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.

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. 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. The treatment of critical-sized bone defects in foot and ankle surgery remains challenging. Traditional methods, such as bone transport, bulk allograft, vascularized bone graft, and Masquelet procedures carry risks including multiple surgeries, donor site morbidity, infection, and non-union. Recently, custom 3D-printed implants have emerged, offering improved anatomical compatibility, eliminating the need for tissue harvesting, and often requiring only a single operation. This study aims to present the largest UK series of custom 3D-printed implants in foot and ankle surgery. Methods. A retrospective multicentre collaborative study was conducted in 10 NHS Trusts. Demographic, surgical and radiographic variables were recorded including: age; sex; side; type of operation; complications; and postop imaging at 6 weeks, 3 months, 6 months and 12 months. Baseline characteristics were described for demographic variables. Categorical variables were expressed as frequencies and percentages. Results. Data was collected on a total of 34 patients. The mean age of patients was 54 years (range 29 to 83). 68% of patients were men. Avascular necrosis was the most common indication for surgery (35%) followed by trauma (21%), total ankle replacement failure (21%), infection (12%), Charcot arthropathy (6%) and AVN and infection (3%). The most common operation performed was a fusion augmented with a truss (44%) and 91% of patients had a combination of regional and general anaesthetic. All patients had an ASA grade of less than 4. Of the patients that had follow-up imaging, the implants were reported intact by 94% at 6 weeks, 78% at 3 months, 68% at 6 months and 67% at 12 months. Discussion. This is the largest case series of custom-made foot and ankle implants in the UK to date. The clinical and radiographic outcomes at one year Follow-up are satisfactory. Further work is required to assess long term implant survivorship

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.

The February 2025 Wrist & Hand Roundup³⁶⁰ looks at: Delayed fixation of distal radial fractures beyond three weeks increases the odds of reoperation; A systematic review of management options for symptomatic scaphometacarpal impingement after trapeziectomy; Diagnosing occult scaphoid fractures: an art or science?; Dual-mobility trapeziometacarpal arthroplasty shows promising outcomes but lacks long-term evidence; 3D-printed titanium scaphoid implant offers a promising alternative for unreconstructable scaphoid nonunion; Lidocaine co-injection reduces pain intensity during corticosteroid injections in hand and wrist conditions; Long-term outcomes of PyroDisk arthroplasty for trapeziometacarpal osteoarthritis; Evaluating the impact of COVID-19 on hand surgery practices: adaptations and missed opportunities.

Aims

The aim of this study was to assess the necessity of revising the acetabular component in revision total hip arthroplasty (THA) in patients with a Vancouver type B2 periprosthetic femoral fracture (PFF) who require revision of the femoral component. The hypothesis was that revision of both the acetabular and femoral components and using a dual-mobility acetabular component would provide a lower postoperative risk of dislocation, without increasing perioperative morbidity and mortality.

Aims

This study was performed to investigate the association between the acetabular morphology and the joint space narrowing rate (JSNR) in the non-arthritic hip.

Aims

The aim of the LightFix Trial was to evaluate the clinical outcomes for one year after the treatment of impending and completed pathological fractures of the humerus using the IlluminOss System (IS), and to analyze the performance of this device.

Aims

Frailty has been gathering attention as a factor to predict surgical outcomes. However, the association of frailty with postoperative complications remains controversial in spinal metastases surgery. We therefore designed a prospective study to elucidate risk factors for postoperative complications with a focus on frailty.

The December 2024 Children’s orthopaedics Roundup³⁶⁰ looks at: Establishing best practice for managing idiopathic toe walking in children: a UK consensus; Long-term outcomes of below-elbow casting in paediatric diaphyseal forearm fractures; Residual dysplasia risk persists in developmental dysplasia of the hip patients after Pavlik harness treatment; 3D printing in paediatricorthopaedics: enhancing surgical efficiency and patient outcomes; Pavlik harness treatment for hip dysplasia does not delay motor skill development in children; High prevalence of hip dysplasia found in adolescents with idiopathic scoliosis on routine spine radiographs; Minifragment plates as effective growth modulation for ulnar deformities of the distal radius in children; Long-term success of Chiari pelvic osteotomy in preserving hip function: 30-year follow-up study.

