Aims

To examine how eukaryotic translation initiation factor 5A (eIF5A) regulates osteoarthritis (OA) during mechanical overload and the specific mechanism.

Aims

We aimed to develop and validate a novel prediction model for osteoporosis based on serotonin, fat-soluble vitamins, and bone turnover markers to improve prediction accuracy of osteoporosis.

Aims

The conversion of previous hip fracture surgery to total hip arthroplasty (CTHA) can be surgically challenging with unpredictable outcomes; reported complication rates vary significantly. This study aimed to establish the medium-term survival and outcomes of CTHA performed following a previous hip fracture surgery.

Aims

Revision hip arthroplasty for femoral stem loosening remains challenging due to significant bone loss and deformities requiring specialized revision stems. The aim of this study was to evaluate the clinical and radiological outcomes, and survival, of a consecutive series of femoral revisions performed using a primary cementless stem with tapered geometry and rectangular cross-section at medium-term follow-up.

Aims

Valgus subsidence of uncemented tibial components following medial unicompartmental knee arthroplasty (UKA) poses a challenge in the early postoperative phase, necessitating a comprehensive understanding of its prevalence, risk factors, and impact on patient outcomes.

Introduction. Global data on BKA mortality is dominated by US Veterans population studies, while smaller single-centre UK cohorts observe a wide range of 1 year mortality (13.8%-61.1%). There is no consensus on mortality rates, perioperative complications and at-risk groups post diabetic BKA in England. Methods. England Hospital Episodes Statistics (HES) data was combined with ONS mortality data (2000–2022) and cleaned using STATA 18. The primary outcome was the rate of all cause mortality. Secondary outcomes were causes of death, re-amputation rates, temporal variation in mortality, and 90 day peri-operative complications. Mortality and amputation free survival was calculated with Kaplan-Meier curve analysis using R, STATA 18. Multivariate logistic regression stratified patient variables associated with mortality and/or re-amputation rate. Results. 28,045 BKA were performed for diabetes in the 20-year period; decreasing from 8.1/100,000 (2002) to 6.5/100,000 (2022). The rates were significantly higher in white males aged 60–79 years old (14/100,000 in 2023). The mortality rates following BKA for diabetic foot disease were 7.1% at 30 days, 12.7% at 90 days, 24.6% at 1 year, and 61.2% at 5 years. Only 17% of patients survived to 10 years post BKA. The 90-day reoperation rate for any cause was 20.7%. The ipsilateral re-amputation rate at any time was 10.4% (n=2909), and the contralateral amputation rate was 8.2% (n=2304). Additional 90-day complications included PE (0.75%, n=211), MI (3.6%, n=1019) and Stroke (1.1%, n=316). Multi-regression analysis demonstrated significantly higher BKA associated mortality rates at all time points in male, British-Asians with higher deprivation status. Conclusions. This landmark 20-year England diabetic population study has revealed high rates of death, further amputation and peri-operative morbidity post BKA. Asian Males in their 60s have the highest mortality rates and represent an at-risk group. Overall, there has been little improvement in post BKA mortality over the last 20 years

Introduction. The use of an arthroereisis screw is well described in the paediatric population for the correction of flexible flat feet. There are no long-term studies of its use in adults. We performed a functional and radiographic evaluation of a single centre, single surgeon series following the use of a subtalar arthroereisis screw, to augment reconstruction in adult patients with acquired adult flat foot deformity secondary to spring ligament / tibialis posterior tendon failure. Methods. We performed a retrospective review of 40 consecutive feet with stage 2 PTTI that underwent flexor digitorum longus transfer, reefing of the spring ligament, translational medialising calcanaeal osteotomy and augmentation with an arthroereisis screw (Kalix, Integra; 22 feet or ProStop, Arthrex; 3 feet), between 2005 and 2021. All arthroereisis screws were electively removed at 6 months. Radiographic values were assessed pre- and post-operatively at 1-year with functional results both at 1-year and average 10-year follow-up. Results. The mean age of patients at surgery was 60 years (range 44–77 years). There was a significant improvement p<0.05) in radiographic parameters (calcaneal pitch, Mearys angle, medial column height, talus to 1st and 2nd metatarsal angle and talonavicular coverage). There were no re-operations. Manchester Oxford Foot Questionnaire, EQ-5D and VAS scores at an average of 10.6 years for pain were reported as 2.3 (range 0–64, Likert scale), 0.94 (range -0.59–1) and 0.2 (0–10), respectively. Health TODAY averaged at 91.4%. Conclusion. We conclude that the use of an arthroereisis screw is a promising adjunct to conventional reconstruction in adult PTTI that protects the spring ligament repair and tendon transfer during the initial healing time of the soft tissues. Excellent radiological and functional results were obtained in our cohort with high levels of patient satisfaction at long-term follow-up

