Prevent the periprosthetic fracture before it happens, and Bone-RADS holds up as a triage tool for lytic lesions

The edition in brief

A JBJS review warns that periprosthetic femoral fractures after hip arthroplasty are rising with the number and age of people carrying implants, carry mortality comparable to hip fragility fractures, and have high reoperation rates, so prevention should be part of every primary arthroplasty plan. An external validation of the American College of Radiology's Bone-RADS score in 423 adult long-bone lytic lesions found each one-point rise associated with an odds ratio of 9.7 for malignancy, with 97.1% sensitivity, 67.4% specificity and a negative predictive value of 92.4%; agreement on the four-tier score was only moderate, but agreement on benign versus possibly malignant was better. In a case series of 100 quadriceps tendon ACL reconstructions, quadriceps strength symmetry at 3 months was associated with knee scores at two years; patients reaching an acceptable symptom state generally had 60% to 70% quadriceps symmetry by 3 months. A Bone & Joint Journal annotation proposes dividing the femoral diaphysis into three zones to plan and report fixation in complex revision knee surgery and distal femoral replacement. The pearl: the basics of infection prevention at the primary arthroplasty still do most of the work.