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Journal articleMusbahi O, Pouris K, Hadjixenophontos S, et al., 2025,
Machine Learning for patient selection in corticosteroid decision making in knee osteoarthritis: a feasibility model
, World Journal of Methodology, Vol: 15, ISSN: 2222-0682Background: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.
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Journal articleBladt F, Varaeva YR, Retter GJ, et al., 2025,
Pilot study of bone turnover biomarkers, diet, and exercise in elite female ballet dancers
, Journal of Dance Medicine and Science, Vol: 29, Pages: 200-210, ISSN: 1089-313XIntroduction: 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 Imperial College London. 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
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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
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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 articleIacona GMV, Rolph AR, Manteigas HFM, et al., 2025,
The cutaneous sympathetic blockade associated with labour epidural analgesia: a quasi-experimental study conducted during labour and after delivery
, BRITISH JOURNAL OF ANAESTHESIA, Vol: 135, Pages: 1231-1239, ISSN: 0007-0912 -
Journal articleClunie GM, FreemanSanderson A, AlYaghchi C, et al., 2025,
Development of a core outcome set for intervention studies in adults with laryngotracheal stenosis
, The Laryngoscope, Vol: 135, Pages: 3756-3765, ISSN: 0023-852XObjectiveAdult acquired laryngotracheal stenosis (LTS) is a chronic condition with heterogeneous treatment options and a significant symptom burden. Synthesis of data across research studies to guide clinical decision-making is challenging due to inconsistent outcome selection and use of unvalidated measures. Our objective was to establish a core outcome set (COS) for studies of LTS interventions in adults.MethodsWe conducted a two-round modified e-Delphi study. We reviewed published systematic reviews and qualitative studies to inform the inclusion of 42 outcomes in the first e-Delphi round, with 10 additional outcomes added by participants for the second voting round. The international expert panel included clinicians, researchers, and people living with LTS. We held two consensus meetings and a final voting round.ResultsThe first e-Delphi round involved 1067 participants from multiple stakeholder groups, with 575 participants voting in the second. Seventeen participants participated in the consensus meetings. The final COS included seven outcomes: (1) Level of breathlessness, (2) Ability to generate audible voice, (3) Ability to manage/clear mucus, (4) Ability to eat and drink, (5) Health-related quality of life, (6) Emotional and mental health symptoms, and (7) Frequency of treatment.ConclusionBy using a rigorous Delphi process informed by multiple stakeholder groups, we gained consensus on seven core outcomes for inclusion in future research relating to LTS. Use of this COS will standardize outcomes measured in future research studies, ensuring they are comparable. Future work is required to identify the best way to measure these outcomes to fully operationalize this COS.
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Journal articleSchütze R, Liew B, Caneiro JP, et al., 2025,
Mechanisms of change in cognitive functional therapy: a longitudinal mediation analysis of the RESTORE clinical trial for disabling chronic low back pain
, Behaviour Research and Therapy, Vol: 193, ISSN: 0005-7967Chronic low back pain (CLBP) is an urgent global health priority given its high prevalence and impact as the leading cause of disability. While several efficacious treatments exist, most have modest effects. Improving outcomes requires a better understanding of treatment mechanisms to enable optimisation. This study explored the mechanisms of cognitive functional therapy (CFT), a biopsychosocial intervention with large, durable effects for adults with disabling CLBP. A longitudinal mediation analysis was performed on data from the RESTORE multisite clinical trial comparing CFT (n = 327) to usual care (n = 165). Mediators (self-efficacy, fear, catastrophising, and pain intensity) were specified based on behavioural theories underlying CFT and previous research. The joint mediation of treatment effects on disability (Roland Morris Disability Questionnaire) and pain intensity (numerical rating scale), were examined using a counterfactual framework for mediation analysis. As hypothesised, earlier changes in self-efficacy, fear, catastrophising, and pain intensity mediated improvements in disability at the end of treatment and at 12-month follow-up, explaining up to 61 % of the effect. Similarly, self-efficacy, fear, and catastrophising mediated the effect of CFT on pain intensity, explaining up to 62 % of the effect. Results are consistent with previous CLBP mediation research highlighting self-efficacy, fear, and catastrophising as likely common mechanisms among effective biopsychosocial treatments. CFT demonstrates large, durable, and clinically important effects on these mechanisms. Findings shed light for clinicians and researchers on how CFT works, although the role of other mechanisms such as movement changes requires further exploration, along with research analysing how different treatment components activate these mechanisms.
