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Bone & Joint Open
Vol. 6, Issue 3 | Pages 328 - 335
12 Mar 2025
Logishetty K Verhaegen JCF Tse S Maheswaran T Fornasiero M Subbiah Ponniah H Hutt JB Witt JD

Aims

The effectiveness of total hip arthroplasty (THA) for patients with no or minimal radiological signs of osteoarthritis (OA) is unclear. In this study, we aimed to: 1) assess the outcome of such patients; 2) identify patient comorbidities and CT or MRI findings which predicted outcome; and 3) compare their outcome to the expected outcome of THA for hip OA.

Methods

Adult patients undergoing THA for hip pain, with no or minimal radiological features of OA (Tönnis grading scale ≤ 1), were identified from a consecutive series of 1,925 THAs. Exclusion criteria were: inflammatory arthritis; osteonecrosis of the femoral head; prior trauma or infection; and patients without minimum one-year follow-up and patient-reported outcome measures (PROMs). The primary outcome measure was the Oxford Hip Score (OHS). Secondary outcome measures were EuroQol-visual analogue scale (EQ-VAS), University of California and Los Angeles (UCLA) scale, and patient satisfaction on a validated three-point ‘better’, ‘same’, or ‘worse’ scale.


Bone & Joint Open
Vol. 6, Issue 3 | Pages 298 - 311
8 Mar 2025
Alt V Szymski D Rupp M Fontalis A Vaznaisiene D Marais LC Wagner C Walter N

Aims

Periprosthetic joint infections (PJIs) pose significant challenges to patients and healthcare systems worldwide. The aim of this study was to estimate the health-economic burden of reimbursement payment in Europe for PJIs following primary hip and knee arthroplasty.

Methods

The calculation was based on health-economic modelling using data on primary hip and knee arthroplasties for the year 2019 from the Statistical Office of the European Union (Eurostat) and published infection rates to estimate the total number of hip and knee PJIs in 30 European countries. Revision procedures were stratified into: 1) debridement, antibiotics, and implant retention (DAIR); 2) one-stage exchange; and 3) two-stage revision procedures. The cases were then multiplied by the respective healthcare system reimbursement payments. Payment data were acquired from a survey of 13 countries (Austria, Croatia, France, Germany, Italy, Lithuania, Netherlands, Norway, Portugal, Slovenia, Switzerland, Turkey, and the UK) and extrapolated for the remaining countries.


Aims

To assess whether chronic knee pain (CKP) influenced health-related quality of life (HRQoL), knee-specific health, wellbeing, and use of opioid analgesia, and identify variables associated with CKP in patients awaiting knee arthroplasty.

Methods

This study included 217 patients (mean age 69.7 years (SD 8.7), 116 female (53%)) who completed questionnaires that included the EuroQol five-dimension questionnaire (EQ-5D) and EuroQol-visual analogue scale (EQ-VAS), Oxford Knee Score (OKS), and wellbeing assessments at six and 12 months after being listed for surgery. Analgesia use at 12 months was also recorded. CKP was defined using the OKS pain score (PS) of ≤ 14 points at 12 months.


Bone & Joint Open
Vol. 6, Issue 2 | Pages 195 - 205
14 Feb 2025
Selim A Dass D Govilkar S Brown AJ Bonde S Burston B Thomas G

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. Methods. All CTHAs performed at our tertiary orthopaedic institution between January 2008 and January 2020 following previous ipsilateral hip fracture surgery were included. Patients were followed up clinically using Oxford Hip Scores (OHS), and radiologically until death or revision surgery. Postoperative complications, radiological implant failure, and indications for revision surgery were reviewed. Results. A total of 166 patients (167 hips) were included in the study, with a mean age of 71 years (42 to 99). Of these, 113 patients (67.7%) were female. CTHA followed cannulated screw fixation in 75 cases, hemiarthroplasty in 18, dynamic hip screw fixation in 47, and cephalomedullary nail in 27 cases. Patients were followed up for a mean of four years (0.1 to 9.3). During the follow-up period, 32 patients (19.2%) died. Overall, 14 patients (8.4%) suffered a complication of surgery, with intraoperative fractures (4.2%) and dislocations (3.6%) predominating. The survival probability was 96% at 9.53 years in the cemented group and 88% at 9.42 years in the uncemented group (p = 0.317). The median OHS improved from 13 (IQR 7.75 to 21.25) preoperatively to 39 (IQR 31 to 45) postoperatively in the uncemented group, and from 14 (IQR 10.5 to 22) to 38 (IQR 27 to 45) in the cemented group. Conclusion. This study highlights that CTHA from hip fracture surgery is associated with higher complication rates than conventional THA, but good medium-term results can be achieved. Their classification within the NJR requires review, acknowledging the increased potential for complications. Cite this article: Bone Jt Open 2025;6(2):195–205


