Hip Function Was Not Associated with the Incidence of Preoperative Deep Vein Thrombosis in Patients Undergoing Primary Total Hip Arthroplasty.

The prevalence of preoperative deep vein thrombosis (DVT) has been reported to be relatively high in patients undergoing total hip arthroplasty. We investigated the prevalence of DVT, the association between hip function and preoperative DVT, and the effect of a history of surgery in patients who underwent primary total hip arthroplasty. We retrospectively analyzed the cases of the patients who underwent primary total hip arthroplasty between April 2013 and February 2020 at our institution. We evaluated the prevalence of preoperative DVT based on the results of the patients' ultrasound screening. We performed univariate and multivariate analyses to investigate the association between the incidence of DVT and patient factors including age, sex, hip function, medical histories, and American Society of Anesthesiologists Physical Status classification. We analyzed 451 patients (494 hips). The prevalence of DVT was 14.2% (64 patients). The multivariate analysis demonstrated that increased age was an independent significant risk factor for DVT. The prevalence of preoperative DVT was relatively high among patients who underwent primary total hip arthroplasty. Preoperative DVT tended to be more prevalent in older patients. Hip function was not associated with the incidence of DVT.

Arthroscopic evaluation after osteochondral autogenous transfer with osteotomy of medial malleolus for osteochondral lesion of the talar dome.

BACKGROUND: The purpose of this study was to investigate the second-look arthroscopic evaluation after osteochondral autogenous transfer (OAT) for osteochondral lesion of the talar dome (OLT) with the criteria of the International Cartilage Repair Society (ICRS). METHODS: Ten patients (twelve ankles) with OLT underwent OAT with osteotomy of the medial malleolus. Clinical outcomes were evaluated using the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale. The condition of the transplanted cartilage was evaluated at the time of second-look arthroscopy using the ICRS Cartilage Repair Assessment. RESULTS: The AOFAS ankle-hindfoot scale was significantly improved from 65.1 ± 1.9 points before surgery to 98.1 ± 2.8 points at the time of second-look arthroscopy (p < 0.01). The ICRS Cartilage Repair Assessment was 11.4 points on average (9-12 points). CONCLUSIONS: The OAT for OLT is considered to be a useful treatment even if invasion by medial malleolus osteotomy is added. LEVEL OF EVIDENCE: Level IV, Case series.

Influence of the knot position on the union of the greater trochanter after bipolar hip arthroplasty via the modified Dall approach: a prospective non-randomized study.

BACKGROUND: In our institute, all elderly patients with displaced femoral neck fracture were treated with cemented bipolar hemiarthroplasty (BHA) using the modified Dall approach. To our knowledge, there are no reports on the knot position of the greater trochanter reattachment. The aim of this study was to determine influence of two knot positions (anterior or posterior) on the complications of the greater trochanter. METHODS: This is a prospective non-randomized study conducted on 95 elderly patients (95 hips) from September 2013 to December 2017. The knot position was changed from anterior to posterior alternately. The X-ray images obtained immediately after the operation were compared with those obtained at 3 months postoperatively; thereafter, the status of the greater trochanter was classified into three types: type A, no apparent shifting and fracture; type C, over 1-mm shifting of the fragment; and type F, fracture of the greater trochanter. RESULTS: Regarding age at operation, sex, BMI, size of the greater trochanteric fragment, stem type, and surgeon, there was no significant difference between two groups. In the anterior group, 34 hips (72.3%), 5 hips (10.6%), and 8 hips (17.0%) were classified under type A, C, and F, respectively. In the posterior group, 44 hips (91.7%), 1 hip (2.1%), and 3 hips (6.3%) were classified under type A, C, and F, respectively. There were significantly fewer greater trochanteric complications in the posterior group. CONCLUSIONS: The posterior knot position improved the union of the greater trochanter after BHA compared with the anterior knot position. TRIAL REGISTRATION: We had approved IRB at our hospital clinical research review committee. Retrospectively registered.

