BACKGROUND: Recent advancements in and the proliferation of autonomous mobility technology, such as intelligent wheelchairs, have made it possible to provide mobility services for patients with reduced mobility due to musculoskeletal disorders. In the present study, we conducted a preliminary clinical study to assess the safety and feasibility of in-hospital autonomous transportation using a driverless mobility (wheelchair) for patients with musculoskeletal disorders. METHODS: From January to February 2022, 51 patients with musculoskeletal disorders exhibiting gait disturbance who presented to our institution were included in the present study. Driverless mobility rides were conducted over a straight-line distance of 100 m from the orthopaedic outpatient reception to the payment counter after the outpatient consultation. We assessed the quality of life using an EQ-5D-5 L index and pain using a VAS score before riding the mobility to investigate the patient's condition. After the ride, a questionnaire survey was conducted to assess patient satisfaction on a 5-point scale. In addition, adverse events during the mobility ride were investigated. RESULTS: Overall satisfaction levels showed that 44 out of 51 (86%) patients rated the level as 3 or higher. There were no significant differences in the level of satisfaction based on the cause of disorders or EQ-5D-5 L Index. Among 19 patients who rated the level of satisfaction as 2-3, the ratio of postoperative patients and those with pain tended to be higher (p < 0.05). While 26 of 51 (51%) patients reported moments of feeling unsafe during the mobility ride, no actual adverse events, such as collisions, were observed. CONCLUSIONS: An in-hospital autonomous transportation service using a driverless mobility for patients with musculoskeletal disorders demonstrated high satisfaction levels and was safe with no severe adverse events observed. The expansion of autonomous mobility deployment is expected to achieve mobility as a service in medical care.
Feasibility Studies , Musculoskeletal Diseases , Patient Satisfaction , Humans , Male , Musculoskeletal Diseases/therapy , Musculoskeletal Diseases/physiopathology , Musculoskeletal Diseases/diagnosis , Female , Middle Aged , Adult , Aged , Quality of Life , Wheelchairs , Transportation of Patients/methods , Mobility Limitation , Surveys and Questionnaires , Aged, 80 and over
Purpose: Thermoelastic stress analysis (TSA) was used to evaluate stress changes over the entire surface of a specimen. This study aimed to assess the relationship between femoral stress distribution, analysed using TSA and changes in bone mineral density (BMD) after total hip arthroplasty (THA). Methods: Stress changes in the simulated bone before and after taper-wedge stem insertion were measured using the TSA. Stress changes were compared with BMD changes around the stem 1 year after surgery in a THA patient (58 hips) with the same taper-wedge stem. Subsequently, we compared the correlation between stress changes and BMD changes. Results: TSA revealed significant stress changes before and after stem insertion, with prominent alterations in the proximal medial region. The BMD changes at 1 year post-THA exhibited a 15%-25% decrease in the proximal zones, while Zones 2-6 showed a -6% to 3% change. Notably, a strong positive correlation (0.886) was found between the stress change rate and BMD change rate. Conclusions: This study demonstrated a high correlation between femoral stress distribution assessed using TSA and subsequent BMD changes after THA. The TSA method offers the potential to predict stress distribution and BMD alterations postsurgery, aiding in implant development and clinical assessment. Combining TSA with finite element analysis could provide even more detailed insights into stress distribution. Level of Evidence: Case series (with or without comparison).