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Journal articlePonniah HS, Montin E, Namireddy S, et al., 2025,
Radiomics in FAI: current status and perspectives
, Bone and Joint Research, Vol: 14, Pages: 832-838Femoroacetabular impingement (FAI) is caused by abnormal contact between the femur and acetabulum, resulting in pain, limited motion, and early osteoarthritis. Existing imaging techniques for diagnosing FAI face considerable challenges. Radiomics involves the quantitative extraction and analysis of imaging features using advanced algorithms, often combined with machine learning (ML), to enhance diagnostic and prognostic precision. When integrated with ML, radiomics can identify patterns beyond conventional imaging measurements, potentially enabling automated, precise, and reproducible assessment of hip morphology and pathology. Early studies demonstrate its potential to differentiate between normal, symptomatic, and asymptomatic cam-type hips. However, challenges persist, including the standardization of imaging protocols, feature selection, access to large datasets, and the explainability of models. This review summarizes the state of the art in radiomics for FAI and highlights its future applications.
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Journal articleBoughton OR, Mann S, O'Toole P, 2025,
Bilateral Proximal Femur Interval Fractures with a Slipped Femoral Capital Epiphysis After Fixation: A Case Report.
, JBJS Case Connect, Vol: 15CASE: This case report, with 3 years of follow-up, describes a 9-year-old boy who suffered sequential Delbet type IV proximal femoral fractures. Three months postoperatively he had a unilateral slipped capital femoral epiphysis and had to undergo further surgery to address this. CONCLUSION: Proximal femur fractures are rare in childhood, and a slipped capital femoral epiphysis after fixation of a Delbet type 4 fracture has only been described once before in the literature. This case report highlights underlying risk factors of subsequent slipped capital femoral epiphysis after a Delbet type IV proximal femoral fracture and emphasizes the importance of careful follow-up.
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Journal articleGupte CM, 2025,
Training the knee surgeons of tomorrow: towards a subspecialist paradigm
, KNEE, Vol: 56, Pages: A3-A8, ISSN: 0968-0160 -
Journal articleGill SS, Haq T, Zhao Y, et al., 2025,
AI demonstrates comparable diagnostic performance to radiologists in MRI detection of anterior cruciate ligament tears: a systematic review and meta-analysis
, EUROPEAN RADIOLOGY, ISSN: 0938-7994 -
Journal articleRowe J, Shen S, de Alcântara ACS, et al., 2025,
Integrating computational and experimental advances in bone multiscale mechanics
, Progress in Materials Science, Vol: 153, ISSN: 0079-6425Decades of bone research have revealed the intricate hierarchical structures in bone, from the nanoscale building blocks of collagen and mineral to the complex micro-architecture and macro-geometry. Multiscale architecture confers bones their incredible toughness and strength that enables us to move through our daily lives. However, childhood and adult diseases can cause bone fragility and subsequent fractures, leading to disability, and mortality. A foundational understanding of bone mechanics across disparate scales is critical to improve the diagnosis and management of such diseases. At present, we have limited knowledge of how macroscale deformations that occur during everyday movement are transferred down to the nanoscale in order to resist fracture, especially due to historic limitations in measuring nanoscale mechanics experimentally. Recent advances in both experimental and computational tools are equipping researchers to probe the nanoscale for the first time. Here we provide a timely review of existing and next-generation experimental and computational tools and offer new perspectives on how to leverage the strengths of each approach to overcome the limitations of others. We focus on bone structure ranging from atomistic phenomena to microscale mineralized fibril interactions to build a bottom-up understanding of continuum bone mechanics and accelerate research towards impactful clinical translation.