Prospective, comparative study of cemented, smooth-surfaced titanium stems and polish-surfaced, stainless steel stems at a minimum follow-up of 10 years.

BACKGROUND: Excellent results have been reported with cemented total hip arthroplasty (THA) using both smooth-surfaced and polished-surfaced stems. However, the superiority of polished-surfaced over smooth-surfaced in cemented THA, or vice versa, is still debated. MATERIALS AND METHODS: Forty-six smooth-surfaced, triple-tapered, titanium-alloy stem (Group C) and 46 Exeter stems (Group T) have been fixed consecutively at different periods at our institute and prospectively evaluated clinically and radiologically. The area and location demonstrating cortical hypertrophy (CH) was measured in the serial radiograph and compared. RESULTS: The mean postoperative follow-up period was 12.4 years for group C and 10.8 years for group T. No significant difference of clinical results was found between both groups. CH was observed in 8 hips (18.6%) of group C and in 7 hips (17.1%) of group T (NS). Among the hips in which distribution of CH was observed at the medial side, a significantly low proportion belonged to group C (adjusted standardized residual = - 2.3) and a significantly high proportion belonged to group T (adjusted standardized residual = 2.3). The largest area of CH found in each group was 166.1 mm2 in group C and 227.6 mm2 in group T (NS). The peak location of CH was 100.4% in group C and 84.3% in group T (p = 0.02). CONCLUSION: Medium-term results of both stems were excellent. CH was observed medially and proximally in group T and laterally and distally in group C.

A case report of idiopathic iliopsoas hematoma which occurred soon after transfer to the wheelchair after total hip arthroplasty.

A 79-year-old woman was diagnosed with osteoarthritis of the left hip and scheduled for total hip arthroplasty. As two lesions were detected in branches of the coronary arteries, she was treated with catheter treatment. The patient was receiving anticoagulant treatment, which was suspended eight days before the operation; however, heparin was started at 6 days before the operation and was stopped 9 hours before the operation. On the 2nd postoperative day soon after transfer to the wheel chair, she was feeling unwell and was suffering from severe pain in her left buttock and left thigh. Her blood pressure had decreased to 70 mmHg. During abdominal contrast-enhanced CT, a hematoma was detected in the left iliopsoas muscle. Catheter therapy was started by the cardiovascular department and bleeding had stopped spontaneously. The patient was able to walk with a cane and was discharged on the 40th postoperative day. ABBREVIATIONS: THA: total hip arthroplasty, CT: computed tomography, JOA score: Japanese Orthopaedic Association hip score, HA: hydroxyapatite, PMMA: polymethyl-methacrylate, APTT: activated partial thromboplastin time.

An anatomical investigation of clock face landmarks around the glenoid for shoulder arthroscopy orientation.

BACKGROUND: For shoulder arthroscopy, few anatomical landmarks are available and inexperienced surgeons tend to be adrift due to the limited visual field of the scope. The purpose of this study was to demonstrate the useful landmarks around the glenoid for accurate orientation, and also the safe distance to avoid suprascapular nerve injury during surgical procedures around the glenoid. METHODS: In 15 human solution-fixed cadavers, a cross-section of the shoulder joint on the labrum surface was created. The positions of the principal anatomical structures surrounding the glenoid were marked on the labrum and measured using our clock face indication system. In 9 shoulders the distances from the labral surface to the spinoglenoid notch were recorded. As an indicator of the scapula size, the distances between the superior and inferior angles of the scapula were also measured. RESULTS: The average landmark positions in the right shoulder were as follows: center of the attachment of the long tendon 11:59, anterior edge of the supraspinatus 11:59, posterior edge of the base of the coracoid process 12:13, superior edge of the subscapularis 1:03, anterior edge of the base of the coracoid process 1:25, inferior edge of the subscapularis 5:27, inferior edge of the teres minor 6:21, border of the infraspinatus and teres minor 7:43, center of the scapula spine 10:06, border of the supra and infraspinatus 10:27. The average distance from the labral surface to the spinoglenoid notch was 23.17 mm, and that from the superior to inferior angle was 144.93 mm. The Pearson correlation coefficient for these distances was 0.007. CONCLUSIONS: The locations of anatomical landmarks surrounding the glenoid were reliably demonstrated using our clock face indication system. The expected distance from the labral surface to the suprascapular nerve was approximately 23 mm, irrespective of the size of the scapula.