BACKGROUND: Glucocorticoids induce osteoporosis, while bisphosphonates treat it, yet both can lead to atypical femoral fractures. Patients on both agents may face challenges in healing from such fractures due to their pathophysiology and pharmacological effects. METHODS: Intramedullary nail surgery was performed on 20 limbs in 19 patients with atypical femoral fractures and autoimmune diseases, who had received bisphosphonates for GC-induced osteoporosis. The average durations of glucocorticoid and bisphosphonate use were 17 and 9 years (standard deviation: 7.59 and 4.35), respectively, and the mean follow-up period was 66 months. Fifteen and five limbs were fractured at the subtrochanter and diaphysis, respectively. The surgical techniques (type of nail) and additional procedures performed in these cases were examined. The post-operative alignment and reduction status on radiographs were examined to determine their relationship with post-operative outcomes. RESULTS: Cephalomedullary long nails were inserted in nine limbs and antegrade intramedullary nails in 11 limbs. As an additional surgical procedure, open reduction, bone grafting and drilling were carried out on six, two, and five limbs, respectively. Regarding malalignment on radiographs, AP images showed varus in four limbs, and lateral images showed extension in two limbs. Regarding the cortical discontinuity, the distal fragment of the 11th limb shifted posteriorly in the lateral view. Gaps at the fracture sites were observed in 11 limbs. As a result, bone union was confirmed in 13 limbs. Five of the seven nonunion limbs required additional surgery. When comparing union and nonunion, open reduction and drilling were involved in nonunion limbs. CONCLUSION: The surgical outcomes of atypical femoral fractures in patients with autoimmune disease and on long-term glucocorticoids and bisphosphonates were poor. Although it is not possible to affirm for sure based on these results alone, management with prophylactic surgery before complete fracture is considered to be required to improve outcomes.
The posterior circumflex humeral artery, a branch of the axillary artery, is compressed by the humeral head during repeated abduction and external rotation of the shoulder joint owing to its anatomical structure. This damages the vascular endothelium, resulting in thrombi, arterial dissection, and aneurysms, a condition known as posterior, circumflex humeral artery pathological lesions. A thrombus may form at the site and becomes a peripheral embolus, resulting in peripheral arterial occlusion.A 21-year-old right-handed elite man college volleyball player noticed coldness and pain in his right hand during a game. Cyanosis was present except in the middle finger, and the beating radial artery was palpable; however, the ulnar artery was not. Doppler ultrasound examination revealed thrombus occlusion of the ulnar artery and common palmar artery of the index finger. Peripheral arterial occlusion was diagnosed due to embolization of a thrombus from this site. The patient stopped practicing volleyball immediately after the onset of symptoms and was started on cilostazol 200 mg and rivaroxaban 15 mg. Subjective coldness of the fingers improved one week after the start of treatment. The patient resumed practice four weeks after the start of treatment and participated in a game by the seventh week.Posterior circumflex humeral artery pathological lesions are caused by overhead motions such as pitching. They are most commonly reported in athletes playing volleyball, although rare, and many cases of aneurysm formation have been reported.Observing a cold sensation in the periphery after practice is necessary for screening.
Background: Primary stability of the femoral stem is important for the long-term results of cementless total hip arthroplasty. Cementless collared stems have been known to have higher stability than collarless stems when there is a contact between the collar and the calcar. The purpose of this study was to compare the stabilities of collared stem and collarless stem in 2 loading conditions: 1) flat walking and 2) stair climbing. Methods: We constructed 3 finite element models. In the first model, the collar had contact with the calcar. The second model had a 1 mm gap between the calcar and the collar. The third model was constructed with a collarless stem. The proximal femur around the stem was divided into 3 zones: the upper zone (Gruen zones 1 and 7), the middle zone (Gruen zones 2 and 6), and the lower zone (Gruen zones 3 and 5). The micromotion at the stem/bone interface was measured at each zone of the 3 models under the 2 loading conditions. Results: The results showed that collared stems were more stable when the collar was in contact with the calcar than when a gap was left between the collar and the calcar. In particular, collar contact was highly effective in suppressing the micromotion proximal to the stem. Conclusions: Compared to the collarless stem, the collared stem had comparable stability when there was a gap at the collar and calcar interface and higher stability when there was contact between the collar and the calcar.
