Stiffness Changes in Shoulder Muscles between Pitchers and Position Players after Throwing Overhead Using Shear Wave Elastography and Throwing Motion Analysis.

Objectives: The objective is to compare stiffness changes around the shoulder muscles between pitchers and position players after throwing overhead using shear wave elastography (SWE) in relation to throwing motion analysis and muscle strength. Methods: A total of 32 male college baseball players (12 pitchers and 20 position players) were observed throwing 20 times, and SWE was performed to evaluate 13 shoulder muscle items-tendons (supraspinatus, infraspinatus, subscapularis, and teres minor), muscles (supraspinatus, infraspinatus [transverse and oblique part], teres minor, lower trapezius, latissimus dorsi, and pectoralis minor), and capsules (posterior and posteroinferior). Motion analysis was used to assess elbow torque, forearm angle, forearm rotation speed, and maximum external rotation angle of the shoulder. Muscle strength was measured using a dynamometer for abduction, internal/external rotation of the shoulder at an abduction of 0°, internal/external rotation of the shoulder at an abduction of 90°, and internal/external rotation of shoulder at a flexion of 90°. Results: In the pitcher group, SWE values for the teres minor muscle and latissimus dorsi muscle increased significantly after throwing. In the position player group, SWE values for the teres minor muscle significantly increased, and SWE values of the pectoralis minor muscle decreased after throwing. In the pitcher group, positive correlations were found between the teres minor muscle and forearm rotation speed and between the latissimus dorsi muscle and forearm angle. No significant difference was found in muscle strength after throwing in any of the groups. Conclusions: Stiffness changes occurred after throwing and were related to the motion analysis, but the regions in which stiffness occurred varied between pitchers and position players.

Effect of limited range of motion of the hip joint and leg-length discrepancy on gait trajectory: an experiment to reproduce the asymmetric gait that occurs in patients with osteoarthritis of the hip joint.

PURPOSE: Although some symptoms that often occur with hip joint osteoarthritis (OA) may be involved in the appearance of gait disturbance, the main cause has not been identified. We hypothesised that the abnormalities in gait trajectory of patients with hip joint OA are mainly caused by limited range of motion of the hip joint or the presence of leg-length discrepancy, or both. To investigate this hypothesis, we examined whether the abnormal gait trajectory in patients with hip joint OA can be reproduced in healthy individuals by asking them to wear a hip orthosis and shoe orthotic (insole). METHODS: We recruited 2 groups of participants: patients with hip joint OA (OA group, 38 patients) and healthy individuals who imitated patients with OA of the hip joint by wearing a hip orthosis or shoe orthotic (10-mm or 20-mm insole) or both (simulated OA group, 6 individuals). For gait analysis, we used a portable, wearable gait analyser with inertial sensors to evaluate 3-dimensional (3D) changes in gait trajectory. RESULTS: In the OA group, the patterns of gait trajectories that were drawn on the 3 planes (coronal, sagittal, and horizontal planes) could be roughly divided into 3 types. The gait trajectories that were drawn when wearing a hip orthosis in the simulated OA group were very similar to 1 of the 3 patterns of gait trajectory that occurs in the OA group. CONCLUSIONS: We were able to reproduce the abnormal gait trajectory that is observed in ⅓ of patients with hip OA in healthy individuals, so we propose that an extreme reduction in hip joint ROM is 1 of the causes of abnormal gait pattern in patients with OA of the hip joint. A difference in leg length of 20 mm alone has little effect on gait trajectory.

Comparison of anemia, renal function, and nutritional status in older women with femoral neck fracture and older women with osteoarthritis of the hip joint.

BACKGROUND: Several studies in older patients with femoral neck fracture found that preoperative anemia and malnutrition were associated with higher mortality and poorer physical function. Therefore, we compared nutritional status, Hb level, and renal function in women with femoral neck fracture and women of the same age with osteoarthritis of the hip joint. METHODS: We enrolled 257 women aged 70 years and older who suffered femoral neck fracture (F group) or who were scheduled to undergo total hip arthroplasty for osteoarthritis of the hip joint (OA group). The F and OA groups were further divided into 2 groups on the basis of age, ie, 74 years old and younger (F70 and OA70) and 75 years old and older (F75 and OA75). To assess whether patients had undernutrition, mortality risk, anemia, and renal dysfunction, we assessed Geriatric Nutritional Risk Index (GNRI), Hb, and eGFR. RESULTS: We found a significant difference in the mean Hb levels and GNRI scores between the F75 and OA75 and F70 and OA70. Moreover, we found a moderate correlation between Hb level and GNRI score in the F75 and OA75. With respect to the GNRI category, the percentage of patients at moderate or major risk was 42.1% in the F70 group and 57.6% in the F75 group but only 1.9% in the OA70 group and 4.3% in the OA75 group. CONCLUSION: We found that women with femoral neck fracture had significantly lower Hb levels and lower GNRI scores than women with hip OA in the same age and that anemia and undernutrition were closely linked in women aged 75 and above. Moreover, we found that more than 40% of patients with a femoral neck fracture had a moderate to major risk on the basis of their GNRI scores.

