This study aimed to investigate the incidence of ≥ 5 mm asymmetry in lower and whole leg lengths (LLs) in patients with unilateral osteoarthritis (OA) secondary to developmental dysplasia of the hip (DDH-OA) and primary hip osteoarthritis (PHOA), and the relationship between lower and whole LL asymmetries and femoral length asymmetry. In total, 116 patients who underwent unilateral total hip arthroplasty were included in this study. Of these, 93 had DDH-OA and 23 had PHOA. Patients with DDH-OA were categorized into three groups: Crowe grade I, II/III, and IV. Anatomical femoral length, femoral length greater trochanter (GT), femoral length lesser trochanter (LT), tibial length, foot height, lower LL, and whole LL were evaluated using preoperative CT data of the whole leg in the supine position. Asymmetry was evaluated in the Crowe I, II/III, IV, and PHOA groups.Aims
Methods
Although the short stem concept in hip arthroplasty procedure shows acceptable clinical performance, we sometimes get unexplainable radiological findings. The aim of this retrospective study was to evaluate changes of radiological findings up to three years postoperatively, and to assess any potential contributing factors on such radiological change in a Japanese population. This is a retrospective radiological study conducted in Japan. Radiological assessment was done in accordance with predetermined radiological review protocol. A total of 241 hips were included in the study and 118 hips (49.0%) revealed radiological change from immediately after surgery to one year postoperatively; these 118 hips were eligible for further analyses. Each investigator screened whether either radiolucent lines (RLLs), cortical hypertrophy (CH), or atrophy (AT) appeared or not on the one-year radiograph. Further, three-year radiographs of eligible cases were reviewed to determine changes such as, disappeared (D), improved (I), stable (S), and progression (P). Additionally, bone condensation (BC) was assessed on the three-year radiograph.Aims
Methods
A higher prevalence of cam morphology has been reported in the athletic population but the development of the cam morphology is not fully understood. The purpose of this systematic review is to establish the timing of development of the cam morphology in athletes, the proximal femoral morphologies associated with its development, and other associated factors. Embase, MEDLINE and the Cochrane Library were searched for articles related to development of the cam morphology, and PRISMA guidelines were followed. Data was pooled using random effects meta-analysis. Study quality was assessed using the Downs and Black criteria and evidence quality using the GRADE framework.Abstract
Objective
Methods
The purpose of this study was to report functional outcome scores following arthroscopic acetabular chondral procedures using the U.K. Non-Arthroplasty Hip Registry (NAHR). Data on adult patients who underwent hip arthroscopy between January 2012 and December 2018 was extracted from the NAHR. Patients who underwent femoral sided chondral procedures were excluded. Patients who underwent osteophyte excision or a concurrent extra-articular procedure were also excluded. Cases were then classified according to the acetabular chondral procedure performed – ‘chondroplasty’, ‘microfracture’ or ‘none’ (no chondral procedure recorded). Outcomes comprised EuroQol-5 Dimensions (EQ-5D) index and the International Hip Outcome Tool 12 (iHOT-12), preoperatively and at 6 and 12 months.Background
Methods
The aim of this study was to use registry data to report and compare early patient outcomes following arthroscopic repair or debridement of the acetabular labrum. Data on adult patients who underwent arthroscopic labral debridement or repair between January 2012 and March 2019 was extracted from the UK Non-Arthroplasty Hip Registry dataset. Patients who underwent microfracture, osteophyte excision or a concurrent extra-articular procedure were excluded. Outcomes comprised EuroQol-5 Dimensions (EQ-5D) index and the International Hip Outcome Tool 12 (iHOT-12), preoperatively and at 6 and 12 months.Objectives
Methods
This study aimed to investigate the effect of body mass index (BMI) on functional outcome following hip preservation surgery using the U.K. Non-Arthroplasty Hip Registry (NAHR). Data on adult patients who underwent hip arthroscopy or periacetabular osteotomy (PAO) between January 2012 and December 2018 was extracted from the UK Non-Arthroplasty Hip Registry dataset allowing a minimum of 12 months follow-up. Data is collected via an online clinician and patient portal. Outcomes comprised EuroQol-5 Dimensions (EQ-5D) index and the International Hip Outcome Tool 12 (iHOT-12), preoperatively and at 6 and 12 monthsBackground