OBJECTIVE: During total hip arthroplasty (THA), both pelvic and femur positions affect leg length (LL) and offset (OS) measurements because LL and OS calipers depend on the fixed reference points on the pelvis and femur, respectively. However, LL and OS measurement errors because of pelvic positional changes have not been described. This study aimed to clarify the effects of pelvic positional changes on LL and OS measurements in relation to the pelvic reference using a THA simulator. METHODS: We developed an experimental THA simulator using Sawbones models of the hemipelvis and femur that facilitated modification of the obliquity, tilt, and rotation of the pelvis. Using an LL and OS caliper, LL and OS measurement errors due to pelvic positional changes were determined with the femoral position fixed. Measurements were performed from two pelvic reference positions: the iliac tubercle (P1) and the top of the iliac crest intersecting the line of the femoral long axis (P2). RESULTS: Concerning pelvic obliquity, the total error of LL was 25.0 mm in P1 and 26.5 mm in P2, while the total error of OS was 13.0 mm in P1 and 10.9 mm in P2. For pelvic tilt, the total error of LL was 9.0 mm in P1 and 3.8 mm in P2, while the total error of OS was 0.5 mm in P1 and 1.0 mm in P2. Regarding pelvic rotation, the total error of LL was 13.8 mm in P1 and 3.2 mm in P2, while the total error of OS was 3.8 mm in P1 and 4.0 mm in P2. CONCLUSIONS: Pelvic positional changes alter LL and OS measurements. The acceptable range (error <2 mm) on LL and OS measurement errors of pelvic obliquity was only 2°, regardless of the pelvic reference position. The pelvic reference position should be at the top of the iliac crest intersecting the line of the long axis of the femur because of a small LL measurement error with pelvic tilt and rotation.
Arthroplasty, Replacement, Hip , Bone Diseases , Humans , Leg/surgery , Pelvis , Lower Extremity/surgery , Femur/surgery , Bone Diseases/surgery
We present a case of a 42-year-old obese female with a body mass index of 38.4 kg/m2. Laparoscopic tumor resection of a left nonfunctioning adrenal tumor was performed in the lateral jackknife position, and the operative time was over 5 h. After awakening, she complained right buttock pain, and we suspected bursitis due to the surgical position and decided to follow up the patient. On the second postoperative day, spontaneous pain worsened, and the computed tomography scan of the hip showed significant swelling of the gluteal muscles, which led us to suspect a gluteal compartment syndrome. Intramuscular compartment pressure was measured under general anesthesia at 72 mmHg, and a fasciotomy was performed. The symptoms improved promptly after surgery and completely disappeared 2 months after surgery. Although the gluteal compartment syndrome is a rare condition in which circulation is impaired by compression of the gluteal muscles, treatment should be initiated promptly before serious complications arise.
Purpose: Since 2003, a hip-preserving technique-concentrated autologous bone marrow aspirate transplantation (CABMAT)-has been applied to treat osteonecrosis of the femoral head (ONFH). We investigated intraoperative and postoperative outcomes of total hip arthroplasty (THA) in patients who underwent CABMAT as hip-preserving surgery for ONFH but developed secondary hip osteoarthritis after progressive femoral head collapse. Methods: A total of 456 hips in 282 patients underwent CABMAT in our hospital between April 2003 and December 2018; 108 hips required THA (THA conversion rate, 23.7%). We enrolled 60 hips (26 hips in 20 men and 34 in 26 women) with a follow-up of over 2 years. We retrospectively analyzed patient background data, time to THA, surgical procedure, postoperative complications, and clinical outcomes from medical records. Results: The disease was steroid-related, alcohol-related, and idiopathic in 48, seven, and five hips, respectively. The mean age at THA was 45.7 years, and mean conversion time was 2.7 years. Cementless THA was performed in all cases; the mean operating time and blood loss were 82.7 min and 210 g, respectively. Postoperative complications were observed in four cases; intraoperative fracture, two cases; superficial infection, one case; and dislocation, one case. The mean follow-up period was 5.7 years; no loosening or deep infections occurred. No patients required revision arthroplasty. Conclusion: We noted no complications related to CABMAT. After a minimum 2-year follow-up, the clinical outcomes were good. CABMAT was found to be an useful hip-preserving surgery, with little effect on conversion to THA, and THA outcomes were good.