Effects of social isolation associated with the COVID-19 pandemic on hip muscle strength, hip joint pain, and walking ability in patients with osteoarthritis of the hip joint.

To reduce the spread of the Sars-CoV-2 virus, governments in many countries adopted a social isolation strategy. However, social isolation may adversely affect people's health, e.g., by decreasing the muscle function of lower limbs. We recruited 118 patients who had undergone total hip arthroplasty (THA) and 87 patients with moderate to severe hip joint osteoarthritis (OA) and measured hip muscle strength, hip joint pain, and walking ability from before to one year after the start of the COVID-19 pandemic. During the pandemic, hip flexion (straight leg raise, SLR) strength decreased in 13.1% of patients in the post-THA group and 25.6% in the severe-OA group; in the severe-OA group, the decrease in SLR strength was mainly in patients aged 65 years and older. In addition, pain increased to mild or moderate and walkable distance decreased in more patients in the severe-OA group.

Changes in serum creatine kinase and C-reactive protein after posterior and direct anterior approaches in total hip arthroplasty.

PURPOSE: Some studies reported that measuring serum creatine kinase (CK) level is an objective method with which to determine the relative invasiveness of surgery. The purpose of this study was to evaluate the change in postoperative serum CK levels as a measure of whether the direct anterior approach (DAA) is less invasive than the posterior approach (PA) regarding postoperative rehabilitation. MATERIALS AND METHODS: We prospectively recruited 71 women who were undergoing total hip arthroplasty, 47 were treated by the PA and 24 by the DAA. Serum CK and C-reactive protein (CRP) levels were measured preoperatively and 3 hours and 1, 4, 7, 10, and 14 days after the operation. RESULTS: The serum CK levels were significantly higher in the DAA group than in the PA group on postoperative days 1, 4, 7, 10, and 14. On postoperative day 4 and 7, the percentage of patients whose serum CK levels were above the normal range was 46.8% and 8.5% in the PA group and 95.2% and 45.5% in the DAA group. CONCLUSIONS: CK levels were significantly higher in the 2 weeks after THA by a DAA than after the same procedure by a PA indicating that DAA causes prolonged muscle damage. Although the DAA is considered to be a muscle-sparing approach this may not be the case and DAA may not actually be a minimally-invasive approach.

Association of ABO blood group with postoperative total bleeding volume in patients undergoing total hip arthroplasty.

BACKGROUND AND OBJECTIVES: As individuals with blood types A, B and AB have approximately 25% higher levels of vWF than those with type O, the risk of developing venous thrombotic events has been investigated in a number of clinical studies, but whether individuals with type O blood experience increased bleeding remains to be clarified. The purpose of this study was to evaluate an association of ABO blood group with intraoperative bleeding and postoperative total bleeding in patients undergoing total hip arthroplasty. MATERIALS AND METHODS: We prospectively recruited 84 women who were undergoing total hip arthroplasty. The differences between blood groups in mean age, body weight, preoperative and postoperative Hct levels, and postoperative/preoperative Hct ratio, intraoperative bleeding volume (IBV), and total bleeding volume (TBV) were evaluated. RESULTS: Twenty-six patients had type A blood, 17 had type B, 9 had type AB, and 30 had type O. There were no significant differences in mean age, body weight or operating time between the different ABO blood groups. While there was no significant difference in these Hct levels or IBV among the different blood groups, there was a significant difference in TBV between type O and type AB, and between type O and non-type O. CONCLUSION: Our study in patients undergoing total hip arthroplasty suggests that patients in blood group O tend to have large amounts of bleeding.

Effect of femoral offset and limb length discrepancy on hip joint muscle strength and gait trajectory after total hip arthroplasty.