Monitoring of blood pressure during total hip arthroplasty using the interface bioactive bone cement (IBBC) technique.

BACKGROUND: Cement implantation syndrome, which is characterized by hypotension, hypoxemia, and cardiac arrhythmia or arrest, has been reported in the literature. The purpose of the present study was to monitor the blood pressure changes that occur after cementing during primary total hip arthroplasty (THA). METHODS: The present study examined 178 cases in which 204 joints were treated with primary THA. Study subjects had a mean age at the time of surgery of 64.5 years (range 35-89). Under general anesthesia, both hip components were cemented in place using an anterolateral approach. After cementing, systolic arterial blood pressure was measured at 1-min intervals for 5 min and then again at 10 min. The maximum regulation ratio (MRR) was calculated as follows: (maximum change in blood pressure - blood pressure before cement application) divided by blood pressure before cement application. RESULTS: No major complications, such as cardiac arrest, occurred in most cases; blood pressure increased until 4 mins on the acetabular side and until 2 min on the femoral side, and then gradually returned to the level observed prior to cement application. On the acetabular side, the mean MRR was 11.2 % [standard deviation (SD): 15.9; range -26 to -80], whereas it was 6.4 % (SD: 14.9; range -31 to -65) on the femoral side. Correlations were detected between MRR classification on the acetabular side and the subject's age at the time of the operation or bleeding control status on the acetabular side. When bleeding control was judged as complete, the tendency for blood pressure to decrease was reduced. Conversely, when bleeding control was judged as good, blood pressure showed a greater tendency to decrease. CONCLUSION: In the present study, no episodes of major hypotension occurred. During THA involving the interface bioactive bone cement (IBBC) technique, when bleeding control on the acetabular side was judged as complete the tendency for blood pressure to decrease was reduced.

Anatomical study for SLAP lesion repair.

PURPOSE: The purpose of this study was to meticulously observe the structures around the origin of the long head of the biceps tendon (LHB) in order to propose a method of anatomical superior labrum anterior and posterior repair. METHODS: Twenty-eight shoulders of 16 cadavers with intact LHB origin were macroscopically investigated. Among them, 20 shoulders with an intact superior labrum were additionally observed, to determine whether the anterior edge of LHB on the labrum (point 'A') was anterior to the supraglenoid tubercle. Serial sections vertical to LHB were observed using ordinary light and polarized microscopy in three glenoids and scanning acoustic microscopy in one. RESULTS: The labrum had a meniscal appearance, and no LHB fibre was sent anterior to the anterior edge of the supraglenoid tubercle. 'A' was not located more posterior than the supraglenoid tubercle. All specimens had the so-called 'the sheet-like structure', in which the portion closer to the LHB origin tends to be stiffer. Fibres of the sheet-like structure ran vertically to LHB. CONCLUSION: Fibre orientation and the stiffness of the sheet-like structure suggest its support of LHB. As LHB fibres do not anteriorly cross over 'A', 'A' could be a landmark for the anterior border of LHB, independent from the sheet-like structure. Considering a previous report mentioning that the horizontal mattress suture maintains the meniscus-like structure which might be sufficient for proper motion of the normal superior labrum, the horizontal mattress suture not crossing over 'A' should be recommended from the viewpoint of functional anatomy.