Antibiotic-loaded acrylic cement beads have a large surface area and excellent sustained-release properties. However, there are some difficulty manufacturing reasonably sized beads and their careful handling. We developed a self-made cement bead maker using a mold of a sphere with a diameter of 8 and 10 mm with a 2-mm-diameter connecting hole. With this instrument, approximately 32 beads can be made from 40 g of bone cement. We clinically applied this technique to 11 cases of periprosthetic joint infection. There was no recurrence of infection noted. The advantages of this device were that it was possible to adjust the combination of antimicrobial agents and that the shape was uniform and easy to handle during surgery.
OBJECTIVE: To verify whether a large-scale international volleyball competition could be conducted safely using the bubble method, both for our participating team and as a whole. METHODS: All 32 men's and women's teams were gathered in one place and a large-scale international volleyball competition was held for over a month without spectators using the bubble method. More than 1,000 people participated in the event, and 572 volleyball players played a total of 248 matches during the competition. There were 54 participants from Japan, including 27 male and female staff and players each. There was one team doctor for both men and women. A total of 2,250 PCR tests and 7,920 antigen tests were performed over 38 days. We investigated the incidence of infection in our team and in all participating teams. RESULTS: There were 9 fever cases from our men's team, but all of them tested negative for COVID-19. Overall, a total of 10,170 tests were performed and only one was positive. CONCLUSION: In order to ensure the health and well-being of all participants, the indoor competition was concluded safely without the occurrence of COIVD-19 clusters in the bubble system with strict adherence to various strict protocols of COVID-19.
PURPOSE: The aim of this study was to evaluate the stress distribution in a synthetic femur that was implanted with a fully hydroxyapatite-coated stem using thermoelastic stress and finite element analyses, and to clarify the differences in the stress distributions between these two methods. METHODS: Thermoelastic stress analysis is a stress-analysis technique that employs the thermoelastic effect. Sinusoidal vertical loads were applied to the head of the stem placed on the synthetic femur, and surface stress distribution images were acquired using an infrared stress measurement system. The finite element model for the synthetic femur and stem were set up similarly to the thermoelastic stress analysis experiment, and vertical load was applied to the head of the stem. Surface stress distribution and stress values obtained via these two methods were compared. RESULTS: Thermoelastic stress analysis showed that compressive and tensile stresses were distributed from the proximal femur to the diaphysis, not only on the medial and lateral surfaces, but also on the anterior and posterior surfaces. However, finite element analysis showed that compressive stress was not distributed on the anterior and posterior surfaces of the femoral intertrochanter. The stress values of thermoelastic stress analysis tended to be higher in the proximal femur than that obtained via the finite element analysis. CONCLUSIONS: The surface stress distribution obtained by these two methods were different specifically in the proximal femur. Our results imply that thermoelastic stress analysis has a better potential than finite element analysis to show the surface stress distribution that reflects the stem design.
BACKGROUND: Femoral neck stress fractures are rare and often recognized as overuse injuries that occur in young athletes or military personnel. A case following osteonecrosis of the femoral head is quite rare; even more uncommon is its occurrence in the bilateral hips. Magnetic resonance imaging has been established as the preferred tool for diagnosing nondisplaced femoral neck stress fracture due to overuse injury. Magnetic resonance imaging was also useful to detect the initial lesion even in this case, although the etiology was different between overuse injury and insufficiency fracture. CASE PRESENTATION: A 41-year-old Japanese woman diagnosed with bilateral early stage idiopathic osteonecrosis of the femoral head was observed non-weight-bearing as much as possible using a stick. However, her pain and difficulty in walking progressed. Bilateral femoral neck stress fractures were subsequently detected by magnetic resonance imaging. The fracture initially appeared as a spot of bone marrow edema at the medial site of the femoral neck, and then developed into a fracture line. The patient underwent internal fixation of both hips with sliding hip screws to stabilize the stress fractures. In addition, the preparatory reaming served as core decompression of the femoral heads, as well as being treatment for osteonecrosis. Her bone mineral density and 25-hydroxy vitamin D values were low for her age. We administered eldecalcitol and teriparatide acetate. Her symptoms mostly improved, and the fracture lines and necrotic lesions on magnetic resonance imaging reduced at 5 months after the surgery. CONCLUSIONS: Bilateral femoral neck stress fractures are a very rare condition and are often missed. It is important to listen to the patient's complaints and perform an appropriate examination. We encountered a case of bilateral femoral neck stress fracture that occurred in a patient with early stage osteonecrosis of the femoral head, and were able to observe progression of stress fracture since before fracture occurred. This is considered to be the first report to capture imaging changes before and after the onset.
