The relationship between spino-pelvic-hip mobility and quality of life before and after total hip arthroplasty.

INTRODUCTION: Total hip arthroplasty (THA) can significantly improve quality of life (QOL) in patients with hip osteoarthritis. A relationship exists between activity levels and postoperative QOL, but its determinants are not well known. The aim of this work was to investigate the relationship between hip, pelvis and lumbar spine mobility and alignment before and after THA with QOL. MATERIAL AND METHODS: Consecutive patients with hip arthrosis and an indication for THA were included prospectively between July 2019 and December 2020, and they underwent lateral radiographs in free-standing, extension, relaxed- and flexed-seated position. Spinopelvic and hip parameters were measured, as well as their changes between positions to assess hip, pelvis and lumbar spine mobility. Patients were also administered QOL questionnaires. Data were collected preoperatively and 6 and 12 months postoperatively. RESULTS: Seventy patients were included; QOL significantly increased 6 months after THA (from 18 [10; 27] to 61 [48; 72], p < 0.001). QOL further increased by 10 points or more after 6 months in 18% of patients, while it decreased in 16%. The latter showed higher pelvic range of motion (between flexion and extension) than the former. CONCLUSIONS: This study confirmed that QOL is significantly improved by THA, and that spinopelvic alignment and function can play a role. Future work should elucidate how to better predict postoperative QOL from preoperative patient characteristics to improve patient treatment and establish early postoperative physical therapy for patients who could benefit from postoperative improvement of activity-related QOL.

Differences among the observers in the assessments of Japanese orthopedic association hip scores between surgeons and physical therapists and the correlations to patients' reported outcomes after total hip arthroplasty.

BACKGROUND: We aimed to assess the utility of a clinician-reported outcome (the Japanese Orthopedic Association [JOA] hip score) as evaluated by clinicians and physiotherapists. This assessment was made by comparing these scores to those of the JOA hip disease evaluation questionnaire (JHEQ), which is a measurement of patient-reported outcomes after total hip arthroplasty. METHODS: In this retrospective case-control study, 52 hips that underwent primary total hip arthroplasty were included in the analyses. The mean age of the participants was 66.8 years (sex, seven male and 45 female participants). The JOA hip score included four categories: pain, range of motion, ability to walk, and active daily living. The JHEQ included three categories: pain, movement, and mental health. These scores were evaluated preoperatively and postoperatively by clinicians or physiotherapists. Pearson's correlation coefficients were utilized to analyze the association of the JOA hip scores to those of the JHEQ. RESULTS: The JOA hip scores were determined by clinicians and physiotherapists (scores of 46.8 and 57.3, respectively) preoperatively and at 24 months (scores of 94.4 and 91.7, respectively) postoperatively. The JHEQ points were 28.8 and 66.2 preoperatively and at 24 months postoperatively, respectively. The correlation coefficients between the JOA hip and JHEQ scores were .66 and .69 preoperatively and .57 and .76 at 24 months postoperatively, as evaluated by clinicians and physiotherapists, respectively. CONCLUSIONS: Although the JHEQ scores were positively correlated to the JOA hip scores by clinicians and physiotherapists preoperatively and postoperatively, this study implies that clinicians may interpret the results in a way that might have been beneficial to them. To comprehend a patients' health status, we should inclusively understand the varying range of information among different evaluators.

Influence of the contralateral hip state after total hip arthroplasty on patient-reported outcomes measured with the Forgotten Joint Score-12.

