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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.

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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.

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

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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.

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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.

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. Methods. We searched the PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases for studies applying ML algorithms in TSA. The analysis focused on dataset characteristics, relevant subspecialties, specific ML algorithms used, and their performance outcomes. Results. Following the final screening process, 25 articles satisfied the eligibility criteria for our review. Of these, 60% focused on tabular data while the remaining 40% analyzed image data. Among them, 16 studies were dedicated to developing new models and nine used transfer learning to leverage existing pretrained models. Additionally, three of these models underwent external validation to confirm their reliability and effectiveness. Conclusion. ML algorithms used in TSA demonstrated fair to good performance, as evidenced by the reported metrics. Integrating these models into daily clinical practice could revolutionize TSA, enhancing both surgical precision and patient outcome predictions. Despite their potential, the lack of transparency and generalizability in many current models poses a significant challenge, limiting their clinical utility. Future research should prioritize addressing these limitations to truly propel the field forward and maximize the benefits of ML in enhancing patient care. Cite this article: Bone Jt Open 2025;6(2):126–134

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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).

Aims. The aim of the present study was to analyze the oncological and neurological outcome of patients undergoing interdisciplinary treatment for primary malignant bone and soft-tissue tumours of the spine within the last seven decades, and changes over time. Methods. We retrospectively analyzed our single-centre experience of prospectively collected data by querying our tumour registry (Medical University of Vienna). Therapeutic, pathological, and demographic variables were examined. Descriptive data are reported for the entire cohort. Kaplan-Meier analysis and multivariate Cox regression analysis were applied to evaluate survival rates and the influence of potential risk factors. Results. A total of 119 consecutive patients (mean age 38 years (SD 37; 1 to 83), mean follow-up 66 months (SD 26; 0 to 505) were investigated. Histological entities included Ewing’s sarcoma (EWS; 33), chondrosarcoma (CSA; 20), osteosarcoma (OSA; 22), and soft-tissue sarcoma (STS; 44). Surgery was performed in 88 patients (74%). Neurological parameters improved in 18 patients (20%) after surgery. Overall, 32 patients (36%) suffered from surgical complications requiring revision. The median survival was 42 months (IQR 10 to 204). The one-, five-, and ten-year survival rates were 73%, 47%, and 39%, respectively. Corresponding five-year survival rates for EWS, CSA, OSA, and STS were 63%, 61%, 40%, and 32%, respectively. The decade of diagnosis, histological entity, surgical intervention, resection margin, and the presence of metastases had significant influence on survival. (Neo-)adjuvant therapies alone had no significant influence on overall survival. Conclusion. Our study clearly demonstrates the positive impact of improved surgical techniques, as well as refined imaging methods and evolved adjuvant therapy options, on survival rate in all tumour entities. However, despite a multimodal treatment plan, the long-term mortality of these tumours remains high. Cite this article: Bone Jt Open 2025;6(2):109–118

Aims. Trauma & Orthopaedic (T&O) surgery has come under scrutiny for lagging behind other medical specialties in promoting gender and cultural equity and diversity within their workforce. The proportions of female, ethnic minority, and sexual and gender minority individuals within orthopaedic membership bodies are disproportionate to the populations they serve. The aim of this study is to report the findings of a national workforce survey of demographics and working patterns within T&O in Scotland. Methods. A questionnaire devised by a working group was delivered by the Client Analyst and Relationship Development (CARD) group. Utilizing a secure third party ensured anonymity for all respondents. Data were recorded and analyzed by the CARD group. Results. A total of 353 responses were recorded, representing 71% of the known workforce. Overall, 261 respondents (74%) identified as male, 85 (24%) female, and seven (2%) preferred not to say. For specialist trainee (ST)3 to ST6, 148 (42%) were female, and for ST7 to ST8, 131 (37%) were female. In total, 226 of all respondents (64%) were white-British, 35 (10%) were white-European, and 92 (26%) were of an ethnic minority background. A total of 321 of respondents (91%) identified as heterosexual, 14 (4%) preferred not to say, and 18 (5%) identified as LGBTQ+ or preferred to self-describe. Conclusion. This is the largest national workforce survey in contemporary surgical literature. The findings demonstrate a greater proportion of female surgeons overall compared to other studies in T&O. This proportion of females was highest among more junior trainees. The Scottish T&O workforce is more ethnically diverse than the demographics of the population it serves. This study suggests that T&O in Scotland is an evolving speciality in terms of equality and diversity, and is making positive progress. Cite this article: Bone Jt Open 2025;6(1):103–108

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

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The aim of this study was to report long-term clinical outcomes of a modern convertible metal-backed glenoid (MBG) in total shoulder arthroplasty (TSA).

