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.

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 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.

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.

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.

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.

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.

Serum chromium levels before and after revision surgery for loosened metal-on-metal total hip arthroplasty.

We investigated the changes of serum chromium levels before and after revision surgery in 10 patients (1 male and 9 females) who underwent exchange of a metal-on-metal articulation for a metal-on-polyethylene component because of aseptic loosening of a metal-on-metal total hip prosthesis. Of the 10 patients, 2 had bilateral metal-on-metal total hip arthroplasty. In the 8 patients who had no residual metal articulation, the mean serum chromium levels before and after revision surgery were 2.53 microg/L and 0.46 microg/L, respectively. In the 2 patients who still had a metal articulation on the contralateral side, the mean serum chromium levels before and after revision surgery were 2.85 microg/L and 1.90 microg/L, respectively. Moderate serum chromium levels in patients with metal-on-metal total hip arthroplasty show a decrease after removal of the metal-on-metal articulation.

Stress fractures of the femoral neck in child with open capital femoral epiphysis.

Stress fracture of the femoral neck has been considered a typical injury of two age groups: active youths and elderly people with osteoporosis. Its occurrence in children with an open capital femoral epiphysis is rare, and only 11 cases have been reported. Here we report two cases, in a 12-year-old boy and a 5-year-old girl (among the youngest patients on record). This fracture can be classified as a compression fracture or a tension fracture. Although tension fractures are not uncommon in military recruits and young athletes, all 13 cases (including our two cases) of femoral neck stress fracture associated with an open capital epiphysis were compression fractures that were treated conservatively.