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. Methods. This prospective multicentre study analyzed 97 knees from 90 patients undergoing UKA across four participating hospitals. A standardized surgical technique was employed uniformly by all participating surgeons. Postoperative evaluations were conducted preoperatively, and one day, four weeks, three months, and one year postoperative, encompassing weightbearing radiographs, bone mineral density assessments, and clinical outcome reports using the Forgotten Joint Score and Oxford Knee Score. Statistical analyses, including non-parametric correlation analysis using the Kendall correlation coefficient and Mann-Whitney U test, were performed to explore associations between subsidence and various patient-related or radiological parameters. Results. A total of eight patients showed more than 2° valgus subsidence (8.2%), higher than previously reported rates. There were significant correlations between subsidence and higher preoperative varus alignment of the tibia, larger adaptation of the preoperative varus to a postoperative neutral or valgus alignment, mediolateral undersizing of the tibial component, excessive lateral load of tibial component by more lateral position of femoral component relative to tibial component, a lower T-score, and female sex. Our study found no significant difference in pain scores between subsidence and non-subsidence groups at various postoperative milestones. Conclusion. These findings corroborate earlier suggested risk factors based on biomechanical models. Further research might provide the opportunity to identify high-risk groups preoperatively and adapt treatment strategies for these patients. Cite this article: Bone Jt Open 2025;6(2):178–185

Background. Fourth-generation percutaneous or minimally invasive hallux valgus surgery utilizes a transverse osteotomy to achieve deformity correction. There are only a small number of series reporting the clinical and radiological outcomes of transverse osteotomies, many of which have methodological limitations such as small sample size, limited radiographic follow up or use of non-validated outcome measures. The aim of this study was to provide a methodological robust investigation into percutaneous transverse osteotomies for hallux valgus deformity. Method. A prospective series of consecutive patients undergoing fourth generation metatarsal extra-capsular transverse osteotomy (META) performed by a single surgeon (PL) between November 2017 and January 2023. The primary outcomes were radiographic deformity correction and clinical foot function assessed using the Manchester-Oxford Foot questionnaire (MOXFQ). Radiographic deformity (Hallux valgus angle (HVA) and intermetatarsal angle (IMA), sesamoid position) was assessed according to AOFAS guidelines. Secondary outcomes included Visual Analogue Scale for Pain and radiographic deformity recurrence (defined as HVA >20° at final radiographic follow up). Results. 729 feet from 483 patients (456 Female, 27 Male, mean age 57.9±11.9 years) underwent META. Radiographic data (minimum 12 months post-surgery) was available for 99 .7% of feet with mean follow up of 2.6±1.3 years (range 1.0–5.7). There was a statistically significant improvement (p<0.05) in both HVA; 29.5±8.5° to 7.3±6.7°, and IMA, 12.9±3.4° to 4.6±2.5°. All MOXFQ domains showed significant improvement (p<0.05); Index 36.6±19.1 to 11.8±13.8, Pain 40.1±22.1 to 15.6±16.4, Walking/Standing 32.2±23.2 to 10.2±15.8 and Social Interaction 40.0±20.6 to 9.7±14.0. The recurrence rate was 4.5% (n=33). The complication rate was 6.1% which included a screw removal rate of 2.9%. Conclusion. This is the largest consecutive series of any percutaneous osteotomy technique to correct hallux valgus deformity. This study demonstrates that the technique leads to significant improvement in clinical and radiographic outcomes with a low rate of recurrence

Background. Freibergs infraction is osteonecrosis of lesser metatarsal heads, most commonly affecting adolescent females. They usually present with pain and swelling of the forefoot. Surgical options include open debridement, cheilectomy, micro fracture osteotomy and excision arthroplasty. The aim of the study is to present the results of our surgical method based on the principle of neo-angiogenesis, neo-osteogenesis and neo-chondrogenesis with bone grafting and AMIC membrane application for Freiberg's disease of lesser metatarsals. Methods. A prospective analysis of twelve patients who had Freiberg's infraction of the lesser toe metatarsals treated with open debridement, microfracture, bone grafting and application of AMIC membrane was carried out. The patients were followed up to seven years and the outcome measures were scored using Smillie's classification, radiological findings and the Manchester-Oxford Foot Questionnaire (MOxFQ). Results. There were 9 (75%) female and 3(25%) male patients. The mean age was 42.7 years (range- 19 to 60). The mean follow-up time was 6.6 years. The most common site was second metatarsal, ten (83%) followed by third metatarsal, two (17%). According to Smillie's classification three lesions were labelled as Stage 3 and ten as Stage 4. There were no postoperative infections. None of the patients needed any further surgical intervention. The mean base line MOxFQ was 43.75 (SD- 43.75±12.40) which improved to 7.19(SD-7.18±4.63) the mean baseline EQ-5D improved from 7.85 (SD-7.85±5.08) to1.39(SD-1.39±0.75) at the final follow up. 80 % of the patients had complete remodelling of the head of metatarsal at the final follow up radiology. Conclusions. Open debridement of the Freiberg\'s disease combined with microfracture of the defect, bone grafting and application of AMIC membrane gives good long term functional 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

