The edition · Orthopaedics
Acetabular osteotomy was linked to longer hip survival in true dysplasia, but not in borderline hips
Twenty-year data on more than a thousand hips separate dysplasia that needs reorientation from borderline hips that mostly do well untreated. Plus how cement choice and mixing order change vancomycin release from spacers, the readiness of AI after hip fracture, and a small Boswellia trial in knee osteoarthritis.
The edition in brief
A Japanese series of 683 hips treated with transposition osteotomy of the acetabulum and 353 untreated contralateral hips found that true dysplasia (lateral centre-edge angle under 20°) left untreated had 69% 20-year survival without advanced arthritis or replacement, against 88% after osteotomy. Borderline hips (20° to under 25°) did well untreated (96%), and osteotomy did not significantly improve failure-free survival there, though arthritis progressed less. It is retrospective. An in vitro study of 60 cement discs loaded with 4 g vancomycin found brand, viscosity and whether monomer or powder went in first changed 28-day elution by up to 120%. A systematic review of 40 studies found machine-learning models after hip fracture predicted mortality moderately to well but were rarely validated externally. A 60-patient trial of a Boswellia extract in mild to moderate knee osteoarthritis reported better WOMAC scores than placebo at eight weeks; it is small and short.
Brand and mixing order changed vancomycin release from cement spacers
Standardise the cement and mixing order for high-dose vancomycin spacers rather than leaving it to habit.
AI after hip fracture: good at predicting death, rarely tested outside its own hospital
Do not base hip fracture decisions on an AI model that has not been externally validated and calibrated.
A small Boswellia trial reported better knee osteoarthritis scores than placebo
Treat Boswellia as, at most, an optional addition to core osteoarthritis care; the evidence is one small eight-week trial.
Necrotising fasciitis: pain out of proportion means explore, not scan
When necrotising fasciitis is suspected, go to theatre for a diagnostic incision rather than waiting for tests.
Osteotomy linked to longer hip survival in true dysplasia, not in borderline hips
Consider reorientation osteotomy for true hip dysplasia, and be selective in borderline hips, which did well untreated in this series.
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