INTRODUCTION

Physical therapy(PT) is an integral component in the management of musculoskeletal conditions. On the other hand, there have been few reports exclusively dedicated to studying PT interventions on the same day of total hip arthroplasty(THA). In this study, we investigate the role of rehabilitation in the early postoperative period on length of stay (LOS), total medical cost, and physical recovery following total hip arthroplasty.

INTRODUCTION

In gap balancing technique, we decided the femoral component rotation according to the ligament balance in flexion. Component and limb alignment are important considerations during TKA. Three-dimensional positioning of TKA implants and exact mechanical axis has an effect on implant loosening, polyethylene stresses, and gait.

According to the recent report, the navigation system made it possible to achieve aligned implants more than conventional TKA. Hybrid Navigation technique which is our procedure is combination of navigation system and modified gap technique. In other words, exact mechanical axis is gained by navigation system, stable stability of knee joint is gained by modified gap technique.

Introduction

With the development of 3D printing technology, there are many different types of PSI in the world. The accuracy of patient specific instrumentation (PSI) in primary total knee arthroplasty (TKA) is dependent on appropriate placement of the cutting blocks. However, previous reports on one type of PSI measured the difference between postoperative prosthetic alignment and postoperative mechanical axis and thus these reports did not evaluate intraoperative comparison of PSIs between two different designs. The purpose of this study was to evaluate the intraoperative accuracy of two different designed PSIs (My knee, Medacta International, Castel San Pietro, Switzerland) with two examiners using CT free navigation system (Stryker, Mahwar, NJ, USA) in regards to sagittal and coronal alignment.

The purpose of this study is to evaluate accuracy of tibia cutting and tibia implantation in UKA which used navigation system for tibia cutting and tibia component implantation, and to evaluate clinical results.

We performed 72 UKAs using navigation system from November, 2012. This study of 72 knees included 56 females and 16 males with an average operation age of 74.2 years and an average body mass index (BMI) of 24.8 kg/m2. The diagnosis was osteoarthritis (OA) in 67 knees and osteonecrosis (ON) in 5 knees. The UKA (Oxford partial knee microplasty, Biomet, Warsaw, IN) was used all cases. We evaluated patients clinically using the Japanese orthopaedic association (JOA) score, range of motion (ROM), operation time, the amount of bleeding and complications. Patients were evaluated clinically at preoperation and final follow up in JOA score and ROM. As an radiologic examination, we evaluated preoperative and postoperative lower limb alignment in FTA (femoro-tibial angle) by weightbearing long leg antero-posterior alignment view X-rays. Also we evaluated a tibial component implantation angle by postoperative CT, and tibia cutting angle by intraoperative navigation system. We defined the tibial angle which a tibia functional axis and the tibia component made in coronal plane, also tibial posterior slope angle which a tibia axis and tibia component made in sagittal plane by CT. We measured tibial angle and tibial posterior slope angle by 3D template system.

We performed UKA in all cases mini-midvastus approach. At first we performed osteotomy of the proximal medial tibia using CT-Free navigation. At this procedure we performed osteotomy to do re-cut if check did cutting surface in navigation, and there was cutting error (>3°), and then to do check again in navigation. Next we did not use navigation and went the osteotomy of the distal femur with an IM rod and drill guide of microplasty system. And then we performed a trial and decided bearing gap and moved to cementing. At first we went cementing of the tibia component. At this procedure we went to drive implant again if check did implant surface in navigation, and there was implantation error(>3°), and to do check. We checked did tibia cutting, tibia implantation carefully in navigation. In addition, We sterilize a clips and use it came to be in this way possible for the check of the first osteotomy side exactly.

ROM was an average of 122.7° of preoperation became an average of 128.2° at final follow up, and JOA score was an average of 50.5 points of preoperation improved an average of 86.6 points at final follow up after UKA. An average of the operation time was 94 minutes, an average of the amount of bleeding was 137.7ml, and complications were one proximal type deep venous thrombosis (DVT) and one pin splinter joining pain by navigation, .Asetic loosening(tibial component) was one case, and this conversed the TKA.

