Analysis of factors influencing patient satisfaction after total hip arthroplasty in a Japanese cohort: the significant effect of postoperative physical activity.

[Purpose] To determine patient satisfaction after total hip arthroplasty in a Japanese cohort and to identify factors that significantly influence patient satisfaction. [Participants and Methods] This study included 285 patients who underwent primary total hip arthroplasty for osteoarthritis. Postoperative satisfaction, Oxford hip score, short form-12 mental component summary score, and University of California Los Angeles activity score were investigated. Muscle strength and daily step counts were determined using a hand-held dynamometer (µ-Tas F1) and activity monitor (ActivPAL) in 89 and 26 patients, respectively. Factors associated with postoperative satisfaction, Oxford hip score-activities of daily living, and University of California Los Angeles activity score were identified. The relationship between the Oxford hip score-activities of daily living and daily step counts was examined. [Results] Overall, 94.7% of the patients reported satisfaction with total hip arthroplasty. The Oxford hip score-activities of daily living and University of California Los Angeles activity score were significantly associated with patient satisfaction. Younger age and hip abductor strength were significantly associated with a higher Oxford hip score-activities of daily living and University of California Los Angeles activity score. The average daily step count was significantly correlated with the Oxford hip score-activities of daily living. [Conclusion] Self-reported physical activity levels significantly influenced patient satisfaction and were correlated with objective muscle strength and daily step count measurements. These findings can guide total hip arthroplasty patient counseling on the importance of muscle strength and activity levels.

Foot and ankle functions and deformities focus on posterior tibial tendon dysfunction using magnetic resonance imaging in patients with rheumatoid arthritis.

OBJECTIVES: Posterior tibial tendon dysfunction (PTTD) affects the support of the medial longitudinal arch and stability of the hindfoot. The purpose of this study was to assess the relationships of PTTD with foot and ankle functions and foot deformities in patients with rheumatoid arthritis (RA). METHODS: A total of 129 patients (258 feet) who underwent magnetic plain and contrast-enhanced magnetic resonance imaging were enrolled in this study. Positive magnetic resonance imaging findings were defined as tenosynovitis and incomplete and complete rupture of the posterior tibial tendon. Foot and ankle functions were assessed using the Japanese Society for Surgery of the Foot standard rating system for the RA foot and ankle scale (JSSF-RA) and self-administered foot evaluation questionnaire. Plain radiographs were examined for the hallux valgus angle, first metatarsal and second metatarsal angle, lateral talo-first metatarsal angle, and calcaneal pitch angle. RESULTS: PTTD was associated with motion in the JSSF-RA (p = .024), activities of daily living in JSSF-RA (p = .017), and pain and pain-related factors in the self-administered foot evaluation questionnaire (p = .001). The calcaneal pitch angle was significantly lower in the feet with PTTD than in those without PTTD (median: 16.2° vs. 18.0°; p = .007). CONCLUSIONS: The present study shows that PTTD was associated with foot and ankle functions and flatfoot deformity. Thus, a better understanding of PTTD in patients with RA is important for the management of foot and ankle disorders in clinical practice.

How does the postoperative medial arch height influence the patient reported outcomes of stage â ¡ acquired adult flatfoot deformity?

BACKGROUND: This study aimed to assess how the postoperative medial arch height influenced postoperative patient-reported clinical outcomes after surgery for stage Ⅱ acquired adult flatfoot deformity. METHODS: A total of 30 feet of 30 patients (7 males, 23 females) who underwent surgery for stage Ⅱ acquired adult flatfoot deformity and could be followed up for at least 2 years were included. The average age at surgery was 60.0 (standard deviation, 13.0) years, and the average follow-up period was 40 (standard deviation, 15.4) months. Among them, 16 patients underwent lateral column lengthening and 14 patients did not. Patient-reported clinical outcomes were evaluated using the Self-Administered Foot Evaluation Questionnaire. Radiographic alignment was evaluated by the talonavicular coverage angle, lateral talo-1st metatarsal angle, medial cuneiform height, medial cuneiform to 5th metatarsal height, and calcaneal pitch. The correlation between postoperative Self-Administered Foot Evaluation Questionnaire and radiographic alignment was assessed with Pearson's correlation analysis. RESULTS: Self-Administered Foot Evaluation Questionnaire and radiographic alignment significantly improved postoperatively in all patients (P < 0.0001). In patients with severe deformity who needed lateral column lengthening, lateral talo-1st metatarsal angle was negatively and medial cuneiform to 5th metatarsal height was positively correlated with physical functioning Self-Administered Foot Evaluation Questionnaire subscales (r = -0.56 and 0.55), and medial cuneiform height was positively correlated with physical functioning, social functioning and general health Self-Administered Foot Evaluation Questionnaire subscales (r = 0.70, 0.55 and 0.73, respectively). CONCLUSION: Postoperative medial arch height could influence physical functioning, social functioning, and general health in patients with severe stage II adult-acquired flatfoot deformity.

Three-year results of denosumab treatment for osteoporosis in women with rheumatoid arthritis and primary osteoporosis: A clinical observational study.

