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Journal articleWynell-mayow W, Hall T, Singh A, et al., 2026, , Bone & Joint Open, Vol: 6, Pages: 1425-1435, ISSN: 2633-1462
AimsCoronal Plane Alignment of the Knee (CPAK) phenotyping is gaining momentum in research and clinical practice to understand individualized knee alignments and predict knee balance in total knee arthroplasty (TKA). The nine CPAK classes are based on joint line obliquity (JLO) and arithmetic hip-knee-ankle angle (aHKA), which are calculated using the medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA). This study aims to assess CPAK classification reproducibility, and analyze what level of angular error is associated with CPAK misclassification.MethodsTwo readers labelled 75 long-leg radiographs (LLRs) from the Osteoarthritis Initiative database for analyses of CPAK inter-reader reproducibility. A single reader then labelled and classified phenotypes for an aggregate total of 1,128 LLRs. Finally, Monte Carlo simulations were run based on 1,128-patient phenotype distribution and the inter-reader reproducibility statistics to understand how CPAK agreement rates were affected by the reproducibility of MPTA and LDFA measurements.ResultsThere was excellent reproducibility in MPTA and LDFA measurements (mean absolute error: 0.41°/0.71°; and intraclass correlation coefficient: 0.96°/0.91°, respectively). These small angular deviations led to one-in-five disagreement in CPAK classification (20.0%; 95% CI 10.9% to 29.1%). An aHKA mean absolute error of < 0.1°, which is potentially unattainable, would be required to reduce inter-reader CPAK disagreement to below 95%.ConclusionCPAK phenotyping from long-leg radiographs may result in clinically significant rates of misclassification. CT imaging may improve reliability, particularly in cases where aHKA and JLO are near to discriminatory values.
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Journal articleGlynou S, Musbahi O, Sousi S, et al., 2026, , Bone & Joint Research, Vol: 15, Pages: 1213-1227, ISSN: 2046-3758
AimsTo evaluate objectively measured physical activity after hip and knee arthroplasty using accelerometry, by comparing bone-preserving procedures with total arthroplasties and benchmarking both against non-arthritic controls.MethodsThis observational study was conducted within the UK Biobank. Adults aged 40 to 69 years with total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), total hip arthroplasty (THA), or hip resurfacing (HR) were identified through linked hospital records and completed seven-day wrist-worn accelerometry (Axivity AX3). Outcomes included adjusted daily step count (primary), peak cadence, moderate-to-vigorous physical activity (MVPA), and Euclidean Norm Minus One (ENMO). Surgical groups were propensity score-matched to non-arthritic controls on demographics, lifestyle factors, and comorbidities. Direct comparisons between procedure types were examined using both propensity-matched analyses and complementary multivariable regression, and adjusted for demographic and clinical covariates. Subgroup analyses considered < 12 months and ≥ 12 months post-surgery.ResultsA total of 2,283 participants were included (TKA = 860, UKA = 162, THA = 1,168, HR = 93). Compared with matched controls, TKA and THA patients showed persistently lower activity, while UKA and HR achieved levels similar to controls. In the knee cohort, UKA patients walked significantly more steps/day than TKA (9,150 vs 7,920; + 15.5%, p < 0.001) with higher cadence. In the hip cohort, HR patients outperformed THA (10,122 vs 9,139 steps/day; + 10.6%, p = 0.032) and demonstrated higher peak cadence, and HR remained comparable to controls. All groups fell within the ‘somewhat active’ to ‘active’ step-count range (7,500 to 12,499 steps/day).ConclusionUKA and HR are associated with higher postoperative activity compared with total arthroplasty (TKA, THA). Accelerometry provides an objective, scalable assessment of functional recovery, highlig
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Journal articleBull D, Zhang J, Xie S, et al., 2026, , Medical Engineering and Physics, ISSN: 1350-4533
Total knee arthroplasty (TKA) success is highly dependent on accurate implant alignment, however, 80% of procedures globally are performed manually. Manual procedures have higher alignment errors compared to robotic platforms and patient-specific instrumentation, yet these have limitations of high cost and intraoperative inflexibility, respectively. This study aimed to evaluate the intraoperative pin positioning accuracy and flexibility of a smartphone-assisted navigation system using CT-derived surgical plans. Three participants used the navigation system to perform 108 guide pin insertions (54 femoral, 54 tibial) on surrogate bone models based on CT-derived surgical plans. Testing included both default mechanical axis targets (0°) and user-selected navigated targets ranging from -3° to 3°. Accuracy was assessed by comparing achieved pin trajectories with the preoperative surgical plan. Median absolute angular deviations achieved ranged from 0.9° to 1.6° across all component–plane combinations, with an overall median deviation of 1.3° (IQR 0.6–2.1°). The proportion of insertions within a predefined ±3° clinical accuracy threshold ranged from 83.3% to 100%, and all component–plane combinations demonstrated deviations significantly within this threshold (p < 0.00001). These findings support the technical feasibility of the smartphone-assisted navigation system for surgical pin positioning under controlled pre-clinical conditions. Further studies will evaluate the navigation system in cadaveric models with experienced orthopaedic surgeon participants.
