Aims. Fracture-related infections (FRIs) are a major concern for patients and healthcare systems, yet their impact on mental health has been largely overlooked. This study aimed to assess the longitudinal impact of FRI on patients’ quality of life. Methods. A prospective study was conducted at a level 1 trauma centre between January 2020 and December 2022. In total, 56 patients participated, with quality of life assessed at five timepoints: one week preoperatively, and one, three, six, and 12 months postoperatively. Statistical analysis was performed using repeated measures analysis of variance (ANOVA) with adjusted post-hoc analysis. Results. The preoperative Physical Component Summary score on the 36-Item Short-Form Health Survey questionnaire (SF-36) was 26.71, increasing to 30.40 at one month, remaining stable at three months. A modest increase was observed at six months (32.45, p = 0.003), but it decreased to 29.72 at 12 months. The preoperative Mental Component Summary score (SF-36) was 46.48, decreasing to 39.89 at one month (p = 0.027) and to 36.03 at three months (p ≤ 0.001). However, it improved at six (42.74) and 12 months (44.05). Positive changes were seen in EuroQol five-dimension questionnaire (EQ-5D) subdimensions, such as mobility, self-care, usual activities, and pain/discomfort, while anxiety/depression scores decreased over time. The EQ-5D visual analogue scale (VAS) score increased to 62.79 at six months (p ≤ 0.001) and decreased to 58.2 at 12 months (p = 0.011). Conclusion. FRIs substantially affect mental health and quality of life, particularly during the initial three months of treatment. This study emphasizes the importance of addressing psychological aspects early in FRI management, advocating for holistic care encompassing both physical and psychological aspects of treatment. Cite this article: Bone Joint Res 2025;14(2):136–142

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To develop a multidisciplinary health research agenda (HRA) utilizing expertise from various disciplines to identify and prioritize evidence uncertainties in orthopaedics, thereby reducing research waste.

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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.

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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.

Background. The ability to return to physical activity is an important indicator of surgical success for end-stage ankle arthritis. There is paucity of literature comparing outcomes between surgical procedures. This study aimed to compare outcomes for physical activity and return to function between total ankle replacement (TAR) and ankle arthrodesis (AA) at 1-year follow-up. Methods. This was a single-centre prospective follow-up study. Patients who underwent TAR (n=33) or AA (n=25) between 2022–2023 completed questionnaires on FAOS scores (Pain, Symptoms, ADL and QOL domains), International Physical Activity Questionnaire (IPAQ), satisfaction scores and return to work/driving. IPAQ physical activities were compared across domains of work, transportation, domestic and leisure activities. Results. AA patients were younger (59.1 vs. 65.8). The AA group had better average FAOS scores for pain, symptoms, ADL, and QOL compared to TAR (51.2 vs. 29.2; 40.6 vs. 67.8, 46.8 vs. 66.4, 31.3 vs. 48.3) (p=0.526), but the TAR group reported higher overall satisfaction (77% vs. 66.6%). Earliest return to work was reported at 2 weeks (TAR) vs. 3 weeks (AA) group and driving at 3 weeks (TAR) vs. 4 weeks (AA). More TAR patients returned to vigorous (25%) and moderate (17.6%) physical activity versus AA (0% and 0%). For transport, 4 AA patients vs. 12 TAR patients returned to this activity. AA patients travelled 30 minutes to 2 hours per week, while TAR patients travelled 30 minutes to 5 hours. For household activities, 15.7% of TAR patients reported vigorous activity versus 0% in AA. AA patients spent less time on average leisure walking (1.25 hrs vs. 2 hrs), and more time sitting per day (9.2 hrs vs. 5.9 hrs). Conclusion. The TAR group demonstrated earlier return to work, driving, and higher levels of physical activity compared to AA patients at 1-year follow-up, despite the AA group having better FAOS scores

