Aims Knee osteoarthritis (OA) is a common cause of pain and disability in adults. Intra-articular injections are important components in the management of knee OA symptoms, but there are concerns that these injections may be associated with the progression of OA. Therefore, this study determined how the likelihood of progression to arthroplasty is influenced by intra-articular injection of corticosteroid (CS) and/or hyaluronic acid (HA) in patients with knee OA. Methods This population-based cohort study included patients aged 40 to 60 years receiving an initial intra-articular injection of CS and/or HA from 1 January 2000 through 31 December 2010, who resided in Olmsted County, Minnesota, USA. The primary outcome was the likelihood of joint arthroplasty by number of intra-articular injections received evaluated by Cox proportional hazards regression. Results A total of 1,897 patients (n = 2,336 knees) who received 8,600 injections (n = 5,786 CS; n = 2,814 HA) were included (mean age 51.9 years (SD 5.5); 1,515 females (64.9%); mean BMI 34.8 kg/m 2 (SD 8.0)), and 917 (39.3%) subsequently underwent arthroplasty. Accounting for age, BMI, and Kellgren-Lawrence (KL) grade at initial injection, the number of intra-articular injections was associated with an increased likelihood of arthroplasty (hazard ratio (HR) 1.12 (95% CI 1.08 to 1.17)). For patients with early OA (KL grade 0 to 1), CS injections (HR 1.27 (95% CI 1.17 to 1.37)) were associated with an increased likelihood of arthroplasty versus HA (HR 1.12 (95% CI 1.06 to 1.19)). Conclusion Each intra-articular injection was associated with a 12% increased likelihood of arthroplasty. With subgroup analysis, CS injections in early OA were associated with a 27% increased likelihood of arthroplasty. Cite this article: Bone Jt Open 2026;7(11):1462–1470.
Aims The purpose of this study was to compare surgical techniques and postoperative outcomes in an age- and sex-matched cohort of patients undergoing total hip arthroplasty (THA) for neck of femur fracture (#NOF) and for osteoarthritis (OA). Methods A single-centre, consecutive series of patients at minimum one-year follow-up following THA for #NOF were compared with a 1:1 age- and sex-matched cohort of patients following THA for osteoarthritis from the same institution. The primary outcome measure was frequency of dislocation at one year postoperatively. Secondary outcomes included rates of all-cause revision, infection, periprosthetic fracture, and mortality at one year and medium-term postoperatively. Cox regression compared medium-term outcomes between groups, accounting for unequal follow-up duration. Results A total of 722 patients were included, with 361 in each group. BMI was greater in the OA group (28.9 kg/m 2 vs 24.7 kg/m 2 ; p < 0.001). Sex, age, American Society of Anesthesiologists grade, and comorbidity profile did not differ between groups (p > 0.247). Overall, 151 patients (41.8%) in the #NOF group received dual-mobility implants, compared with eight (2.2%) in the OA group (p < 0.001). Femoral offset was similar between groups (42.6 mm and 42.7 mm, p = 0.892). Dislocation rates were greater in the #NOF group than the OA group at one-year (4.4% vs 1.1%; p = 0.011) and by final follow-up. The one-year rates of periprosthetic fracture, all-cause revision, and mortality were similar between groups (p > 0.340), although risk of mortality was greater by final follow-up after THA for #NOF (hazard ratio 1.577; p = 0.033). Conclusion Despite the more frequent use of dual-mobility implants in THA for #NOF than OA and the otherwise comparable patient demographics and implants used, the risk of early dislocation after THA for #NOF was four times greater than in an age- and sex-matched elective THA cohort. Early postoperative complication rates were otherwise comparable between the groups. Cite this article: Bone Jt Open 2026;7(11):1455–1461.
Aims Hip and knee arthroplasty volumes are increasing among working-age patients with end-stage osteoarthritis (OA). This study aimed to assess pre- and postoperative work absence, return to work (RTW), workplace modifications, and the exploratory productivity impact associated with work disruption. Methods This retrospective cohort study included patients aged ≤ 65 years undergoing primary total hip (THA) or total knee arthroplasty (TKA) between April 2023 and March 2025 at a UK national elective orthopaedic centre (National Treatment Centre - Fife Orthopaedics, UK). Eligible patients completed outcome measures and a RTW questionnaire. Exploratory productivity modelling used gross value added (GVA)-based assumptions and national arthroplasty data to estimate potential productivity loss. Results Of the 92 patients included, 68 (73.9%) returned to work postoperatively. RTW was more frequent among patients aged < 50 years (n = 30/33, 90.9%) and after THA compared with TKA (n = 40 (85.1%) vs n = 28 (62.2%) respectively). Among those intending to RTW, 68/77 (88.3%) did so, with similar rates after THA (n = 40/44, 90.9%) and TKA (n = 28/33, 84.8%). Median time to RTW was 2.5 months (IQR 1.5 to 3.4). Initial work modifications were required by 46/68 (67.6%) patients, and nine of 77 (11.7%) patients intending to RTW either failed to return for joint-specific reasons, or lost/changed jobs due to their osteoarthritis or surgery. Preoperative work cessation occurred in 34/92 (37.0%) patients and was associated with failure to RTW (p = 0.004). Longer waiting times were associated with higher rates of preoperative work cessation, affecting 4.3%, 28.3%, and 33.7% of patients waiting three, 12, and 24 months, respectively. Illustrative GVA-based modelling estimated Scotland-wide productivity loss of £146 to 425 million annually. Conclusion Most working-age patients returned to work after arthroplasty, although many required work modifications. Preoperative work cessation was associated with non-return, and longer waiting list times were associated with greater modelled productivity loss. These exploratory findings support improved employment counselling, RTW pathway optimization, and prospective multicentre evaluation. Cite this article: Bone Jt Open 2026;7(11):1446–1454.
