Results
- Showing results for:
- Reset all filters
Search results
-
Journal articleLeslie D, Mullington CJ, 2026, , Anaesthesia, Vol: 81, Pages: 675-684
INTRODUCTION: The UK NHS is committed to reaching net zero carbon emissions by 2040. Volatile anaesthetic agents are potent greenhouse gases and alternative intravenous methods exist. We aimed to predict the cost-effectiveness of a transition from volatile anaesthesia to total intravenous anaesthesia to reduce carbon emissions. METHODS: A general anaesthetic for a 40-year-old, 78-kg patient was modelled. Two volatile anaesthetic agents (desflurane and sevoflurane) were compared with propofol-remifentanil total intravenous anaesthesia. Total intravenous anaesthesia with and without processed electroencephalography was modelled. Cost-effectiveness was calculated as the cost per kg carbon dioxide equivalent saved by transition to total intravenous anaesthesia, benchmarked against the UK emission trading scheme carbon permit price of £41.84 (US$54.90, €47.28) per tonne carbon dioxide equivalent. RESULTS: Total intravenous anaesthesia was less carbon intensive than sevoflurane and desflurane (2.0 vs. 9.8 kg and 209.2 kg carbon dioxide equivalent, respectively). Total intravenous anaesthesia was more expensive than sevoflurane when processed electroencephalography was used (£13.03 (US$17.08, €14.72) vs. £9.76 (US$12.79, €11.03)) but cheaper when it was not (£5.31 (US$6.95, €6.00) vs. £9.76 (US$12.79, €11.03)). When processed electroencephalography was used, the incremental cost-effectiveness ratio of transitioning from sevoflurane to total intravenous anaesthesia was £416 (US$544, €470) per tonne carbon dioxide equivalent. Total intravenous anaesthesia (with and without processed electroencephalography) was cheaper than desflurane (£18.94 (US$24.77, €21.41)). DISCUSSION: Using our model parameters and the different carbon dioxide emissions and similar cost, transitioning from desflurane anaesthesia to total intravenous anaesthesia is cost-effective. Transitioning from sevoflurane an
-
Journal articleMaslivec A, Allott N, Guest B, et al., 2026, , Bone Joint J, Vol: 108-B, Pages: 447-454
AIMS: A ceramic-on-ceramic hip resurfacing implant (cHRA) was developed and introduced in a Medicines and Healthcare products Regulatory Agency (MHRA)-approved clinical investigation. This study aimed to examine function and physical activity levels of patients with a cHRA implant using subjective and objective measures, both preoperatively and 12 months postoperatively. METHODS: A total of 82 unilateral cHRA patients consented to this study as part of the larger MHRA-approved clinical investigation. In addition to their patient-reported outcome measures (PROMs), self-reported measures of physical activity and gait analysis were undertaken preoperatively (median 1.7 weeks (IQR 0.6 to 4.2)) and postoperatively (median 52.1 weeks (IQR 50.0 to 53.9)). These data were then compared with data from a group of 43 age-, sex-, and BMI-matched healthy controls. Kinetics and kinematics were recorded using an instrumented treadmill and 3D motion capture. Statistical parametric mapping was used for analysis. RESULTS: cHRA improved PROMs and self-reported physical activity from preoperative levels. cHRA improved top walking speed (5.75 km/hr (SD 1.04) vs 7.27 km/hr (SD 0.71)), achieved a more symmetrical ground reaction force profile (symmetry index value: 10.6% (SD 9.4) vs 0.9% (SD 2.1)), and increased hip range of motion (31.7° (SD 6.2°) vs 45.9° (SD 5.3°)) from preoperative levels. Postoperative data were not statistically distinguishable from the healthy controls in any domain. CONCLUSION: These short-term results of cHRA appear promising, with the potential to restore a near-normal gait pattern and overall quality of life.