A high body mass index tilts the pelvis caudally in the lateral decubitus position for total hip arthroplasty.

BACKGROUND: Accurate cup placement is essential for obtaining excellent outcomes in total hip arthroplasty (THA). We evaluated the pelvic lateral tilt of the patient (which affects the incline of the acetabular cup in THA) and investigated the factors affecting it. METHODS: We reviewed the medical records of THA procedures performed at our hospital between October 2015 and January 2021 for which an anteroposterior pelvic radiograph was always taken preoperatively once the patient was placed in the lateral decubitus position. These radiographs were used to measure the lateral pelvic tilt in each case. We analysed whether patient factors (sex, body mass index [BMI], range of motion of abduction or adduction in both hips, surgical history of both hips, and lumbar Cobb angle) influenced the tilt. RESULTS: We reviewed 363 cases (341 primary, 22 revision). The mean pelvic lateral tilt was 4.1°, and the operated hip was located on the caudal side compared to the unoperated hip. Statistical analyses revealed that the patient BMI and surgical history of the operated and unoperated hips significantly influenced tilt. CONCLUSIONS: The pelvis in the lateral decubitus position leaned 4.1° to the caudal side, most commonly due to a high BMI. Surgeons should consider this when performing acetabular cup implantation in THA.

The influence of anterior and posterior knot placement on hip function after total hip arthroplasty using a modified Dall's approach: a prospective non-randomised comparative study.

BACKGROUND: The direct lateral modified Dall's approach for total hip arthroplasty (THA) provides an excellent vision of the hip joint by osteotomising the greater trochanter (GT). A robust method for the reattachment of osteotomised fragments is essential to prevent complications around the GT. Ultra-high molecular weight polyethylene cables are reported to be useful for reattachment; but the optimal suture method of these cables is unknown. The purpose of this study was to investigate the influence of the knot position on hip function after primary THA. METHODS: In a prospective non-randomised study 216 primary THA were included, being scheduled for an operation with a modified Dall's approach. They were divided into 2 groups, anterior (A) and posterior (P) according to the knot position for the GT. Hip function was assessed using the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), pain visual analogue scale (VAS), satisfaction VAS and Merle d'Aubigne-Postel hip score at 3 and 6 months postoperatively. A logistic regression analysis was used to investigate factors influenced by the knot position. RESULTS: Patient demographics were comparable between the 2 groups. Differences of the knot position did not affect the radiological failure rate of GT reattachment. Regression analysis showed a significantly positive impact on pain VAS and flexion range at 6 months postoperatively for posterior knot position. CONCLUSIONS: For the reattachment of osteotomised fragments, the posterior knot may be superior to the anterior knot.

Good result for twelve years after bilateral hip and knee arthroplasties for ankylosis with juvenile idiopathic arthritis: a case report.

Juvenile idiopathic arthritis (JIA) can lead to joint deformity and bone destruction, which can cause gait disturbances. To the best of our knowledge, there are no case reports with over 10 years of follow-up on quadruple joint arthroplasties (QJA) for bilateral hip and knee ankylosis associated with JIA. We present the case of a 29-year-old woman with JIA. The patient suffered from bilateral ankylosis of the hips and knees and developed a swing gait requiring double crutches. We performed staged QJA with careful attention to postoperative rehabilitation and her physical features, which included excessive pelvic anteversion, poor bone quality, and short statue of bones. Twelve years after surgery, the patient was able to walk without any support and showed good clinical functional scores. In addition, no radiological loosening following QJA was observed. We hereby introduce a surgical strategy for total hip arthroplasty for excessive pelvic anteversion, which involves two methods to calculate pelvic tilt on a pelvic anteroposterior radiograph. These methods were able to approximately predict postoperative pelvic changes.

Inverted reamer technique for bone grafting of the acetabulum: technical note.

