Royal Orthopaedic Hospital

Background: Limb-salvage surgery using extendable distal femoral endoprostheses has become the standard reconstruction following tumor resection in skeletally immature patients, allowing continued growth and improved function. However, mechanical complications, particularly tibial pain, remain challenging and poorly understood. This study aimed to identify radiographic predictors of tibial pain and evaluate their potential utility in early risk detection. Methods: A retrospective cohort study was conducted of 29 skeletally immature patients (mean age 10.4 years) who underwent expandable distal femoral endoprosthetic replacement between 2008 and 2018 at a tertiary orthopedic oncology center. Standardized radiographs were analyzed at 6 months and final follow-up (mean 75 months) to assess cortical thickness, stem-to-cortex distances, stem migration, stress shielding, pedestal formation, and periosteal reaction. Associations between radiographic parameters and tibial pain were assessed using multivariable logistic regression, t-tests, and chi-square analyses. Results: Seventeen patients (58.6%) developed activity-limiting tibial pain requiring analgesics, as documented during follow-up. Mean medial and lateral cortical thickness increased from 3.0 mm and 3.4 mm to 4.1 mm and 5.1 mm, respectively. The logistic regression model demonstrated strong explanatory power (Pseudo R2 = 0.57, p = 0.004). Medial cortical thickness at last follow-up was the only significant independent predictor of tibial pain (p = 0.042), and was significantly associated with tibial pain. Patients with tibial pain exhibited greater medial cortical thickening (p < 0.001). Stem migration (φ = 0.421, p = 0.065), stress shielding (φ = 0.476, p = 0.044), pedestal formation (φ = 0.608, p = 0.004), and periosteal reaction (φ = 0.569, p = 0.008) were also associated with pain. Conclusions: Medial cortical hypertrophy emerged as a potential radiographic biomarker for tibial pain. after expandable distal femoral endoprosthesis in growing patients. The findings suggest that cortical remodeling, stress shielding, and pedestal formation collectively reflect stem micromotion and bone adaptation. Early radiographic surveillance of these parameters warrants further investigation in prospective studies to determine their clinical utility. Larger multicenter studies are warranted to validate these predictors and refine postoperative monitoring protocols.

Ultrasound (US)-guided interventions are a core skill for radiologists and trainees; however, access to affordable, durable, and realistic training models remains limited. Animal tissue phantoms such as chicken breast are messy, perishable, and culturally unacceptable to many learners. Commercial phantoms are expensive and often inaccessible in low-resource regions. We describe the ADIP–Agar (Abu Dhabi Intervention Practice Agar) phantom—a low-cost, reproducible, vegetarian-friendly model prepared from agar–agar. As the agar–agar model was developed, refined, and repeatedly tested over several years in Abu Dhabi, we designated it the ADIP–Agar. Over 6 years of hands-on interventional US workshops in Abu Dhabi, trainees consistently expressed overwhelmingly positive feedback, with 97% preferring agar-based phantoms over chicken breast models. ADIP–Agar enables layered construction, stable embedded targets, realistic echotexture, and excellent durability when refrigerated. Its simplicity, reusability, and trainee endorsement make it a practical training tool for basic and intermediate US-guided procedures.

This study presents a comprehensive bibliometric analysis of Indian research on the application of generative artificial intelligence (GAI) in healthcare imaging from 2017 to 2025. It aims to evaluate the research output, citation impact, collaborative patterns, and key thematic areas to understand India's position in this rapidly evolving global landscape. We used a comprehensive search strategy on the Scopus database, limited to publications with an Indian affiliation from 2017 to 2025. Data on author names, affiliations, publication years, keywords, and citations were extracted from 383 records. The analysis employed citation analysis, co-authorship networks, and keyword co-occurrence analysis, with VOSviewer software used for data visualization. Globally, 2,761 papers were published in this field, with an average growth rate of 133.2%. India ranked third globally in publication volume with 383 papers, but its average citations per paper (CPP) were 6.55, much below the global average of 21.71. Conference papers dominated India's output (58.49%) but had a low CPP of 2.92, in contrast to higher-impact journal articles (11.29 CPP). Key institutions such as SRM Institute of Science and Technology were highly productive, while others, such as the GLA University, demonstrated high citation impact. The most prevalent keywords were "generative adversarial networks" and "medical imaging," highlighting a strong focus on technical applications. Indian research in GAI in healthcare imaging is marked by a significant increase in output, establishing the country as a major contributor. Although India ranks third globally in research output, its citation impact remains below the global average, reflecting the need to improve research quality, visibility, and international collaboration.

Objectives: The use of chemical shift imaging (CSI) for characterizing localized and diffuse bone marrow lesions is well established. However, the CSI characteristics of soft-tissue musculoskeletal tumors have not yet been established. The aim of this study is to describe the CSI features of soft-tissue tumors and establish their potential clinical usefulness. Material and Methods: Magnetic resonance imaging with CSI of eighty histopathologically proven musculoskeletal soft tissue tumors was retrospectively assessed. In-phase and out-of-phase signal intensity was measured to calculate the percentage reduction in signal (drop-out). Signal drop-out was correlated with histopathological diagnosis. Results: Based on the histopathological diagnosis, 80 patients in our study were grouped in 5 cohorts comprising lipomatous, lipomatous variant, neural, myxoid, and other soft tissue tumors. The mean signal drop was highest in the lipoma variant cohort (−27.4 ± 18.5%), followed by the lipoma cohort (−12.4 ± 5.9%), the neural tumors cohort (−2.7 ± 5.2%), the myxoid tumors cohort (−1.9 ± 5.2%), and the other soft tissue tumor cohort (0.8±18.3%). The difference was statistically significant ( P < 0.001). Signal dropout demonstrated good ability to identify lipoma variants with an area-under-the curve of 0.85 (95% confidence interval [CI] = 0.69–0.99). There was excellent intra-observer reliability (intra-class co-efficient [ICC] = 0.996, 95% C.I. 0.990–0.998) and inter-observer reliability (ICC 0.990, 95% C.I. 0.971–0.996). Conclusion: Lipoma variants demonstrate increased signal dropout compared to other soft-tissue tumors; CSI shows promise in augmenting the diagnostic pathway in the evaluation of soft tissue tumors.

