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. 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.Aims
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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.
The February 2025 Trauma Roundup360 looks at: Risk factors for nonunion in femoral neck fracture patients with internal fixation: a multicentre (TRON group) retrospective study; Tranexamic acid administered at time of hospital admission does not decrease transfusion rates or blood loss for extracapsular hip fractures; The effect of anterior support screw (AS2) in unstable femoral trochanteric fractures; The effect of coronal plane angulation on patient-reported outcome measures of operatively treated distal femur fractures; Do proximal humerus fractures treated nonoperatively benefit from supervised physiotherapy?; Cephalomedullary nails: are dual lag screws superior to single lag screws?; Does cement need to be pressurized for hemiarthroplasty?.
To evaluate how fore- and midfoot coronal plane alignment differs in feet with hallux valgus (HV), using 3DCT when measured in standard weightbearing (SWB) versus sesamoid view (SV) position, and to determine whether first metatarsophalangeal (MTP) dorsiflexion affects the relationship between the first metatarsal (M1) head and the sesamoid bones. A consecutive series of 34 feet that underwent 3DCT in SWB and SV positions for symptomatic HV was assessed, of which four feet were excluded for distorted or incomplete images. Two foot and ankle clinicians independently digitized a series of points, and measured a series of angles according to a pre-defined protocol. Measurements include navicular pronation angle, M1 head (Saltzman angle), and metatarsosesamoid rotation angle (MSRA).Aims
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Older adults with hip fractures are at high risk of experiencing complications after surgery, but estimates of the rate of specific complications vary by study design and follow-up period. The aim of this systematic review was to determine the prevalence of complications in older adults after hip fracture surgery. MEDLINE, Embase, CINAHL, and CENTRAL databases were searched from inception until 30 June 2023. Studies were included if they reported prevalence data of complications in an unselected, consecutive population of older adults (aged ≥ 60 years) undergoing hip fracture surgery.Aims
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Aims. Loosening of the glenoid component in the long term remains an important complication of the anatomical total shoulder arthroplasty (aTSA). The aim of this study was to explore the bony integration of a hybrid glenoid component based on an analysis of CT scans. Methods. In a prospective multicentre study, patients who underwent primary aTSA, whose hybrid design of glenoid component included a fully-polyethylene flanged upper peg and a porous-coated titanium lower peg, and who were reviewed with CT scans between 12 and 24 months postoperatively, were included. Two independent observers reviewed the scans. Bony integration of the upper peg was scored as described by Arnold et al, and integration of the lower peg was scored as described by Gulotta et al. Perforation of the glenoid vault in any plane was also assessed. Results. From an initial group of 120 aTSAs in 116 patients, 104 CT scans were analyzed in 100 patients (four bilateral shoulders, mean age 66 years (SD 11), 62 female and 38 male). Osteolysis around the upper peg was found in 32 patients (32 aTSAs; 31%). Of the remaining patients, 72 had a mean Arnold score of 5.6 points (SD 0.9), and 70 (67%) had perfect integration. The lower peg had a mean Gulotta score of 6.5 points (SD 1.4). There was perfect integration of the lower peg in 70 patients (70 aTSAs; 67%). A total of nine patients (nine aTSAs; 9%) had no bony integration at either peg. There was perforation of the glenoid in an anterior or posterior direction at the level of the upper peg in three and 28 patients, respectively. This occurred at the level of the lower peg in 11 and 18 patients, respectively. The inter- and intraobserver reliability was good (k = 0.782 and 0.86, respectively). No implant breakage occurred at a mean follow-up of 16 months (12 to 24). The clinical outcome was satisfactory at a mean follow-up of 32 months (24 to 35), as assessed by a visual analogue scale score for pain, the Constant-Murley score, Subjective Shoulder Value, and American Shoulder and Elbow
The February 2025 Shoulder & Elbow Roundup360 looks at: Reverse shoulder arthroplasty is superior to plate fixation for displaced proximal humeral fractures in the elderly; Long-term outcomes of reverse total shoulder arthroplasty for complex proximal humerus fractures; The RAND/UCLA algorithm does streamline the clinical decision-making process; Smoking negatively impacts long-term outcomes and survival after anatomical total shoulder arthroplasty; Evaluating subscapularis tears: special tests lack sensitivity to tear severity and pain; Rotator cuff tear progression: insights into rates, risk factors, and the need for standardized reporting; Outcomes and complications of revision reverse shoulder arthroplasty: a systematic review; Prevalence and risk factors of glenohumeral chondral damage in shoulder instability: implications for early surgical stabilization.
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. 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.Aims
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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. This retrospective cohort study examined all operations recorded by orthopaedic trainees in Ireland and the UK between July 2012 and July 2022. The primary outcome was operative autonomy, which was defined as the trainee performing the case without the supervising trainer scrubbed.Aims
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Hallux valgus (HV) presents as a common forefoot deformity that causes problems with pain, mobility, footwear, and quality of life. The most common open correction used in the UK is the Scarf and Akin osteotomy, which has good clinical and radiological outcomes and high levels of patient satisfaction when used to treat a varying degrees of deformity. However, there are concerns regarding recurrence rates and long-term outcomes. Minimally invasive or percutaneous surgery (MIS) has gained popularity, offering the potential for similar clinical and radiological outcomes with reduced postoperative pain and smaller scars. Despite this, MIS techniques vary widely, hindering comparison and standardization. This review evaluates the evidence for both open Scarf and Akin osteotomy and newer-generation MIS techniques. Fourth-generation MIS emphasizes multiplanar rotational deformity correction through stable fixation. While MIS techniques show promise, their evidence mainly comprises single-surgeon case series. Comparative studies between open and MIS techniques suggest similar clinical and radiological outcomes, although MIS may offer advantages in scar length and less early postoperative pain. MIS may afford superior correction in severe deformity and lower recurrence rates due to correcting the bony deformity rather than soft-tissue correction. Recurrence remains a challenge in HV surgery, necessitating long-term follow-up and standardized outcome measures for assessment. Any comparison between the techniques requires comparative studies.
