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.

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.

Physiologic Leg Bowing is not a Physiologic Condition but Instead is Associated with Vitamin D Disorders in Toddlers.

When children around 2-year-old show leg bowing without lower-limb radiographic abnormalities for rickets, the leg bowing is classified as "physiologic" genu varum without conducting a blood test. However, it has recently been suggested that toddlers who are diagnosed with physiologic genu varum may in fact have some form of bone metabolic disorder. In this 1:2 case-control study, blood samples were obtained from 33 toddlers with genu varum without radiographic abnormalities for rickets and 66 age- and gender-matched healthy children. Serum alkaline phosphatase (sALP), intact parathyroid hormone (siPTH), 25-hydroxy vitamin D [s25(OH)D], calcium (sCa), and inorganic phosphate (sP) were measured. s25(OH)D of the subjects with genu varum (24.8 ng/ml) were significantly lower than those of the control (33.6 ng/ml) (p < 0.001). The frequency of vitamin D insufficiency/deficiency (< 20 ng/ml) of the subjects with genu varum (39%) was significantly higher than that in the control (14%) (p = 0.004) (odds ratio by vitamin D insufficiency/deficiency: 4.1 [1.5-11.1, p = 0.004]). sCa in subjects with genu varum (10.2 ng/ml) were significantly higher than in control (9.8 ng/ml) (p < 0.001), as were sALP (1057 IU/l) and siPTH (28.4 pg/ml) (740 IU/l and 8.8 pg/ml in control, respectively; p < 0.001). siPTH levels were associated with s25(OH)D levels in subjects with genu varum (r = - 0.57, p < 0.001), while no association was observed in the control (r = 0.11, p = 0.36). Genu varum without radiographic abnormalities of rickets was associated with both vitamin D and bone-metabolic disorders in toddlers, indicating that physiologic genu varum is not a physiologic condition in toddlers.

Association between leg bowing and serum alkaline phosphatase level regardless of the presence of a radiographic growth plate abnormality in pediatric patients with genu varum.

When children around 2 years of age show leg bowing and diseases are ruled out based on radiographic findings without conducting blood tests, they are classified as "physiologic" genu varum. Since whether or not physiologic genu varum is associated with bone metabolism is unclear, this study was conducted to clarify the association between genu varum and bone metabolism in children. Thirty-five pediatric patients with genu varm who visited our out-patient clinic were enrolled. While two of the 35 children had nutritional rickets, showing abnormalities on both blood test (ALP, ≥1000 IU/L; iPTH, >65 pg/mL and 25(OH)D, ≤20 ng/mL) and radiographs (such as cupping, fraying or splaying), five of 35 children showed abnormalities on blood tests but not radiographs. While metaphyseal-diaphyseal angle (MDA) correlated with serum 25-hydroxy vitamin D (r = -0.35, p = 0.04) and magnesium (r = -0.36, p = 0.04), MDA and femorotibial angle (FTA) correlated with alkaline phosphatase (r = 0.43, p = 0.01 and r = 0.51, p = 0.006, respectively). A ridge regression analysis adjusted for age and body mass index indicated that ALP was associated with MDA and FTA. A logistic regression analysis adjusted for age and BMI indicated that higher ALP influenced an MDA >11°, which indicates the risk for the progression of genu varum (odds ratio 1.002, 95% confidence interval 1.0003-1.003, p = 0.021). The higher ALP (+100 IU), the higher risk of an MDA >11° (odds ratio 1.22). In conclusion, genu varum is associated with the alkaline phosphatase level regardless of the presence of radiographic abnormalities in the growth plate in children.

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.

Long-term results of rotational acetabular osteotomy for osteonecrosis with collapse of the femoral head in young patients.

PURPOSE: The surgical treatment of osteonecrosis with collapse of the femoral head is still controversial. The purpose of this study was to investigate the clinical outcome of rotational acetabular osteotomy by Ninomiya and Tagawa for osteonecrosis of the femoral head in young patients. PATIENTS AND METHODS: Rotational acetabular osteotomy was performed in 202 consecutive patients between 1995 and 2003. Among them, rotational acetabular osteotomy with osteonecrosis of the femoral head was performed in 31 patients (42 hips). The mean age at the time of surgery was 31.2 years (range 16-45). The mean duration of follow-up was 16.1 years (range 13.1-21 years). RESULTS: The mean preoperative Japanese Orthopedic Association hip score of 56.8 points improved to a mean of 72.4 points at the final follow-up. The 10-year survival rate with conversion to total hip arthroplasty as an end-point was 91.9%, and the 15-year survival rate was 75.5%, the 20-year survival rate was 67.9%. The conversion to total hip arthroplasty was performed in nine hips. The average time to the conversion to total hip arthroplasty was 12.1 years. CONCLUSIONS: Even though the necrotized range is wide, if normal cartilage remains on the lateral side of the femoral head, it can be utilized for the weight-bearing region by laterally rotating the acetabulum. Since the outcome was favorable, we believe that this is a valuable treatment option for this disease.