BACKGROUND: Socket fixation with bone grafting for dysplastic hips is technically demanding, and inadequate coverage of the socket may cause poor results in patients with severely dysplastic hips. An accurate technique to form a bone graft to fit into the defect is necessary. We aim to introduce the simple method of bone grafting, "inverted reamer technique" in cemented total hip arthroplasty (cTHA). METHODS: After acetabular preparation with a normal acetabular reamer, the bone graft was prepared from the resected femoral head with the inverted reamer. The graft can be press-fit into the defect of the acetabulum with good compatibility through this method. Then, the bone graft was fixed with 1-3 screws and the socket was implanted with bone cement. RESULTS: The "inverted reamer technique" can easily and automatically create a well-fit graft. This method is simple and technically less demanding; it can be performed by every surgeon, including trainee and inexperienced surgeons. CONCLUSION: This method can improve the outcome of cTHA for dysplastic hips by preserving bone stock and increasing bone coverage of the socket implanted in the anatomic position.

Pathohistological investigation of osteochondral tissue obtained during total knee arthroplasty after osteochondral autologous transfer: a case report.

BACKGROUND: Osteochondral autologous transfer is one of the repair techniques for cartilage defects of knee with promising knee function recovery. There are no reports including histopathological images concerning human osteochondral tissue after osteochondral autologous transfer. This is the first report to present pathohistological findings of transplanted plugs and host tissues extracted from the human body 3 years after osteochondral autologous transfer. This study aimed to explore the cause factor of chronic pain using histological techniques. CASE PRESENTATION: A 67-year-old Japanese man presented with adjusted total knee arthroplasty 3 years after osteochondral autologous transfer. Although in pain, arthroscopic assessment was not severe. The specimens which was gained during total knee arthroplasty were investigated in gross and microscopically using immunohistochemical staining technic. Histological examination revealed that the gap between grafted plugs and host osteochondral tissues was filled with fibrous tissue that stained positive for type I collagen. A degenerative change and some neovascularity were observed in the regenerated tissue and host trabecular bone. Furthermore, cysts and bone marrow edema were observed. CONCLUSION: Our data suggests that the host osteochondral morbidity around grafted plugs might be related to chronical pain and revision surgery.

Benchmark dose of working hours in relation to subjective fatigue symptoms in Japanese male workers.

PURPOSE: We used a multiple logistic regression model to calculate benchmark doses (BMDs) and their 95% lower confidence bound (BMDL) of working hours for subjective fatigue symptoms. METHODS: A self-administered questionnaire survey was conducted in 3069 male daytime workers between the ages of 18 and 60 years who worked in a Japanese steel company. Dependent variables were positive findings for eight properties by using the Cumulative Fatigue Symptoms Index (CFSI): decreased vitality, general fatigue, physical disorders, irritability, decreased willingness to work, anxiety, depressive feelings, and chronic tiredness. Independent variables were daily working hours, age, lifestyle factors, working conditions (type of work and number of holidays), marital status, and living arrangements. Using significant parameters for working hours and those for other covariates, BMD/BMDL of working hours was calculated for the corresponding property of the CFSI. Additionally, benchmark response (BMR) was set at 5% or 10%. RESULTS: The BMD/BMDL of working hours per day with a BMR of 5% were 11.8/10.8 (irritability), 11.4/10.2 (anxiety), and 11.2/10.6 (chronic tiredness), and those with a BMR of 10% were 14.2/12.6 (irritability), 14.2/12.1 (anxiety), and 13.1/12.2 (chronic tiredness). CONCLUSIONS: These results strongly suggest that special attention should be given to workers whose working hours exceed these BMD/BMDL values.

Long-term longitudinal study on the relationship between alternating shift work and the onset of diabetes mellitus in male Japanese workers.