Introduction. Osteochondral defects (OCDs) of the talus were identified as a “TOP 10” research priority in foot and ankle surgery by the James Lund Alliance in partnership with BOFAS, BOA and NIHR. To develop a research strategy, the views of BOFAS members regarding OCDs of the talus were surveyed. The results are reported here. Methods. A questionnaire concerning the presentation, investigation and management of OCDs was formulated with input from the BOFAS National Clinical Study Group and ratified by the Scientific Committee. It concerned primary OCDs of the talus that had failed non-surgical management. It was distributed to BOFAS members via email using _Microsoft Forms_. Results. There were 90 responses. Data on presenting symptoms, investigations, initial management and decision making was collected. Surgical treatment was grouped according to defect size: small or large and shallow or deep. This gave 4 categories. For the purposes of the study a large defect had a width >15mm and a deep defect had a depth >5mm. For small, shallow lesions 85 respondents chose microfracture as the first line surgical treatment. For large shallow lesions 59 respondents chose microfracture, 18 chose bone marrow stimulation plus scaffold e.g. AMIC or ACIC and 6 chose bone marrow stimulation plus a biological agent e.g. cBMA or PRP. For small deep lesions microfracture was again most popular (69 respondents). For large deep lesions microfracture was chosen by 43 respondents, AMIC/ACIC by 23 and OATs by 7. Further data was collected on post op rehabilitation. Discussion. The study demonstrates that microfracture is the most popular first line treatment for primary OCDs of the talus of any size. That said, a wide range of treatments are in practice. This information will facilitate the development of high-quality studies to identify the most appropriate evidence-based treatment for OCDs of the talus

The aim was to demonstrate that Supramalleolar osteotomy is a valuable treatment method in eccentric ankle arthritis in young and middle aged since it is an under-utilised procedure. We retrospectively analysed the outcome of it performed over 12 year period. We also compared the results of recently introduced computer-assisted PSI Integrated custom-made implants with standard implants. Data was analysed from 48 patients over a period of 12 years of which 40 were by standard implant and 8 by computer assisted custom implant. 31 varus, 18 valgus deformity. The mean age was 57 (26–79 y/o), male:female ratio was 27:19. Mean follow-up was 15.25 months for standard implants; For the computer-assisted procedures the follow up range is 24 to 2 months. TAS, TTS and TT angels were measured pre and post-operatively. Fixation using a plate with/without bone graft or custom-made implant was performed by a single surgeon. MOXFQ and AOFAS questionnaires were completed pre and post-operatively. All followed similar rehabilitation programme. Average radiological healing time was 24.3 weeks. MOXFQ score improved from 55.17 to 25.11 and AOFAS from 20.16 to 56.21. Complications were 2 non-unions, 1 delayed union, 1 stress fracture. 8 patients require fusion/replacement between 3–5 years. The PSI Integrated computer-assisted technique gave improved accuracy than standard freehand method with better scores and a smoother approach for the surgeon. Early results with this technique are encouraging as we were able achieve 3 dimentional correction compared to the 2 dimentional correction achieved by the freehand method. Our results are comparable to similar studies. Being a joint preserving technique, Supra Malleolar Osteotomy should be considered either as an interim or definitive procedure especially with the development of computer assisted technologies which makes the technique easier to reproduce