Introduction. Definitive treatment for ankle arthritis is either Total Ankle Replacement (TAR) or Ankle Fusion (AF). AF may pre-dispose to hindfoot fusion resulting in a debilitatingly rigid ankle-hindfoot complex. In comparison, TAR may protect against adjacent joint disease but is associated with high revision rates. We do not know the life-time risks of further surgery, adjacent joint disease progression and rare but serious complications of TAR versus AF. Methods. An England population cohort study was performed using the ONS mortality linked Hospital Episode Statistics database (1998–2023). The primary outcome was Kaplan-Meier curve analysis of revision surgery free survival of TAR versus AF. Secondary outcome measures were the rates of any re-operation to the ankle/hindfoot, including hindfoot fusion rate, 90-day complications, and peri-operative mortality. Results. 10,335 TAR and 30,704 AF were analysed. The revision rate of TAR was significantly higher than AF at all time points, including 5 years (6.7% vs 2.1%), 10 years (11.1% vs 2.9%) and 20 years (13.1% vs 3.1%). There was no significant difference in 20-year risk of hindfoot fusion following AF (5.94%, 95% CI 5.15 to 6.8%) versus TAR (4.80%, 95% CI 3.4% to 6.6%). TAR was associated with higher risks of intra-operative fracture (0.42% vs 0.10%, RR = 4.35) and re-operation for wound infection (0.26% vs 0.15%, RR 1.74) but fewer pulmonary emboli (0.23% vs 0.58%, RR = 0.40).28.9% of TAR resulted in a further operation; 60% of which were for exploration/debridement, infection, aspiration and/or revision. Conclusions. Both TAR and AF are safe definitive treatments of ankle arthritis with low peri-operative risk. The risk of subsequent hindfoot fusion after AF is very low and not significantly higher than after TAR. England TAR revision rates are lower than reported globally with many smaller operations performed before the more complex revision surgery

Aims

Unicompartmental knee arthroplasty (UKA) is associated with an accelerated recovery, improved functional outcomes, and retention of anatomical knee kinematics when compared to manual total knee arthroplasty (mTKA). UKA is not universally employed by all surgeons as there is a higher revision risk when compared to mTKA. Robotic arm-assisted (ra) UKA enables the surgeon to position the prosthesis more accurately when compared to manual UKA, and is associated with improved functional outcomes and a lower early revision risk. Non-randomized data suggests that, when compared to mTKA, raUKA has a clinically meaningful greater functional benefit. This protocol describes a randomized controlled trial that aims to evaluate the clinical and cost-effectiveness of raUKA compared to mTKA for individuals with isolated medial compartment osteoarthritis (OA).

Aims. This study aimed to investigate whether the use of CT-based navigation enhances: 1) the accuracy of cup placement; and 2) the achievement rate of required range of motion (ROM). Additionally, we investigated the impact of using a large femoral head and dual-mobility liner on the achievement rates. Methods. This retrospective study analyzed 60 manual and 51 CT-based navigated primary total hip arthroplasties performed at a single facility. Postoperative CT scans and CT-based simulation software were employed to measure the cup orientation and to simulate the ROM. We compared the absolute errors for radiological inclination (RI) and radiological anteversion (RA) between the two groups. We also examined whether the simulated ROM met the required ROM criteria, defined as flexion > 110°, internal rotation > 30°, extension > 30°, and external rotation > 30°. Furthermore, we performed simulations with 36 mm femoral head and dual-mobility liner. Results. The absolute errors of RI and RA from the preoperative plan were significantly smaller in the CT-based navigation group (3.7° (SD 3.5°) vs 5.1° (SD 3.5°); p = 0.022, and 3.9° (SD 3.5°) vs 6.8° (SD 5.0°); p = 0.001, respectively). The proportion of cases achieving the required ROM in all directions was significantly higher in the CT-based navigation group (42% vs 63%; p = 0.036). The achievement rates of the required ROM were significantly higher with the use of a 36 mm ball or dual-mobility liner compared to the use of a 32 mm ball (65% vs 51%; p = 0.040 and 77% vs 51%; p ≤ 0.001, respectively). Conclusion. CT-based navigation enhanced required ROM achievement rates by > 20%, regardless of the ball diameter. The improved accuracy of cup placement through CT-based navigation likely contributed to the enhancement. Furthermore, the use of large femoral heads and dual-mobility liners also improved the required ROM achievement rates. In cases with a high risk of dislocation, use of these devices is preferred. Cite this article: Bone Jt Open 2025;6(2):155–163

Aims

The Bracing Adolescent Idiopathic Scoliosis (BASIS) study is a randomized controlled non-inferiority pragmatic trial of ‘full-time bracing’ (FTB) compared to ‘night-time bracing’ (NTB) for the treatment of adolescent idiopathic scoliosis (AIS). We anticipated that recruiting patients to BASIS would be challenging, as it is a paediatric trial comparing two markedly different bracing pathways. No previous studies have compared the experiences of AIS patients treated with FTB to those treated with NTB. This qualitative study was embedded in BASIS to explore families’ perspectives of BASIS, to inform trial communication, and to identify strategies to support patients treated in a brace.