INTRODUCTION: This study investigated the results of 3 years of denosumab treatment for osteoporosis in women with rheumatoid arthritis (RA) and primary osteoporosis (PO). MATERIALS AND METHODS: This study enrolled 112 women with RA (RA group) and 104 women with a PO group who received 60 mg denosumab for 3 years. Bone mineral densitiy (BMD) of the lumbar spine, total hip and femoral neck as well as levels of bone turnover markers [N-terminal propeptide of type I procollagen (P1NP) and tartrate-resistant acid phosphatase-5b (TRACP-5b)] were measured at years 1, 2, and 3. RESULTS: The percent changes (Δ) in BMD values at years 1, 2, and 3 were as follows: RA group: 6.7 ± 6.2%, 8.9 ± 6.5%, and 9.8 ± 8.2% and PO group: 6.0 ± 4.8%, 8.9 ± 7.5%, and 12.6 ± 8.7% for the lumbar spine; RA group: 4.5 ± 4.6%, 5.2 ± 5.1%, and 6.8 ± 5.9% and PO group: 3.8 ± 4.5%, 4.6 ± 7.4%, and 6.8 ± 4.6% for the total hip; and RA group: 2.7 ± 5.1%, 4.1 ± 6.8%, and 4.3 ± 6.7% and PO group: 3.6 ± 8.0%, 4.5 ± 10.9%, and 5.7 ± 10.5% for the femoral neck, respectively. The ΔBMD for the lumbar spine, total hip, and femoral neck as well as ΔP1NP and ΔTRACP-5b did not differ significantly between the two groups at any time points. CONCLUSION: Denosumab treatment for osteoporosis had a similar efficacy over 3 years among women with RA and PO. A better understanding of denosumab treatment for this patient population is important in clinical practice.

Association between low back pain and quality of life in patients with rheumatoid arthritis according to patient-reported outcomes using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ): A cross-sectional study.

OBJECTIVES: To evaluate factors associated with low back pain (LBP) and effect on quality of life (QOL) using patient-reported outcome in patients with rheumatoid arthritis (RA). METHODS: Overall, 414 patients with RA who answered the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were included in this study. LBP-positive was defined a visual analog scale (VAS) of LBP (LBP VAS) of ≥ 30 mm. RESULTS: The rate of LBP-positive group was 24.9%. Body mass index (BMI) (odds ratio [OR]: 1.116), tender joint count (TJC) (OR: 1.598), global VAS (OR: 1.016), and Health Assessment Questionnaire Disability Index (HAQ-DI) (OR: 2.392) were found as significant LBP-associated factors. When adjusted for sex and van der Heijde-modified total Sharp score, BMI (OR: 1.120), TJC (OR: 1.619), global VAS (OR: 1.016), pain VAS (OR: 1.015), and HAQ-DI (OR: 2.312) were found to be the significant factors associated with LBP. Moreover, LBP VAS had relatively high correlations in all domains of the JOABPEQ scores (correlation coefficient: LBP, -0.601; lumbar function, -0.624; walking ability, -0.548; social life function, -0.479; and mental health, -0.463). CONCLUSIONS: This study investigated the effect of LBP in patients with RA. The results of this study indicate that LBP is associated with the physical function and QOL in patients with RA. We believe that our results will be useful for physical function and QOL assessments in patients with RA with LBP.

Spinal sagittal balance associated with age, vertebral fracture, and functional disability in patients with rheumatoid arthritis: A cross-sectional study.

Objectives: The purpose of this study was to assess the relationships between spinal sagittal balance and functional ability of Japanese patients with rheumatoid arthritis.Methods: A total of 491 patients with rheumatoid arthritis who underwent the measurement of sagittal vertical axis for the assessment of spinal sagittal balance were enrolled. Factors associated with sagittal vertical axis were analyzed by categorizing patients according to sagittal vertical axis (<4 cm, 4-9.5 cm, and >9.5 cm). In addition, univariate and multivariate regression analysis were performed to identify factors associated with Health Assessment Questionnaire Disability Index (HAQ-DI) in different age groups.Results: The percentage of patients with sagittal vertical axis <4 cm, 4-9.5 cm, and >9.5 cm was 61.1%, 32.4%, and 6.5%, respectively. Age, vertebral fracture, and gait speed were associated with sagittal vertical axis. Sagittal vertical axis was associated with HAQ-DI in the 80-90 years age group.Conclusion: Sagittal balance was associated with age, vertebral fracture, and gait speed. In super-aged patients with rheumatoid arthritis, HAQ-DI was affected by sagittal balance. Management of super-aged patients with rheumatoid arthritis should include evaluation of joints as well as spinal alignment.

Compensatory Function of the Subtalar Joint for Lower Extremity Malalignment.

It is important to evaluate the subtalar joint and hip-knee-ankle alignment to understand lower extremity alignment. In this review, we focused on the compensatory changes in the subtalar joint alignment for the deformity of the knee and ankle joint, reviewing previous research. The subtalar joint alignment was compensatory valgus in patients with varus knee and ankle deformity, whereas it was uncertain whether the subtalar joint alignment was compensatory varus in patients with valgus knee and ankle deformity. The subtalar joint valgus alignment improved after total knee arthroplasty or high tibial osteotomy for varus knee deformity, even if the deformity was severe. In contrast, whether the subtalar joint alignment changed after the surgery for ankle or valgus knee deformity has not been considered. Further research on the compensatory function of the subtalar joint is needed.

A novel convenient method for high bacteriophage titer assay.

The recent various applications of phages (bacteriophages) including phage therapy have brought about a revival of phage investigation. The phage titer assay is indispensable for phage experiments. However, the conventional standard method is a plaque counting method which requires a little skill with tedious repeating operation. Furthermore, it is not directly applicable to high phage titers. In this paper, we describe a novel convenient "cross streak and paper disk assay method" for high titer concentration without plaque counting.