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

Aims. We compared the clinical outcomes of a fixed bearing (Infinity) and a mobile bearing (Zenith) ankle replacement in a demographically similar group of patients, from a single, non designer centre. Methods. Between December 2010 and May 2016, 118 consecutive mobile bearing prostheses (Zenith) and between September 2017 and November 2019, 118 consecutive fixed bearing (Infinity) prostheses were implanted in a total cohort of 230 patients. Demographic, clinical, and patient reported outcome measures (PROMs) data were collected. The end point of the study was failure of the implant requiring revision of one or more of the components. Kaplan Meier survival tables were generated. Results. Demographics were similar for both groups (age, pre-operative arthritic diagnosis and co-morbidities). 32 patients (36 ankles) died during follow-up, but none required revision. Of the surviving 198 patients (200 ankles; 93 Zenith, 107 Infinity), mean follow-up was 9.1 years (6.0 – 13.1 years) for Zenith and 5.0 years for Infinity (3.6 – 6.8 years). A total of 11 implants (9.3%) failed for Zenith and 1 implant (0.8%) failed for Infinity, requiring revision. Average time to failure for Zenith was 3.4 years (0.4 – 10.5 years) and the time to failure for Infinity was 4.1 years. Implant survival at five years, using revision as an endpoint, was 91.3% for Zenith and 98.7% for Infinity. There was a mean improvement in Manchester-Oxford Foot and Ankle Questionnaire (MOXFQ) from 85.0 to 32.8 for Zenith and 79.3 to 26.4 for Infinity, and visual analogue scale (VAS) scores from 7.0 to 3.2 for Zenith and 6.9 to 2.7 for Infinity. The commonest reason for revision was aseptic loosening for both implants. Conclusion. Our results show a significantly better survivorship for the fixed bearing over the mobile bearing prosthesis. Whilst the fixed bearing prosthesis had better PROMS scores, this was not significant

Background. Distinguishing stable from unstable ankle fractures is key to successful ankle fracture management. Gravitational stress views (GSV) may be a convenient and less painful alternative to manual stress testing. The aim of this study was to assess whether this test accurately predicts ankle instability. Methods. Patients presenting to a single trauma centre between 2011 and 2013 with an isolated fibula fracture and a an anatomically-aligned mortise on initial plain film radiographs were reviewed. After initial x-ray, patients underwent a gravity stress view. Measurements from plain film radiographs were recorded and analysed. Electronic case notes and National Imaging Archives were reviewed retrospectively at a minimum of 10 years post-injury. Patients were contacted to complete patient reported outcome measures (PROMS). Results. One-hundred and forty-two (142) patients met the inclusion criteria and were included in the study. Mean initial film medial clear space (MCS) measurement was 3.46mm (1.0 to 6.0) compared to GSV MCS that was 4.9mm (2.0 to 8.8) (p<0.001). No patient underwent surgery and all patients had successful conservative management with anatomical union seen at their 6 week radiograph. No patient returned with a complication related to their ankle fracture during the follow-up period. With a MCS acquired from GSV of >5mm, 65 patients would have undergone unnecessary surgical intervention. At MCS of >6mm, 26 patients would have undergone surgery unnecessarily and at a MCS of >7mm 10 patients would have had unnecessary surgery. To date, 50 patients have provided PROMs. Mean Olerud and Molander Score (OMAS) at 10 years was 86.63 (SD 23.27, 95% CI 79.47 – 93.79), Manchester Oxford Foot Questionnaire (MOXFQ) was 79.41 (SD 32.94, 95% CI 69.39 – 89.42) and Euroqol-5D-3L was 0.86 (SD0.22, 95% CI 0.79 – 0.93). Conclusion. Stress views may over-diagnose instability in patients with an isolated fibula fracture in an otherwise normal initial radiograph

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). Methods. The total versus robotic-assisted unicompartmental knee arthroplasty (TRAKER) trial is a patient- and assessor-blinded, pragmatic parallel two-arm randomized superiority trial of adults undergoing elective primary knee arthroplasty for primary medial compartment OA at a single NHS hospital (ClinicalTrials.gov NCT05290818). Participants will be randomly allocated on a 1:2 basis to either raUKA or mTKA, respectively. The primary analysis will compare the Oxford Knee Score (OKS) six months after surgery. Secondary outcomes measured at three, six, and 12 months include the OKS, Forgotten Joint Score, patient expectations, EuroQol five-dimension questionnaire (EQ-5D), and EQ-visual analogue scale (EQ-VAS), patient satisfaction, range of motion, postoperative complications, need for further surgery, resource use, and financial costs. Cost-effectiveness will be measured over a ten-year time span. A total of 159 patients will be randomized (n = 53 raUKA vs n = 106 mTKA) to obtain 80% power to detect a five-point difference in OKS between the groups six months after surgery. Conclusion. The trial findings will provide evidence about the clinical and cost-effectiveness of raUKA compared to mTKA in patients with isolated medial compartment OA. This will inform future National Institute for Health and Care Excellence guidelines on primary knee arthroplasty in the UK. Cite this article: Bone Jt Open 2025;6(2):164–177