Femoral Neck Fractures , Fractures, Stress , Osteonecrosis , Adult , Female , Femoral Neck Fractures/diagnostic imaging , Femoral Neck Fractures/surgery , Femur Head , Femur Neck , Fracture Fixation, Internal , Fractures, Stress/diagnostic imaging , Fractures, Stress/surgery , Humans
Venous thromboembolism (VTE) is a severe complication in orthopedic surgeries. Herein, we developed a novel leg exercise apparatus (LEX) to encourage postoperative limb movement in bedridden patients to prevent VTE. We aimed to evaluate its feasibility and safety in individuals at risk of VTE. Twenty patients (four men, 16 women) who underwent total joint arthroplasty in the lower extremity were enrolled in this prospective study. Exercise using the LEX was performed for 5 min at 30 cycles/min, four times/day during postoperative days 1-7. Clinical assessments included the evaluation of vital signs, venous ultrasonography, and blood tests within seven days postoperatively, and adverse events (pulmonary embolism and cerebral hemorrhage) were monitored. Overall, 16/20 (80%) patients completed the 7-day exercise regimen. There were no cases of severe adverse events, changes in vital signs, or lower-extremity deep vein thrombosis in patients who performed exercises with the LEX. Thus, the results of this pilot study show that this novel apparatus may be a safe and feasible tool for VTE prophylaxis after joint arthroplasty of the lower extremities.
Venous Thromboembolism , Arthroplasty/adverse effects , Feasibility Studies , Female , Humans , Leg , Lower Extremity/blood supply , Lower Extremity/diagnostic imaging , Male , Pilot Projects , Prospective Studies , Venous Thromboembolism/diagnostic imaging , Venous Thromboembolism/etiology , Venous Thromboembolism/prevention & control
Digital tomosynthesis (DTS) is a new imaging technique derived from radiography, and its usefulness has been gradually reported in the field of orthopedic diagnosis in recent years. A fully hydroxyapatite (HA)-coated stem, which is used for total hip arthroplasty (THA), is a type of cementless stem that has been widely used recently and reported to have good results. However, stem loosening on plain radiographs is difficult to determine in some cases due to cancellous condensation around the stem. In this retrospective cross-sectional study, we compared the results of plain radiography versus DTS to evaluate the imaging findings after THA using a fully HA-coated stem. Twenty joints each in the 3 y and 1 y postoperative groups underwent plain radiography and DTS. On DTS, bone formation around the stem was confirmed in all cases; however, this formation was not reproducible on plain radiography, and there were cases in which the reaction could not be confirmed or cases with cancellous condensation resembling reactive lines. This reaction was not reproducible on plain radiographs, and in some cases, the reaction could not be confirmed, or there were cases with cancellous condensation that resembled reactive lines. Therefore, DTS was useful in the diagnosis of bone formation around the implant.
Ultrasonography and MRI are used for imaging evaluation of patellar tendinopathy, and "thickening of the tendon" is known as one of the characteristic findings. However, there are no evidence-based quantitative criteria to help evaluate this phenomenon. The purpose of this study was to investigate an objective measure of patellar tendon thickness. Patellar tendon thickness was evaluated in 65 elite university athletes using both ultrasonography and MRI. The relationship between tendon thickness and clinical patellar tendinopathy was investigated, and the cutoff value of the tendon thickness was calculated. Of the 129 knees included in the analysis, clinical patellar tendinopathy was found in 16 knees (12.4%). The proximal patellar tendon was significantly thicker in athletes with clinical patellar tendinopathy on both ultrasonography (8.3 mm vs. 5.1 mm; p < 0.001) and MRI (9.9 mm vs. 5.5 mm; p < 0.001). Setting the cutoff value to a thickness of >7.0 mm was an accurate predictor of clinical patellar tendinopathy (ultrasonography: sensitivity 81.3%, specificity 95.6%; MRI: sensitivity 100%, specificity 89.4%). Both ultrasonography and MRI measurement of the proximal patellar tendon thickness reflected the presence of clinical patellar tendinopathy. Defining "thickening of the patellar tendon" as thicker than 7.0 mm on both ultrasonography and MRI therefore has clinical significance.
