"AimsThe aim of this study was to evaluate the overall mortality rate in patients with periprosthetic joint infection (PJI) after total knee arthroplasty (TKA), the overall mortality over time, and mortality after treatment.MethodsOvid MEDLINE, Embase, CINAHL, Cochrane Library, Scopus, and Web of Science, were searched for studies reporting the rate of mortality in patients with TKA PJI until December 2023. Full-length studies with extractable data dealing with mortality in these patients were included. Studies were excluded if they involved TKAs which were undertaken for oncological or traumatic indications or septic arthritis, or were partial or revision TKAs. Studies in which primarily high-risk patients, such those with an organ transplant or cancer, were also excluded, in order to allow the mortality rate in patients with PJI after TKA in routine clinical practice to be evaluated. Data were abstracted using a standardized form. Meta-analyses of the proportions with random-effects estimators were used to report the mortality rate after TKA PJI, over time, and after treatment. The study adhered to the 2020 PRISMA guidelines.ResultsA total of 83,353 patients with a PJI after TKA from 39 studies were included. At a mean follow-up of 4.4 years (1 month to 17 years), the overall mortality rate after TKA PJI was 13.3% (95% CI 8.8 to 18.5). It was 4.8% (1.2 to 18.0), 7.0% (2.2 to 29.9), and 6.4% (3.0 to 46.0) at three, 12, and 24 months, respectively. The rate significantly differed between the different forms of surgical treatment for PJI (p < 0.001): debridement, antibiotics, and implant retention (DAIR) 12.3% (95% CI 3.9 to 24.0); one-stage exchange arthroplasty 0.47% (95% CI 0 to 1.5); and two-stage exchange arthroplasty 11.5% (95% CI 8.5 to 15.0). There were no significant differences in the mortality rate between patients treated with DAIR and those who underwent a two-stage exchange arthroplasty at three and 12 months.ConclusionMortality after TKA PJI remains high, surpassing the five-year rates of mortality in patients with cancer of the breast and prostate. The burden associated with PJI necessitates a multidisciplinary approach and dedicated funding to improve patient care, address this critical issue generally, and reduce mortality.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"93 1","pages":"177-184"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146095484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychometric evaluation of Patient-Reported Outcome Measurement Information System (PROMIS) measures in children and adolescents with lower limb orthopaedic conditions : construct validity, reliability, and responsiveness.","authors":"Hillary Brenda Nguyen,Patricia E Miller,Nicholas Sullivan,Susan T Mahan,Samantha A Spencer,James R Kasser,Matthew Milewski,Dennis Kramer,Collin J May","doi":"10.1302/0301-620x.108b2.bjj-2025-0277.r1","DOIUrl":"https://doi.org/10.1302/0301-620x.108b2.bjj-2025-0277.r1","url":null,"abstract":"AimsThe Patient-Reported Outcomes Measurement Information System (PROMIS) has not been broadly validated for use in paediatric patients with lower limb musculoskeletal conditions. The aim of this study was to evaluate the psychometric properties of PROMIS administered using computerized adaptive testing.MethodsThis was a single-centre prospective study involving consecutive patients, aged between 11 and 17 years, with orthopaedic conditions affecting the lower limbs. The convergent and divergent construct validity of PROMIS domains with corresponding subscales of the Paediatric Outcomes Data Collection Instrument (PODCI) were assessed in Group A. The reliability was assessed by retesting a sub-group (Group B) of patients from Group A with the same PROMIS domains in those whose condition was not expected to vary within a month of their initial assessment. PROMIS domain responses preoperatively, and > six months postoperatively, were assessed in Group C.ResultsThe construct validity was assessed in 280 patients in Group A, and convergent validity was achieved between the PROMIS and PODCI Mobility domains (r = 0.73; p < 0.001), Upper Extremity domains (r = 0.52; p < 0.001), PROMIS Physical Activity domain and PODCI Sports and Physical Function subscale (r = 0.57; p < 0.001), PROMIS Depressive Symptoms domain and PODCI Happiness subscale (r = -0.54; p < 0.001), and PROMIS Pain domain and PODCI Pain/Comfort subscale (r = -0.71; p < 0.001). Divergent validity criteria were met with a correlation of < 0.30. The median number of questions required to answer on PROMIS was less than on PODCI. Reliability was assessed in 51 patients in Group B, in whom the PROMIS domains were collected again following a mean of 20 days. Test-retest reliability was highest for Mobility (intraclass correlation coefficient (ICC) = 0.84), Depressive Symptoms (ICC = 0.75), and Pain (ICC = 0.74). Responsiveness was assessed in 150 patients in Group C in whom PROMIS domains were collected preoperatively and at a mean of ten months postoperatively. The largest effect sizes were seen in the Pain and Mobility domains, with smaller improvements in the Physical Activity, Depressive Symptoms, and Upper Extremity domains.ConclusionPROMIS domains of Mobility, Physical Activity, Depressive Symptoms, and Pain may be useful for assessing patient-reported health status in paediatric patients with lower limb orthopaedic conditions.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"52 1","pages":"259-266"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146095491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and treatment of failed surgical treatment of carpometacarpal joint arthritis of the thumb.","authors":"Jody Law,Jeffrey Yao","doi":"10.1302/0301-620x.108b2.bjj-2024-1632.r3","DOIUrl":"https://doi.org/10.1302/0301-620x.108b2.bjj-2024-1632.r3","url":null,"abstract":"The surgical treatment of carpometacarpal (CMC) arthritis of the thumb is widely performed, and provides good pain relief and restoration of function. This condition may be successfully treated using one of many surgical procedures. While the incidence of failure following these procedures is low, potential complications include persistent pain, deformity, and weakness. Identifying the cause of persistent symptoms requires a careful and methodical approach. This review aims to highlight the common reasons for failure, provide a comprehensive discussion of the literature surrounding failed surgical treatment of CMC arthritis of the thumb, and offer a detailed, algorithmic approach to the diagnosis and treatment of this condition.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"58 1","pages":"153-159"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146095488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}