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Article History

Received: 29 April 2025

Accepted: 5 August 2025

First Online: 21 October 2025

Declarations

:

: Ethical approval has been granted by the North West – Greater Manchester Central Research Ethics Committee on 7th March 2023 (REC reference: 23/NW/0004). Patients are required to provide informed consent prior to participation.

: Not applicable—no identifying images or other personal or clinical details of participants are presented here or will be presented in reports of the trial results. Informed consent materials are attached as supplementary materials.

: The authors declare the following competing interests:CH is a member of the NIHR HTA Commissioning Committee (2015–2022) and Deputy Chair (2019–2022), NIHR Senior Investigator, member of the NIHR HTA General Committee (2023 to present) and Chair (2023–present), member of the NIHR CTU SAC (2020–2022), Co-Director NIHR RSS (2023–present), and member of the HTA Commissioning Sub-Board, HTA Post-Funding Committee teleconference, HTA Funding Committee Policy Group (formerly CSG), and HTA - Fast-Track Funding Committee.AR is a Trustee and Executive Member of the British Orthopaedic Association. His department has received educational and research grants from DePuy J&J Ltd, Stryker Ltd, and Smith & Nephew Ltd that are unrelated to this work.JW, NIHR Academic Clinical Lecturer, is funded by the NIHR.All other authors declare that they have no competing interests.