Methods
Slipped capital femoral epiphysis (SCFE) creates a complex deformity of the hip that can result in cam type of femoroacetabular impingement (FAI), which may in turn lead to the early development of osteoarthritis of the hip. The purpose of this study was to evaluate the existing literature reporting on the efficacy of hip arthroscopic treatment of patients with FAI secondary to SCFE. A systematic computer search was conducted based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using Embase, PubMed (Medline), and Cochrane Library up to November 2019. Data such as patient demographics, surgical outcomes and complications that described arthroscopic surgery following FAI secondary to SCFE were retrieved from eligible studies. Two authors independently reviewed study inclusion and data extraction with independent verification.Background
Methods
In our institution, we started to perform THA with SuperPATH approach, including preservation of soft tissue around the hip (James Chow et al. Musculoskelet Med 2011) since July 2014, aiming for fast recovery and prevention of hip dislocation. For minimally-invasive approaches, however, there have been a few reports on malalignment of the implants related to shortage of operative field. The purpose of this study is to examine the short-term results of THA using SuperPATH, especially implant alignment. We performed a study of 45 patients (45 hips) with osteoarthritis of the hip joint who had a THA with SuperPATH approach. There were 8 men and 37 women with an average age of 73 years, which were minimally 24 months followed. Dynasty Bioform cup and Profemur Z stem (Microport Orthopaedics) were used for all cases. Patients were clinically assessed with Merle d'Aubigne score and complications. Implant alignment and stability were radiologically evaluated by annual X-ray and CT acquired two months after surgery.Introduction
Materials and methods
Many minimally-invasive approaches have been described in an effort to improve short-term results of total hip arthroplasty (THA), aiming for fast recovery and prevention of dislocation. In our institution, we started to perform THA with SuperPATH approach, including preservation of soft tissue around the hip (James Chow et al. Musculoskelet Med 2011) since July 2014. The purpose of this study is to examine the short-term results of THA using SuperPATH, especially treatment progress of rehabilitation. We performed a study of 30 patients (30 hips) with osteoarthritis of the hip joint who had a THA with SuperPATH approach. There were 4 men and 26 women with an average age of 71 years, which were followed up for 24 months. Patients were clinically assessed with Merle d'Aubigne score, postoperative hip pain during walking by Numerical Rating Scale (NRS:0–10), complications and treatment progress of rehabilitation in regard to moving and activities of daily living. Implant alignment and stability were radiologically evaluated by annual X-ray and CT acquired two months after surgery.Introduction
Materials and methods
Accuracy of implantation is a recognized prognostic factor for the long-term survival of TKA. The purpose of this study was to analyze the accuracy of component orientation and post-operative alignment of the leg following CT-based navigation-assisted TKA and to compare these parameters with those of a conventional surgical technique. We retrospectively compared the alignment of 130 total knee arthroplasties performed with a CT-based navigation system with that of 130 arthroplasties done with a conventional alignment guide system. The knee joints were evaluated using full-length weight-bearing antero-posterior and lateral radiographs.Background
Methods