-
Journal articleMestriner MB, Reynolds A, Barrosso BG, et al., 2026, , Am J Sports Med, Vol: 54, Pages: 1027-1034
BACKGROUND: The rectus femoris (RF) tendon may be an option for combined anterior cruciate ligament (ACL) and anterolateral (AL) reconstruction utilizing a double-stranded (DRF) tendon for the ACL and a single-stranded tendon (SRF) for AL reinforcement; however, biomechanical data remain limited. PURPOSE/HYPOTHESIS: This study aimed to biomechanically assess the DRF for ACL reconstruction using a patellar tendon (PT) graft and the SRF for AL reconstruction using an iliotibial band (ITB) graft. The hypothesis was that the biomechanical properties of the DRF graft would not differ from those of the PT graft, and the SRF graft would not differ from the ITB graft. STUDY DESIGN: Controlled laboratory study. METHOD: Eight fresh-frozen human knees were used: 2 male and 6 female, with a mean age of 49 years (range, 36-64 years). Each knee produced 4 grafts: DRF, SRF, PT, and ITB. Each graft was mounted in a materials test machine. The cross-sectional area was measured using alginate molding. After 10 preconditioning cycles to 250 N, each specimen was extended to failure at 100 mm/min. The Friedman test assessed differences between the 4 graft types using matched samples. The Dunn multiple-comparison test was used to examine differences among graft types. RESULTS: The ultimate strengths (N) of the grafts were as follows: DRF, 1978 ± 338; SRF, 1445 ± 584; PT, 1824 ± 557; ITB, 819 ± 268 (DRF and PT >ITB; P < .01). The elastic moduli (MPa) were as follows: DRF, 272 ± 59; SRF, 617 ± 153; PT, 318 ± 90; ITB, 631 ±4 31 (DRF and PT<SRF; P < .05). The ultimate tensile stresses (MPa) were as follows: DRF, 51 ± 12; SRF, 89 ± 28; PT, 62 ± 19; ITB, 56 ± 24 (SRF > DRF; P < .05). CONCLUSION: As hypothesized, the DRF graft exhibits mechanical properties that do not differ from those of the PT graft. Likewise, the SRF graft showed biomechanical properties that do not differ from those of the
-
Journal articleKaria M, Behforootan S, Stoy L, et al., 2026,
The relationship between radiographic metrics and mechanical properties of the proximal femur
, Advances in Orthopedics, ISSN: 2090-3464Background: Bone mechanical properties, including strength and stiffness, influence intraoperative fracture risk and implant stability in hip arthroplasty. Surgeons frequently utilize radiographic metrics to evaluate bone quality and inform surgical strategies. This study investigates the correlation between radiographic bone metrics and mechanical properties of the femoral neck.Methods: Femoral neck cortical bone samples from 23 patients undergoing elective hip arthroplasty were subjected to mechanical compression testing to measure elastic modulus and ultimate strength. Density was also measured. Radiographic metrics, including cortical thickness index, canal flare index, canal-bone ratio, and canal-calcar ratio, were determined from preoperative radiographs. The correlations between these metrics and bone mechanical properties were analysed using linear regression, with intra- and inter-observer reliability assessed.Results: Analysis included 19 of the 23 participants. Whilst cortical thickness index measurements demonstrated a weak positive correlation with bone density (R2 = 0.291; p = 0.013) and ultimate strength (R2 = 0.279; p = 0.015), canal-bone ratio showed a weak negative correlation with both factors (R2 = 0.291; p = 0.013 and R2 = 0.279; p = 0.015, respectively). Both cortical thickness index and canal-bone ratio demonstrated excellent inter and intra-observer reliability. Neither canal flare index nor canal-calcar ratio correlated with any mechanical properties, and none of the radiographic metrics correlated with elastic modulus.Conclusions: Cortical thickness index and canal-bone ratio correlate weakly with bone strength and density, but not with elastic modulus. Given their limited utility, radiographs should be used with caution in surgical decision-making regarding impaction force and implant fixation strategy.