Objective: In this study, thermoelastic stress analysis was conducted to clarify the surface stress distribution of a femur in which a BiCONTACT E stem was inserted. The contact sites between the stem and femur were examined to investigate the association with the range of stress distribution. Materials and Methods: BiCONTACT E was set up using two synthetic femurs that mimic the morphology and mechanical properties of living bone. Preoperative planning was performed using three-dimensional imaging software. The synthetic bone was placed in a sample holder. After the stem was implanted into the synthetic bone, computed tomography imaging was performed. The contact sites between the stem and the cortical part of the synthetic bone were examined using the imaging software. Subsequently, thermoelastic stress measurements were performed on the sample. Results: The results of thermoelastic stress analysis indicated a minimum change in the sum of principal stresses [Δ (σ1+σ2)] on the medial side and a maximum change in the sum of principal stresses on the lateral side. Thus, no minimum change was observed in the sum of the principal stresses at the maximum proximal part. It is reasonable to assume that the use of a cementless stem can inevitably lead to bone atrophy in the proximal part of the femur. The contact sites between the stem and femur were also investigated, and the results of the study clearly and quantitatively demonstrated the correlation of the contact sites with a range of stress distributions. Conclusion: The surface stress distribution of a femur, in which a BiCONTACT E stem was inserted, was clarified. The contact sites between the stem and femur were also investigated. Furthermore, the correlation between these results and clinical bone response was investigated in this study.
BACKGROUND: Leg length (LL) and offset (OS) are important factors in total hip arthroplasty (THA). Because most LL and OS callipers used in THA depend on fixed points on the pelvis and the femur, limb position could affect measurement error. This study was conducted on a THA simulator to clarify the effects of lower limb position and iliac pin position on LL and OS errors and to determine the permissible range of limb position for accurate LL and OS measurement. METHODS: An LL and OS measurement instrument was used. Two pin positions were tested: the iliac tubercle and the top of the iliac crest intersecting with the extension of the femoral axis. First, the limb was moved in one direction (flexion-extension, abduction-adduction, or internal-external rotation), and LL and OS were measured for each pin position. Next, the limb was moved in combinations of the three directions. Then, the permissible range of combined limb position, which resulted in LL and OS measurement error within ±2 mm, was determined for each pin position. RESULTS: Only 4° of abduction/adduction caused 5-7 mm error in LL and 2-4 mm error in OS, irrespective of pin position. The effects of flexion-extension and internal-external rotation on LL error were smaller for the top of the iliac crest than for the iliac tubercle, though OS error was similar for both pin positions. For LL, the permissible range of the combined limb position was wider for the top of the iliac crest than for the iliac tubercle. CONCLUSION: To minimize LL and OS measurement errors in THA, adduction-abduction must be maintained. The iliac pin position in the top of the iliac crest is preferred because it provides less LL measurement error and a wider permissible range of combined limb position for accurate LL measurement.