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Journal articleGill SS, Prashar A, Kamath AG, et al., 2025,
Artificial Intelligence in Anterior Cruciate Ligament Tear Diagnosis: A Bibliometric Analysis of the 50 Most Cited Studies
, INDIAN JOURNAL OF RADIOLOGY AND IMAGING, ISSN: 0971-3026 -
Journal articleGray M, Boughton O, Wiles C, et al., 2025,
Runaway resorption of microcracks contributes to age-related hip- fracture patients
, Scientific Reports, Vol: 15, ISSN: 2045-2322Microdefects, including microcracks and resorption trenches, may be important contributors to bone fragility. 3D microdefect morphology was imaged using synchrotron micro-CT to develop a classification system for investigating the relationship with bone mechanics and hip-fractures. Femoral heads from ageing hip-fracture patients (n = 5, 74–82 years) were compared to ageing non-fracture controls (n = 5, 72–84 years). Two trabecular cores were prepared from the chiasma; one was imaged using synchrotron micro-CT to measure microdefects and one was mechanically tested to measure tensile strength. Morphological and mechanical data were compared and correlated using Mann Whitney U test and Pearson’s rank correlation. All the procedures performed were in accordance with the ethical standards of the Imperial College Tissue Bank (R13004) and the 1984 Declaration of Helsinki. Microdefects varied and were classified into four categories based on shape and measurable parameters. Hip-fracture donors exhibited significantly higher density of all microdefects (p < 0.05). Microdefect volume was strongly negatively correlated with ultimate tensile strength (p < 0.05) and stiffness (p < 0.05). Microdefects might contribute to loss of bone strength and fragility fracture via runaway resorption. Microcracks could promote focussed osteoclastic resorption and the formation of resorption pits which create stress risers leading to the re-formation of microcracks under continued load. CT-based classification methods should be used to explore the complex interaction between microdefects, metabolism, and bone fracture mechanics.
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Conference paperHakami HH, Sgambato BG, Banger MS, et al., 2025,
Biomechanical analysis of spine and shoulder compensation in a user of an ultrasound-based human–machine interface for hand control
, 2025 International Conference on Control, Automation and Diagnosis (ICCAD), Publisher: IEEE, Pages: 1-6Upper limb amputation often leads to compensatory movement patterns that increase the risk of overuse injuries in the shoulder and spine. This work highlights the urgent need for a refined model of compensatory strategies, particularly how prosthetic degree of freedom (DoF) restrictions influence movement distribution across the shoulder and spine. Such a model is crucial for informing the design and control of nextgeneration prostheses that minimize compensatory burden and improve user outcomes. A male participant with trans-radial amputation - who routinely uses a simple on/off myoelectric prosthesis was fitted with a custom socket and a prosthetic controlled by a 32-channel A-mode ultrasound interface, and performed the Clothespin Relocation Test. Motion capture and surface electromyography were used to assess shoulder and trunk compensation across three wrist configurations: restricted supination/pronation, flexion/extension, and a combined restriction. Limiting supination/pronation at the wrist resulted in greater shoulder range of motion and lumbar muscle activity, while flexion/extension restrictions led to increased thoracic spine involvement. The combined supination/pronation and flexion/extension at the wrist joint reduced the total compensation but shifted the load to the nondominant shoulder. These results highlight the adaptable nature of the musculoskeletal system and underscore the importance of optimizing wrist DoFs in prosthetic design. Findings also inform rehabilitation strategies by identifying high-risk compensatory zones, offering guidance to improve prosthetic function and reduce long-term musculoskeletal injury.