-
Journal articleMullington CJ, Iacona GMV, Rolph AR, et al., 2026, , Br J Anaesth, Vol: 136, Pages: 1066-1067
-
Journal articleGompels BD, Subramanian A, Epanomeritakis IE, et al., 2026, , Knee, Vol: 60
BACKGROUND: Paediatric ACL injuries are increasingly common and present significant challenges. Inappropriate treatment can lead to long-term complications like instability, growth disturbance, and osteoarthritis. The Paediatric ACL National Audit (PANA) Study assesses UK practices and adherence to Best Orthopaedic Practice (BOAST) guidelines for managing these injuries, identifying opportunities to improve care for young patients. METHODS: PANA was a collaborative audit of 22 hospitals in England, Wales, and Scotland, measuring adherence to BOAST guidelines in treating paediatric ACL injuries. Orthopaedic surgeons and trainees collected data through a secure online questionnaire about service provision for skeletally immature patients, including diagnostic imaging, rehabilitation, post-operative follow-up, and surgical techniques. RESULTS: Our analysis revealed variability in adherence to the BOAST guidelines for ACL injuries in paediatric patients, with 65% of centres using acute knee pathways and 68% utilising collaborative imaging pathways. About 59% of centres conduct radiological growth monitoring, while only 30% report functional outcomes. Less than 50% report re-rupture rates, and 74% adhere to rehabilitation protocols. CONCLUSION: The rise in ACL injuries in the paediatric population highlights the need for standardised care delivery and reporting. Following the release of the BOAST guidelines in 2022, this nationwide audit has revealed discrepancies in UK practices. A multidisciplinary approach is essential for improving patient care and outcomes by standardising and promoting best practice.
-
Journal articleGarner AJ, Dandridge OW, Cobb JP, 2026, , Bone Joint Res, Vol: 15, Pages: 148-156, ISSN: 2046-3758
AIMS: Lateral unicompartmental arthroplasty (UKA-L) is a bone- and cruciate-preserving procedure in the treatment of isolated lateral compartment gonarthrosis, but relatively little is known of its associated gait characteristics and patient-reported outcomes. METHODS: A total of 20 individuals, at a mean 35 months (SD 37) post UKA-L, were measured on an instrumented treadmill. They were compared to age-, sex-, and BMI-matched healthy controls (n = 22) and individuals with unilateral total knee arthroplasty (TKA, n = 28) mean 44 months (SD 46) post-surgery (p = 0.382). Top walking speed, temporospatial parameters, and vertical ground reaction forces of gait were analyzed. Oxford Knee Scores (OKS) and EuroQol five-dimension questionnaire (EQ-5D) scores were compared. RESULTS: The UKA-L group walked at a mean speed of 7.0 km/hour (SD 0.6), which was 0.2 km/hour (3%) slower than the healthy control group (7.2 km/hour (SD 0.7); p = 0.681) but 26% faster than the TKA group (5.5 km/hour (SD 0.7), p < 0.001). UKA-L displayed nearer normal vertical ground reaction forces throughout the stance phase. TKA demonstrated significantly reduced maximum weight acceptance, increased mid-stance, and reduced push-off forces compared to healthy and UKA-L subjects (all p < 0.05). UKA-L recorded similar step and stride lengths to healthy controls, and were 12% and 10% longer than TKA, respectively (p < 0.05). UKA-L was associated with a mean OKS of 44 (SD 3) compared to 36 (SD 6) for TKA (p < 0.001), and mean EQ-5D of 0.90 (SD 0.09) vs 0.78 (SD 0.14) for TKA (p = 0.003). CONCLUSION: UKA-L restores healthy gait characteristics at top walking speeds. Compared to TKA, faster walking speeds, nearer-normal vertical ground reaction forces, longer stride lengths, and a more consistent gait pattern demonstrate the importance of functional cruciate ligaments to gait. UKA-L is associated with high patient satisfaction and good quality of life in the treatment of isolated lateral compar
-
Journal articleMorton S, Manek R, Mohammadi N, et al., 2026, , Br J Anaesth