Aims. Control of acute pain following knee arthroplasty (KA) with a perioperative peripheral nerve block (PNB) may improve functional outcomes and reduce the risk of chronic postoperative knee pain (CPKP). The aims of this study were to assess whether a PNB influences patient-reported outcomes and risk of CPKP at one year following KA. Methods. A retrospective study was conducted over a two-year period and included 3,338 patients who underwent KA, of whom 1,434 (43.0%) had a lower limb PNB. A total of 2,588 patients (77.6%) completed and returned their one-year follow-up questionnaire. The Oxford Knee Score (OKS) and pain component (OKS-PS), EuroQol five-dimension questionnaire (EQ-5D), and EQ-visual analogue scale (VAS) were collected preoperatively and at one year postoperatively. Patient satisfaction was also recorded at one year. The OKS-PS was used to define CPKP at one year. Results. The PNB group were younger (mean difference (MD) 0.7 years, 95% CI 0.0 to 1.3; p = 0.039), had a worse OKS (MD 0.7, 95% CI 0.1 to 1.3; p = 0.027), and were more likely to have had a spinal anaesthesia relative to a general anaesthetic (odds ratio 4.2, 95% CI 3.23 to 5.45; p < 0.001). When adjusting for confounding factors, patients in the PNB group had a significantly reduced improvement in their OKS (MD -0.9, 95% CI -1.6 to -0.1; p = 0.022), which may not be clinically meaningful. There were no significant differences in the OKS-PS (p = 0.068), EQ-5D (p = 0.313), or EQ-VAS (0.855) between the groups when adjusting for confounding factors. When adjusting for confounding factors using binary regression analysis, there were no differences in patient satisfaction (p = 0.132) or in the risk of CPKP (p = 0.794) according to PNB group. Conclusion. PNBs were independently associated with worse knee-specific outcomes, but whether these are clinically meaningful is not clear, as the difference was less than the minimal clinically important difference. Furthermore, PNBs were not independently associated with differences in health-related quality of life, patient satisfaction, or risk of CPKP. Cite this article: Bone Jt Open 2025;6(2):147–154

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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.

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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.

The February 2025 Sports Roundup³⁶⁰ looks at: Long-term outcomes of focal cartilage lesions of the knee; Comparison of early and delayed multiligament knee reconstruction; Platelet-rich plasma does not improve recovery after partial meniscectomy; Patient height and sex predict semitendinosus autograft diameter.

The February 2025 Knee Roundup³⁶⁰ looks at: Once-weekly semaglutide in patients with obesity and knee osteoarthritis; How many patients should have a unicompartmental knee arthroplasty?; Staged revision of the infected knee arthroplasty and endoprosthesis; The metal allergy argument and knee arthroplasty; Is kinematic alignment all it’s cracked up to be?; Is bone-patella-bone the gold standard for revision?; Blood flow restriction and the dissatisfied knee arthroplasty.

