Sports activity participation and subjective health status of patients after total hip arthroplasty via the anterolateral-supine approach: a case series study.

BACKGROUND: No reports have been published about participation in sports activity and subjective health status after total hip arthroplasty via the anterolateral approach in the supine position (ALS-THA) in Japanese patients. This study assessed sports activity participation and subjective health status, as well as factors potential associated with these variables, in patients who underwent ALS-THA. METHODS: Of 698 patients who underwent total hip arthroplasty at our institution between 2013 and 2018, questionnaires were sent to 355 patients under 80 years old who had undergone ALS-THA and 242 responded. Patients were asked about their subjective health status, participation in sports activity, the EuroQol 5-dimensions 5-level (EQ-5D-5L), the University of California Los Angeles (UCLA) activity scale score and the Forgotten Joint Score (FJS). Patient characteristics and hospitalization information were also collected. Patients' subjective health status was categorized as "healthy" or "unhealthy". Univariate and multivariate logistic regression analyses were performed to determine factors associated with participation in sports activity after ALS-THA and a "healthy" status. RESULTS: The pre- and postoperative sports activity participation rates were 54.0% and 57.8%, respectively. Most patients (76.8%, n = 182) were considered "healthy". Age (P = .019) and UCLA activity score (P < .001) were significantly associated with sports activity after ALS-THA. FJS (P = .002) and EQ-5D-5L (P = .004) were significantly associated with a "healthy" status. CONCLUSION: Patients participating in sports activity after ALS-THA are older and have higher UCLA activity scores and patients considered "healthy" have higher FJS and EQ-5D-5L scores.

Sports activity participation after curved periacetabular osteotomy for acetabular dysplasia.

BACKGROUND: Curved periacetabular osteotomy (CPO) was developed to treat acetabular dysplasia. Given that CPO can improve physical function in the early post-operative period, patients might be able to participate in sports activities post-operatively. Therefore, this study examined the post-operative sports activity participation and characteristics of acetabular dysplasia patients who have undergone CPO. METHODS: A total of 52 patients who underwent CPO for acetabular dysplasia were given a questionnaire on pre- and post-operative sports activities; 43 patients responded. We surveyed patients' sports activities, satisfaction, and physical function. Patients were divided according to whether they participated in sports activities after CPO. Physical function was compared before and after CPO. RESULTS: The pre- and post-operative sports activity participation rates were 55.8 and 72.1%, respectively. Patients mostly performed low-impact sports activities. Moreover, patients who participated in sports activities post-operatively had smaller pre-operative range of motion of hip flexion and returned to full weight bearing earlier. CONCLUSIONS: Among acetabular dysplasia patients who underwent CPO, 72.1% participated in sports activities post-operatively. Post-operatively, patients participated not only in low-impact sports activities, but also in high-impact ones. These findings might be useful for advising patients who are concerned about participating in sports activities after CPO.

A portable pneumatic compression device to prevent venous thromboembolism in orthopedic patients with the highest risks of both venous thrombosis and bleeding: A case series study.

PURPOSE: There is a pressing need for safe venous thromboembolism (VTE) prophylaxis in orthopedic patients with the highest risks of both venous thrombosis and bleeding. Portable intermittent pneumatic compression device (IPCD) has proven to be effective and safe in patients with a high risk of venous thrombosis and low bleeding risk. Therefore, this study examined the effectiveness, safety, and wearing compliance of portable IPCD for postoperative VTE prophylaxis in patients with the highest risks of both venous thrombosis and bleeding. METHODS: The cases consisted of 38 patients who had used a portable IPCD and had the highest risks of both venous thrombosis and bleeding. We examined the incidence of VTE to assess the effectiveness of the portable IPCD, the presence of hemorrhagic adverse events to assess safety, and the wearing rate to assess wearing compliance. RESULTS: The incidences of asymptomatic and symptomatic deep vein thrombosis were 5.3% and 2.6%, respectively. The incidence of hemorrhagic adverse events was 21.1% in patients who received anticoagulants and wore an IPCD simultaneously and 0% in patients who wore an IPCD but did not receive anticoagulants. The wearing rate (i.e. ≥18 h/day) was 100%. CONCLUSION: Portable IPCD has the potential for safe VTE prophylaxis in patients at high risks for both venous thrombosis and bleeding. Therefore, we suggest that such patients use a portable IPCD for VTE prophylaxis.