Arthroplasty, Replacement, Hip/methods , Bone Nails , Leg Bones/anatomy & histology , Lower Extremity , Pelvis , Arthroplasty, Replacement, Hip/adverse effects , Humans , Leg Length Inequality/etiology , Models, Anatomic
INTRODUCTION: We aimed to clarify childhood acetabular development and to identify the incidence of children's hip dysplasia in Japan using radiographs of the contralateral hip. METHODS: We performed radiological cross-sectional evaluation of hip development in 211 patients (106 boys, 211 hips) in different age groups (age range: 3-9 years). We excluded patients who complained of bilateral coxalgia at the first visit or had received a diagnosis of acetabular dysplasia. We measured the acetabular index (AI), center-edge angle (CEA), and acetabular head index (AHI) in plain radiographs taken at the first visit. RESULTS: A significant correlation was found between age and CEA in boys, but other parameters had no significant correlation. The mean AI values in boys and girls were 18 ± 3° and 20 ± 4° (p < 0.01), respectively, and the mean CEA values were 25 ± 5° and 24 ± 5° (p = 0.43), respectively. The mean AHI values in boys and girls were 83 ± 6% and 81 ± 7%, respectively (p < 0.01). Two of the 120 children (66 boys and 54 girls) aged ≥6 years old had a hip CEA < 15°; both were girls. CONCLUSIONS: We found decreased acetabular development in girls, and 4% (2/54) of girls without any history of dislocation belonged to Severin's group III. Acetabular dysplasia was observed more frequently in children from Japanese than in those from other countries. Girls with less than two standard deviations in hip dysplasia indices had an AI of 28°, an AHI of 67%, and a CEA of 14°. These reference values may be useful as prognostic indicators for hip dysplasia and OA in adulthood.
Stress fractures following total hip arthroplasty in the lower limbs away from the surgical area are very rare. We report a case of stress fracture in the isolated distal fibula that presented five months after total hip arthroplasty in a patient with developmental dysplasia of the hip. A 67-year-old woman diagnosed with coxarthrosis of the right hip joint, classified as Crowe's group 3, underwent total hip arthroplasty with acetabular reconstruction using a bulk bone graft. The surgery successfully treated the preoperative leg length discrepancy and flexion and external rotation contractures. The alignment of the right lower limbs changed from slight varus to valgus knee following surgery. The postoperative process went well; however, she experienced lateral ankle pain on the affected side five months after surgery. No obvious fracture was observed via radiograph; however, she received a subsequent diagnosis of isolated distal fibula stress fracture. Additionally, she was diagnosed with vitamin D deficiency. Valgus alignment change of the knee joint and vitamin D deficiency were considered the main causes of the stress fracture. Stress fractures should be suspected in patients complaining of unexpected pain following total hip arthroplasty, even in distant areas of the affected limb, especially in osteoporotic patients.
PURPOSE: In developmental dysplasia of the hip (DDH), the centers of hip rotation move in the superior and lateral direction. In total hip arthroplasty for such cases, movement of the center of hip rotation is in the inferior and medial direction. It causes an increase in leg length and a decrease in acetabular offset. We therefore evaluated the change of hip offset and leg length before and after surgery with two stems having a high offset option. PATIENTS AND METHODS: The preoperative diagnosis was secondary osteoarthritis due to DDH excluded Crowe IV. A stem selection was decided based on preoperative two-dimensional templating. Total 55 hips in 50 patients were followed up for minimum 10 years. Pre- and postoperative clinical evaluations were performed using a hip joint function scoring system. Radiographic evaluations were used for offset and leg length measurements and other associated factors. RESULTS: Both stems showed excellent clinical results. A high offset option was used in 60% of all cases. No postoperative dislocations were observed. The biological fixation was stable in all cases. The hip offset was restored without excessive leg lengthening in most cases. CONCLUSION: Anatomical consistency could be maintained by using a stem which matched geometry of the proximal part and had offset option. These cementless tapered stems having a high offset option are suitable for Crowe I to III hip dysplasia if two-dimensional X-ray templates fit the shape of the proximal femurs. They were associated with excellent clinical results and biological fixation. The offset option may be useful to adjust leg length and offset in DDH patients.
Arthroplasty, Replacement, Hip , Developmental Dysplasia of the Hip/surgery , Hip Prosthesis , Leg Length Inequality/prevention & control , Osteoarthritis, Hip/surgery , Adult , Aged , Aged, 80 and over , Developmental Dysplasia of the Hip/complications , Female , Humans , Leg Length Inequality/etiology , Male , Middle Aged , Osteoarthritis, Hip/etiology , Prosthesis Design , Radiography , Retrospective Studies , Time Factors , Treatment Outcome