BACKGROUD: Femoral offset (FO) and limb length discrepancy (LLD) are important perioperative considerations when performing THA. Decreased FO prevents improvement of gait and muscle recovery and residual LLD has a prominent influence on patient satisfaction with THA, while few studies have investigated the relationship between FO and/or LLD and gait disturbances. We investigated the association between these two factors and hip muscle strength and the results of 3-D gait analysis after THA. METHODS: We evaluated 92 patients (including 20 patients who underwent gait analysis) in whom total hip arthroplasty was performed for unilateral evere osteoarthritis of the hip joint. FO and LLD were measured on a standard anteroposterior radiograph of the pelvis. Hip muscle strength was evaluated by isometric hip flexion (in the manner of straight leg raising test: SLR) and hip abduction strength. To evaluate 3-D walking trajectory, we used a portable gait analyzer. RESULTS: Reduction of global FO by > 5 mm after THA compared to the contralateral hip was associated with hip abductor muscle weakness. On the other hand, LLD ≤ 20 mm had no influence on hip abductor muscle strength and SLR strength. In gait analysis, SLR strength showed a significant difference between the sagittal plane symmetrical and asymmetrical groups. CONCLUSION: Postoperative global FO > 5 mm less than that of the contralateral hip was associated with hip abductor muscle weakness. And, from the results of 3-D gait analysis, SLR weakness may increase gait asymmetry in the sagittal plane.

Influence of surgical approach on final outcome in total hip arthroplasty for osteoarthritis in patients older than 80 years.

PURPOSE: We compared the outcome of total hip arthroplasty (THA) in this age group using direct anterior or posterior approach. METHODS: We performed a retrospective analysis following consecutive primary THA in patients over 80 years. RESULTS: The DAA group demonstrated significantly shorter length of stay, better functional improvement, no dislocation or revision while PA group required two revisions due to dislocation. CONCLUSIONS: The use of DAA for THA in the elderly was associated with shorter hospitalization and superior functional outcomes in the early post-operative period, and had a lower rate of dislocation without increasing risk of early revision.

Influence of hip joint dysfunction on motor disorders in Japanese patients with osteoarthritis of the hip: Assessment of the JHEQ and GLFS-25 scores and hip muscle strength.

BACKGROUND: Motor disorders are caused by orthopedic problems that are mainly related to aging. These disorders can lead to a decline of physical activity and impairment of ADL. When evaluating a patient's motor function after treatment, it is necessary to determine whether or not the level of function is age-appropriate. To investigate the influence of hip joint dysfunction on motor disorders, we determined the JHEQ and GLFS-25 scores and performed muscle strength testing in female patients with hip osteoarthritis. METHODS: The subjects were 108 women who had received THA, 56 women scheduled for THA, and 64 women on conservative treatment. The JHEQ score (evaluation scale for hip joint function) and GLFS-25 score (evaluation scale for ADL) were determined and muscle strength testing was conducted at a routine outpatient visit. RESULTS: A strong correlation was found between the total JHEQ score and the GLFS-25 score (r = - 0.837). Patients after THA and patients with successful conservative treatment aged 60-79 years showed similar motor function to healthy persons of the same age. There was a significant difference of straight leg raising and abduction strength (both p < 0.01) between patients in GLFS-25 levels 1-3 and patients in GLFS-25 levels 4-7. CONCLUSION: While hip joint dysfunction has a strong influence on overall motor function, the patients after THA and patients with successful conservative treatment showed similar motor function to healthy persons of the same age. And patients with hip osteoarthritis must preserve or increase SLR strength to maintain adequate motor function.

Postoperative hemoglobin and recovery of hip muscle strength after total hip arthroplasty.

BACKGROUND: The presence/absence of postoperative anemia are presumed to have an impact on early recovery after surgery. This study was performed to compare hip muscle strength and hemoglobin during the perioperative period in 82 patients undergoing THA. METHODS: Evaluation of presence/absence of anemia was performed by calculating the 10-day postoperative/preoperative Hb ratio. Muscle strength was investigated before and 2 months after surgery. RESULTS: Postoperative SLR strength showed a significant difference between the patients whose 10-day postoperative/preoperative Hb ratio was <85% and ≧ 85%. CONCLUSION: We need to consider perioperative strategies to minimize anemia in order to improve patient outcomes.

Early clinical evaluation of total hip arthroplasty by three-dimensional gait analysis and muscle strength testing.