In total knee arthroplasty (TKA), rotational alignment of the femoral component is determined by the measured resection technique, in which anatomical landmarks serve as determinants, or by the gap balancing technique, in which the femoral component is positioned relative to the resected aspect of the tibia. The latter technique is considered logically more favorable for obtaining rectangular extension and flexion gaps. However, in patients with severe changes attributed to osteoarthritis and/or a severely limited range of motion, it is difficult to perform adequate posterior clearance (e.g. bone spur excision) before resecting the posterior femoral condyle, often causing unbalanced extension and flexion gaps after resection. Thus, the gap balancing technique is more technically demanding and requires higher skill. We employed a computed tomography (CT)-based navigation system to develop a simple and standardized surgical technique by performing two assessments: Assessment 1, we investigated the relationship between the position of the femoral component determined by the gap balancing technique and anatomical landmarks; and Assessment 2, we placed the femoral component at the position determined by the measured resection technique and within the acceptable gap-balanced range determined in Assessment 1. In Assessment 1, 18 knees with osteoarthritis were treated by posterior stabilized TKA for varus deformity. The extension-flexion balance after resection of the distal femoral condyle and the proximal tibia was within 3° in all cases. Posterior bone resection was performed parallel to the resected aspect of the tibia and at 90° of flexion under constant compression applied using a tensor. In other words, the rotational alignment of the femoral component was determined by the gap balancing technique, and its position relative to the posterior condylar axis (PCA) and clinical transepicondylar axis (CEA), which are landmarks in the measured resection technique, and the condylar twist angle (CTA; the angle between the CEA and PCA) were measured, and their relationships were quantitatively determined. The CTA, which was determined based on the preoperative CT data, was 4.7– 9.6° (mean, 7.05 ± 1.35°), while the aspect of the femoral resection was 3.0–8.3° externally rotated (mean, 5.6 ± 1.6°) to the PCA; a strong positive correlation was found between the rotational alignment of the femoral component and the CTA (p < 0.0001, R2 = 0.871). The aspect of the femoral resection was 0.3–2.6° internally rotated (mean, 1.4 ± 0.6°) to the CEA, and no correlation with the CTA was apparent. In Assessment 2, 39 knees with an extension-flexion balance ≤3° were examined to determine the internal-external rotation balance. Based on the results of Assessment 1, we employed the measured resection technique and placed the femoral component by rotationally aligning the target, which was 1.4° internally rotated to the CEA. The final rotational alignment of the femoral component was 2.0 ± 0.6° internally rotated to the CEA; the internal-external rotation balance at 90° of flexion was good and more toward external rotation by 0.72 ± 1.61°. The results demonstrated that the measured resection technique enables placement of the femoral component within an acceptable range of rotational alignment.
Change of the pelvic tilt is an important factor affecting walking after total hip arthroplasty (THA). There are many reports of static evaluation of pelvic tilt by X-ray, however, there are few reports of dynamic evaluation during walking. In this study, we investigated change of pelvic tilt of THA subjects before and after operation during walking using an optical position sensor. 5 normal volunteers (mean age 26.6 years old, Control group) and 10 patients who underwent primary THA due to unilateral osteoarthritis of the hip (mean age 61 years old, THA group) were enrolled. We have measured angle of the hip and inclination of the pelvis in the mid-stance phase of the affected limb during walking using a motion analyzer (MAC3D system) and acquired physical assessment of the hip preoperatively, 3 weeks postoperatively and 3 months postoperatively. The acquired data of inclination of the pelvis was classified as Duchenne or Trendelenburg type compared with that of normal volunteers.Purpose
Subjects and Methods
Few clinical hip score include toe-reach motion after THA (put-on-socks, nail-cutting). Some reports have shown whether THA patients can put on socks or not in daily activity, and not shown how they can do it. The purpose of this study is to investigate real pattern of put-on-socks motion in daily activities after THA, and to evaluate safe range of motion for prevention of hip dislocation. Reviewing clinical chart, we investigated highly frequent pattern in wearing socks motion that would cause hip dislocation in ADL in 100 patients with normal lower extremities except for hip joint more than one year after THA, then, we classified the motion pattern. Using an optical 3-D motion analysis (MAC3D system, Motion Analysis, USA), we measured necessary angle of the hip in 10 THA subjects (mean age at operation 61 years old) one year postoperatively, while the patients make such frequent patterns of movement as above. Simultaneously, individual 3-dimensional skeletal model was reconstructed from CT data and implant CAD data. Driving 3-D skeletal model combined with motion analysis data on display (Zed Hip, LEXI), we calculated angle from posture that hip flexion angle was maximum during wearing-socks motion to impingement point (implant and/or bone) for each direction. ALL joint angle was defined as “zero” in supine position.Background:
Materials and Methods:
Atypical femoral fracture focused on relation of bisphosphonate use, frequently. However, the mechanism of atypical femoral fracture was not yet clarified. Atypical femoral fractures have been kept femoral shaft cortical thickness and BMD, practically. We hypothesized that atypical femoral fractures were associated with impaired bone quality and curvature of femoral shaft. We experienced four atypical femoral fractures. One was subtrochanteric and three were shaft fracture. Two cases received bisphosphonate therapy for 3–5 years. BMD, bone metabolic markers, and bone quality markers were evaluated. Histomorphometry and collagen cross-link analysis were performed. Curvature of femoral shaft and 3-D finite element analysis in one incomplete fracture case were assessed.Introduction
Materials & Methods
Few clinical hip score include toe-reach motion after THA (put-on-socks, shoe-ties, nail-cuttingãf»ãf»ãf») Some reports have shown whether THA patients can put on socks or not in daily activity, and not shown how they can do it. The purpose of this study is to investigate real pattern of put-on-socks motion in daily activities after THA, and to evaluate the characteristics of the motion quantitatively. 1st step Reviewing clinical chart, we investigated highly frequent pattern in wearing socks motion that would cause dislocation in ADL in 100 patients with normal lower extremities except for hip more than one year after THA, then, we classified the motion pattern. 2nd step: Using an optical 3-D motion analysis we measured necessary angles on trunk, hip, knee and ankle in 10 healthy volunteers and 20 THA subjects one month postoperatively, while the volunteers or THA subjects make such frequent patterns of movement based on the 1st step. ALL joint angle was defined as “zero” in static standing position. We also compared the angles in THA subjects with those of the volunteers. Motion analysis technology with optical sensors is; Track 30 infrared reflection sensors on subjects' body surface with infrared camera in the requested motions (MAC3D system, Motion Analysis, USA). Collect 3-D coordinates of 30 sensors' positions over time during subjects' motions. Calculate joint angle, driving 3-D installed skeletal model combined with motion data collected in 2) on display over time (SIMM, Musculographics).Background
Materials and Methods
We developed a new type of bioactive bone cement, CAP (Hydroxyapatite composite resin; composed of 77% w/w hydroxyapatite granules and bisphenol-A glycidyl methacrylate-based resin) for bony defect filling. Elastic modulus of CAP is similar to a cortical bone, while it is injectable before hardening and physiologically bonding with bone in 4 to 8 weeks. We present a new method of treatment for unstable Colles’ fracture with this material in clinical use. Experimental comminuted Colles’ fracture was produced in three fresh frozen cadavara. Fracture was reduced and fixed percutaneously with K-wires. 4.5mm drill hole was opened on the radial cortex 3cm proximal to the fracture site. Comminuted fragments were pushed-up to the subchondral area with a blunt rod and CAP was injected through the same way. After cement hardening, K-wires were removed. X-ray photos were examined before fracture, after fracture and after reconstruction with CAP, in order to evaluate the shape of the radius. CT was examined to evaluate the placement of CAP. Radiographic parameters of radii were well recovered after reconstruction with CAP. Over correction of the radial length was observed in one bone but good reduction was generally achieved (Table). This means realignment of the distal radioulnar joint, which results in good outcome clinically. In transverse section of CT, 41 to 69% (average 55%) of subchondral area was filled with CAP. Filling of CAP was better in an osteoporotic bone. These results show the usefulness of this material for treatment of unstable Colles’ fracture especially in osteoporotic patients.