Aims. We estimated the prevalence of people living with at least one hip, knee, or shoulder arthroplasty in the Netherlands. Methods. We included the first hip (n = 416,333), knee (n = 314,569), or shoulder (n = 23,751) arthroplasty of each patient aged ≥ 40 years between 2007 and 2022 (hip/knee) or 2014 and 2022 (shoulder) from the Dutch Arthroplasty Register (LROI). Data on the size of the Dutch population were obtained from Statistics Netherlands. Annual incidences and deaths from hip and knee arthroplasty since 2010, and shoulder arthroplasty since 2015, were observed from the LROI. Annual incidences and deaths before those years were estimated using Poisson regression analyses and parametric survival models based on a Gompertz distribution. Non-parametric percentile bootstrapping with resampling was used to estimate 95% CIs. Results. Annual incidences per 100,000 Dutch inhabitants aged ≥ 40 years increased for hip arthroplasties from 221 (95% CI 214 to 229) in 1990 to 360 in 2022, for knee arthroplasties from 181 (95% CI 174 to 188) to 272, and for shoulder arthroplasties from 11 (95% CI 8.0 to 16) to 34. In 2022, 791,000 (95% CI 787,000 to 794,000) people in the Netherlands were living with at least one joint replacement, representing 8.4% (95% CI 8.4 to 8.5) of the Dutch population aged ≥ 40 years. For hip, knee, and shoulder arthroplasties, these were 436,000 (95% CI 433,000 to 438,000), 383,000 (95% CI 380,000 to 386,000), and 34,000 (95% CI 33,000 to 36,000) people, corresponding to 4.7% (95% CI 4.6 to 4.7), 4.1% (95% CI 4.1 to 4.1), and 0.4% (95% CI 0.3 to 0.4) of the Dutch population, respectively. The most common age group living with at least one joint replacement was the ≥ 80-year age group, representing 38% (95% CI 37 to 38) of the Dutch population aged ≥ 80 years. Conclusion. Approximately 800,000 people in the Netherlands were living with at least one hip, knee, or shoulder replacement in 2022, representing one in 12 Dutch inhabitants aged ≥ 40 years. Cite this article: Bone Jt Open 2025;6(1):74–81

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The aim of this study was to explore differences in operative autonomy by trainee gender during orthopaedic training in Ireland and the UK, and to explore differences in operative autonomy by trainee gender with regard to training year, case complexity, index procedures, and speciality area.

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The primary aim of this study is to compare mobility status of patients receiving oral oxycodone with those receiving subcutaneous alfentanil as analgesic methods prior to mobilization to help physiotherapy compliance after hip fracture surgery. The secondary aims are to assess postoperative pain, health-related quality of life, in-hospital length of stay, total use of analgesia over postoperative days 1 and 2 (POD 1 and POD 2), complication rates within 30 days, and 30-day mortality rates.

Aims. The Peri-Implant and PeriProsthetic Survival AnalysiS (PIPPAS) study aimed to investigate the risk factors for one-year mortality of femoral peri-implant fractures (FPIFs). Methods. This prospective, multicentre, observational study involved 440 FPIF patients with a minimum one-year follow-up. Data on demographics, clinical features, fracture characteristics, management, and mortality rates were collected and analyzed using both univariate and multivariate analyses. FPIF patients were elderly (median age 87 years (IQR 81 to 92)), mostly female (82.5%, n = 363), and frail: median clinical frailty scale 6 (IQR 4 to 7), median Pfeiffer 4 (1 to 7), median age-adjusted Charlson Comorbidity Index (CCI) 6 (IQR 5 to 7), and 58.9% (n = 250) were American Society of Anesthesiologists grade III. Results. Overall, 90.5% (n = 398) of the patients were treated surgically, 57.0% (n = 227) retained the implant, and 88.7% (n = 353) managed with fixation. Mortality rates were 8.2% (n = 3.6) in-hospital, 11.4% (n = 50) at 30 days, 21.1% (n = 93) at six months, and 21.6% (n = 95) at 12 months. Medical complications, mainly delirium, were common in the acute setting (52.7%, n = 215). The nonunion rate was 4.1% (n = 18). Mortality risk factors in the univariate analysis were age, living at a nursing home, no walking outdoors, frailty variables, fractures in the distal epiphysis, fractures around a proximal nail, discharge to a healthcare facility, and no osteoporotic treatment at discharge. Protective factors against mortality in the univariate analysis were surgical treatment by an experienced surgeon, management without an arthroplasty, allowing full weightbearing, mobilization in the first 48 hours postoperatively, and geriatric involvement. Risk factors for mortality in the multivariate analysis were cognitive impairment (Pfeiffer’s questionnaire) (hazard ratio (HR) 1.14 (95% CI 1.05 to 1.23), p = 0.002), age-adjusted CCI (HR 1.18 (95% CI 1.07 to 1.30), p = 0.001), and antiaggregant or anticoagulant medication at admission (HR 2.00 (95% CI 1.19 to 3.38), p = 0.009). Haemoglobin level at admission was protective against mortality (HR 0.85 (95% CI 0.74 to 0.97), p = 0.018). Conclusion. Mortality in FPIFs occurs mainly within the first six months of follow-up. Early co-management and clinical optimization, particularly targeting frail older patients, is crucial in reducing mortality following these fractures. Cite this article: Bone Jt Open 2024;6(1):43–52