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Journal articleGu R, Bai W, Xie S, et al., 2026, , Knee, Vol: 62, ISSN: 0968-0160
Background Segmentation of lower limb bones is essential for accurate preoperative planning in total knee arthroplasty (TKA), yet fully annotated CT datasets are rarely available in clinical practice. This study evaluated whether a partially supervised deep learning framework can leverage incompletely annotated CT data to generate anatomically accurate femur and tibia segmentations suitable for TKA planning. Method A 3D nnU-Net model was trained using 205 healthy full-leg CT scans with mixed annotation completeness, including 17 fully annotated cases and partially labelled femur or tibia in the remaining scans. Performance was evaluated on an internal healthy dataset (n = 40), a cadaveric dataset (n = 15), and an osteoarthritis (OA) dataset acquired for robotic TKA planning (n = 10). Accuracy was assessed using Dice similarity coefficient (DSC), Hausdorff distance (HD), HD95, and root-mean-square surface distance (RMSE). Clinical relevance was evaluated using landmark localisation errors and joint alignment measurements (mLDFA and mPTA). Results On the cadaveric dataset, mean DSC values were 96.53% (femur) and 97.41% (tibia), with RMSE < 1 mm. On the OA dataset, mean DSC remained approximately 96.5% with HD95 < 1.7 mm across acquisition windows. Alignment measurements derived from automatic and manual segmentations showed small differences (mLDFA: 86.81° vs 87.02°, p = 0.11; mPTA: 86.74° vs 87.29°, p = 0.08), with no statistically significant differences observed. Conclusion Partially supervised training enables accurate lower limb segmentation from incompletely annotated CT datasets and preserves clinically relevant alignment measurements required for TKA planning.
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Journal articleElliott DA, Gill SS, Gupte CM, 2026, , Am J Sports Med, Vol: 54, Pages: 3070-3080
BACKGROUND: Sex disparities in return-to-sport (RTS) outcomes after anterior cruciate ligament reconstruction (ACLR) remain poorly reported. Female athletes may demonstrate higher rates of anterior cruciate ligament (ACL) injuries than male athletes yet exhibit lower RTS rates. PURPOSE: To compare postoperative RTS outcomes between male and female patients after primary ACLR. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A systematic search of the PubMed, MEDLINE, Embase, Scopus, and Web of Science databases was conducted from database inception through September 2025, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies directly comparing RTS outcomes between males and females after primary ACLR with ≥12 months of follow-up were included. Data were synthesized using an exploratory random-effects meta-analysis. Odds ratios with 95% confidence intervals were calculated for dichotomous outcomes, and mean differences for continuous variables. RESULTS: In total, 25 studies including 7183 athletes (2892 females, 4291 males) met the inclusion criteria. Female athletes demonstrated significantly lower odds of RTS at 12 months (OR, 0.76; 95% CI, 0.62-0.92; P = .005) and up to and including 24 months (OR, 0.72; 95% CI, 0.61-0.85; P < .001). No significant sex-based differences were observed for RTS to competition or return to preinjury levels. CONCLUSION: Female athletes are significantly less likely to RTS after ACLR during the critical midterm recovery period. These findings highlight the need for sex-specific rehabilitation and psychological support strategies to optimize RTS outcomes in female athletes.
