Associations of Lower-Limb Phase Angle with Locomotion and Motor Function in Japanese Community-Dwelling Older Adults.

Whole-body phase angle (PhA) is associated with motor function and geriatric diseases. However, it was unclear which parts of the upper- or lower-limb PhA were involved. This study investigated the differences in the PhA of the upper and lower extremities and their relationships with frailty, locomotive syndrome indices, and motor function in community-dwelling older adult participants. This study was a cross-sectional observational study. In 69 community-dwelling older adults, the PhA at each measurement site (whole body, upper limbs, and lower limbs), motor function, Kihon Checklist (KCL), and 25-Geriatric Locomotive Function Scale (GLFS-25) were measured. This study examined differences in each PhA and its relationship with motor function and geriatric diseases. Multiple regression analysis was performed using GLFS-25 as the dependent variable and sex and lower-limb PhA as independent variables. In this cohort (mean age: 72.3 ± 5.7 years; 18 males and 51 females), lower-limb PhA was significantly lower than upper-limb PhA. Unlike other PhAs, lower-limb PhA was related to grip strength, TUG, F/w, and GLFS-25. Multiple regression analysis showed that the lower-limb PhA was independently related to GLFS-25. Cellular health of the lower extremity is associated with gait, standing function, and indicators of locomotive syndrome.

Relationship between the Hip Abductor Muscles and Abduction Strength in Patients with Hip Osteoarthritis.

This study aimed to determine which muscle the gluteus maximus, gluteus medius, gluteus minimus (Gmin), or tensor fasciae latae (TFL) contributes most to hip abduction strength and to identify effective sites for cross-sectional area (CSA) Gmin and TFL measurement in hip osteoarthritis (OAhip) patients. Twenty-eight patients with OAhip were included. The muscle CSA and volume were determined using magnetic resonance imaging. Peak isometric strength was determined using hand-held dynamometry. Muscle volumes were normalized to the total muscle volume of hip abductors. Multiple regression analysis was performed. The difference between the CSA of Gmin and TFL was calculated, and correlations with volume and muscle strength were determined. Gmin volume was related to abductor muscle strength (p=0.042). The peak CSA of the Gmin correlated with muscle volume and strength. The CSA of the TFL correlated with volume, with no difference between the CSA of the most protruding part of the lesser trochanter and peak CSA. Gmin volume was strongly related to abductor muscle strength. Peak CSA is a useful parameter for assessing the CSA of the Gmin among patients with OAhip. The CSA of the TFL should be measured at the most protruding part of the lesser trochanter.

Analysis of Phase Angle and Balance and Gait Functions in Pre-Frail Individuals: A Cross-Sectional Observational Study.

We measured the muscle mass and phase angle of each body part to evaluate the relationship between balance and gait functions in individuals with a pre-frailty status. This cross-sectional observational study determined the skeletal muscle mass-to-body weight ratio and phase angles of 21 control (robust) and 29 pre-frail subjects. Their Brief-Balance Evaluation Systems Test, Timed Up-and-Go (TUG) test, Life-Space Assessment, and Modified Fall Efficacy Scale scores plus the relationship between muscle mass, phase angle, and motor function were evaluated. In the pre-frailty group (three males, 26 females, aged 75.58±7.60 years), significant correlations were noted between the Brief-Balance Evaluation Systems Test score and lower-limb (r=0.614) and wholebody (r=0.557) phase angles, and between the TUG test score and lower-limb muscle mass-to-body weight ratio (r=-0.616), lower-limb phase angle (r=-0.616), and whole-body phase angle (r=-0.527). Evaluating the phase angle of the lower extremities of pre-frail patients and intervening accordingly may help clinicians maintain and improve these patients' balance and gait functions.

Appropriate sites for the measurement of the cross-sectional area of the gluteus maximus and the gluteus medius muscles in patients with hip osteoarthritis.

PURPOSE: To evaluate the relationship between the volume, cross-sectional area, and peak isometric muscle strength of the gluteus maximus and gluteus medius muscles in patients with hip osteoarthritis, and to use this information to identify effective sites for measurement of the cross-sectional area of these muscles. METHODS: Twenty-four patients with hip osteoarthritis were included. The muscle cross-sectional area and volume were calculated from magnetic resonance images. The cross-sectional area was calculated at three levels: the inferior point of the sacroiliac joint, just above the femoral head, and at the greatest muscle diameter. Peak isometric strength was assessed using hand-held dynamometry, using the extension and external rotation for the gluteus maximus and abduction and internal rotation for the gluteus medius. Measured outcomes were compared between the two muscles, and the association between muscle volume, cross-sectional area, and peak isometric muscle strength was evaluated using Pearson's correlation. RESULTS: Volume was correlated with the cross-sectional area in the gluteus maximus (r ≥ 0.707) and with the cross-sectional area (r ≥ 0.637) and peak isometric strength (r ≥ 0.477) in the gluteus medius. There was no difference between the cross-sectional area measured at the greatest muscle diameter and just above the femoral head (p = 0.503) for the gluteus maximus and at the inferior point of the sacroiliac joint (p = 0.651) for the gluteus medius. CONCLUSION: The cross-sectional area, when used to calculate the muscle volume, should be evaluated just above the femoral head for the gluteus maximus and at the inferior point of the sacroiliac joint for the gluteus medius.

Three-dimensional Evaluation of Abnormal Gait in Patients with Hip Osteoarthritis.