Expression and regulation of macrophage-inducible C-type lectin in human synovial macrophages.

Recent evidence suggests that synovial macrophage activation may be involved in cartilage destruction and pain in osteoarthritis (OA). The macrophage-inducible C-type lectin (Mincle) Clec4e is expressed in macrophages and is regulated in inflammatory conditions. Given that the regulation of Mincle in synovial macrophages has not been elucidated, we investigated the expression and regulation of Mincle in human synovial tissue (ST) harvested from patients with radiographic knee OA during total knee arthroplasty. Immunohistochemical and flow cytometric analyses were used to identify cells with Mincle expression in resected tissues. CD14-positive (CD14+; macrophage-rich cell fraction) and CD14-negative (CD14-; fibroblast-rich cell fraction) cells were extracted from the ST and used to assess MINCLE mRNA expression levels. To determine the role of tumor necrosis factor alpha (TNF-α) in the regulation of MINCLE expression, TNF-α was used to stimulate cultured CD14+ cells. Immunohistochemical staining revealed Mincle-positive cells in the synovial lining layer. Flow cytometric analysis showed that CD45+CD14+ cells were Mincle positive while CD45-/CD14- cells were Mincle negative. MINCLE expression was significantly higher in CD14+ cells than in CD14- cells. Stimulation of cultured CD14+ macrophages with TNF-α significantly increased MINCLE mRNA expression, while stimulation with TNF-α neutralizing antibody significantly decreased expression. That Mincle expression was observed in synovial macrophages and its expression was induced by TNF-α suggests that Mincle might have a key role in synovial inflammation in the osteoarthritic synovium.

Long-term outcomes of Wagner self-locking stem with bone allograft for Paprosky type II and III bone defects in revision total hip arthroplasty: A mean 15.7-year follow-up.

PURPOSE: Massive bone defects represent a challenge in revision total hip arthroplasty (THA). Wagner self-locking (SL) stem is a favorable option for this technique; however, its long-term outcomes with bone allograft have rarely been reported. The purpose of this study was to investigate the long-term outcomes of this stem with bone allograft for Paprosky type II and III bone defects in revision THA. METHODS: A total of 38 patients (40 hips) who underwent revision THA with the Wagner SL stem were retrospectively reviewed. Bone allograft was placed in every patient. Clinical outcomes were determined using the Japanese Orthopedic Association's hip scoring system (JOA hip score). Stem subsidence, stem fixation, and remodeling of the grafted bone were assessed radiographically. The survival rate of the stem was assessed by Kaplan-Meier survival analysis. RESULTS: The mean JOA hip score at the latest follow-up was 75.3 points. Stem subsidence of ≥10 mm was observed in four hips (10.0%). Moreover, 67.5% (27/40) of hips were stable, and 27.5% (11/40) had fibrous fixation. Bone restoration was observed in 25 hips (62.5%). At a mean follow-up of 15.7 years, the cumulative stem survival rates were 96.6%and 91.7% with "stem re-revision for loosening" and "stem re-revision for any reason" as the end points, respectively. CONCLUSION: The Wagner SL stem with bone allograft for proximal femoral bone defects in revision THA is a clinically beneficial procedure.

Intracapsular cuneiform osteotomy compared with in-situ pinning for the management of slipped capital femoral epiphysis.