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Journal articleLogishetty K, Haggis P, Salih S, et al., 2025,
Femoral versus acetabular osteotomy for treating combined version deformities leading to femoroacetabular impingement: a case-control matched study
, Journal of Hip Preservation Surgery, Vol: 12, Pages: 164-168, ISSN: 2054-8397The aim of this study was to compare outcomes between anteverting proximal femoral osteotomy (APFO) and anteverting periacetabular osteotomy (APAO) for femoroacetabular impingement syndrome (FAIS) due to combined acetabular retroversion (ARV) and femoral retrotorsion (FRT). We also compared these outcomes with hip arthroscopy (HA) for FAIS without ARV or FRT. Twelve patients with ARV and FRT underwent either APAO (six) or APFO (six) at two centres. A control group of 24 patients underwent HA for FAIS without version abnormality. Outcome measures included various hip scores, time to radiological bony union, complications, and conversion to hip arthroplasty. At the 2-year follow-up, no AFPO or APAO hips required arthroplasty. Patient-reported outcome scores showed no significant difference between the APAO and APFO groups: Non-Arthritic Hips Scores (NAHS) (APAO: median 72, range 52–78; APFO: 76, 52–80, P = .76), International Hip Outcome Tool 12 (iHOT-12) (APAO: 64, 48–70 vs. APFO: 55, 46–72, P = .57), EuroQol 5 Dimension Visual Analogue Scale (APAO: 72, 57–78 vs. APFO: 75, 49–80 P = .78), and University of California Los Angeles Score (APAO: 7, 4–8 vs. APFO: 6, 4–9 P = .43). APAO patients achieved radiological union faster (10.2 weeks: 6.6–19.3 vs. 19.2 weeks: 12–23, P = .05). Aside from metalwork removal, one AFPO patient required revision intramedullary nail to induce union. Compared to AFPO or APAO, HA patients (NAHS: 86.7, 72.1–94.1; iHOT-12: 73.1, 63.2–88.1) had better outcome scores (P < .05). Both APFO and APAO can achieve good outcomes and short-term survivorship for combined ARV and FRT, although function may be inferior to HA in patients without rotational abnormalities.
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Journal articleAllott NEH, Oladipo FT, Cox KL, et al., 2025,
The methods of quantifying knee laxity in the ACL injured population: A review
, KNEE, Vol: 55, Pages: 85-103, ISSN: 0968-0160 -
Journal articleMusbahi O, Ahmed A, Hall T, et al., 2025,
Deep learning classification models demonstrate high accuracy and clinical potential in radiograph interpretation in the arthroplasty clinical pathway: a systematic review and meta-analysis
, Journal of Experimental Orthopaedics, ISSN: 2197-1153Artificial intelligence (AI) is set to transform medical imaging, streamlining, andimproving the delivery of care. Used to diagnose disease, plan surgery, and monitorpatients post-operatively, imaging is a cornerstone of the osteoarthritis-arthroplastyclinical pathway. To date, no systematic review has examined AI’s diagnostic andprognostic role in interpreting radiographs and cross-sectional imaging in thearthroplasty pathway. With growing interest from the orthopaedic community, thismeta-analysis broadly evaluates the performance of deep learning (DL) algorithms inthese imaging tasks. Ovid Medline, Ovid Embase, Scopus, and Web of Science weresystematically searched for studies published between January 1, 2012, and April 1,2024, evaluating DL algorithms for diagnostic and prognostic tasks along theosteoarthritis-arthroplasty pathway. Eligible studies included those that usedestablished diagnostic or surgical candidacy assessments as ground truth. Studyquality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2tool, and pooled sensitivity and specificity were determined. Hierarchical summaryreceiver operating characteristic curves assessed diagnostic performance. Of the2355 studies identified, 138 studies were included. Of these, 66 studies were used inthe meta-analysis for the results of AI-only interpretation and 11 studies for the resultsof human-only interpretation. The AI studies had a pooled sensitivity of 0.88 (95% CI:0.81 to 0.92) and a pooled specificity of 0.91 (95% CI: 0.87 to 0.94). In comparison, theclinician interpretation studies had a pooled sensitivity of 0.76 (95% CI: 0.64 to 0.85)and a pooled specificity of 0.79 (95% CI: 0.59 to 0.90). This meta-analysis highlightsthe potential of DL algorithms to improve efficiency in osteoarthritis classification andprognosis in the arthroplasty pathway based on low-to-moderate quality evidence.Although the results are not generalizable, the findings suggest DL models have th