Aims

There has been limited literature regarding outcomes of acetabular rim syndrome (ARS) with persistent acetabular os in the setting of acetabular dysplasia. The purpose of this study was to characterize a cohort of adolescent and young adult patients with ARS with persistent os and compare their radiological and clinical outcomes to patients with acetabular dysplasia without an os.

Lisfranc injuries were previously described as fracture-dislocations of the tarsometatarsal joints. With advancements in modern imaging, subtle Lisfranc injuries are now more frequently recognized, revealing that their true incidence is much higher than previously thought. Injury patterns can vary widely in severity and anatomy. Early diagnosis and treatment are essential to achieve good outcomes. The original classification systems were anatomy-based, and limited as tools for guiding treatment. The current review, using the best available evidence, instead introduces a stability-based classification system, with weightbearing radiographs and CT serving as key diagnostic tools. Stable injuries generally have good outcomes with nonoperative management, most reliably treated with immobilization and non-weightbearing for six weeks. Displaced or comminuted injuries require surgical intervention, with open reduction and internal fixation (ORIF) being the most common approach, with a consensus towards bridge plating. While ORIF generally achieves satisfactory results, its effectiveness can vary, particularly in high-energy injuries. Primary arthrodesis remains niche for the treatment of acute injuries, but may offer benefits such as lower rates of post-traumatic arthritis and hardware removal. Novel fixation techniques, including suture button fixation, aim to provide flexible stabilization, which theoretically could improve midfoot biomechanics and reduce complications. Early findings suggest promising functional outcomes, but further studies are required to validate this method compared with established techniques. Future research should focus on refining stability-based classification systems, validation of weightbearing CT, improving rehabilitation protocols, and optimizing surgical techniques for various injury patterns to ultimately enhance patient outcomes.

Cite this article: Bone Joint J 2024;106-B(12):1431–1442.

Aims

The first metatarsal pronation deformity of hallux valgus feet is widely recognized. However, its assessment relies mostly on 3D standing CT scans. Two radiological signs, the first metatarsal round head (RH) and inferior tuberosity position (ITP), have been described, but are seldom used to aid in diagnosis. This study was undertaken to determine the reliability and validity of these two signs for a more convenient and affordable preoperative assessment and postoperative comparison.

Introduction. Symptomatic hip dysplasia is often treated with periacetabular osteotomy (PAO). Studies investigating the effect of PAO have primarily focused on radiographic measurements, pain-related outcomes, and hip survival whereas evidence related to sport participation is limited. Methods. All patients in our institutional database were deemed eligible for this cohort study if they underwent PAO and had answered at least one question related to sport participation. Patients were asked if they were playing sport preoperatively, 6 months after PAO as well as 2, 5, 10, 15 and 20 years after. In addition, patients were asked if they were able to play their preferred sport, what type and at what level they were playing sport, and if surgery had improved their sport performance. Results. Among 2398 patients surveyed, 1926 (80%) were included and 56% were playing sport 6 months after PAO. This number was 61% two years after PAO, and remained around that for the following years, before dropping 15 years after PAO. Between 56% and 71% of patients felt that their sporting performance improved following PAO at the different time points. Between 39% (6 months after PAO) and 63% (15 years after PAO) were able to participate in their preferred sport. Conclusion. The majority of patients undergoing PAO due to hip dysplasia will return to, and maintain, sport after PAO. More than half of patients undergoing PAO believe that the surgery improved their sports performance, and long after the surgery more than half of patients undergoing PAO are able to play their preferred sport