Intracapsular cuneiform osteotomy was initially introduced to restore the morphology of the proximal femur after slipped capital femoral epiphysis (SCFE). However, whether this procedure results in a higher risk of avascular necrosis (AVN) or lower incidence of cam deformity than in-situ pinning is unclear. The aim of this study was to compare the outcomes of intracapsular cuneiform osteotomy and in-situ pinning to treat SCFE in children. Twenty-three children who suffered from SCFE underwent either intracapsular cuneiform osteotomy (eight patients, eight hips) or in-situ pinning (15 patients, 18 hips) between 2006 and 2014. No patient was lost to follow-up at a mean of 4.5 years. In the osteotomy group, the Japanese Orthopedic Association's hip score system score increased from 50.5 (20-89) to 98.9 (95-100) and from 65.9 (48-90) to 99.0 (44-100) in the in-situ pinning group. On the basis of the slip angle, α angle, and epiphyseal-metaphyseal offset, intracapsular cuneiform osteotomy showed a significantly better result in restoring the morphology of the proximal femur than in-situ pinning (P<0.001). The incidences of AVN, chondrolysis, and lower limb discrepancy were similar between the two groups. On the basis of clinical outcomes, both intracapsular cuneiform osteotomy and in-situ pinning had acceptable abilities to treat SCFE. The incidence of AVN was not related to which technique was used. Osteotomy significantly restored the morphology of the proximal femur.

Use of the painDETECT questionnaire to differentiate the nature of hip pain associated with a labrum tear.

The nature of pain associated with a labrum tear of the hip joint can vary widely among patients and does not always correlate with findings from diagnostic imaging. Identifying the components of the pain (nociceptive, neuropathic, or mixed pattern) is important to direct treatment. This report aimed to describe the use of the painDETECT questionnaire as a screening tool in order to classify the nature of the pain in three patients who presented with pain that was atypical for a labrum tear. The painDETECT questionnaire was an effective tool to identify appropriate pain management strategies in each case.

Long-term clinical and radiographic results of the cementless Spotorno stem in Japanese patients: A more than 15-year follow-up.

PURPOSE: Although previous studies have reported encouraging results of cementless Spotorno (CLS) stem, studies with more than 15 years of follow-up are rare. The objective of this study is to investigate the long-term results of CLS stem and the factors potentially influencing the outcomes. METHODS: The clinical and radiographic data of 79 hips (64 patients) were reviewed. Clinical outcome was determined using the Japanese Orthopedic Association's hip scoring system (JOA hip score). Survival rate was assessed by Kaplan-Meier survival analysis. The main end point for survival analysis was revision of stem. The correlations between patient demographics, radiographic factors, and stem survival rates were analyzed. RESULTS: At a mean follow-up period of 20.1 years, the mean JOA hip score at final follow-up was 84.7 points. Stem survival rate for all revisions was 97.5% at 20 years, and stem survival for aseptic loosening was 98.9%. Varus alignment had a significant negative influence on the survival of the femoral stem. CONCLUSION: This study demonstrates acceptable long-term clinical and radiographic results of the CLS stem in Japanese patients. Caution should be exercised to avoid varus stem alignment.

Pre-operative simulation of periacetabular osteotomy via a three-dimensional model constructed from salt.

INTRODUCTION: Periacetabular osteotomy (PAO) is an effective joint-preserving procedure for young adults with developmental dysplasia of the hip. Although PAO provides excellent radiographic and clinical results, it is a technically demanding procedure with a distinct learning curve that requires careful 3D planning and, above all, has a number of potential complications. We therefore developed a pre-operative simulation method for PAO via creation of a new full-scale model. METHODS: The model was prepared from the patient's Digital Imaging and Communications in Medicine (DICOM) formatted data from computed tomography (CT), for construction and assembly using 3D printing technology. A major feature of our model is that it is constructed from salt. In contrast to conventional models, our model provides a more accurate representation, at a lower manufacturing cost, and requires a shorter production time. Furthermore, our model realized simulated operation normally with using a chisel and drill without easy breakage or fissure. We were able to easily simulate the line of osteotomy and confirm acetabular version and coverage after moving to the osteotomized fragment. Additionally, this model allowed a dynamic assessment that avoided anterior impingement following the osteotomy. RESULTS: Our models clearly reflected the anatomical shape of the patient's hip. Our models allowed for surgical simulation, making realistic use of the chisel and drill. Our method of pre-operative simulation for PAO allowed for the assessment of accurate osteotomy line, determination of the position of the osteotomized fragment, and prevented anterior impingement after the operation. CONCLUSION: Our method of pre-operative simulation might improve the safety, accuracy, and results of PAO.