Bone & Joint Open
Vol. 6, Issue 2 | Pages 186 - 194
13 Feb 2025
Battaglia AG D'Apolito R Ding BTK Tonolini S Ramazzotti J Zagra L

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.

Methods

We retrospectively evaluated 113 patients (115 hips) with intraoperative Paprosky type I (n = 86) or II (n = 29) defects, who underwent femoral revision with Alloclassic Zweymüller SL stem for one-stage aseptic revision or two-stage septic revision from January 2011 to December 2020. The mean follow-up was 77.9 months (SD 33.8). Nine patients were lost to follow-up (deceased or not available), leaving 104 patients (106 hips) for the clinical and radiological analysis. Clinical assessment was performed with Harris Hip Score (HHS) and visual analogue scale (VAS) before surgery and at final follow-up.


Bone & Joint Open
Vol. 6, Issue 2 | Pages 178 - 185
11 Feb 2025
Gallant A Vandekerckhove P Beckers L De Smet A Depuydt C Victor J Hardeman F

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.


Bone & Joint Open
Vol. 6, Issue 2 | Pages 155 - 163
8 Feb 2025
Konishi T Hamai S Kawahara S Hara D Sato T Motomura G Utsunomiya T Nakashima Y

Aims

This study aimed to investigate whether the use of CT-based navigation enhances: 1) the accuracy of cup placement; and 2) the achievement rate of required range of motion (ROM). Additionally, we investigated the impact of using a large femoral head and dual-mobility liner on the achievement rates.

Methods

This retrospective study analyzed 60 manual and 51 CT-based navigated primary total hip arthroplasties performed at a single facility. Postoperative CT scans and CT-based simulation software were employed to measure the cup orientation and to simulate the ROM. We compared the absolute errors for radiological inclination (RI) and radiological anteversion (RA) between the two groups. We also examined whether the simulated ROM met the required ROM criteria, defined as flexion > 110°, internal rotation > 30°, extension > 30°, and external rotation > 30°. Furthermore, we performed simulations with 36 mm femoral head and dual-mobility liner.


Bone & Joint Open
Vol. 6, Issue 2 | Pages 126 - 134
4 Feb 2025
Schneller T Kraus M Schätz J Moroder P Scheibel M Lazaridou A

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.


Bone & Joint Open
Vol. 6, Issue 2 | Pages 109 - 118
1 Feb 2025
Schneider E Tiefenboeck TM Böhler C Noebauer-Huhmann I Lang S Krepler P Funovics PT Windhager R

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.


Bone & Joint Open
Vol. 6, Issue 1 | Pages 82 - 92
14 Jan 2025
Ranieri R Borroni M Delle Rose G Conti M Garofalo R Castagna A

Aims. 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). Methods. After a minimum of 15 years, a previously studied cohort of 35 patients who received a modern convertible MBG during the period 1996 to 2005 was contacted for clinical and radiological follow-up. At last follow-up, patients were evaluated radiologically and clinically according to the Constant Score, Simple Shoulder Test, and visual analogue scale for pain. Complications and revisions were recorded, and survival analysis was performed. Results. At the last follow-up, 20 patients were contacted. Of these, 15 patients had experienced at least one complication, and ten underwent revision surgery. The mean time to revision was 13.8 years (7 to 20). Cuff failure was the most common complication. Conversion to reverse shoulder arthroplasty, while maintaining the baseplate, was possible in five cases, with good results. In patients in whom the baseplate was removed, revision was performed significantly later (18.4 vs 11.1 years; p = 0.016). The general revision-free survival was 73% (95% CI 49.5 to 87.3) at 15 years and 38% (95% CI 11.8% to 64.3%) at 20 years, while MBG revision-free survival was 96.0% (95% CI 74.8% to 99.4%) at 15 years and 54% (95% CI 16.2% to 80.8%) at 20 years. Clinical scores showed a negative trend over time, although not statistically significant. Radiologically, polyethylene wear was observed in all cases and was complete in 12 out of 19 cases, and five glenoids were ‘at risk’ for loosening. Conclusion. At long-term follow-up, convertible MBG-TSA revealed a high rate of complications and revision surgery, mainly due to soft-tissue failure and polyethylene wear occurring with time. Prompt conversion to RSA maintaining the baseplate provided good results and a low complication rate. Radiological follow-up at about ten years is strictly recommended and, if metal-to-metal contact is observed, conversion to RSA is advisable. These results emphasize the need for continued research into improving TSA outcomes, especially in cases of MBG usage. Cite this article: Bone Jt Open 2025;6(1):82–92