BACKGROUND: Operating theatre performance is an essential component of healthcare resource optimisation. Because of its time-critical nature, emergency operating theatre performance is a problem distinct to that of elective surgery. Process performance can be quantified through the related terms: productivity, efficiency, and effectiveness. This systematic review examined the metrics used to quantify emergency operating theatre performance and the methodological quality of the associated literature. METHODS: PubMed, ISI Web of Knowledge, and Embase were searched from inception to December 2024 using Medical Subject Headings terms relating to metric, performance, and operating theatre. Studies were reviewed independently for inclusion and quality (ROBINS-I and GRADE). Only clinical studies are presented here. RESULTS: In total, 32 clinical studies were included, and 19 performance metrics were identified (six efficiency; 10 effectiveness; three productivity). The median (range) performance metrics per study was 4 (1-7). Frequently reported metrics were out-of-hours operating (19 studies; 59%), delay (17 studies; 53%), and utilisation (13 studies; 41%). Eleven (34%) studies were low quality and 21 (66%) were very low quality. Twenty-six (81%) studies used insufficient metrics, 30 (94%) studies used non-generalisable metrics, 29 (91%) studies did not quantify trade-off between metrics, and 16 (50%) studies had insufficient scope of investigation. Interventions evaluated included reallocating theatre time (eight studies; 25%), increasing emergency theatre capacity (eight studies; 25%), and instituting acute care surgery services (six studies; 19%). CONCLUSIONS: Currently, there is no widely recognised framework to assess the quality of emergency theatre performance study designs. There is a tendency within clinical studies to focus on effectiveness rather than efficiency, potentially reflecting clinicians' focus on patient outcome. Systematic biases that reduce evidence
-
Journal articleSingh Gill S, Jones GG, Cobb J, et al., 2026, , Bioengineering, Vol: 13, ISSN: 2306-5354
Knee osteoarthritis (OA) affects around 37% of U.S. adults over 60, with over 25% expe-rience depressive symptoms (DSs), linked to worse pain and outcomes. Yet their impact on analgesic use and recovery remains unclear. This study aimed to assess if DSs influ-ence analgesic use and functional outcomes in knee OA. Using data from the Osteoar-thritis Initiative (n = 3680), we used a Machine Learning (ML)- based Gradient Boosting Machine (GBM) model to perform propensity score matching, matching pa-tients with knee OA and DSs (n = 487) to those without DSs (n = 487). Outcomes at baseline, 1 and 2 years included analgesic use, function (WOMAC), quality of life (KOOS-QoL), and physical health (SF-12 PCS). Regression and timepoint models com-pared follow-up with baseline. DSs alone were not associated with greater opioid use up to Year 2 (OR = 0.89, 95% CI: 0.45–1.73; p = 0.73). Among patients with DSs, SF-12 PCS improvement was less likely at Year 1, while decline was more likely up to Year 2. DSs in OA were linked to poorer physical health, but often greater functional gains than those in OA without DSs, and with no difference in opioid use. These findings highlight the need for multidisciplinary strategies, addressing both pain and psychosocial well-being.
-
Journal articleHussein Hakami H, Sgambato BG, Banger MS, et al., 2026, , Sci Rep, Vol: 16
Upper-limb amputation often leads to compensatory trunk and shoulder movements, increasing the risk of secondary musculoskeletal complications. This issue is exacerbated by the limited wrist functionality in current prosthetic systems, which restrict natural movement patterns during daily activities. Here, we investigate how limitations in the degrees of freedom (DoF) of the prosthetic wrist influence compensatory upper body motion during functionally relevant tasks. Three transradial amputees, experienced in the use of both body-powered and myoelectric prostheses, were fitted with custom sockets and a prosthetic hand controlled via a 32-channel A-mode ultrasound interface. Eight able-bodied participants served as controls. All participants performed three standardized tasks-drinking, lightbulb insertion, and the Clothespin Relocation Test-while trunk and shoulder kinematics and kinetics were recorded using motion capture and surface electromyography. The results demonstrated task-dependent compensation, with the Clothespin Relocation Test eliciting the greatest trunk flexion and bilateral shoulder involvement. Distinct adaptive patterns emerged between dominant and non-dominant sides, with increased reliance on proximal joints as wrist DoFs were restricted. The findings highlight the need for prosthetic designs and rehabilitation strategies that are tailored to specific tasks and user movement patterns. Quantifying compensatory motion provides a foundation for developing user-centered control systems that enhance function and reduce long-term musculoskeletal strain.