BACKGROUND: As improvement of gait is an important reason for patients to undergo total hip arthroplasty (THA) and they generally tend to evaluate its success based on postoperative walking ability, objective functional evaluation of postoperative gait is important. However, the patient's normal gait before osteoarthritis is unknown and the changes that will occur postoperatively are unclear. We investigated the change in gait and hip joint muscle strength after THA by using a portable gait rhythmograph (PGR) and muscle strength measuring device. PATIENT AND METHODS: The subjects were 46 women (mean age: 65.9 years) with osteoarthritis of the hip. Gait analysis and muscle strength testing were performed before THA, as well as 3 weeks and 3 months after surgery. We measured the walking speed, step length, and gait trajectory using PGR prospectively. PGR is attached to the patient's waist and records signals at a sampling rate of 100 Hz. Isometric torque of hip flexion and abduction were measured by using a hand-held dynamometer. RESULTS: There was no improvement at 3 weeks postoperatively, but the walking speed, stride length and muscle strength were clearly showed improvement at 3 months postoperatively. The walking trajectory was not normal preoperatively, since the trajectory was not symmetrical and did not intersect in the midline or form a butterfly pattern, and abnormality of the trajectory tended to persist postoperative 3 months despite resolution of hip joint pain after surgery. CONCLUSION: Since postoperative improvement of gait is an important consideration for patients undergoing THA, it seems relevant to evaluate changes in the gait after surgery and three-dimensional analysis with a PGR may be useful for this purpose.

Safely transitioning to the direct anterior from posterior approach for total hip arthroplasty.

PURPOSE: We compare the complication rate in transition to direct anterior (DAA) from posterior approach (PA) for total hip arthroplasty (THA). METHODS: This is a retrospective cohort single-surgeon study of consecutive primary THAs over a transition period from PA to DAA. RESULTS: There were no significant differences in dislocation rate, femoral fracture, lateral femoral cutaneous nerve injury or success rate in cup inclination and anteversion angle between two groups. CONCLUSION: We conclude that this single-surgeon study demonstrates the safely transitioning to DAA from PA in THA with no significant increase in complications in a selected patients.

Changes in serum chromium levels over 12 years after Metasul metal-on-metal total hip arthroplasty.

We reported the longitudinal changes in serum chromium levels over a minimum of 7 years postoperatively in five men and 25 women with a mean age of 60.3 years after primary unilateral total hip arthroplasty with a Metasul metal-on-metal articulation. The serum chromium ion level showed little variation (0.6-1.2 µg/L) from 2 to 12 years postoperatively in 16/30 patients after unilateral primary Metasul metal-on-metal total hip arthroplasty. On the other hand, the serum chromium level stayed high or showed gradual elevation in 8/30 patients, even though they had well-fixed and well-functioning prostheses.

Early clinical results of total hip arthroplasty assessed with the 25-question Geriatric Locomotive Function Scale and muscle strength testing.

BACKGROUND: We think that it is necessary to evaluate whether the patient after total hip arthroplasty has achieved age-appropriate locomotor ability by improvement in hip joint function. The 25-question Geriatric Locomotive Function Scale (GLFS-25) have been determined age-specific standard values for the general population. The aim of this study was to compare postoperative hip muscle strength and functional performance at 3 months after THA with preoperative levels, and to compare the outcomes at 3 months after THA with the function of age-matched adults without hip disease. METHODS: The GLFS-25 scores and muscle strength were investigated before THA and 3 months after surgery in 12 men and 75 women who underwent total hip arthroplasty. RESULTS: The mean preoperative and postoperative GLFS-25 score was 55.4 and 19.1, respectively. With regard to the influence of age, the mean scores before and after THA were respectively 52.0 versus 18.2 for patients aged 60-69 years and 61.2 versus 17.3 for those aged 70-79 years in the normal/mild OA group. When female patients from the normal/mild OA group and the implant group classified into levels 4-7 after THA were combined (n = 15), their mean preoperative and postoperative straight leg raising (SLR) strength was 0.56 Nm/kg and 0.75 Nm/kg, respectively. On the other hand, the mean preoperative and postoperative SLR strength was respectively 0.54 Nm/kg and 0.86 Nm/kg for patients classified into levels 1-3 after THA (n = 45). CONCLUSION: Before THA, 90% of the patients who has severe hip disturbance were in need of nursing care (levels 4-7), while the percentage decreased to 30% after surgery. There was a difference of SLR muscle strength between the patients in levels 4-7 and those in levels 1-3 after THA, suggesting that achieving levels 1-3 postoperatively might depend on whether SLR muscle strength shows improvement.

Rotational acetabular osteotomy for acetabular dysplasia and osteoarthritis: a mean follow-up of 20 years.