Aims. Periacetabular osteotomy (PAO) is well established for acetabular reorientation and has shown successful improvement in patient-reported outcome measures (PROMs). Nevertheless, studies focusing on postoperative outcomes related to patient individual factors are still underrepresented. Therefore, this study aimed to analyze the functional outcome and activity level in relation to patient sex with a minimum follow-up of two years after PAO for mild to severe hip dysplasia. Methods. A single-centre study was conducted, enrolling patients undergoing PAO and completing a preoperative and postoperative radiological and clinical outcome assessment. The PROMs were assessed using the modified Harris Hip Score (mHHS), the Hip disability and Osteoarthritis Outcome Score (HOOS) with the subscales for pain, sport, activities of daily living (ADL), and quality of life (QoL), and the University of California, Los Angeles (UCLA) activity score. Kendall’s tau were calculated for correlation analyses. Results. In total, 145 patients (28 male, 117 female) were included. The PROMs improved significantly across males and females at the latest follow-up. Female patients had significantly lower preoperative PROMs: mHHS (47 vs 57.4; p = 0.002); HOOS pain (44.9 vs 60; p = 0.003), sport (47 vs 57.4; p = 0.002), ADL (58.9 vs 69.3; p = 0.032), and QoL (26.8 vs 39.3; p = 0.009); and UCLA (5.6 vs 6.7, p = 0.042) scores. Males showed higher postoperative UCLA scores (7.5 vs 6.7; p = 0.03). Kendall’s tau showed significant negative correlation between BMI and UCLA scores in females and males (-0.21 to -0.29; p = 0.002/0.048), while BMI and HOOS sport (-0.16; p = 0.015) and ADL (-0.2; p = 0.003), as well as QoL (-0.14; p = 0.031) and preoperative acetabular inclination (-0.13; p = 0.049) were only significantly negatively correlated in females. Conclusion. Patient sex affects PROMs before and after PAO. Female patients experience higher improvement in hip function and activity level, due to poorer preoperative PROMs than males. Thus, these data are particularly interesting in providing preoperative guidance regarding postoperative outcome expectations. Cite this article: Bone Jt Open 2024;6(1):35–42

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The aim of this study was to evaluate the radiological outcome of patients with large bone defects in the femur and tibia who were treated according to the guidelines of the diamond concept in our department (Centre for Orthopedics, Trauma Surgery, and Paraplegiology).

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This study aims to define a set of family-centred core outcomes for infants undergoing brace treatment to facilitate consistent reporting for future high-quality research.

Aims. Around the world, the emergence of robotic technology has improved surgical precision and accuracy in total knee arthroplasty (TKA). This territory-wide study compares the results of various robotic TKA (R-TKA) systems with those of conventional TKA (C-TKA) and computer-navigated TKA (N-TKA). Methods. This is a retrospective study utilizing territory-wide data from the Clinical Data Analysis and Reporting System (CDARS). All patients who underwent primary TKA in all 47 public hospitals in Hong Kong between January 2021 and December 2023 were analyzed. Primary outcomes were the percentage use of various robotic and navigation platforms. Secondary outcomes were: 1) mean length of stay (LOS); 2) 30-day emergency department (ED) attendance rate; 3) 90-day ED attendance rate; 4) 90-day reoperation rate; 5) 90-day mortality rate; and 6) surgical time. Results. A total of 8,492 knees from 7,746 patients were included in the study. Overall robotic use had risen to 20.4% (2023 Q3 to Q4: 355/1,738) by the end of 2023, with Mako being the most popular at 10.3% (179/1,738). R-TKA had the shortest mean LOS compared with N-TKA and C-TKA (5.5 vs 6.3 and 7.1 days, respectively; p < 0.001). Only Mako (9.7%) demonstrated reduced 90-day ED attendance compared to C-TKA (13.1%; p = 0.009), Cori/Navio (15.0%; p = 0.005), and Rosa (16.4%; p < 0.001). No differences in 90-day reoperation rate and mortality were observed between all groups. Mean surgical times were longer in R-TKA groups by 20.6 minutes (p < 0.001). Conclusion. R-TKA use has increased in recent years, and has been shown to reduce hospital stay despite having a slightly longer surgical time, proving a promising candidate to alleviate the burden on healthcare systems. Individual differences between R-TKA systems contributed to variable clinical outcomes. Cite this article: Bone Jt Open 2024;6(1):12–20