-
Journal articleBoughton O, Green C, Haider Rizvi SZ, et al., 2026, , Techniques in Orthopaedics, Vol: Publish Ahead of Print, ISSN: 0885-9698
-
Journal articleDronkers EAC, Clunie GM, Iacovidou A, et al., 2026, , The Laryngoscope, Vol: 136, Pages: 243-250, ISSN: 0023-852X
ObjectiveFull-thickness resection and skin grafting of the laryngotracheal junction, the “Maddern Procedure,” can be used to treat patients with recalcitrant laryngotracheal stenosis. We report the long-term surgical outcomes of this procedure.MethodsA consecutive series of 27 females with idiopathic, iatrogenic, or vasculitic subglottic stenosis who underwent the Maddern procedure between 2012 and 2023 were retrospectively reviewed. Airway outcome was assessed using the Modified Medical Research Council Dyspnea (mMRC) Scale. Secondary outcomes included voice, swallowing, mucus management, complications, and the need for subsequent airway surgery.ResultsMost patients had idiopathic subglottic stenosis (n = 20, 74.1%), followed by vasculitic (n = 4, 14.8%) and intubation-related (n = 3, 11.1%) etiologies. Patients had an average of 7.3 (SD 3.4) endoscopic procedures before undergoing the Maddern procedure. Mean pre-Maddern inter-treatment interval was 7.5 months (SD 3.4). The median follow-up was 6.6 years (interquartile range 0.75–11.3). The mMRC dyspnea scale improved from 2.7 (SD 0.73) to 0.52 (SD 0.85). The five-year recurrence-free rate was 63%. It differed between etiologies, ranging from 83% for idiopathic stenosis to 67% for intubation-related and 0% for vasculitis-related stenoses. During the first 4 years after Maddern, 67% of patients reported daily cough and the need to use nebulizers regularly.ConclusionThe Maddern procedure is an effective and durable option for patients with idiopathic subglottic stenosis. Careful screening of patients with presumed idiopathic subglottic stenosis for possible underlying auto-immune conditions remains important when considering patients for this procedure.Level of EvidenceLevel 4.
-
Journal articleMusbahi O, Pouris K, Hadjixenophontos S, et al., 2025, , World Journal of Methodology, Vol: 15, ISSN: 2222-0682
Background:Relieving pain is central to the early management of knee osteoarthritis, with a plethora of pharmacological agents licensed for this purpose. Intra-articular corticosteroid injections are a widely used option, albeit with variable efficacy. Aim:To develop a machine learning model that predicts which patients will benefit from corticosteroid injections.Methods:Data from two prospective cohort studies (OAI and MOST) was combined. The primary outcome was patient-reported pain score following corticosteroid injection, assessed using the WOMAC pain scale, with significant change defined using Minimally Clinically Important Difference and Meaningful Within Person Change. A machine learning algorithm was developed, utilising Linear Discriminant Analysis, to predict symptomatic improvement, and examine the association between pain scores and patient factors by calculating the sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and F2 score.Results:A total of 330 patients were included, with a mean age of 63.4 (SD: 8.3). The mean WOMAC pain score was 5.2 (SD: 4.1), with only 25.5% of patients achieving significant improvement in pain following corticosteroid injection. The machine learning model generated an accuracy of 67.8% (95 CI: 64.6% – 70.9%), F1 score of 30.8%, and an AUC score of 0.60. Conclusion:The model demonstrated feasibility to assist clinicians with decision-making in patient selection for corticosteroid injections. Further studies are required to improve the model prior to testing in clinical settings.