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Journal articleLeslie D, Mullington CJ, 2026, , Anaesthesia
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Journal articleLawton P, GarciaHaro L, McGregor A, et al., 2026, , Biochemistry and Molecular Biology Education, ISSN: 1470-8175
The transition to university presents a significant challenge for undergraduate students in Biomedical Sciences, many of whom lack prior laboratory experience. This inexperience can create a discrepancy between students' perceived and actual competencies, leading to a self-efficacy gap when compared to peers with previous laboratory exposure. To address this and prepare students for a research-intensive curriculum, we introduced the “Biomedical Kitchen”, a novel, transdisciplinary simulation. This innovative course uses analogies between gastronomy and biomedical research, including precision, dexterity, and recording observations to provide a low-stakes, accessible environment for developing practical research skills, without explicit focus on kitchen chemistry. We evaluated the programme's effectiveness by measuring student self-efficacy before and after the sessions, and then subsequently at an interval through their laboratory module. The results demonstrate that the intervention effectively adjusted self-efficacy; revealing a group which increased and a separate group which decreased in self-efficacy, suggesting a more realistic self-appraisal. Furthermore, students described the sessions as a fun and authentic environment for practising skills and building rapport with teammates, including 6 months after they have engaged with disciplinary curricular content. In conclusion, the Biomedical Kitchen is an innovative pedagogical tool that successfully aligns student self-efficacy with practical ability. It provides a valuable opportunity for students to practice essential technical and transferable skills, better preparing them for the demands of a research-oriented course.
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Journal articleAl-Saadawi A, Gill SS, Sousi S, et al., 2026, , Bone & Joint Open, Vol: 7, Pages: 1046-1055, ISSN: 2633-1462
AimsHip and knee arthroplasty are among the most commonly performed surgical procedures worldwide but carry a risk of cardiovascular complications, including myocardial infarction (MI). Therefore, this study aimed to assess the long-term incidence of MI following hip and knee arthroplasty, and subsequent mortality, in a UK-based cohort.MethodsA retrospective cohort study was conducted using linked Hospital Episode Statistics (HES), Office for National Statistics (ONS) mortality data, and Clinical Practice Research Datalink (CPRD) records. Patients undergoing total hip arthroplasty (THA), hip resurfacing arthroplasty (HRA), total knee arthroplasty (TKA), or unicompartmental knee arthroplasty (UKA) between 2 January 1998 and 29 March 2021 were identified. An inverse probability weighting approach based on propensity scores was used, and outcomes were assessed using weighted logistic regression for MI incidence at 30, 90, and 365 days postoperatively, and multiple Cox proportional hazards models for MI-related mortality.ResultsIn total, 1,148,298 procedures were included in the final analysis. Of those undergoing hip arthroplasty, 713 (0.13%) patients experienced a MI within 30 days postoperatively, rising to 947 (0.17%) at 90 days and 1,989 (0.38%) patients at one year. In the knee arthroplasty cohort, the number of patients experiencing a MI was 656 (0.11%) at 30 days, 890 (0.15%) at 90 days, and 1,853 (0.32%) at one year postoperatively. Factors associated with increased MI incidence included age, male sex, non-white ethnicities, geographical region, higher deprivation status, and elevated comorbidity scores. Weighted logistic regression demonstrated significantly lower odds of MI, and MI-related mortality in patients undergoing UKA and HRA compared with TKA and THA, respectively.ConclusionIn England, post-arthroplasty MI remains uncommon but carries significant mortality risk. Bone-preserving procedures are associated with a significantly reduced incidence of MI an
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Journal articleMurphy J, Strutton PH, Morgan C, et al., 2026, , J Pain, Vol: 49
The R2 blink reflex (R2BR) provides a neurophysiological marker of trigeminofacial somatosensory processing in the human brainstem. In the current study, we paired the R2BR with a heterotopic noxious conditioning stimulus (HNCS) applied via semi-automated cuff pressure algometry to the lower limb across repeated test sessions. Twenty-four healthy participants completed two identical sessions in which the R2BR stimulus-response function was assessed across 11 intensities (0.9-1.9x threshold) at baseline, during tonic cuff-pressure conditioning applied to the contralateral lower limb, and during post-conditioning recovery periods. Overall R2BR excitability was also quantified using an excitability index derived from the stimulus-response function. The HNCS produced bidirectional effects on R2BR excitability, causing both inhibition and facilitation of the reflex across repeated sessions. Post-conditioning R2BR responses returned to baseline levels. The baseline R2BR excitability index demonstrated fair-to-good test-retest reliability (ICC = 0.73), whereas reliability during conditioning was reduced to poor-to-fair (ICC = 0.57). These findings demonstrate that a HNCS can modulate R2BR responses in a bidirectional manner, which was observed across repeated test sessions. These results indicate that the combined use of a semi-automated lower limb cuff pressure HNCS with the R2BR may provide a complementary neurophysiological approach for assessing descending inhibitory and facilitatory influences over brainstem reflex pathways. PERSPECTIVE: The R2 blink reflex (R2BR) paired with a semi-automated cuff-pressure HNCS provides a neurophysiological approach for assessing bidirectional endogenous modulatory influences on brainstem reflex excitability.