PURPOSE: The purpose of this study was to examine the influence of the contralateral hip state on postoperative assessment using the Forgotten Joint Score-12 (FJS-12) in comparison with the McMaster Universities Osteoarthritis Index (WOMAC) and the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ). METHODS: One hundred and thirty-four hips underwent total hip arthroplasty (THA) between 2014 and 2015. Of these, the subjects were 106 hips with degenerative hip arthrosis as a primary disease for whom initial THA was performed on the affected side. The WOMAC and JHEQ were investigated before surgery and 1 month, 6 months, and 1 year after surgery. The FJS-12 was examined 1 month, 6 months, and 1 year after surgery. RESULTS: We divided the subjects into three groups based on the state of the contralateral hip, which was not surgically treated in this study: healthy (n = 43), THA (n = 31), and OA (n = 31) groups. One year after surgery, the mean FJS-12 scores in the healthy, THA, and OA groups were 69.1, 52.8, and 68.0 points, respectively. In the THA group, the score was significantly lower than in the healthy and OA group. There were no significant differences in WOMAC and JHEQ scores among the three groups. CONCLUSIONS: The FJS-12 score in the presence of an arthroplasty on the contralateral side was more markedly influenced by the contralateral hip state compared with that in the presence of contralateral painful OA. This result suggests that it is necessary to understand the characteristics of PROs and utilize them for post-THA assessment.

Validity of a tablet computer version of the Japanese Orthopaedic Association hip disease evaluation questionnaire: a pilot study.

The Japanese Orthopaedic Association hip disease evaluation questionnaire (JHEQ) was established as a new patient-reported outcome for patients with hip disease. We developed a JHEQ application beta version for tablet computers. The application has a slider system to input visual analogue scale (VAS) measurements. The purposes of this study were 1) to test whether the VAS that was acquired from this slider system was equal to the value recorded on paper and 2) to evaluate the validity and agreement of the JHEQ tablet version. A total of 57 patients were analyzed in the study (mean age, 60.2 years; range, 29-81 years). They received either the paper-and-pencil version (paper version) or the tablet computer version (tablet version). To evaluate the validity of the tablet version, we analyzed differences in the VAS and total scores between the paper version and tablet computer version. In addition, we calculated Cronbach's alpha, the intraclass correlation coefficient (ICC), and the Pearson's correlation coefficient (CC). The VAS scores in the tablet version were significantly lower than those in the paper version (22.3 ± 5.4 vs. 17.0 ± 4.5 and 28.1 ± 6.1 vs. 23.5 ± 5.3, respectively; all P < 0.05). Values of Cronbach's alpha, the ICC, and the CC among subscales ranged from 0.90 to 0.95. In conclusion, the total JHEQ score on the tablet computer beta version was in agreement with the score on the paper version. However, the VAS on the tablet version, which used a slider bar system, proved unreliable.

Lateral femoral cutaneous nerve injury with the direct anterior approach for total hip arthroplasty.

PURPOSE: Although injury of the lateral femoral cutaneous nerve (LFCN) is a known complication after total hip arthroplasty (THA) via the direct anterior approach (DAA), the impact of this complication on postoperative quality of life (QOL) is unclear. This study aims to investigate the incidence of LFCN injury after DAA for THA, and to determine the impact of LFCN injury on QOL and hip function. METHODS: We prospectively investigated 122 hips operated upon using the DAA regarding the incidence of LFCN injury using self-reported questionnaires, hip functional scores such as the Harris Hip Score (HHS) and the Japanese Orthopaedic Association (JOA) score, and patient-reported outcomes such as the Western Ontario and McMaster Universities Osteoarthritis Index, the Japanese Orthopaedic Association Hip disease Evaluation Questionnaire (JHEQ), and the Forgotten Joint Score-12 (FJS). RESULTS: LFCN injury was seen in 39 hips (31.9 %). In affected hips, the leading symptom was hypo-aesthesia (46.2 %), followed by tingling or jolt-like sensation (28.2 %). There was no difference in the HHS and JOA score between those with LFCN injury and those without. There was a significant difference in the FJS-12 between the two groups (50.9 ± 25.3 for hips with LFCN injury vs 64.3 ± 25.7 without, p = 0.01). There was a non-significant tendency for patients with LFCN injury to have a lower JHEQ than those without (63.6 ± 19.6 for hips with LFCN injury vs 70.8 ± 22.9 without, p = 0.13). CONCLUSIONS: The incidence of LFCN injury decreased QOL but not hip function after DAA for THA.