Aims

In our previous research, we have found that melatonin (MEL) affects the osteoporotic process. By balancing bone remoulding, autophagy is involved in age-related bone loss. However, as a regulator of autophagy, whether MEL influences senile osteoporosis via regulating autophagy remains unclear.

Aims

Machine learning (ML) holds significant promise in optimizing various aspects of total shoulder arthroplasty (TSA), potentially improving patient outcomes and enhancing surgical decision-making. The aim of this systematic review was to identify ML algorithms and evaluate their effectiveness, including those for predicting clinical outcomes and those used in image analysis.

Aims

Autologous bone graft (ABG) is considered the ‘gold standard’ among graft materials for bone regeneration. However, complications including limited availability, donor site morbidity, and deterioration of regenerative capacity over time have been reported. P-15 is a synthetic peptide that mimics the cell binding domain of Type-I collagen. This peptide stimulates new bone formation by enhancing osteogenic cell attachment, proliferation, and differentiation. The objective of this study was to conduct a systematic literature review to determine the clinical efficacy and safety of P-15 peptide in bone regeneration throughout the skeletal system.

Aims. To establish cut-off values for lateral pubofemoral distance (PFD) measurements for detecting hip dysplasia in early (four days) and standard care (six weeks) screening for developmental dysplasia of the hip (DDH). Methods. All newborns, during a one-year period (October 2021 to October 2022), were offered a PFD ultrasound (US) examination in addition to the existing screening programme for DDH. Newborns who were referred for standard care hip US, suspected for DDH, received a secondary PFD US examination in conjunction with the standard care Graf/Harcke hip US examination. Receiver operating characteristic curves and empirically optimal cut-off values were calculated with a true positive defined as a Graf type ≥ IIc hip. Results. We included 2,735 newborns, of whom 758 received both early PFD hip US and standard care Graf/Harcke hip US. For early (four days) PFD screening, the optimal cut-off point was calculated to be 6.2 mm (95% CI 4.7 to 7.7) producing a sensitivity of 80% (95% CI 55% to 100%) and a specificity of 87% (86% to 89%). For PFD screening performed at standard care (six weeks) hip US, the optimal cut-off point was calculated to be 5.6 mm (95% CI 4.9 to 6.3) producing a sensitivity of 100% (95% CI 100% to 100%) and a specificity of 96% (95% CI 95% to 97%). Conclusion. PFD US screening produces a high degree of both sensitivity and specificity for detecting DDH. Age-specific cut-off values should be used to heighten the accuracy of PFD US screening. Cite this article: Bone Jt Open 2025;6(2):119–125

The February 2025 Hip & Pelvis Roundup³⁶⁰ looks at: Postoperative periprosthetic femoral fractures after hip arthroplasty: quantifying the other half of the picture; Hip arthroscopy in patients with borderline dysplasia: how do we know when it will not work?; The morbidly obese patient remains a challenge for arthroplasty surgeons; Unexpected positive cultures in aseptic revision hip and knee arthroplasty: does it make a difference?; Failed spinal anaesthesia in hip and knee arthroplasty surgery; Clinical failure of femoral neck fracture is associated with varus necks; Navigating the angles: how variations in femoral and acetabular versions influence hip pain and treatment; High-tech or hands-on? Similar outcomes in direct anterior total hip arthroplasty.

Aims

In this study, we aimed to evaluate incidence trends and potential risk factors associated with Perthes’ disease in Denmark, using publicly available data.

Aims

Sagittal lumbar pelvic alignment alters with posterior pelvic tilt (PT) following total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH). The individual value of pelvic sagittal inclination (PSI) following rebalancing of lumbar-pelvic alignment is unknown. In different populations, PT regresses in a linear relationship with pelvic incidence (PI). PSI and PT have a direct relationship to each other via a fixed individual angle ∠γ. This study aimed to investigate whether the new PI created by acetabular component positioning during THA also has a linear regression relationship with PT/PSI when lumbar-pelvic alignment rebalances postoperatively in patients with Crowe type III/IV DDH.

The February 2025 Foot & Ankle Roundup³⁶⁰ looks at:Percutaneous Zadek osteotomy for insertional Achilles tendinopathy; Association of extraosseous arterial diameter with talar dome osteochondral lesions; Autologous chondrocyte implantation for osteochondral lesions of the talus; Symptomatic thromboembolism and mortality in foot and ankle surgery in the UK; Corticosteroid or hyaluronic acid in Morton’s neuroma?

The February 2025 Trauma Roundup³⁶⁰ looks at: Risk factors for nonunion in femoral neck fracture patients with internal fixation: a multicentre (TRON group) retrospective study; Tranexamic acid administered at time of hospital admission does not decrease transfusion rates or blood loss for extracapsular hip fractures; The effect of anterior support screw (AS2) in unstable femoral trochanteric fractures; The effect of coronal plane angulation on patient-reported outcome measures of operatively treated distal femur fractures; Do proximal humerus fractures treated nonoperatively benefit from supervised physiotherapy?; Cephalomedullary nails: are dual lag screws superior to single lag screws?; Does cement need to be pressurized for hemiarthroplasty?.