Bone & Joint Open
Vol. 6, Issue 1 | Pages 74 - 81
13 Jan 2025
van Veghel MHW van Steenbergen LN Gademan MGJ van den Hout WB Schreurs BW Hannink G

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.


Aims

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.

Methods

A single-centre, prospective cohort study of 64 patients will be undertaken. Patients undergoing surgery for femoral neck fractures at the study centre will be recruited. Patients with a hip fracture meeting the inclusion/exclusion criteria will be enrolled on admission. Patients who have been administered oral oxycodone will be compared to those prescribed alfentanil for pain prior to mobilization with physiotherapists on POD 1 and POD 2. Which drug a patient receives is reliant of the prescriptions given by the medical team, and in current practice this varies at approximately 50:50. Mobilization will be defined as the ability to stand on and weightbear both feet with or without assistance.


Bone & Joint Open
Vol. 6, Issue 1 | Pages 26 - 34
6 Jan 2025
Findeisen S Mennerat L Ferbert T Helbig L Bewersdorf TN Großner T Schamberger C Schmidmaier G Tanner M

Aims

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).

Methods

The following retrospective, descriptive analysis consists of patients treated in our department between January 2010 and December 2021. In total, 628 patients were registered, of whom 108 presented with a large-sized defect (≥ 5 cm). A total of 70 patients met the inclusion criteria. The primary endpoint was radiological consolidation of nonunions after one and two years via a modified Lane-Sandhu Score, including only radiological parameters.


Bone & Joint Open
Vol. 6, Issue 1 | Pages 12 - 20
3 Jan 2025
Chan KCA Cheung A Chan P Luk MH Chiu KY Fu H

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


Bone & Joint Open
Vol. 6, Issue 1 | Pages 3 - 11
1 Jan 2025
Shimizu A Murakami S Tamai T Haga Y Kutsuna T Kinoshita T Takao M

Aims

Excellent outcomes have been reported following CT-based robotic arm-assisted total hip arthroplasty (rTHA) compared with manual THA; however, its superiority over CT-based navigation THA (nTHA) remains unclear. This study aimed to determine whether a CT-based robotic arm-assisted system helps surgeons perform accurate cup placement, minimizes leg length, and offsets discrepancies more than a CT-based navigation system.

Methods

We studied 60 hips from 54 patients who underwent rTHA between April 2021 and August 2023, and 45 hips from 44 patients who underwent nTHA between January 2020 and March 2021 with the same target cup orientation at the Department of Orthopedic Surgery at Ozu Memorial Hospital, Japan. After propensity score matching, each group had 37 hips. Postoperative acetabular component position and orientation were measured using the planning module of the CT-based navigation system. Postoperative leg length and offset discrepancies were evaluated using postoperative CT in patients who have unilateral hip osteoarthritis.


Bone & Joint Open
Vol. 5, Issue 12 | Pages 1123 - 1129
20 Dec 2024
Manara JR Nixon M Tippett B Pretty W Collopy D Clark GW

Aims

Unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) have both been shown to be effective treatments for osteoarthritis (OA) of the knee. Many studies have compared the outcomes of the two treatments, but less so with the use of robotics, or individualized TKA alignment techniques. Functional alignment (FA) is a novel technique for performing a TKA and shares many principles with UKA. Our aim was to compare outcomes from a case-matched series of robotic-assisted UKAs and robotic-assisted TKAs performed using FA.