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Journal articleMurphy J, Krecke J, Morgan C, et al., 2026, , Eur J Neurosci, Vol: 64
The R2 blink reflex (BR) is a polysynaptic brainstem-mediated response that can be activated by innocuous and noxious electrocutaneous stimulation of the supraorbital nerve and has been used as a biomarker across pharmacological studies. Whilst standard patch electrodes activate both the tactile (R1) and nociceptive (R2) components of the blink reflex, concentric electrodes preferentially evoke a nociceptive-specific response (NBR) by isolating the R2 component. This preregistered systematic review (CRD420251014203) aims to assess the pharmacological modulation of nociceptive R2 responses as measured by both standard patch and concentric electrodes in healthy participants. Following PRISMA guidelines, systematic searches of PubMed, Cochrane and Ovid identified studies examining R2 responses in healthy adults receiving a pharmacological intervention. Data were extracted on study design, drug category, stimulation electrode, dosage and outcome measures. Nine studies met inclusion criteria, which included eight distinct drug classes. Limited effects on the R2 response were found for opioids, selective serotonin receptor agonists, nonsteroidal anti-inflammatory drugs and ketamine. In contrast, α2-adrenoreceptor modulators, benzodiazepines, nitrous oxide and selective adenosine A1 receptor agonists demonstrated effects. The stimulation electrode used did not affect the impact of intervention on nociceptive R2 responses where comparable studies were available. These findings indicate that nociceptive R2 components of the BR, whether evoked using standard or concentric electrodes, exhibit comparable sensitivity to pharmacological modulation. Future research should further delineate the contributions of local and descending modulatory systems to nociceptive-specific and tactile processing within trigeminofacial circuits.
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Journal articleVasooja D, Cinar A, Mostafavi M, et al., 2026, , Biomechanics, Vol: 6, ISSN: 2673-7078
Background/Objectives: Trabecular bone exhibits brittle behaviour governed by microscale deformation and damage, yet quantifying crack progression is difficult because classical fracture-mechanics approaches do not apply to architecturally discontinuous porous tissue. This pilot study evaluates whether synchrotron X-ray computed tomography (XCT) combined with digital volume correlation (DVC) can provide a practical, geometry-normalised approach for quantifying crack-opening behaviour in human trabecular bone. Methods: Semicylindrical specimens from femoral heads of hip-fracture donors (n = 5) and non-fracture controls (n = 5) underwent stepwise three-point bending during XCT imaging. Full-field displacement maps were used to measure crack mouth opening displacement (CMOD), crack length (a), and their ratio CMOD/a, used here as a geometry-normalised comparative descriptor of brittle response rather than an intrinsic material property. Automated phase-congruency crack detection (PCCD) was compared with manual measurement. Results: XCT–DVC resolved three-dimensional displacement discontinuities during crack initiation and propagation in all specimens. Hip-fracture donors exhibited significantly lower critical crack-opening ratios (CMOD/a)* than Controls (median 0.31 vs. 0.47; p = 0.008) and reached instability at lower applied loads. Total crack extension (Δa*) was similar between groups. Automated crack tracking using phase-congruency-based segmentation showed excellent agreement with manual measurements (r2 = 0.98), supporting reliable extraction of crack geometry from DVC displacement fields. Conclusions: In this small pilot sample, XCT–DVC provided a feasible, geometry-normalised approach for comparing crack-opening behaviour where classical fracture-mechanics parameters cannot be applied. The close agreement between automated and manual crack measurements supports the reproducibility of the displacement-based measurement pipeline. The lower criti
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Journal articleBrkljac M, Bandeira E, Shrey S, et al., 2026, , Bone & Joint Open, Vol: 7, Pages: 838-844, ISSN: 2633-1462