-
Journal articleBladt F, Varaeva YR, Retter GJ, et al., 2025, , Journal of Dance Medicine and Science, Vol: 29, Pages: 200-210, ISSN: 1089-313X
Introduction: Elite ballet is one of the most demanding physical activities for the skeleton, making dancers susceptible to bone stress injuries. This pilot study compared bone remodeling in professional female ballet dancers from the Royal Ballet Company with controls from 51³Ô¹ÏÍø. Methods: The study included dancers (n = 5, median age 29 ± 16 years) and controls (n = 6, median age 24 ± 8.5 years). The main outcome measure was bone turnover, assessed by measuring the ratio of resorption (NTX) and formation (P1NP) markers in urine and serum. Estrogen metabolism was evaluated through 2OH/16OH metabolite ratios. Both markers were measured using ELISA kits. Diet was tracked using 72-hour diaries, and weekly exercise hours were recorded through 2-week diaries and cross referenced with training logs. Results: Results showed significantly higher bone resorption to formation ratio (NTX/P1NP) in dancers versus controls (P < .050), and elevated estrogen metabolite ratios (2OH/16OH) (P < .010). These findings occurred despite similar dietary profiles between groups including fat (P = .874) carbohydrate (P = .501) and protein (P = .099). Dancers showed significantly higher weekly exercise hours (46.50 ± 38.75 vs 14.75 ± 11.75 hours/week, P < .001) and lower BMI (18.36 ± 1.35 vs 20.77 ± 3.66, P = .020). Conclusions: The pilot data suggest elite ballet dancers may exhibit an imbalance in bone remodeling with high resorption and low formation relative to controls. This imbalance in bone turnover markers could serve as a screening tool for identifying dancers at increased risk of bone stress injuries. The NTX/P1NP ratio could potentially offer a low-cost, non-invasive approach to identify
-
Journal articleBradshaw FE, Gompels BD, Mainwaring E, et al., 2025, , Knee, Vol: 57, Pages: 444-454
AIMS: Anterior cruciate ligament (ACL) injuries disproportionately affect female athletes, with a two-to eightfold increased risk compared to males. Using a modified Delphi approach, this study aimed to identify and prioritise key research questions regarding ACL injury prevention, diagnosis, treatment, rehabilitation, and care delivery in the female population. METHODS: A modified priority setting exercise (Delphi) was conducted with the Women's ACL Orthopaedic Steering Group, the British Orthopaedic Association (BOA), and the British Association for Surgery of the Knee (BASK). Two rounds of online surveys were distributed via Qualtrics between June and November 2024, followed by an in-person workshop on 14th November 2024. The initial poll collected research questions from patients, carers, and healthcare professionals. A systematic literature review was categorised into questions based on existing evidence. The second survey prioritised 50 questions, with the top 30 discussed at the final workshop, where the top ten research priorities were determined through structured discussion and consensus-building. RESULTS: A total of 166 questions were submitted, of which 116 were deemed relevant. Following the literature review, 50 questions were included in the second survey. The final workshop, attended by 14 participants, identified ten key research priorities, focusing on sex-specific rehabilitation, injury prevention strategies, and psychological recovery. CONCLUSION: This study presents a consensus-driven research agenda to address critical gaps in managing female ACL injuries. These ten priorities will guide future research, enhance clinical outcomes, and promote gender-specific strategies for ACL injury prevention and rehabilitation.
-
Journal articleAlagha MA, Cobb J, Liddle A, et al., 2025,
Prediction of quality-of-life improvement after total hip arthroplasty - A simplified and internally validated model based on 82,526 total hip replacements from the Swedish Arthroplasty Register
, Bone & Joint Open, ISSN: 2633-1462Introduction: Pain and poor health-related quality of life measures serve as the primary indication for primary elective total hip replacement (THR). It remains challenging to predict whether THR delivers the patient-anticipated improvements. Our study aimed to develop and validate statistical and machine learning prediction models of 1-year clinical improvement in patient-reported outcome measures (PROMs) after elective THR.Methods: We included 82,526 patients with primary elective THRs from the Swedish Arthroplasty Register (SAR) for forecasting one-year improvements in the EQ-5D index, EQ-VAS and combined EQ-5D/EQ-VAS scores. Two Minimal Clinically Important Difference (MCID) thresholds were applied for the EQ-5D index score based on the Standardised Response Mean (SRM = 0.196) and Capacity of Benefit (CoB = 0.428) approaches. MCIDcut off for the EQ-VAS was set to 7.81. Twenty-one features were used to feed the models. To avoid estimates bias we eliminated missing data. Model performance was tested using the area under the receiver operating characteristic curve (AUC), and features importance were identified in the best performing algorithm.Results: Applying the SRM MCID, approximately two-thirds of patients reported one-year improvements in EQ-5D index (66.3%) and EQ-VAS (69.1%). The improvement rate decreased to 51.7% when we combined improvements in both outcomes. A higher CoB cut-off for EQ-5D index yielded lower rates (~40% for the EQ-5D index and 31.3% for the combined measure). The Gradient boosting machine (GBM) consistently outperformed other models by a narrow margin in predicting significant clinical improvements in one-year PROMs and achieved a good to excellent binary discriminative power (AUCs range 0.80 – 0.97%). Pre-operative PROMs, EQ-5D index, EQ-VAS and Charnley classification, along with age, collectively contributed to over 80% of the algorithmic power in the ensemble GBM model.Conclusion: We developed an interpretable machine learning