INTRODUCTION: Rotational acetabular osteotomy (RAO), a joint-conserving surgery in which the femoral head coverage by autologous cartilage is improved to achieve joint stability, is one of the most common joint-conserving surgeries for acetabular dysplasia of the hip in adult patients. Favorable outcome of RAO for pre- and initial coxarthrosis has been reported with middle- to long-term observation; however, surgery should be selected for advanced coxarthrosis. The objective of this study was to investigate the long-term clinical outcomes and radiological arthritis changes in patients who were treated with RAO and could be followed for 15 years or longer, and to investigate the joint conservation rate by preoperative arthritis stage. PATIENTS AND METHODS: The subjects were 156 patients (178 joints) treated with rotational acetabular osteotomy alone between January 1989 and June 2000. Of those, 106 patients (115 joints) were retrospectively investigated. The mean age at the time of surgery was 41.4 years (14-60 years), and the mean duration of follow-up was 20 years and 4 months (15-26 years and 7 months). RESULTS: There were no significant differences in the Harris hip score among the three groups before surgery; however, the score was significantly lower in the advanced than pre/initial coxarthrosis cases at final follow-up. The joint conservation rate with the end point defined as time of total hip arthroplasty was 70.4% at 20 years after surgery. By stage, joint conservation rates were 88.9, 78.9, and 59.3% in pre-, initial, and advanced coxarthrosis cases, respectively, demonstrating a significantly lower rate in the advanced coxarthrosis cases (p = 0.034). The mean time to conversion was 23, 14.5, and 13.7 years in the pre-, initial, and advanced coxarthrosis cases, respectively. CONCLUSION: The outcome of rotational acetabular osteotomy in most hips with pre- or initial coxarthrosis was satisfactory. Rotational acetabular osteotomy is an effective surgery for treating symptomatic developmental dysplasia of the hip in selected patients.

Cementless total hip arthroplasty for patients with rheumatoid arthritis: a more than 10-year follow-up.

BACKGROUND/PURPOSE: In this study, cementless THA was performed for RA patients, and its clinical outcomes, as well as radiographic findings and implant survival rates, were examined more than 10 years after surgery in comparison with the outcomes of the same procedure performed for patients with hip osteoarthritis (OA) during the same period. METHOD: We studied 28 cases of THA for RA clinically and radiologically at a minimum follow-up duration of 10 years. The patients consisted of 4 males and 22 females, with a mean age at the time of surgery of 53.1. The clinical and radiographic results were compared with an age-matched and sex-matched group of patients who had undergone THA for the diagnosis of primary or secondary OA. RESULTS: In the RA group, the mean Harris hip score was 48.3 before surgery, and improved to 76.8 at the time of the final survey. In the control group, the score also improved from 46.8 before to 86.5 after surgery, while revealing significant differences between the groups (p = 0.0002). In the RA group, 2 joints required revision THA on the acetabular side due to aseptic loosening, while such revision was not performed on the femoral side despite the presence of more than 2 mm of subsidence in 2 joints. The implant survival rate was 92.9 and 100 % in the RA and control groups, respectively, without significant differences (p = 0.493). CONCLUSIONS: Although its clinical outcomes were significantly different from those for OA, a satisfactory implant survival rate was achieved, at 92.9 % in RA patients.

Cementless total hip arthroplasty in patients aged ≥80 years.

BACKGROUND/PURPOSE: We evaluate the clinical and radiological results of cementless total hip arthroplasties (THAs) in patients aged ≥80 years. METHODS: We compared the clinical and radiological results of 30 cementless THAs done in patients aged ≥80 years (older group) and aged 60-69 years (control group). RESULTS: The Harris Hip score significantly decreased in the older group 1 year after the operation and at the final follow-up observation (p = 0.001), but no joints required revision surgery due to poor initial fixation or early loosening. CONCLUSION: Cementless THA in the elderly is safe and durable at the time of the follow-up.

Total hip arthroplasty after previous rotational acetabular osteotomy.

BACKGROUND/PURPOSE: Rotational acetabular osteotomy (RAO) is a joint-conserving surgery in which femoral head coverage is improved using autologous cartilage to stabilize the joint. For advanced coxarthrosis, it has been reported that radical surgery should be selected, compared to the pre- and early stages. The objective of this study was to determine the clinical outcomes of patients in whom coxarthrosis progressed after RAO and came to undergo total hip arthroplasty (THA). METHODS: We compared 24 total hip arthroplasties done in dysplastic hips after previous rotational acetabular osteotomy (RAO group) with a well-matched control group of 24 primary arthroplasties (control group) done during the same period at an average follow-up of 85 months (range 15-195). RESULTS: RAO group required significantly longer operative times and had more intraoperative blood loss. There was no significant difference between the two groups in terms of Harris Hip Score and radiographic outcome. Revision was performed in four and one joints in the RAO and control groups, respectively, showing no significant difference between the two groups (p = 0.165). CONCLUSION: THA after previous RAO leads to midterm results similar to those of other dysplastic hips. RAO does not seem to compromise the midterm clinical and radiographic outcome.