Methods

From a prospectively collected database between April 2015 and December 2019, patients who underwent a robotic-assisted medial UKA (RA-UKA) were case-matched with patients who had undergone a FA robotic-assisted TKA (RA-TKA) during the same time period. Patients were matched for preoperative BMI, sex, age, and Forgotten Joint Score (FJS). A total of 101 matched pairs were eligible for final review. Postoperatively the groups were then compared for differences in patient-reported outcome measures (PROMs), range of motion (ROM), ability to ascend and descend stairs, and ability to kneel.


Bone & Joint Open
Vol. 5, Issue 12 | Pages 1092 - 1100
8 Dec 2024
Fraser E Spence S Farhan-Alanie OM Doonan J Mahendra A Gupta S

Aims

Limb salvage surgery (LSS) is the primary treatment option for primary bone malignancy. It involves the removal of bone and tissue, followed by reconstruction with endoprosthetic replacements (EPRs) to prevent amputation. Trabecular metal (TM) collars have been developed to encourage bone ingrowth (osseointegration (OI)) into EPRs. The primary aim of this study was to assess whether OI occurs when TM collars are used in EPRs for tumour.

Methods

A total of 124 patients from July 2010 to August 2021 who underwent an EPR for tumour under the West of Scotland orthopaedic oncology team were identified. Overall, 81 patients (65%) met the inclusion criteria, and two consultants independently analyzed radiographs at three and 12 months, as well as the last radiograph, using a modified version of the Stanford Radiological Assessment System.


Bone & Joint Open
Vol. 5, Issue 11 | Pages 1041 - 1048
19 Nov 2024
Delgado C Martínez-Rodríguez JM Candura D Valencia M Martínez-Catalán N Calvo E

Aims

The Bankart and Latarjet procedures are two of the most common surgical techniques to treat anterior shoulder instability with satisfactory clinical and functional outcomes. However, the outcomes in the adolescent population remain unclear, and there is no information regarding the arthroscopic Latarjet in this population. The purpose of this study was to evaluate the outcomes of the arthroscopic Bankart and arthroscopic Latarjet procedures in the management of anterior shoulder instability in adolescents.

Methods

We present a retrospective, matched-pair study of teenagers with anterior glenohumeral instability treated with an arthroscopic Bankart repair (ABR) or an arthroscopic Latarjet (AL) procedure with a minimum two-year follow-up. Preoperative demographic and clinical features, factors associated with dislocation, and complications were collected. Recurrence, defined as dislocation or subluxation, was established as the primary outcome. Clinical and functional outcomes were analyzed using objective (Rowe), and subjective (Western Ontario Shoulder Instability Index (WOSI) and Single Assessment Numeric Evaluation (SANE)) scores. Additionally, the rate of return to sport was assessed.


Bone & Joint Open
Vol. 5, Issue 11 | Pages 1013 - 1019
11 Nov 2024
Clark SC Pan X Saris DBF Taunton MJ Krych AJ Hevesi M

Aims

Distal femoral osteotomies (DFOs) are commonly used for the correction of valgus deformities and lateral compartment osteoarthritis. However, the impact of a DFO on subsequent total knee arthroplasty (TKA) function remains a subject of debate. Therefore, the purpose of this study was to determine the effect of a unilateral DFO on subsequent TKA function in patients with bilateral TKAs, using the contralateral knee as a self-matched control group.

Methods

The inclusion criteria consisted of patients who underwent simultaneous or staged bilateral TKA after prior unilateral DFO between 1972 and 2023. The type of osteotomy performed, osteotomy hardware fixation, implanted TKA components, and revision rates were recorded. Postoperative outcomes including the Forgotten Joint Score-12 (FJS-12), Tegner Activity Scale score, and subjective knee preference were also obtained at final follow-up.


Bone & Joint Open
Vol. 5, Issue 11 | Pages 1003 - 1012
8 Nov 2024
Gabr A Fontalis A Robinson J Hage W O'Leary S Spalding T Haddad FS

Aims

The aim of this study was to compare patient-reported outcomes (PROMs) following isolated anterior cruciate ligament reconstruction (ACLR), with those following ACLR and concomitant meniscal resection or repair.

Methods

We reviewed prospectively collected data from the UK National Ligament Registry for patients who underwent primary ACLR between January 2013 and December 2022. Patients were categorized into five groups: isolated ACLR, ACLR with medial meniscus (MM) repair, ACLR with MM resection, ACLR with lateral meniscus (LM) repair, and ACLR with LM resection. Linear regression analysis, with isolated ACLR as the reference, was performed after adjusting for confounders.