Validation study of the Forgotten Joint Score-12 as a universal patient-reported outcome measure.

PURPOSE: The Forgotten Joint Score-12 (FJS-12) is for patients to forget their artificial joint and is reportedly a useful patient-reported outcome tool for artificial joints. The purpose of this study was to determine whether the FJS-12 is as useful as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) or the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) in Japan. METHODS: All patients who visited our hospital's hip joint specialists following unilateral THA from August 2013 to July 2014 were evaluated. Medical staff members other than physicians administered three questionnaires. Items evaluated were (1) the reliability of the FJS-12 and (2) correlations between the FJS-12 and the total and subscale scores of the WOMAC or JHEQ. RESULTS: Of 130 patients, 22 were excluded. Cronbach's α coefficient was 0.97 for the FJS-12. The FJS-12 showed a significantly lower score than the WOMAC or JHEQ (p < 0.01). The FJS-12 was moderately correlated with the total WOMAC score (r = 0.522) and its subscale scores for "stiffness" (r = 0.401) and "function" (r = 0.539) and was weakly correlated with the score for "pain" (r = 0.289). The FJS-12 was favorably correlated with the total JHEQ score (r = 0.686) and its subscale scores (r = 0.530-0.643). CONCLUSION: The FJS-12 was correlated with and showed reliability similar to that of the JHEQ and WOMAC. The FJS-12, which is not affected by culture or lifestyle, may be useful in Japan.

Differences in peri-hip articular pain after total hip arthroplasty between taper wedge stem and fit-and-fill stem.

Background: Total hip arthroplasty (THA) for hip disorders helps to alleviate pain and improve active daily life. When determining the effects of medical therapy and the subsequent clinical results, patient quality of life (QOL) also needs to be assessed. Recently, patient-reported outcomes (PRO) have become important as evaluation criteria. This study aimed to evaluate patient QOL and various PRO between different types of cementless stems and to clarify the relationship between PRO and stem-cortical bone contact. Methods: The study comprised 138 consecutive patients undergoing cementless THA for hip osteoarthritis. We assessed three different types of PRO: the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ), patient's joint perception, and peri-hip articular joint pain (PHAP). We measured the state of contact between femur and implant by density mapping. Results: No significant difference was noted in PRO between stem types based on the JHEQ and patient's joint perception. PHAP occurred more frequently in the patients with a taper wedge stem versus a fit-and-fill stem. In both groups, distal contact was associated with PHAP but not with JHEQ results and patient's joint perception. Conclusion: The difference in PHAP between the two stem types groups was significant, with postoperative PHAP being higher with the taper wedge stem because of the more distal contact between the taper wedge stem and femur cortical bone.

Early postoperative relationship between patient-reported outcome measures and gait biomechanical factors after total hip arthroplasty.

BACKGROUND: Patient-reported outcome measures (PROMs) have recently been considered as indicating clinical outcomes after total hip arthroplasty (THA). Although various factors are reportedly associated with post-THA and PROMs, the relationship with gait parameters, which are objective assessment factors after THA, remains unclear. RESEARCH QUESTION: What is the relationship between PROMs and gait biomechanical factors four weeks after THA? METHODS: Forty-five patients (six men and 39 women) who underwent THA were included. Three-dimensional gait analysis was performed four weeks post-THA; joint angle, internal moment, and power of the lower extremity at the first and second peaks of the vertical component of the floor reaction force were assessed for the operated side. PROMs were evaluated using the Japanese Orthopedic Association Hip Disease Evaluation Questionnaire (JHEQ). The relationship between the JHEQ score and extracted gait parameters was analyzed using gender and gait speed as control factors. RESULTS: For the JHEQ sub-domain, movement was positively correlated with the internal knee extension moment values at the first peak (r = 0.347). There was no significant correlation between JHEQ and the internal hip abduction moment value at the first peak. Mental status was negatively correlated with the hip flexion angle value at the second peak (r = -0.373), and positively correlated with the hip flexion moment value (r = 0.348). Total JHEQ scores and mental status were negatively correlated with the power of hip flexion value at the second peaks, respectively (r = -0.316, -0.444). SIGNIFICANCE: The results of this study may provide recovery guidelines to be used as an index for gait assessment in the early post-THA period. Further studies are needed to verify whether gait parameters can improve PROMs in the early post-THA period.