A novel patient-reported outcome measure for anterior cruciate ligament injury: evaluating the reliability, validity, and responsiveness of Japanese anterior cruciate ligament questionnaire 25.

PURPOSE: Despite objectively good results, up to 70 % of individuals may not return to their pre-injury level of sports activity after anterior cruciate ligament (ACL) reconstruction surgery. Although psychological responses have been shown to affect outcomes after ACL injury, an appropriate means of measuring their effects, in addition to functional status, has not been determined. The purpose of this study was to develop a patient-reported questionnaire for measuring psychological factors associated with outcomes after ACL injury and to evaluate its reliability, validity, and responsiveness. METHODS: After item analysis based on the results of two pilot studies and a short relevance assessment, 25 questionnaire items were selected for the Japanese Anterior Cruciate Ligament Injury Questionnaire 25 (JACL-25) and assessed for validity, reliability, and responsiveness in subjects with ACL injury. RESULTS: The JACL-25 had no floor or ceiling effects and no confounding factors. A Cronbach's alpha coefficient of 0.981 and a Guttman split-half coefficient of 0.983 indicated excellent reliability. Large standardized response means (1.30-1.62) and effect sizes (0.96-1.51) from the preoperative to postoperative period indicated good responsiveness. Construct structures were created, and these items were separated into three domains. Strong correlations between the JACL-25 and the International Knee Documentation Committee Subjective Knee Form (r s = -0.86), Lysholm Score (r s = -0.73), and Tegner Activity Scale (r s = -0.65) indicated good concurrent validity of the JACL-25. CONCLUSIONS: The present study demonstrated that the JACL-25 was valid, reliable, and responsive enough to evaluate psychological factors associated with outcomes in individuals with ACL injuries. LEVEL OF EVIDENCE: Diagnostic study, Level III.

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.

The incidence of and risk factors for developing atypical femoral fractures in Japan.

The long-term treatment with anti-resorptive drugs for osteoporotic patients is suggested to be associated with an increase in atypical femoral fractures (AFFs). However, their incidence, patient characteristics, and risk factors have not been fully elucidated especially in Asian countries. This retrospective observational cohort study found fourteen AFFs in ten patients (four bilateral fractures) among 2,238 hip and femoral shaft fractures treated in our associated hospitals between 2005 and 2010; this incidence (0.63%) was similar to Caucasians. Of the ten patients with AFFs, nine (90%) and six (60%) were using bisphosphonates (BPs) and glucocorticoids (GCs), respectively, compared to 14.3 and 8.6% for patients with typical femoral fractures who were using these agents. As comorbid conditions, five patients had collagen disease (CD) and two had diabetes. A fracture location-, age- and gender-matched (1:3) case-control study revealed that administration of BPs, GCs, and suffering from collagen disease (CD) were significant risk factors for developing AFFs [odds ratios 36.0 (95% confidence intervals 3.8-342.2), 13.0 (2.3-74.1) and 9.0 (1.6-50.3), respectively]. Interestingly, all of the patients with atypical subtrochanteric femoral fractures, defined as those within 5 cm of the lesser trochanter, were taking GCs due to CD, and the age of these patients (average of 54.8 years) was significantly younger than those with atypical diaphyseal femoral fractures (average of 77.2 years, p < 0.05). In conclusion, the incidence of AFFs in the Japanese population was similar to that of Caucasians, and taking BPs and GCs and suffering from CD were risk factors for developing AFFs.

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.

Delayed sciatic nerve injury by posterior flange of reinforcement ring after acetabular revision surgery.

Delayed onset of sciatic neuropathy after total hip arthroplasty is uncommon, and late hardware-induced sciatic nerve complications are rarely reported. Here, we report a patient in whom the posterior flange of the reinforcement ring caused severe late sciatic nerve injury. Sciatic nerve radiography was useful for diagnosing flange-related sciatic nerve injury.

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.

Effects of Pre-Donated Autologous Blood Transfusion on Peri-Operative Hemoglobin Concentration and Mid-Term Health Outcomes in Primary Total Knee Arthroplasty.

The effects of auto-BT in primary TKA on the perioperative hemoglobin (Hb) concentration and mid-term health outcomes are unknown. This study was performed to analyze the detailed changes in the perioperative Hb concentration before and after the operation (days 0-14 postoperatively), cardiovascular events, and mortality rate within 1 and 5 years postoperatively. One hundred patients undergoing primary TKA with auto-BT using 800 mL of preoperatively collected blood at the authors' institution were included. The mean Hb concentration before and after autologous blood collection was 12.7 ± 1.1 and 11.7 ± 1.2 g/dL, respectively. After primary TKA with auto-BT, the mean Hb concentration on day 0, 1, 3, 7, and 14 was 10.2 ± 1.2, 9.9 ± 1.2, 10.4 ± 1.3, 10.5 ± 1.3, and 11.0 ± 1.3 g/dL, respectively. Only one (1%) patient required additional allogenic blood transfusion. No patients developed cardiovascular events, and the 1- and 5-year postoperative mortality rate was 1.0% and 2.0%, respectively. Primary TKA with auto-BT showed relatively small perioperative changes in the Hb concentration, a low incidence of cardiovascular events, and a low mortality rate within 1 and 5 years postoperatively. These findings suggest that auto-BT, in which blood is preoperatively collected, is beneficial for patient safety and health, even if its cost-effectiveness may be debatable.