Clinical results of arthroscopic surgery in patients over 50 years of age-what viability does it have as a joint preservative surgery?

BACKGROUND: To identify whether hip arthroscopy is a suitable option for treating hip pain in elderly patients and investigate the clinical outcomes of hip arthroscopic surgery for labrum tear and/or osteoarthritis in patients over 50 years of age. METHODS: Between August 2009 and May 2014, a series of 23 patients (6 men and 17 women) with a mean age of 59 years underwent arthroscopy. We retrospectively examined the clinical records, radiographs, and outcome questionnaires from all patients. The mean follow-up period was 28 months. RESULTS: The mean Japan Orthopedic Association hip score after surgery improved by a statistically significant amount. Eight patients (34.8%) were noted to have a progression of osteoarthritis (OA) diagnosed by radiograph, and one underwent THA after 13 months following arthroscopic surgery. The patients in which OA progression was noted were identified as having radiographical OA preoperatively and acetabular cartilage damage in the arthroscopic findings. CONCLUSIONS: Arthroscopic surgery performed in selected patients over 50 years of age might be beneficial if classified as Tönnis grade 0 preoperatively and/or classified as Outerbridge grade II in the arthroscopic findings.

Early fracture of the modular neck of a MODULUS femoral stem.

We present the case of a 46-year-old woman who underwent revision surgery approximately 4 years after total hip arthroplasty because of a fracture of the modular neck of a MODULUS femoral stem. The fractured surfaces of the retrieved implant were inspected using optical and scanning electron microscopy. Three-dimensional finite element analysis was also performed to identify the stresses that might have caused the failure. We concluded that active, obese patients who are implanted with a high-offset, small-sized modular component could experience stress-induced fractures of the modular neck, with proper fixation and osseointegration of the distal stem, especially if residual bone or tissue is present on the inner surface of the neck that could contribute to micromovement and decreased proximal fixation.

Clinical Results and Prognostic Factors for Outcomes of Valgus Femoral Osteotomy Combined with Chiari Pelvic Osteotomy for Osteoarthritis of the Hip.

BACKGROUND: Surgeons have long debated whether advanced or end-stage osteoarthritis of the hip in young patients should be treated with total hip arthroplasty or osteotomy. We reviewed the intermediate-term clinical results of valgus femoral osteotomy combined with Chiari pelvic osteotomy (VCO) for advanced or end-stage osteoarthritis associated with severe acetabular dysplasia of the hip in young patients and analyzed prognostic factors related to conversion to total hip arthroplasty. METHODS: The study group included 54 hips in 50 patients (5 men and 45 women; average age at the time of surgery, 45.6 years). The minimum and average durations of follow-up were 10 and 17.6 years, respectively. The Japanese Orthopaedic Association hip score (JOA score) was used for clinical evaluation. The probability of survival of the VCO from the time of the operation until the end point of conversion to total hip arthroplasty was calculated with use of the Kaplan-Meier method. We defined prognostic factors of outcome (conversion to total hip arthroplasty) with the Cox proportional hazards model. RESULTS: The mean total JOA score increased from 53.0 points preoperatively to 77.1 points at 1 year postoperatively, 81.6 points at 5 years, and 76.8 points at 10 years. The survival rates were 83.3%, 59.7%, and 46.9% at 10, 15, and 20 years, respectively. On univariate and multivariate analyses, patients with a low degree of acetabular roof obliquity had better postoperative results. CONCLUSIONS: VCO is a surgical approach that preserves joint function in young patients with advanced or end-stage osteoarthritis associated with severe acetabular dysplasia of the hip. The postoperative prognosis of VCO was improved in patients with a low degree of acetabular roof obliquity. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The incidence of deep vein thrombosis (DVT) during hip arthroscopic surgery.