Grafting of autologous concentrated bone marrow processed using a point-of-care device for patients with osteonecrosis of the femoral head: A phase 1 feasibility and safety study.

Introduction: Along with the accumulating reports of autologous concentrated bone marrow (CBM) grafting for osteonecrosis of the femoral head (ONFH), the related medical device, a "point-of-care device" has also been recently developed. However, no study has confirmed the feasibility, safety, and efficiency of CBM grafting using a specific point-of-care device. Materials and methods: We designed this phase I, prospective clinical study to evaluate the feasibility and safety of autologous CBM grafting processed using a point-of-care device, the BioCUE system, in patients with ONFH. The primary outcomes were the safety and adverse event (AE), the secondary outcomes included pain score; hip function score; ONFH stage using X-ray; and the volume of the osteonecrotic area on 3T MRI. Besides, safety quality tests on the final product of concentrated bone marrow were performed. Results: Two patients (a 34-year-old man and a 33-year-old woman; three hips) with systemic lupus erythematosus were included. The incidence of AEs was 100% such as pain or transient fever after the operation, but all AEs were nonserious. No peri-operative complications were observed. Pain and hip function score remained unchanged from the preoperative to the postoperative observational periods. Safety quality test demonstrated were all negative or under the threshold. Conclusion: The feasibility and safety of grafting of concentrated autologous CBM in patients with ONFH using a point-of-care device were confirmed. A further clinical study aiming for the authorization of this procedure should be conducted in the future.

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.

Spontaneous healing of lateral femoral cutaneous nerve injury and improved quality of life after total hip arthroplasty via a direct anterior approach.

PURPOSE: How the symptomatology of lateral femoral cutaneous nerve (LFCN) injury changes after total hip arthroplasty (THA) via direct anterior approach (DAA) is not known. Our hypothesis was that the symptoms of LFCN injury after THA via DAA in longer follow-up periods would resolve spontaneously, leading to an improved quality of life (QOL). The aims of this study were to investigate how the symptom LFCN injury changed after DAA-THA, and how those changes affected QOL. METHODS: We investigated the incidence of LFCN injury after DAA-THA using self-reported questionnaires at two time points (initial survey: August 2014, present survey: August 2015). QOL was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index, the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire, and the Forgotten Joint Score-12 (FJS-12). Types (dysesthesia or hypesthesia) and changes of the symptom were surveyed. RESULTS: About 122 hips at average12.8 months postoperatively (initial survey), and of those, 89 hips at average 26.2 months postoperatively (present survey) were analyzed. The incidence of LFCN injury decreased significantly, from 31.9% to 11.2% ( p < 0.001). Spontaneous improvement of symptoms was seen in 96%. The difference of FJS-12 between patients with and without LFCN injury at the initial survey disappeared at the present survey. The dysesthesia group showed significant correlations between rate of improvement in LFCN injury and increase of QOL. CONCLUSION: Most symptoms of LFCN injury resolved spontaneously with longer follow-up periods. In particular, improvement of dysesthesia as a symptom of LFCN injury was associated with better QOL.

Clinical assessment after total hip arthroplasty using the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire.

AIMS: The aim of this study was to evaluate clinical outcomes using the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ). METHODS: 100 consecutive patients at 6 months after total hip arthroplasty (THA) were evaluated. RESULTS: The improvement rate for the pain subscale was significantly higher than that for the movement and mental subscales. Preoperative scores on the JHEQ movement and mental subscales were positively correlated to scores on the same subscales at 6 months after surgery. CONCLUSION: We conclude that the most predictable aspect of THA is pain relief and preoperative hip-joint ROM and mental status influence 6-month postoperative outcomes.