Introduction. Knee arthroplasty (KA), encompassing Total Knee Replacement (TKR) and Unicompartmental Knee Replacement (UKR), is one of the most common orthopedic procedures, aimed at alleviating severe knee arthritis. Postoperative KA management, especially radiographic imaging, remains a substantial financial burden and lacks standardised protocols for its clinical utility during follow-up. Method. In this retrospective multicentre cohort study, data were analysed from January 2014 to March 2020 for adult patients undergoing primary KA at Imperial NHS Trust. Patients were followed over a five-year period. Four machine learning models were developed to evaluate if post-operative X-ray frequency can predict revision surgery. The best-performing model was used to assess the risk of revision surgery associated with different number of X-rays. Result. The study assessed 289 knees with a 2.4% revision rate. The revision group had more X-rays on average than the primary group. The best performing model was Logistic Regression (LR), which indicated that each additional X-ray raised the revision risk by 52% (p<0.001). Notably, having four or more X-rays was linked to a three-fold increase in risk of revision (OR=3.02; p<0.001). Our results align with the literature that immediate post-operative X-rays have limited utility, making the 2nd post-operative X-ray of highest importance in understanding the patient's trajectory. These insights can enhance management by improving risk stratification for patients at higher revision surgery risk. Despite LR being the best-performing model, it is limited by the dataset's significant class imbalance. Conclusion. X-ray frequency can independently predict revision surgery. This study provides insights that can guide surgeons in evidence-based post-operative decision-making. To use those findings and influence post-operative management, future studies should build on this predictive model by incorporating a more robust dataset, surgical indications, and X-ray findings. This will allow early identification of high-risk patients, allowing for personalised post-operative recommendations

Introduction

Accurate assessment of alignment in pre-operative and post-operative knee radiographs is important for planning and evaluating knee replacement surgery. Existing methods predominantly rely on manual measurements using long-leg radiographs, which are time-consuming to perform and are prone to reliability errors. In this study, we propose a machine-learning-based approach to automatically measure anatomical varus/valgus alignment in pre-operative and post-operative standard AP knee radiographs.

Introduction

Shoulder arthroplasty (SA) has been performed with different types of implants, each requiring different replacement systems. However, data on previously utilized implant types are not always available before revision surgery, which is paramount to determining the appropriate equipment and procedure. Therefore, this meta-analysis aimed to evaluate the accuracy of the AI models in classifying SA implant types.

Introduction. Assessment of the humeral head translation with respect to the glenoid joint, termed humeral head migration (HHM), is crucial in total shoulder arthroplasty pre-operative planning. Its assessment informs current classification systems for shoulder osteoarthritis as well as the evaluation of surgical correction. In current clinical practice, HHM assessment relies on computed-tomography (CT) imaging. However, the associated supine position might undermine its functional relevance as it does not reflect the weight-bearing condition with active muscle engagement associated with the upright standing position of most daily activities. Therefore, we assessed to what extent HHM in a supine position is associated with HHM in a range of functional arm positions. Method. 26 shoulder osteoarthritis patients and 12 healthy volunteers were recruited. 3D shapes of the humerus and scapula were reconstructed from their respective CT scans using an image processing software. 3. , and their CT-scan-based HHMs were measured. Furthermore, all subjects underwent low-dose biplanar radiography . 4. in four quasi-static functional arm positions while standing: relaxed standing, followed by 45 degrees of shoulder extension, flexion, and abduction. Using a previously validated method implemented in the programming platforms. 5. , 3D shapes were registered to the pairs of biplanar images for each arm position and the corresponding functional HHM was measured. Bivariate correlations were assessed between the CT-based HHM and each functional arm position. Result. HHM in 45 degrees of flexion and extension both showed significant and strong correlations (r>0.66 and P<0.01) with HHM assessed in the supine position. However, such a high correlation was not found for relaxed standing and 45 abduction. Conclusion. Although HHM in a supine position correlates with HHM in 45-degree extension and flexion, it is poorly associated with the HHM in abduction and relaxed standing. These results may suggest the inclusion of more functionally-relevant patient positioning toward better-informed shoulder arthroplasty planning. Acknowledgement. Funding from PRosPERos-II Project