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.

Comparison of the 5-Year Outcomes Between Standard and Short Fit-and-Fill Stems in Japanese Populations.

Background: Fit-and-fill stems are known to have excellent outcomes; however, severe stress shielding has been reported in Japanese populations. Short fit-and-fill stems were modified for Asians; however, there have been no previous reports of its outcome. In this study, we compared the 5-year (mean 68-month) outcomes of 2 fit-and-fill stems with different lengths (standard or short). Material and methods: We reviewed 100 total hip arthroplasties in each standard- or short-stem group. Radiographs were evaluated for femoral morphology, stress shielding, bone remodeling, and fixation. Clinical evaluation was performed using the Japanese Orthopaedic Association (JOA) scores. Results: There was no difference in the degree of stress shielding between the 2 groups. Significant differences were observed in radiolucent lines in zone 4 (P = .005) and cortical hypertrophy in zone 3 (P < .0001) and 5 (P = .048) between the 2 groups. The canal flare index (P < .0003), cortical index (P < .0003), height (P < .0345), and stem size (P < .0081) individually affected stress shielding in the standard-stem group. In contrast, the cortical index (P < .0107) was the only relative factor in the short-stem group. All stems were judged to have bone ingrowth. The JOA score improved significantly (P < .0001); however, there were no significant differences between the 2 groups. Conclusion: The outcomes of both standard and short fit-and-fill stems were favorable. There were no significant differences in the stress shielding or JOA scores. Although there were a few differences in bone remodeling and factors affecting stress shielding, stem length reduction has been achieved without adverse effects with the Japanese femur.

Appearance and Frequency of Deep Venous Thrombosis After Total Hip Arthroplasty.

Objectives: Postoperative venous thromboembolism is an important peri-operative complication associated with total hip arthroplasty (THA). In particular, early detection of deep venous thrombosis (DVT) is important for the prevention of pulmonary embolism (PE). However, the methods and timing of examinations for DVT detection differ among the facilities. This study aimed to clarify the time, site, and frequency of DVT after THA. Materials and Methods: Background characteristics including age, sex, body mass index, diagnosis, operation type, operation time, and anesthesia type were investigated in 348 patients who underwent THA at our hospital between April 2017 and April 2019. Blood tests were performed preoperatively and on postoperative days (POD) 0, 1, 3, 7, 14, and 21. Simultaneously, vascular ultrasonography was performed to investigate the time and site of thrombus occurrence before and after the surgery. Results: DVT was observed in 27.2% of the patients on POD 21. The DVT-positive ratio was 9.4% (6/64) in males and 31.3% (89/284) in females. There was a significant difference between the groups (p = 0.0002). Patients in the DVT-positive group were significantly older than those in the DVT-negative group (73.0 ± 7.9 years vs. 63.3 ± 11.2 years, p = 0.0041). DVT mainly occurred in the soleal vein (74.7%). However, there was no significant difference between the operated and non-operated sides. In the DVT-positive group, thrombus occurred in 13.3% of preoperative cases, 20.0% on POD 0, 46.7% on POD 1, 13.3% on POD 3, 6.7% on POD 7, and 0% on POD 14 and 21. Conclusions: Vascular ultrasonography showed that thrombus occurred most frequently in the soleal vein. Thrombus occurred in 66.6% of DVT-positive patients by POD 1, indicating that thrombus appeared very early after surgery. All thrombus cases were formed by POD 7.

Acetabular cartilage abnormalities in elderly patients with femoral neck fractures.

INTRODUCTION: Both hemiarthroplasty (HA) and total hip arthroplasty (THA) are widely accepted surgical procedures for hip replacement following displaced femoral neck fractures. However, in cases involving an intact joint line before surgery, the choice between HA and THA remains debatable. This study investigated the prevalence of acetabular cartilage and labral abnormalities in elderly patients with femoral neck fractures. METHODS: Thirty-seven patients underwent hip arthroplasty for femoral neck fractures between April 2020 and February 2021. After excluding 4 patients, 33 patients (6 men and 27 women; mean age = 82.2 [range = 67-98] years) with fractures in 12 left and 21 right hips were included. After femoral head removal during arthroplasty, the acetabulum was macroscopically examined for the presence of cartilage and labral lesions. Acetabular cartilage abnormalities were classified as either overall degeneration or partial damage according to the cartilage damage classification system. RESULTS: Acetabular cartilage abnormalities, including overall degeneration or partial damage, were found in all hips (100%). Out of the 33 hips, overall degeneration, partial damage, and labral abnormalities were detected in 32 (96.9%), 16 (48.4%), and 9 (27.2%) hips, respectively. DISCUSSION: In this study, most elderly patients with femoral neck fractures exhibited acetabular cartilage and labral abnormalities, which were already present at the time of surgery. Therefore, surgeons should carefully examine these abnormalities as they may impact postoperative outcomes such as pain and function.