Frozen shoulder is a common and debilitating condition characterized by pain and restricted movement at the glenohumeral joint. Various treatment methods have been explored to alleviate symptoms, with suprascapular nerve block (SSNB) emerging as a promising intervention. This meta-analysis aimed to assess the effectiveness of SSNB in treating frozen shoulder. The study protocol was registered with PROSPERO (CRD42023475851). We searched the MEDLINE, Embase, and Cochrane Library databases in November 2023. Randomized controlled trials (RCTs) comparing SSNB against other interventions were included. The primary outcome was any functional patient-reported outcome measure. Secondary outcomes were the visual analogue scale (VAS) for pain, range of motion (ROM), and complications. Risk of bias was assessed using the Cochrane risk of bias v. 2.0 tool.Aims
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Aims. The transepicondylar axis is a well-established reference for the determination of femoral component rotation in total knee arthroplasty (TKA). However, when severe bone loss is present in the femoral condyles, rotational alignment can be more complicated. There is a lack of validated landmarks in the supracondylar region of the distal femur. Therefore, the aim of this study was to analyze the correlation between the surgical transepicondylar axis (sTEA) and the suggested dorsal cortex line (DCL) in the coronal plane and the inter- and intraobserver reliability of its CT scan measurement. Methods. A total of 75 randomly selected CT scans were measured by three experienced surgeons independently. The DCL was defined in the coronal plane as a tangent to the dorsal femoral cortex located 75 mm above the joint line in the frontal plane. The difference between sTEA and DCL was calculated. Descriptive statistics and angulation correlations were generated for the sTEA and DCL, as well as for the distribution of measurement error for intra- and inter-rater reliability. Results. The external rotation of the DCL to the sTEA was a mean of 9.47° (SD 3.06°), and a median of 9.2° (IQR 7.45° to 11.60°), with a minimum value of 1.7° and maximum of 16.3°. The measurements of the DCL demonstrated very good to excellent test-retest and inter-rater reliability coefficients (intraclass correlation coefficient 0.80 to 0.99). Conclusion. This study reveals a correlation between the sTEA and the DCL. Overall, 10° of external rotation of the dorsal femoral cortical bone to the sTEA may serve as a reliable landmark for initial position of the femoral component.
Lower limb reconstruction (LLR) has a profound impact on patients, affecting multiple areas of their lives. Many patient-reported outcome measures (PROMs) are employed to assess these impacts; however, there are concerns that they do not adequately capture all outcomes important to patients, and may lack content validity in this context. This review explored whether PROMs used with adults requiring, undergoing, or after undergoing LLR exhibited content validity and adequately captured outcomes considered relevant and important to patients. A total of 37 PROMs were identified. Systematic searches were performed to retrieve content validity studies in the adult LLR population, and hand-searches used to find PROM development studies. Content validity assessments for each measure were performed following Consensus-based Standards for the selection of health measurement Instruments (COSMIN) guidelines. A mapping exercise compared all PROMs to a conceptual framework previously developed by the study team (‘the PROLLIT framework’) to explore whether each PROM covered important and relevant concepts.Aims
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Surgeon and patient reluctance to participate are potential significant barriers to conducting placebo-controlled trials of orthopaedic surgery. Understanding the preferences of orthopaedic surgeons and patients regarding the design of randomized placebo-controlled trials (RCT-Ps) of knee procedures can help to identify what RCT-P features will lead to the greatest participation. This information could inform future trial designs and feasibility assessments. This study used two discrete choice experiments (DCEs) to determine which features of RCT-Ps of knee procedures influence surgeon and patient participation. A mixed-methods approach informed the DCE development. The DCEs were analyzed with a baseline category multinomial logit model.Aims
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Day-case knee and hip replacement, in which patients are discharged on the day of surgery, has been gaining popularity during the last two decades, and particularly since the COVID-19 pandemic. This systematic review presents the evidence comparing day-case to inpatient-stay surgery. A systematic literature search was performed of MEDLINE, Embase, and grey literature databases to include all studies which compare day-case with inpatient knee and hip replacement. Meta-analyses were performed where appropriate using a random effects model. The protocol was registered prospectively (PROSPERO CRD42023392811).Aims
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Aims. A recent study used the RAND Corporation at University of California, Los Angeles (RAND/UCLA) method to develop anatomical total shoulder arthroplasty (aTSA) appropriateness criteria. The purpose of our study was to determine how patient-reported outcome measures (PROMs) vary based on appropriateness. Methods. Clinical data from a multicentre database identified patients who underwent primary aTSA from November 2004 to January 2023. A total of 390 patients (mean follow-up 48.1 months (SD 42.0)) were included: 97 (24.9%) were classified as appropriate, 218 (55.9%) inconclusive, and 75 (19.2%) inappropriate. Patients were classified as “appropriate”, “inconclusive”, or “inappropriate”, using a modified version of an appropriateness algorithm, which accounted for age, rotator cuff status, mobility, symptomatology, and Walch classification. Multiple pre- and postoperative scores were analyzed using Pearson’s chi-squared test and one-way analysis of variance (ANOVA). Postoperative complications were also analyzed. Results. All groups achieved significant improvement in mean PROM scores postoperatively. “Appropriate” patients experienced significantly greater improvement in visual analogue scale (VAS) and American Shoulder and Elbow