Aims. The Birmingham Orthopaedic Oncology Meeting (BOOM), held in January 2024, convened 309 delegates from 53 countries to discuss and refine 21 consensus statements on the optimal management of chondrosarcoma. Methods. With representation from Europe (43%; n = 133), North America (17%; n = 53), South America (16%; n = 49), Asia (13%; n = 40), Australasia (5%; n = 16), the Middle East (4%; n = 12), and Africa (2%; n = 6), the combined experience of treating bone sarcomas among attendees totalled approximately 30,000 cases annually, equivalent to 66 years of experience in the UK alone. The meeting’s process began with the formation of a local organizing committee, regional leads, and a scientific committee comprising representatives from 150 specialist units across 47 countries. Supported by major orthopaedic oncology organizations, the meeting used a modified Delphi process to develop consensus statements through online questionnaires, thematic groupings, narrative reviews, and anonymous pre-meeting polling. Results. Strong (> 80%) consensus was achieved on 19 out of 21 statements, reflecting agreement among delegates. Key areas of consensus included the role of radiology in diagnosis and surveillance, the management of locally recurrent disease, and the treatment of dedifferentiated chondrosarcoma. Notably, there was agreement that routine chemotherapy has no role in chondrosarcoma treatment, and radiological surveillance is safe for intraosseous chondrosarcomas. Despite the overall consensus, areas of controversy remain, particularly regarding the treatment of atypical cartilage tumours and surgical margins. These unresolved issues underscore the need for further research and collaboration within the orthopaedic oncology community. Conclusion. BOOM represents the largest global consensus meeting in orthopaedic oncology, providing valuable guidance for clinicians managing chondrosarcoma worldwide. The consensus statements offer a reference for clinical practice, highlight key research priorities, and aim to improve patient outcomes on a global scale. Cite this article: Bone Joint J 2025;107-B(2):246–252

Hip fractures commonly occur in older patients, with high levels of frailty and comorbidity. Many of these patients have limited mobility before their fracture, and even after surgery, their mobility may remain limited. It is therefore not surprising that they are at a high risk of developing pressure sores, particularly on their heels, and a variety of devices and interventions have been proposed to reduce this risk. Foam or air mattresses, designed to reduce contact pressure on the patient’s whole body, are now routinely used in many healthcare systems. However, there is wide variation in their design. We developed the WHiTE 14;PRESSURE 3 trial to address the lack of evidence in this area. This is a three-arm multicentre randomized trial including health economic evaluation and recruiting patients from NHS hospitals in the UK. The trial compares standard strategies for the prevention of pressure sores with standard care plus a constant low-pressure device and with standard care plus a heel off-loading device. This annotation describes the development of this trial.

Cite this article: Bone Joint J 2025;107-B(2):135–138.

The February 2025 Children’s orthopaedics Roundup³⁶⁰ looks at: Are antibiotics enough for the initial management of paediatric Gustilo-Anderson type I upper limb open fractures?; Advanced imaging for tibial tubercle fractures; Spinal fusion improves quality of life in cerebral palsy scoliosis: a multicentre study; Hip displacement after triradiate closure in ambulatory cerebral palsy; Telehealth validation for adolescent idiopathic scoliosis: comparable clinical measurements enhance access to care; Long-term prognostic markers for residual dysplasia in developmental dysplasia of the hip after closed reduction; Open versus closed reduction for paediatric lateral humeral condyle fractures: better outcomes with closed techniques; Delayed diagnosis of paediatric septic hip leads to poor outcomes and doubling of healthcare costs.

The February 2025 Spine Roundup³⁶⁰ looks at: The effect of thoraco-lumbo-sacral orthosis wear time and clinical risk factors on curve progression for individuals with adolescent idiopathic scoliosis; Does operative level impact dysphagia severity after anterior cervical discectomy and fusion? A multicentre prospective analysis; Who gets better after surgery for degenerative cervical myelopathy? A responder analysis from the multicentre Canadian spine outcomes and research network; Do obese patients have worse outcomes in adult spinal deformity surgeries?; An update to the management of spinal cord injury; Classifying thoracolumbar injuries; High- versus moderate-density constructs in adolescent idiopathic scoliosis are equivalent at two years; Romosozumab for protecting against proximal junctional kyphosis in deformity surgery.