INTRODUCTION: The use of hip arthroscopy has been widely increasing. Although deep vein thrombosis (DVT) is thought to be a serious complication of orthopaedic surgery, there were few reports discussing DVT related to hip arthroscopic surgery. This study aimed to investigate the incidence and risk factors of DVT related to hip arthroscopic surgery. MATERIALS AND METHODS: This retrospective study included 72 patients. Clinical diagnosis of DVT was confirmed through ultrasonography performed preoperatively and 3 days postoperatively. Additionally, D-dimer levels were measured preoperatively and on postoperative days 1, 3, and 7. Age, body mass index, operation time, procedure type, and D-dimer levels were statistically compared between the two groups (identified DVT vs. no identified DVT). RESULTS: Five patients (6.94 %) were diagnosed with DVT clinically, although all cases were asymptomatic. The mean age of the patients with identified DVT was 62.0 ± 6.1 years; significantly higher than the mean age of the patients without DVT (45.1 ± 1.7 years; P = 0.0188). CONCLUSION: The incidence of DVT during hip arthroscopy, investigated by ultrasound, was 6.94 %. From our results, we recommend screening for and treatment of asymptomatic DVT, especially in older patients, during hip arthroscopic surgery.

Comparison of Gait Motion Including Postoperative Trunk Deflection Between Direct Lateral and Anterolateral Approaches in Supine Total Hip Arthroplasty.

BACKGROUND: A prospective study was conducted to compare the effect of an anterolateral approach in the supine position (ALS) with that of a direct lateral (DL) approach on gait motion, including trunk deflection, in walking after total hip arthroplasty. We hypothesized that trunk deflection in walking after ALS would be significantly improved in comparison with use of the DL approach. METHODS: The subjects were 15 patients, with 7 in the ALS group and 8 in the DL group. Walking before and 9 and 28 weeks after surgery was analyzed using 3-dimensional motion analysis. RESULTS: Walking velocity, stride length, hip joint range of motion in the sagittal plane in walking, and locomotion range of trunk inclination were significantly improved 28 weeks after surgery in both groups. In gait analysis, there were no significant differences between the 2 groups. CONCLUSION: This study was conducted to compare the effect of ALS with that of a DL approach on locomotion in walking after total hip arthroplasty. Hip pain at 9 weeks after surgery was significantly improved using ALS compared to the DL approach, but there were no significant differences in gait function at 28 weeks after surgery using ALS or DL approach. Further long-term studies are required to examine differences between these procedures.

Prevalence of radiographic findings of femoroacetabular impingement in the Japanese population.

BACKGROUND: Femoroacetabular impingement (FAI) is one factor known to cause pain and osteoarthritis (OA) of the hips. Although secondary OA due to hip dysplasia is common among Japanese populations, primary OA is seldom observed. Concomitantly, FAI is also thought to be uncommon in Japan, but relatively few epidemiological studies have addressed this issue. This study aimed to clarify the prevalence of radiographic findings of FAI in a Japanese population and to evaluate whether FAI is a risk factor for the development of arthritic changes. METHODS: We retrospectively examined 87 patients who underwent unilateral hip osteotomy with a Charnley category A hip joint on the contralateral side. Anteroposterior-view radiographs of the non-operated hip joint were assessed for the presence of hip dysplasia, as well as pistol grip deformity and crossover sign indicative of cam-type and pincer-type impingement, respectively. The presence of arthritic changes in the non-operated hip joint was assessed in follow-up radiographs, and factors contributing to the development of arthritis were determined by survival analysis. RESULTS: Of the 87 hips examined, dysplasia was noted in 38 (43.6%). While no pistol grip deformity was observed, crossover sign, which is indicative of pincer-type impingement, was identified in 9 of 38 dysplastic hips (23.7%) and 15 of 49 non-dysplastic hips (30.6%). Arthritic changes were present in 13 of 38 dysplastic hips (34.2%) and 11 of 49 non-dysplastic hips (22.4%). Survival analysis revealed that the presence of the crossover sign in non-dysplastic hips was significantly associated with the development of arthritis. CONCLUSIONS: The prevalence of the crossover sign in hips in a Japanese population is similar to that reported in Western populations, despite the fact that FAI is believed to be less prevalent in the Japanese population. Furthermore, the presence of the crossover sign in non-dysplastic hip joints is associated with the development of arthritis. Based on our results, pincer-type impingement could be commonly associated with the development of arthritis in Japanese populations.