Indexes for objectively evaluating abnormal gait in hip osteoarthritis (OA) patients and determining effective interventions are unclear. We analyzed the abnormal gait of hip OA patients by focusing on movements of the trunk and pelvis to establish an effective evaluation index for each direction of motion. We studied 28 patients with secondary hip OA due to developmental dysplasia of the hip and 16 controls. The trunk and pelvic movements during gait were measured in the medial-lateral (x), vertical (y), and back-and-forth (z) directions by a triaxial angular accelerometer. Gait speed, steps, step length, muscle strength, range of motion, and timed up-and-go (TUG) test performance were measured. We determined the correlations between physical function and the index of abnormal gait in the hip OA patients. Movements other than trunk and pelvic motions in the y-direction indicated abnormal gait in the patients. Significant correlations were found between abnormal gait and range of motions (extension, internal rotation), TUG score, stride length, and steps. The TUG test, stride length and steps were important for evaluating abnormal gait in hip OA patients. Individual interventions for each movement direction are required.

Investigation on the measurement sites of the cross-sectional areas of the gluteus maximus and gluteus medius.

PURPOSES: To verify the relationship between muscle volume and muscular strength of different cross-sectional areas (CSAs) of the gluteus maximus and medius, and to clarify the effective evaluation index. METHODS: Twenty healthy adults were enrolled in this cross-sectional study. Magnetic resonance images were evaluated, and CSAs of the gluteus maximus and medius were calculated. Calculation sites were the peak CSA, lowest end of the sacroiliac joint CSA, and just above the femoral head CSA. Muscle volume and muscular strength were measured. The correlation between muscular CSA, muscle volume, and muscular strength was verified using Pearson's correlation coefficient (p < 0.05). One-way analysis of variance and the Tukey-Kramer test were used to verify differences in each CSA (p < 0.05). RESULTS: A significantly positive correlation was found between muscular CSA, muscle volume, and muscular strength of both muscles (p < 0.05). For the gluteus maximus, the muscular CSA calculated just above the femoral head showed a significantly larger value than that calculated at the lowest end of the sacroiliac joint (p < 0.05). For the gluteus medius, the peak CSA and muscular CSA calculated at the lowest end of the sacroiliac joint were significantly larger than that calculated just above the femoral head (p < 0.05). CONCLUSIONS: The maximum CSA of the gluteus maximus was found just above the femoral head and that of the gluteus medius was near the lowest end of the sacroiliac joint; hence, CSAs should be calculated at these sites. The CSA reflected muscle volume and strength.

Three-dimensional Assessment of Femoral Head Coverage in Normal and Dysplastic Hips: A Novel Method.

The acetabular coverage of the femoral head has been assessed in two-dimensions as the projected covered area or the covered angle on plain radiographs. We present a novel method of the three-dimensional assessment of femoral head coverage obtained by evaluating the covered volume of the femoral head in both normal and dysplastic hips. We also assessed the covered angles on the vertical slices passing through the center of the femoral head. The mean covered volume of the femoral head was 57.4% in normal hips and 26.6% in dysplastic hips. In dysplastic hips, the L-CE, A-CE, and P-CE angles were 7.7°, 21.8°, and 95.8°, respectively, while the acetabular angle was 27.5°. In normal hips, the CE angles were 34.0°, 56.8°, and 109.4°, respectively, while the acetabular angle was 7.2°. Our study suggests the usefulness of a novel 3D assessment for acetabular coverage of the femoral head. This assessment provided the precise 3D information necessary to diagnose hip dysplasia and assess the deficiency of acetabular coverage in these patients. Moreover, we may detect a cut-off between normal and dysplastic hips in the 3D assessment by assessing a large number of dysplastic hips both morphologically and using the new assessment.

Effects of weekly and fortnightly therapeutic exercise on physical function and health-related quality of life in individuals with hip osteoarthritis.

BACKGROUND: Most previous studies on the effects of therapeutic exercise on osteoarthritis (OA) of the hip joint included participants with knee OA or postoperative participants. Moreover, although some systematic reviews recommend therapeutic exercise for hip OA, a consensus on the effective interventional frequency has not been reached. This study aimed to investigate the effects of therapeutic exercise performed at different frequencies on physical function and health-related quality of life in participants with hip OA. METHODS: Individuals diagnosed with hip OA (36 women, age 42-79 years; 19 in 2009 and 17 in 2010) were recruited from the cooperating medical institutions. They were divided into two groups depending on the frequency of therapeutic exercise: fortnightly in 2009 (fortnightly group) and weekly in 2010 (weekly group). Participants in each group performed the same land-based and aquatic exercises on the same day for a total of ten sessions. Muscle strength of the lower extremity, "timed up and go" (TUG), time of one-leg standing with open eyes (TOLS), Harris Hip Score, and scores of the Medical Outcomes Survey Short Form-36 questionnaire, were measured before and after interventions. RESULTS: The fortnightly group had no significant changes in lower-extremity muscle strength following intervention, but the strength of all muscles in the weekly group improved significantly after intervention. Further, in both groups, TUG and TOLS of the worse side of the hip joint significantly improved after interventions. CONCLUSIONS: Weekly exercise improves muscle strength of the lower extremity and may therefore be an effective interventional technique for managing hip OA. In addition, in persons with hip OA, therapeutic exercise consisting of both land- and water-based exercises markedly improved physical function.

Tranexamic acid for reduction of blood loss during total hip arthroplasty.

In this study, we evaluated the hemostatic effects of tranexamic acid (TNA), an antifibrinolytic drug, by examining the timing of its administration during total hip arthroplasty. One hundred seven patients being treated for osteoarthritis of the hip joint were randomly divided into 5 groups based on the timing of TNA administration. The intraoperative blood loss, postoperative blood loss, and hemoglobin of these patients who received TNA at different times during the procedure were monitored. We found that the intraoperative blood loss in the preoperative TNA administration groups was significantly lower than both control and postoperative TNA administration groups. Furthermore, 1 g TNA 10 minutes before surgery and 6 hours after the first administration was most effective for the reduction of blood loss during total hip arthroplasty.