Osteochondral lesions of the talus (OLTs) are common pathologies, associated to chronic pain and disability. Currently, there is no agreed gold standard for surgical treatment of OLTs, due to lack of superiority trials. Aim: Compare the post operative outcomes of osteochondral autologous transplantation (OATS) and matrix associated stem cell transplantation (MAST), as primary and revision procedures Methods: Prospective study of OATS and MAST from 2013 to 2023, in a single surgeons practice Primary study outcome: rate of revision. Secondary outcomes: PROMS (VAS and FAOS), complications and return to sports. Data collected via chart, radiological review, and telephonic survey. Inclusion criteria: aged 16 years and above; OLTs greater than 10mm2, Primary and Revision. Exclusion criteria: Unable to/Refused consent (N=1), Rheumatological joint disease (N=1). Degenerative joint. Lost to follow up. Statistical analysis with Chi-squared test, Fischers exact test, Wilcoxon sum test, and linear regression. Results: N=90. Equal distribution of OATS being used for primary and for revision (50% (16) /50% (16)), MAST had a slight prevalence of revision over primary (55% revision (32) / 45% primary (26) p 0.6). There was a significant association between prior surgery and the need for a revision procedure in the MAST cohort. (β = 1.491, SE = 0.562, p = 0.008). Return to sport was seen in 90% of the OAST and 67% of MAST (p 0.11). There was statistically significant improvement in PROMs for both techniques (VAS and FAOS), but no significant change between the outcomes in primary versus revision surgeries. Conclusion: OATS is an appropriate technique for managing OLTs, both as a primary and salvage procedure, with significant improvement of PROMS (VAS and FAOS), and elevated rate of return to sports (90%). MAST as a primary intervention showed similar outcomes to those of OATS, but poorer outcomes as a salvage procedure, with higher rates of revision thereafter (p .01)

Background. Hallux Valgus (HV) is a common forefoot deformity that can cause pain and difficulty with walking. There are a range of surgical techniques to treat HV deformity, but there is a risk of recurrence. This paper reviews the clinical assessment and management of recurrent HV as well as a detailed description of how percutaneous surgical techniques can be used to treat recurrent HV. This paper identifies technical challenges of percutaneous HV surgery for recurrent HV deformity as well as strategies to address and mitigate these. Method. This was a multicenter retrospective review of adult patients who had recurrent hallux valgus deformity (defined as hallux valgus angle&gt;15° and having previously undergone primary surgical intervention for HV deformity correction) who were treated with a percutaneous metatarsal extra-capsular transverse osteotomy (META) technique, with at least one year of follow-up data. Demographic information, hallux valgus angle, intermetatarsal angle, Manchester-Oxford Foot Questionnaire (MOXFQ), visual analog scale (VAS), and EQ-5D-5L scores were collected. Results. We retrospectively evaluated 34 feet from 32 patients with a mean age of 63.1±9.2 (range 41–82) who underwent revision hallux valgus surgery using a percutaneous technique. The mean follow up was 3.6±2.3 (range 0.5–8.7 years. The breakdown of index HV surgeries was: 17 Chevron, 9 Scarf/Akin, 6 medial bunionectomy, 1 Lapidus, 1 proximal rotation osteotomy. There was a statistically significant improvement in both clinical foot function and radiographic deformity after surgery. The mean HV angle decreased from 32.9±8.6° to 13.4±7.3°, and the intermetatarsal angle decreased from 12.7±3.8° degrees to 3.8±3.1°(p<0.05). The mean MOXFQ Index score significantly improved from 49.4±23.1 to 14.6±19.4 (p<0.05). Conclusion. This paper suggests that percutaneous surgical techniques using a transverse osteotomy and screw fixation can successfully treat a wide range of recurrent HV deformity severities with significant improvement in clinical and radiographic outcomes

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. Minimally invasive (percutaneous) distal first metatarsal osteotomy with internal fixation is an established technique for hallux valgus deformity correction. Published data is limited to 2–3 years follow-up. This study aimed to assess patients undergoing MICA (Minimally Invasive Chevron and Akin) with minimum 5-year follow up, to evaluate the longer-term results of this procedure using validated patient reported outcome measures (PROMs). Methods. Five-year PROM data was prospectively collected from 117 patients who underwent 169 primary MICA osteotomies between July 2014 and April 2018, performed by a single surgeon. Primary clinical outcome measures included visual analogue scale for pain (VAS-pain), Manchester-Oxford Foot Questionnaire (MOXFQ) and EuroQol-5 Dimensions Index (EQ-5D). Data were collected preoperatively, at 2 years and after a minimum of 5 years. Statistical significance was set at p< 0.05. Results. 169 MICA were performed on 117 patients (112 females, 5 males). Mean follow-up was 6.7 years (standard deviation (SD) 0.96 years). All patients completed minimum 5-year follow-up scores. The MOXFQ scores (mean ± SD) for all 169 feet improved for all domains: from 44.5 ± 22.1 preoperatively to 10.3 ± 17.0 post-operatively for Pain (p<0.001), from 39.2 ± 24.5 to 9.3 ± 17.9 for Walking and Standing (p<0.001) and from 48.2 ± 22.8 to 8.7 ± 17.6 for Social Interaction (p<0.001). VAS-pain improved from 30.8 ± 22.7 to 12.9 ± 21. (p<0.001). EQ-5D Index improved from 0.74 ± 0.14 to 0.90 ± 0.12 (p<0.001). Conclusion. This is the largest study at this time point presenting PROM data following minimally invasive distal first metatarsal osteotomy. It is also the longest in follow up for this technique. This study demonstrates significant improvement in PROMs at the mid-term and MICA can be considered as an effective and long-lasting option for the management of hallux valgus deformity

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. 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

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

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.

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.

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 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.

The February 2025 Research Roundup³⁶⁰ looks at: Walk your way to longer life: quantifying physical activity’s role in extending longevity; Is information about musculoskeletal malignancies from large language models or web resources at a suitable reading level for patients?; Contemporary surgical management of osteosarcoma and Ewing’s sarcoma; L-arginine and tendon healing; What you can’t hear might not stress you out as much.