In the radiologic evaluation, FTA was an average of 182.1° of preoperation corrected an average of 175.9°after UKA. In other words, an average of 6.2° were corrected by UKA. The tibia component implantation angle was an average of 90.18° in a measurement by the CT after UKA, intoraoperative tibia component implantation angle was an average of 90.32° in a measurement by the navigation system. These two differences did not accept the significant difference at an average of 1.33°.(P=0.5581). Similarly, the posterior slope angle were as follow; average of 5.65°by CT and average of 5.75°by navigation. These two differences did not accept the significant difference at an average of 1.33°. (P=0.6475)

Discussion: We performed UKA using navigation and evaluated the implantation accuracy for tibia osteotomy, tibia implantation. They were good alignment with an average of 90.18°, and outliers more than 3° were two cases(2.8%). It will be necessary to examine long-term progress including clinical results complications in future. We are performed UKA now in femur side using PSI(patient specific instruments) and tbia side using Navigation.

Instability following total hip arthroplasty (THA) is an unfortunately frequent and serious problem that requires thorough evaluation and preoperative planning before surgical intervention. Prevention through optimal index surgery is of great importance, as the management of an unstable THA is challenging even for an experienced joints surgeon. However, even after well-planned surgery, a significant incidence of recurrent instability still exists. Moreover leg-length discrepancy (LLD) after THA can pose a substantial problem for the orthopaedic surgeon. Such discrepancy has been associated with complications including nerve palsy, low back pain, and abnormal gait. Consequently we may use a big femoral head or increase femoral offset (FO) in unstable THA for avoiding LLD. However we do not know the relationship between FO and STT. The objective of this study is to assess hip instability of three different FOs in same patient undergoing THA during an operation.

We performed 70 patients who had undergone unilateral THA using CT based navigation system at a single institution for advanced osteoarthoritis from May 2013 to May 2014. We used postero-lateral approach in all patients. After cup and stem implantation, we assessed soft tissue tensioning in THA during operation. Trial necks were categorized into one of three groups: standard femoral offset (sFO), high femoral offset (hFO, +4mm compared to sFO) and extensive high femoral offset (ehFO, +8 mm compared to sFO). We measured distance of lift-off about each of three femoral necks using CT based navigation system and a force gauge with hip flexed at 0 degrees and 30 degrees under a traction of lower extremity. Traction force was 40% of body weight.

Forty patients had leg length restored to within +/− 3mm of the contralateral side by post-operative CT analysis. We examined these patients. Traction force was 214±41.1Nm. The distances of lift-off were 8.8±4.5mm (sFO), 7.4±4.1mm (eFO), 5.1±3.9mm (ehFO) with 0 degrees hip flexion and neutral abduction(Abd) / adduction(Add) and neutral internal rotation(IR)/ external rotation(ER). The distance of lift-off were 11.5±5.9mm (sFO),10.5±5.5mm (eFO),9.1±5.9mm (ehFO) with 30 degrees hip flexion and neutral Abd / Add and neutral IR/ER. Significant difference was observed between 0 degrees hip flexion and 30 degrees hip flexion on each FO (p<0.05). On changing the distance of lift-off, hFO to ehFO (2.2±1.6mm)was more stable than sFO to hFO (1.4±1.7mm)with 0degrees hip flexion.(p<0.05). On the other hands, hFO to ehFO (1.4±1.6mm) was more stable than sFO to hFO (1.0±1.3mm) with 30 degrees hip flexion. However, we did not find significant difference (p=0.18).

Hip instability was found at 30 degrees hip flexion more than at 0 degrees hip flexion. We found that changing ehFO to sFO can lead to more stability improvement of soft tissue tensioning than sFO to eFO, especially at 0 degrees hip flexion. Whereas In a few cases, the distance of lift-off did not change with increasing femoral offset by 4mm. When you need more stability in THA without LLD, We recommend increasing FO by 8mm.

INTRODUCTION

Soft-tissue balancing of the knee is fundamental to the success of total knee arthroplasty(TKA). Preparing rectangular extension and flexion joint gaps in the most important goal in TKA, because it facilitates functional stability of the knee. In gap balancing technique, we decided the femoral component rotation according to the ligament balance in flexion. Component and limb alignment are important considerations during TKA. Three-dimensional positioning of TKA implants and exact mechanical axis has an effect on implant loosening, polyethylene stresses, and gait. According to the recent reports, the navigation system made it possible to achieve aligned implants more than conventional TKA. Hybrid Navigation technique which is our procedure is combination of navigation system and modified gap technique. In other words, exact mechanical axis is gained by navigation system, stable stability of knee joint is gained by modified gap technique.