Background and objectiveElectric scooters (e-scooters) have been adopted as a popular mode of transport, both in the UK and internationally, as part of a growing movement for greener forms of transport. Despite its environmental advantages, e-scooter use has been associated with rising trauma presentations to healthcare systems worldwide. This study aimed to evaluate the burden of e-scooter-related injuries presenting to a single trauma and orthopaedic (T&O) centre before and after the introduction of the Birmingham e-scooter rental scheme.MethodsA retrospective observational study was conducted to identify all e-scooter-related trauma presentations referred to the on-call T&O department at an inner-city hospital in Birmingham between 2018 and 2022. Data collected included patient demographics, injury patterns, surgical intervention rates, and length of hospital stay. Injuries were classified into long-bone fractures, other fractures, soft tissue injuries, spinal injuries, and head injuries. The study included both e-scooter riders and pedestrians.ResultsA total of 74 patients were included in the study, with a median age of 21 years (range: 2-86), and 73% (n = 54) were male. Limb fractures accounted for 73% (n = 54) of injuries, including 50% (n = 27) long-bone fractures and 11% (n = 6) open fractures. Soft tissue injuries comprised 19% (n = 14) of total injuries, head injuries 7% (n = 5), and spinal injuries 1% (n = 1). Of note, 70% of all patients required surgery for their injuries, with a mean inpatient stay of 3.4 days, and four patients were identified as pedestrians. The majority of the e-scooter-related trauma (87.8%) occurred after the introduction of the rental scheme in October 2020.ConclusionsThe introduction of the Birmingham rental e-scooter scheme has been associated with a marked increase in orthopaedic trauma, with a significant proportion requiring operative management. This highlights the significant burden of e-scooter-related trauma on orthopaedic services and emphasises the need for enhanced safety measures and evaluation of the impact of such schemes on healthcare services.

AimsFollowing resection of a primary bone tumour, reconstruction is commonly performed using either a megaprosthesis or biological reconstruction. Periprosthetic joint infection (PJI) remains one of the most frequent complications. Various treatment strategies exist for PJI, including debridement, antibiotics, and implant retention (DAIR), and single- and two-stage revision, although consensus on optimal management remains elusive. This study aimed to investigate the global practices regarding DAIR in tumour cases through an electronic survey among orthopaedic oncology surgeons.MethodsA global cross-sectional observational survey study was distributed to 272 orthopaedic oncology surgeons who attended the BOOM Consensus Meeting in January 2024. The survey contained 19 multiple choice questions focusing on DAIR practices. Responses were collected anonymously and analyzed using descriptive statistics.ResultsThe survey was completed by 173/272 surgeons (64%) from 44 countries. While 62% (169/272) routinely performed radical soft-tissue debridement in DAIR, only 39% exchanged all modular components, indicating variability in surgical approaches. DAIR was more commonly performed in acute rather than chronic infections, with 55% finding it very useful in acute cases. The use of local antibiotic delivery was supported by 56%, although only 49% found antibiotic cement coatings beneficial. Systemic antibiotic duration post-DAIR varied, with 39% favouring six weeks and 35% preferring three months.ConclusionThe study highlights global inconsistencies in DAIR practices for PJI in orthopaedic oncology, with financial disparities impacting modular component exchange. Standardized definitions are lacking, and we propose that if only polyethylene is changed, then the procedure is referred to as ‘poly exchange’; we recommend defining the procedure as DAIR when extensive debridement, lavage, and removal, wash, and reimplanting of all modular components is done while retaining stable stems, followed by suppressive antibiotic therapy; and finally, we recommend that if all the modular components are changed for new ones, the procedure is referred to as ‘DAIR plus’.Cite this article: Bone Jt Open 2025;6(11):1495–1503.

Homozygous KY variants have been described to cause congenital myopathy, myofibrillar myopathy type 7, and hereditary spastic paraplegia. We report the findings in two families harboring the homozygous missense NM_178554.4:c.727T > C p.(Cys243Arg) and splice site NM_178554.4:c.710 + 1G > A KY variants leading to early-onset myopathy with equinovarus deformity, lateral tongue atrophy, kyphoscoliosis, and contractures. Myopathological examination showed a myopathic pattern in conjunction with fibers containing eosinophilic sarcoplasmic inclusions positive for kyphoscoliosis peptidase and filamin-C but not desmin, myofibrillar degeneration, and focal mitochondrial loss. Kyphoscoliosis peptidase protein expression levels were markedly reduced, and in silico analysis of the predicted protein variants suggested impairment of the kyphoscoliosis peptidase catalytic triad.