-
Journal articleGreenfield S, Samarth G, McGregor A, et al., 2026,
A systematic review and meta-analysis on partial foot amputation in diabetic foot ulcers
, Journal of Vascular Surgery, ISSN: 0741-5214Objective:Partial foot amputations (PFA) serve as a limb-preserving alternative to major amputations in diabetic patients with advanced foot disease. This systematic review aimed to analyse clinical outcomes, including major and minor re-amputation rates, wound healing, re-ulceration, and mortality following PFA in diabetic adults.Data Sources and Review Methods:A comprehensive search of MEDLINE and Embase databases was conducted following PRISMA guidelines. Studies reporting on diabetic patients undergoing PFA for dysvascular or infective causes were selected. Out of 2437 screened abstracts, 46 studies met the inclusion criteria, representing 32,496 patients. Data extraction was performed using Covidence, and study quality was assessed using the ROBINS-I Tool.Results:Major amputation rates following PFA ranged from 0%-10% for digit and metatarsal amputations, 8%-54% for transmetatarsal amputation (TMA), and 11%-44% for midfoot amputations. The random effects model estimated a major amputation rate of 23% (95% CI 15%-30%), with high heterogeneity (I²=90%). Minor re-amputation rates varied from 12%-33%, notably high after 1st metatarsal amputation. One-year all-cause mortality was 16% (95% CI 10%-22%), with wide variability across studies. Delayed wound healing and high re-ulceration rates were common, particularly following TMA, with re-ulceration rates reaching up to 69%.Conclusion:PFA in diabetic patients carries significant risks of re-amputation, delayed healing, and limb loss. Clinicians should ensure that these risks are communicated during shared decision-making with patients. Standardisation of post-operative care, including multidisciplinary approaches involving orthotists and structured rehabilitation protocols, could help improve outcomes. Further research is needed to explore optimised care strategies and long-term functional outcomes following PFA.
-
Journal articleWynell-mayow W, Hall T, Singh A, et al., 2025,
Interobserver reliability of coronal plane alignment of the knee (CPAK) phenotype classification: external validation using data from the osteoarthritis initiative
, Bone & Joint Open, ISSN: 2633-1462 -
Journal articleHolthof SR, Nejima S, Rock M, et al., 2025, , Knee Surgery, Sports Traumatology, Arthroscopy, Vol: 33, Pages: 3896-3905, ISSN: 0942-2056
Purpose:This study implemented a novel robotic test method to quantify the effect of three distinct total knee arthroplasty (TKA) designs on knee kinematics and stability. It was hypothesised that the implant geometries would affect stability and rollback, with differences between the native and replaced knees, as well as between implant designs.Methods:Eight fresh-frozen cadaveric knees were tested across the arc of flexion-extension under 710 N compressive load, combined with either no anterior-posterior (AP) tibial force, 90 N anterior or 90 N posterior drawer force using a robotic actuator. The same testing protocol was used post-TKA using three distinct implant designs (gradually reducing femoral condylar radius medially stabilised, multi-radius medially conforming and single-radius symmetrical), matched to the same bone cuts. Laxity and rollback were analysed using statistical parametric mapping and implant designs were compared to the intact knee and each other.Results:No significant differences in AP laxity were found between the intact knee (4.7 ± 0.7 mm), gradually reducing radius (6.3 ± 1.3 mm) and multi-radius designs (5.7 ± 1.1 mm). The single-radius implant showed significantly larger average AP laxity envelope (11.6 ± 2.3 mm) than the intact knee, the multi-radius design and the gradually reducing radius design and was more variable between knees. The rollback among the intact knee and TKAs were not significantly different: gradual radius 81% of native, multi-radius 85% and single-radius 90%.Conclusions:Significant differences of AP laxity were found between the pre- and post TKA knee and between implant designs. Rollback did not differ significantly. Implanted knee behaviour also showed differences of sensitivity to cadaveric specimen and implantation variation among the prosthesis designs.Clinical relevance:Instability
-
Journal articleIacona GMV, Rolph AR, Manteigas HFM, et al., 2025, , BRITISH JOURNAL OF ANAESTHESIA, Vol: 135, Pages: 1231-1239, ISSN: 0007-0912
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.