AimsIntraoperative periprosthetic femoral fractures (IPFs) are a serious complication of total hip arthroplasty (THA), typically attributed to surgical technique. Manual impaction provides tactile feedback but varies with surgeon fatigue and experience. Automated impaction systems offer consistent energy delivery, potentially improving safety and efficiency. This study aimed, through a systematic review and meta-analysis, to compare the risk of IPF and operating times between automated and manual impaction during primary uncemented THA.MethodsWe performed a systematic review and random-effects meta-analysis of primary uncemented THA studies comparing automated and manual impaction techniques. Outcomes included IPFs and operating time. Pooled odds ratios (ORs) were calculated for IPF risk, and differences in mean operating time between techniques were analyzed using mean differences with 95% CIs.ResultsComparative data were available from five studies (n = 2,607 THAs). Meta-analysis included three studies (n = 2,377), with 1,408 hips in the automated group (14 IPFs) and 969 hips in the manual group (three IPFs). There was no significant difference in IPF risk between techniques (pooled OR 1.29; 95% CI 0.52 to 3.21; p = 0.59). Operating time was reported in three studies. The pooled mean difference suggested a shorter operating time with automated impaction (−1.34 minutes; 95% CI −15.60 to 12.92; p = 0.72).ConclusionAutomated impaction was not associated with a lower risk of IPF or operating time compared with manual techniques in primary uncemented THA. Fracture risk and efficiency may instead depend on femoral component–femur compatibility and implant sizing. Further randomized studies incorporating diverse femoral component designs and automated impaction systems, alongside formal economic evaluation, are required.
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Journal articleAlagha MA, Gupta R, Jordan C, et al., 2026, , Bone & Joint Research, Vol: 15, Pages: 892-902, ISSN: 2046-3758
Cementless fixation is the predominant method used in hip arthroplasty worldwide; however, seating implants via impaction remains a balancing act – too much energy may cause fracture, and too little may not seat the implant adequately. Currently, the optimal energy level required for femoral implant fixation is unknown, which adversely affects the variability of long-term implant stability. This study investigated how varying impaction energies affect strain behaviour, fracture risk, and implant fixation in synthetic bone models using cementless femoral implants.MethodsA standardized surgical technique was used to prepare a total of 20 synthetic bone models (Sawbones) – 12 healthy and eight osteoporotic – for femoral impaction. The implants were impacted at three different energy levels (low, medium, and high) using a validated in vitro rig simulator for soft-tissue compliance, with four specimens tested at each velocity and bone type. Strain behaviour and fracture risk, measured as peak strain, were analyzed using digital image correlation with two high-speed cameras. Implant stability was assessed via pull-out fixation tests.ResultsHigher impaction energy increased fracture risk but did not significantly increase implant stability. In healthy bone models, mean tensile peak strain was 0.31, 0.69, and 0.97 for low, medium, and high energy strikes, respectively. Osteoporotic models showed the greatest difference between the low and medium energies during the initial two strikes, with peak strains of 0.42 to 0.46 versus 0.79 to 0.84, with subsequent strikes resulting in minimal variation between the two velocities. Implant pull-out forces were similar among the different impaction energy levels within each group (healthy p = 0.105, osteoporotic p = 0.686), and consistently lower in osteoporotic bones across all energy levels.ConclusionThese biomechanical findings on synthetic bones confirm that multiple lower-energy strikes lead to similar implant fi
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Journal articleMusbahi O, Sousi S, Al-saadawi A, et al., 2026,
Accelerometer-Measured Post-Operative Physical Activity Confers a Significant Mortality Benefit Following Joint Arthroplasty
, Bone & Joint Research, ISSN: 2046-3758 -
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. Imperia59% 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.