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Journal articleAlagha MA, Cobb J, Liddle A, et al., 2025,
Adverse outcomes after cemented and cementless primary elective total hip arthroplasty in 60,064 matched patients: a study of data from the Swedish arthroplasty register
, The Journal of Arthroplasty, Vol: 40, Pages: 1738-1744.e2, ISSN: 0883-5403BackgroundThe choice between cemented and cementless fixation in primary elective total hip arthroplasty (THA) remains a subject of ongoing debate. However, comparisons between the two are subject to limited adjustments for patient characteristics, diagnoses, and surgical factors, as well as by limited outcome time endpoints. Our study aimed to compare the effect of femoral fixation on safety and implant survival outcomes in matched patients.MethodsUsing propensity score techniques, we matched patients undergoing cemented (n = 101,523) and cementless (n = 52,996) primary elective THA in the Swedish Arthroplasty Register based on age, sex, American Society of Anesthesiologists grade, body mass index, hospital type, and preoperative diagnosis between 2008 and 2018. We used both regression and survival models for 30, 60, and 90 days, as well as one and two years, to compare outcomes, including mortality, revision, and periprosthetic femoral fracture necessitating revision surgery. There were 30,032 cementless femoral fixations one-to-one matched with cemented ones using the Gradient Boosting Machine modeling to estimate the propensity score.ResultsRegression analyses showed that cementless fixation had lower mortality outcomes (odds ratio (OR) 0.73, 95% confidence interval (CI) 0.69 to 0.78, P < 0.001), but significantly worse revision (OR 1.51, 95% CI 1.38 to 1.65, P < 0.001) and periprosthetic femoral fracture (OR 2.40, 95% CI 1.92 to 2.99, P < 0.001). Kaplan–Meier survival models showed statistically significant lower mortality risks for uncemented fixation at the 2-year interval (hazard ratio 0.82, 95% CI 0.71 to 0.94, P = 0.006), but not at earlier endpoints. Revision and periprosthetic femoral fractures were both higher for cementless rather than cemented fixation.ConclusionsThis study found no significant differences in early mortality between cemented and cementless femoral implants. However, cementless fixation was associated with increased risk
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Journal articleHamawandi M, Zhou X, Mudway I, et al., 2025,
Traffic-derived metal bioaccumulation in bone tissue as a driver of osteoporosis
, Medical Hypotheses, Vol: 200, ISSN: 0306-9877Long-term air pollution exposures, particularly to fine particulate matter, have been linked to a wide range of health issues, including cardiovascular and respiratory diseases. Recent studies have expanded this scope to include skeletal disorders, such as osteoporosis and bone fragility. This is particularly concerning given the global burden of osteoporosis, which affects 500 million people worldwide and causes 13.5 million fractures annually. While traditional air pollution sources like exhaust emissions have been extensively studied, the role of non-exhaust sources, such as brake and tyre wear, remains largely unexplored. These non-exhaust sources are becoming a critical environmental concern, especially with the adoption of heavier electric vehicles. We hypothesize that lifetime accumulation of metals from non-exhaust traffic emissions contributes to the development of osteoporosis. This hypothesis is supported by several lines of evidence: epidemiological studies showing associations between air pollution exposures and increased fracture risk, particularly in populations living near busy roads; clinical studies demonstrating metal accumulation in the bone of individuals with osteoporosis and molecular studies showing the disruptive effects of metals on bone remodeling processes, including bone formation and resorption. To investigate this further, we propose a research approach combining in vitro, in vivo, ex vivo and computational modeling techniques. By studying the effects of metals on bone cells, analyzing the impact of metal exposure in animal models and simulating long-term exposure scenarios, we aim to elucidate the mechanisms underlying air pollution-induced bone damage. This research could inform urban planning policies, vehicle design and public health interventions protecting bone health.
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