Aims The number of arthroplasty revision surgeries is increasing, yet patient-centred outcomes such as mental wellbeing, fulfilment of expectations for postoperative outcomes such as pain, function, and activities of daily living, as outlined in the Hospital for Special Surgery Knee Scale (HSS), and the Hip/Knee Replacement Expectations Survey (HRES/KRES), as well as the importance patients assign to such outcomes, remain insufficiently understood. Moreover, little is known about the role of their significant others. While essential to patients’ recovery and wellbeing, they may experience substantial emotional and practical burdens themselves. Here we present the protocol of the REJOIN study (Outcomes of REvision surgery after primary JOINt replacement), which aims to examine the impact of revision surgery on patients and their significant others. The study describes patients’ expectations and their fulfilment, mental wellbeing, functional outcomes, and the perceived value of outcomes following surgery, as well as the health-related quality of life (QoL) and caregiver burden experienced by their significant others. In addition, it investigates risk factors associated with the aforementioned outcomes. Methods This will be a multicentre, longitudinal observational study. All eligible patients scheduled for revision surgery after total hip or knee arthroplasty between March 2026 and February 2033 are invited to participate together with their significant other. We aim to include 3,650 patients. Data will be gathered preoperatively, and at three, six, 12, and 24 months. Results The main outcome parameters are expectations and their fulfilment, measured through three different data sources: patient-reported outcome measures (PROMs) gathered for usual care, patients’ medical files, and study questionnaires. The PROMs comprise of the HSS, HRES/KRES, mental health (Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Screen (HADS)), QoL (EuroQol five-dimension questionnaire (EQ-5D)), pain (Numeric Rating Scale (NRS) pain), hip/knee functioning (Oxford Hip Score/Oxford Knee Score (OHS/OKS)), patient-prioritized importance of outcomes (their top three), strain on significant other (CarerQol-7D), positive experiences of significant other (PES), and hip/knee function according to significant other (OHS/OKS by significant other). Conclusion The REJOIN study offers a systematic approach to evaluate the impact of revision surgery on patients and their significant others with regard to expectation fulfilment, mental wellbeing, and functional outcome. Cite this article: Bone Jt Open 2026;7(11):1439–1445.
Aims To assess sagittal stability in vivo using an automated arthrometer and to evaluate its relationship with patient-reported outcomes (PROMs) and range of motion (ROM) following primary total knee arthroplasty (TKA). Methods This prospective, double-blind cohort study included 80 patients. Either posterior-stabilized (PS) rotating platform (RP) or a fixed bearing cruciate-retaining (CR) design was used. Clinical outcomes were collected preoperatively, at three and 12 months, using the Oxford Knee Score (OKS), Knee injury and Osteoarthritis Outcome Score (KOOS), Patient Knee Implant Performance (PKIP) score, and EQ-5D-5L questionnaire. Sagittal stability was measured using the GNRB/Dyneelax arthrometer. Differences were analyzed using paired t -tests and analysis of variance; correlations and multivariable regression were used to identify predictors of stability. Results All PROMs improved from baseline (p < 0.001). CR knees showed greater early PKIP improvement at three months 12.8 (SD 6.5) vs 8.4 (SD 7.6); p = 0.007). At both three and 12 months, PS knees demonstrated reduced anterior tibial translation across all loads (e.g. 6.2 mm (SD 2.3) vs 4.7 mm (SD 1.6) at 150 N; p = 0.002). Multivariable regression confirmed that implant design (p = 0.016) and sex (p < 0.001) were independent predictors of stability. No correlation was found between sagittal stability and PROMs. Overall, ROM remained unchanged at three months but improved significantly at 12 months. No differences in flexion were noted between the CR and PS groups. Conclusion PS implants demonstrated lower anterior translation under arthrometric testing compared with CR implants. However, this mechanical difference did not translate into superior short-term functional outcomes, and no correlation was found between arthrometric stability and PROMs. ROM improved in both groups without design-related differences. Cite this article: Bone Jt Open 2026;7(11):1429–1438.
