Evidence library

Atypical femoral fracture risk rose with longer bisphosphonate use, was substantially higher in Asian women, and fell rapidly after stopping; in white women the hip and other fractures prevented far exceeded the atypical fractures caused.

Pooled registry data suggested that just under 60% of hip replacements last 25 years; case series reported higher survival than registries, which are considered less prone to bias.

Serious adverse events were associated with older age, comorbidity and male sex, while lifetime revision risk was greatest in younger patients, particularly younger men, with most revisions occurring in the early years after surgery.

After network implementation there were improvements in risk-adjusted odds of survival, faster senior care and CT, and more patients treated in major trauma centres.

Group-level minimal important change was roughly 11 points for the OHS and 9 for the OKS (about 8 and 7 points for individual patients), whereas the between-group minimal important difference for trials was about 5 points for both scores.

UKA had significantly lower early mortality, fewer thromboembolic events, myocardial infarctions and strokes, shorter stay and fewer readmissions, but significantly higher revision and reoperation rates.

Stemmed metal-on-metal hips had significantly poorer survival than other bearings, with larger heads failing earlier, whereas larger heads improved survival for ceramic-on-ceramic bearings; younger women with large metal-on-metal heads had particularly high revision rates.

Roughly 10-34% of patients after TKR reported unfavourable long-term pain, compared with about 7-23% after THR, a higher proportion after knee than hip replacement.

There was no significant difference in 15-year survival between knees aligned within the neutral range and outliers.

Femoral head involvement and age at diagnosis were the strongest prognostic factors; in children over 6 years with more than half of the head involved, osteotomy gave significantly better femoral head sphericity than non-operative treatment.

Roughly 60% of hips were preserved at 20 years, and older age, poorer preoperative function and pre-existing arthritis predicted failure.

Recommended a simplified scoring system in which higher scores indicate better outcome, and gave guidance on handling missing items and interpreting scores.

Recurrence was common, mostly within the first two years, and was most strongly associated with young age and male sex.

Scores of 0-8 predicted survival under 6 months, 9-11 at least 6 months and 12-15 at least 1 year, and predicted prognosis agreed well with actual survival.

Older age, ulnar (rather than median) nerve injury, more proximal injury and longer delay to repair were associated with worse motor recovery; age and delay also predicted sensory recovery.

Functional outcomes at 2 years were similar after salvage and amputation, with substantial disability in both groups. Poor outcome was linked to complications needing readmission and to social and economic factors rather than treatment choice, and reconstruction carried a higher rehospitalisation rate.

Decompression within 48 hours was associated with significantly better recovery of sensory and motor deficits and urinary and rectal function than later surgery, with no extra gain from operating within 24 hours versus 24-48 hours; pre-existing chronic back pain and rectal dysfunction were associated with worse sphincter outcomes.

Infants whose biceps recovered within the first three months achieved normal function, whereas recovery in the fourth to sixth months was followed by significantly worse Mallet scores; this supported microsurgical repair for infants with no biceps recovery by six months.

The questionnaire showed good internal consistency, reproducibility and validity, and was sensitive to change after knee replacement.

The 12-item questionnaire was reliable, correlated with established measures and was responsive to change after surgery, supporting its use as a joint-specific patient-reported outcome.

Most hips achieved an anatomical reduction, which was harder to obtain in complex patterns, older patients and with longer delay to surgery. Clinical outcome tracked the radiographic result: anatomical reduction and a congruent roof predicted good results, whereas femoral head injury, older age and operative complications predicted poorer ones.

Avascular necrosis developed in almost half of unstable slips and in none of the stable slips, and satisfactory results were far more frequent in stable hips; early reduction was not shown to be linked to AVN.

Lesions that fractured had a higher mean score than those that did not (10 versus 7), and fracture risk climbed as the score rose above 7; Mirels proposed that lesions scoring 7 or less can be irradiated safely, whereas higher scores merit prophylactic fixation before radiotherapy.

Defined the MCID as the smallest difference in score that patients perceive as beneficial and that would mandate a change in management, and showed it could be estimated using global ratings of change.

Three progressive radiographic groups were seen - change confined to the scaphoid, radioscaphoid arthritis, then generalised wrist arthritis - with longer non-union duration in each successive group. Displacement and carpal instability correlated with more severe arthritis, and few non-unions remained arthritis-free after ten years.

Described the scapholunate advanced collapse (SLAC) pattern as the commonest form of wrist degenerative arthritis, with scaphotrapeziotrapezoid arthritis the next most frequent; in SLAC, arthritis progresses from the radioscaphoid to the capitolunate joint while the radiolunate joint is characteristically spared.

Stage I (low grade), II (high grade) and III (metastatic), each subdivided into A (intracompartmental) and B (extracompartmental), stratified prognosis and linked to defined surgical margins (intralesional, marginal, wide, radical).