Purpose

Instability following total hip arthroplasty (THA) is an unfortunately frequent and serious problem that requires through evaluation and preoperative planning before surgical intervention. Prevention through optimal index surgery is of great importance, as the management of an unstable THA is challenging even for an experienced joints surgeon. However, even after well-planned surgery, a significant incidence of recurrent instability still exists. As you know Sir John Charnley is one of the first orthopaedic surgeons to address the issue of soft-tissue tensioning (STT) in the THA. Moreover leg-length discrepancy (LLD) after THA can pose a substantial problem for the orthopaedic surgeon. Such discrepancy has been associated with complications including nerve palsy, low back pain, and abnormal gait. The objective of this study is to assess hip instability of three different FOs in same patient undergoing THA during an operation.

The alumina on alumina articulation in THA has induced less macrophage reaction and cytokine section than polyethylene bearings. Thus THA using alumina on almina articulation has induced little periprosthetic osteolysis. However alumina fracture is still a concern.

We had underwent 100 THAs that it was a cemented polyethylene backed acetabular component with an alumina inlay(ABS Cup; Kyocera, Kyoto, Japan), PHS stem(Kyocera) and 28mm alumina femoral head. This system was formerly used in only Japan, over 10 years results have not reported yet.

We retrospectively reviewed 94 patients(100 hips) with cemented alumina on alumina THAs to identify factors relating to alumina failure, and to evaluate mid-term(>10years) results. 16 patients died from unrelated causes within 10 years of the operation and 14 patients was lost to follow up. The remaining 70 patients(79 Hips) were evaluated after a mean follow-up of 10 years.

We performed clinical evaluation using the JOA score, and radiological evaluation was performed that inclination and anteversion angle of cup measurement with 2D template system at anteroposterior radiograph. On the radiographs at the final examination, radiolucency and osteolysis were evaluated around the acetabular component, and around the femoral component. These evaluations were scheduled for 3,6,9, and 12 months and yearly thereafter. All the operations were performed by same surgeon, at same center. Cumulative survival rates were calculated using the Kaplan-Meier method with failure defined as the end point of revision for alumina failure or for any reason. To compare groups with and without alumina failures in age, BMI, gender, activity, function, abduction angle, size of component, or existence of radiolucent lines, we used the nonparametric Mann-Whitney U-test.

The mean age of the patients at surgery was 63.0 years. The mean follow up term was 13.8 years. Inclination and anteversion mean angle of cup were 45.6°and 14.2°.ã��Revision surgery was performed because of alumina inlay failure in 4hips(2 fractures and 2 dissociation;5.1%), loosening in 2 hips(2 cup loosenings; 2.5%) recurrent dislocation in 1 hip, and femoral fracture in 1 hip, no deep infection and DVT.

The 10-year survival rate was 92.4% with revision for any reason and 95.9% with revision for alumina failure as the end point. We detected 3 ceramic failures at a mean of 8.9 years(4.1ï¼ï¿½12.5) after the index operation.

There were no differences in BMI, function, cup angles(inclination and anteversion), and cup loosening among the 4hips with alumina failure. But there were differences in age, gender, and activity with alumina failure.

This alumina on alumina THA yielded passably mid-term results, but it was occurred a high rate of catastrophic alumina inlay failure. In July 2000, we discontinued use of this type of THA to avoid alumina failure. This ABS cup was banned in 2002, because of numerous alumina failures. We suggest all patients with this type of acetabular component be followed carefully.

Cemented polyethylene-backed alumina-on-alumina THA with a composite of alumina inlay had a relatively high rate of catastrophic alumina inlay failure(5.1ï¼ï¿½) during a mean of 13.8 years' follow up. There were differences in age, gender, and activity with alumina failure.

Objectives

There are few reports on total hip arthroplasty (THA) for hip osteoarthritis associated with so-called Perthes-like change including high great trochanter, short neck hip or flattened femoral head (hereinafter called “Perthes-like change”) as the operative procedures are difficult. We studied THA for “Perthes-like change” carried out in our department.