OBJECTIVE: This study investigated the effect of alternating shift work (ASW) on the onset of diabetes mellitus in Japanese workers compared with onset in day-shift work (DSW). METHODS: A longitudinal study was carried out on a DSW group (n = 3203) and ASW group (n = 2426) of a steel company who received their annual health checkups over a 10-year period between 1991 and 2001. The association between job schedule type and onset of diabetes mellitus (glycated hemoglobin A1c > or =6.0% or medication) was investigated by multivariate pooled logistic regression analyses. RESULTS: The odds ratio (95% confidence interval) for the development of diabetes mellitus in the ASW group compared with the DSW group was 1.35 (1.05-1.75). CONCLUSIONS: Our study revealed that the ASW is an independent risk factor for the onset of diabetes mellitus.

A longitudinal study on the relationship between shift work and the progression of hypertension in male Japanese workers.

OBJECTIVE: In this 1991-2001 cohort study of 6495 male workers in a Japanese steel company, we investigated whether shift work affects progression from mild hypertension to severe hypertension. DESIGN: A prospective cohort study. PARTICIPANTS: Participants had mild hypertension at entry into the study with systolic blood pressure of 140-159 mmHg or diastolic blood pressure of 90-99 mmHg or both before treatment. In summary, 2911-2941 workers were included for each endpoint. Pooled logistic regression analysis was performed to adjust for the effect of contributing factors and annual variations. MAIN OUTCOME: Either severe hypertension (systolic blood pressure >or= 160 mmHg and/or diastolic blood pressure >or= 100 mmHg), severe systolic hypertension (systolic blood pressure >or= 160 mmHg) or severe diastolic hypertension (diastolic blood pressure >or= 100 mmHg) was defined as a different endpoint of observation. RESULTS: Job schedule was significantly associated with progression from mild hypertension to severe hypertension and severe diastolic hypertension. The odds ratios of shift workers compared with regular day workers were 1.23 (95% confidence interval: 1.05-1.44) and 1.28 (95% confidence interval: 1.07-1.52) for severe hypertension and severe diastolic hypertension, respectively. Age, body mass index, creatinine, gamma-glutamyl transpeptidase, and glycosylated hemoglobin A1c were also significantly associated with severe hypertension, severe systolic hypertension and severe diastolic hypertension. CONCLUSION: Our study revealed that shift work is a significant and independent risk factor for the progression of hypertension.

Three-shift system increases job-related stress in Japanese workers.

We assessed the relationship between shift work and job stress. The target subjects were 4,962 male workers (3,078 day workers and 1,884 shift workers) aged 18 to 60 yr who work in a Japanese steel company. We used the "Brief Job Stress Questionnaire", which was developed by a research group organized by the Japanese Ministry of Labour. We evaluated the effect of shift work on job stress using logistic regression analysis including age, lifestyle factors, work conditions, marital status, and living arrangements in the model. Job schedule type was significantly associated with job control, with an odds ratio of 2.22 for shift workers compared to day workers. The logistic regression analysis revealed that the odd ratios for having one or more stressor items in an unfavorable condition were significantly higher for shift workers compared to day workers. Increase in the amount of overtime and decrease in the number of holidays led to a significant deterioration in job stress. Our study reveals that the 3-shift system of employment increases work-related stress, and that job control is low among shift workers. To reduce job stress in this occupational population, a reduction in the amount of overtime and an increase in the number of holidays seem to be useful interventions.

The relationship between shift work and the onset of hypertension in male Japanese workers.

We assessed the effect of shift work on the onset of hypertension. The design of this study was that of a cohort study from 1991-2001. In sum, 5338 workers comprised this cohort. The event was the onset of hypertension (systolic blood pressure >or=140 mm Hg and/or diastolic blood pressure >or=90 mm Hg and/or medication). Pooled logistic regression analysis was performed, including job schedule type, age, body mass index, lifestyle, and the results of blood chemistries as covariates. The odds ratio of the onset of hypertension in shift workers for daytime workers was 1.10 and significant. Our study revealed that shift work independently affected the onset of hypertension, and suggested that shift work is a risk factor for the onset of hypertension.