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Journal articleBoyles R, Kiatwongwanich N, Vicente M, et al., 2026, , Eur J Neurosci, Vol: 63
Transcranial magnetic stimulation (TMS) mapping provides valuable insight into corticospinal organisation and plasticity, but conventional protocols are often too time-consuming to be practical in clinical settings. This study aimed to refine a rapid, multimuscle TMS mapping protocol capable of comprehensively characterising upper limb motor representations, including both distal and proximal muscles, and to examine how stimulation intensity and voluntary muscle activity shape cortical map metrics and motor evoked potential (MEP) latency. Nineteen healthy adults underwent neuronavigated TMS mapping of eight upper limb muscles using a rapid random walk protocol. Cortical maps were acquired at multiple stimulation intensities referenced to the motor threshold of the first dorsal interosseous muscle, both at rest and during a task requiring low levels of muscle activity. Map area, volume and centre of gravity were quantified using relative and absolute thresholds, alongside automated analysis of MEP onset latency. Cortical representations showed stable somatotopic organisation across conditions, with proximal-muscle centres of gravity located more medially than distal muscles. Increasing stimulation intensity preferentially expanded distal muscle map area and volume, whereas voluntary muscle activity selectively facilitated proximal-muscle representations, even after controlling for background muscle activity. These effects revealed a clear proximal-distal gradient in the physiological modulation of cortical maps. MEP latencies were shorter for proximal muscles and during active contraction. At rest, latency increased with distance from the map centre for several muscles, but this spatial gradient was abolished or inverted during voluntary activity. These findings demonstrate that rapid, multimuscle cortical mapping is feasible and yields physiologically meaningful metrics across the upper limb. The results highlight a functional dissociation between proximal and dista
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Journal articleSharma S, Ramnarine A, Fouad K, et al., 2026, , Journal of the Pediatric Orthopaedic Society of North America, Vol: 15
Introduction: Multiple parameters, including VO<inf>2</inf>max, ventilatory efficiency, lung volumes, and exercise tolerance, have been examined, yet their progression with pediatric scoliosis remains unclear. Although pulmonary function tests are widely used, they may underestimate functional impairment, as spirometric measures can remain relatively preserved despite clinically meaningful reductions in exercise capacity. This review aims to define the extent of functional impairment, its association with curve severity, and the potential of VO<inf>2</inf>max as a marker of surgical recovery. Materials and methods: We systematically searched PubMed, Embase, and Cochrane for eligible studies reporting cardiopulmonary outcomes in pediatric scoliosis. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tools and the ROBINS-I risk-of-bias tool. Results were synthesized narratively following the Synthesis Without Meta-analysis guideline. Conclusions: From 455 records, 6 studies met the inclusion criteria. Adolescents with idiopathic scoliosis consistently demonstrated reduced aerobic capacity, with mean VO<inf>2</inf>max values ranging from 27.9 to 33.6 mL kg<sup>−1</sup>·min<sup>−1</sup>, approximately 20-25% below reference norms, indicating mild-to-moderate cardiopulmonary impairment. Functional tests such as the 6-min walk and E-fit correlated strongly with VO<inf>2</inf>max, validating their use as practical surrogates of aerobic performance. Greater curve severity and thoracic deformity were associated with progressive reductions in forced expiratory volume in one second, forced vital capacity, and VO<inf>2</inf>max, reflecting restrictive ventilatory physiology. Postoperative studies showed stable but not improved VO<inf>2</inf> or pulmonary function, suggesting that surgery preserves rather than enhances respiratory capacit
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Journal articleMorton S, Manek R, Mohammadi N, et al., 2026, , British Journal of Anaesthesia, Vol: 136, Pages: 1546-1567, ISSN: 0007-0912
BackgroundOperating 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.MethodsPubMed, 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.ResultsIn 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%).ConclusionsCurrently, 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 evidenc
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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
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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.
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