Revision total hip arthroplasty using an interlocking stem with an allograft-prosthesis composite.

We report the clinical and radiographic outcomes and complications of revision surgery using a cementless interlocking stem with an allograft-prosthesis composite (APC). This study included 11 patients with an average follow-up of 73 years. Of the 11 revisions, 1 was aseptic, 7 were septic, and 3 were periprosthetic femoral fractures. The mean Harris hip score improved from 25.6 points before surgery to 74.8 points at final follow-up. Osseous union at the proximal allograft-host bone junction occurred in 10 hips (90.9%) ; the greater trochanter did not unite in 4 of 7 hips (57.1%). Moderate and severe allograft resorption occurred in one hip each. Postoperative complications included 1 deep infection, 2 heterotopic ossifications, and 1 dislocation. Using an interlocking stem with an allograft-prosthesis composite in revision surgery provided acceptable results in the presence of circumferential massive bone deficiency of the proximal femur.

Two-stage revision total hip arthroplasty for periprosthetic infections using antibiotic-impregnated cement spacers of various types and materials.

Antibiotic-impregnated hip cement spacers of various types and materials have been used in the treatment of periprosthetic hip infections. We developed a handmade spacer by using polymethylmethacrylate (PMMA) and/or α -tricalcium phosphate ( α -TCP). In this study, we retrospectively reviewed the surgical outcomes in 36 consecutive patients treated with 2-stage revision total hip arthroplasty by using our antibiotic-impregnated hip cement spacers. We aimed to analyze the infection control and reinfection rates after revision surgery. Moreover, we analyzed the possible predictors of postoperative reinfection. After exclusion of 1 patient who died immediately after the first-stage surgery, infection was controlled in 33 of the 36 hips (success rate, 91.7%). Two of these 33 hips underwent resection arthroplasty. Of the 36 hips that had been treated with the antibiotic-cement spacer, 31 hips (86.1%) were eligible for the second-stage prosthesis re-implantation. The 31 protocol hip joints of patients followed up for >6 months (mean, 48.6 months). Ten of these 31 hips (32.3%) became reinfected. No possible predictor examined differed significantly between the reinfection-positive and reinfection-negative groups. However, spacers consisting of PMMA cement alone were associated with the highest risk of reinfection. Therefore, α -TCP-containing antibiotic-impregnated hip cement spacers might decrease the reinfection rate in patients undergoing re-implantation.

Evaluation of bipolar hemiarthroplasty for the treatment of steroid-induced osteonecrosis of the femoral head.

PURPOSE: Bipolar hemiarthroplasty (BHA) for idiopathic osteonecrosis of the femoral head (ONFH) is performed at our institution. The purpose of this study was to evaluate the clinical and radiographic findings after BHA for the treatment of steroid -induced ONFH. METHODS: Thirty-seven hips in 27 patients were assessed (seven men, 11 hips; 20 women, 26 hips), average patient age at the time of surgery of 42.6 (range 20-83) years, with steroid-induced ONFH treated with BHA between 1995 and 2005. The mean follow-up duration was approximately ten (range five to 15) years. Patients were evaluated according to the Japan Orthopaedic Association (JOA) hip score. Kaplan-Meier survivorship was calculated to examine revision arthroplasty failure rate. Radiographic analysis of loosening included radiolucent lines and osteolysis of the acetabulum or femur. Causes of loosening were analysed using multiple logistic regression. RESULT: JOA hip score increased from 53 points (preoperative) to 87 points (final follow-up). Survival rates were 96.8 % and 78.6 % at ten and 15 years, respectively. Prosthesis loosening occurred on the acetabular side in five hips (13.5 %). No femoral-component loosening was observed. BHA had poor results in patients with Association Research Circulation Osseous (ARCO) stage IV ONFH and in patients under 40 years of age. CONCLUSION: BHA, with strict surgical indications, may be a good option for treating ONFH. Based on these results, total hip arthroplasty is recommended for patients with ARCO stage IV ONFH or for patients under 40 years of age.