Revision hip arthroplasty for excessive bone loss because of osteolysis or infection is difficult theme. Bone grafting is essential technique for bone loss and need of allograft is increasing. Recently, many hospital bone banks are established in Japan. The aim of this study is investigate efficacy and safety of allograft in our hospital bone bank. We evaluated management, result and complication of allografts retrieved from living donors in our institute.Background
Material and method
The patients with hip fracture have a general complication including heart disease. The heart echo is useful for the preoperative evaluation of cardiac function. The purpose of this study was to assess the relationship between echocardiographic findings and postoperative walking ability of patients with hip fracture.Introduction
Objectives
The cement mantle thickness for cemented stem during total hip arthroplasty (THA) is different between the complete cement mantle technique and the line-to-line technique. In the line-to-line technique, the size of the rasp is same as that of the stem. We performed THA in321 hipsof 289 patientsusing a new designed triple-tapered polished cemented stem. We investigated the short-term result of these 321 hips clinically and radiographically. From February 2002 to December 2012, 321 THAs were performed in 289 patients with the use oftriple-tapered polished cemented stem (Trilliance). Of these, 306 hips in 274 patients who were followed over 6 months, were evaluated. All THAs were undergone with direct anterior approach in supine position. The third generation cementing technique was standardized. The mean age at surgery was 65.3 years and the mean follow-up period was 24.6 months. Clinical results were evaluated by Japanese Orthopaedic Association (JOA) hip score. Intra-postoperative complications were investigated. Radiographic examinations were performed to investigate the findings of stem loosening, stress shielding, radiolucent line, osteolysis, stem subsidence, stem alignmentand cementing grade on plain radiograph.Introduction
Materials and Methods
The purpose of the present study was to describe the long-term results of THA for ONFH in patients with SLE. From 1994–2001, 18 cementless THAs (14 SLE patients) were included in the present study. Four hips (3 patients) were lost to follow-up. The remaining 14 hips (11 patients) were available for evaluation. The mean follow-up period was 13.1(range, 10.0–16.4) years. The follow-up rate was 77.8%. The mean age at the time of surgery was 35.2 (range, 27.4–51.0) years.Objectives
Methods
Nociceptive and neuropathic components both contribute to chronic pain. Since these components require different pain management strategies, correct pain diagnosis before and during treatment is important. Freynhagen et al. (2006) reported that they had developed and validated the pain-DETECT questionnaire (PD-Q) to detect neuropathic components in chronic low back pain patients. They also reported that 37% of unselected cohort of chronic LBP patients had predominantly neuropathic pain. However, the extent to which neuropathic components relate to the pathomechanism of pain deriving from osteoarthritis of hip joint remains unknown. The purpose of this study was to utilize PD-Q to investigate the relationship between neuropathic components and pain deriving from osteoarthritis of the hip joint. Between March and August 2010, 125 patients with osteoarthritis of hip joint completed PD-Qs about their pain. From this data set, we investigated whether or not the patients’ pain contained neuropathic components.Introduction
Methods
The purpose of this study was to clarify the incidence of steroid-induced osteonecrosis among different collagen diseases and to evaluate the predictive factors for steroid-induced osteonecrosis in a prospective MRI study. We prospectively used MRI to study 337 eligible collagen disease patients requiring corticosteroid therapy and succeeded in examining 1199 joints (hips and knees) in 302 patients with MRI for at least one year starting immediately after the onset of corticosteroid therapy, a one-year follow-up rate of approximately 90%. The underlying collagen diseases included systemic lupus erythematosus (SLE) in 687 joints and a variety of other collagen diseases in 512 joints.Introduction
Methods
The purpose of this study was to assess N-acetyl aspartate changes
in the thalamus in patients with osteoarthritis of the hip using
proton magnetic resonance spectroscopy. Nine patients with osteoarthritis of the hip (symptomatic group,
nine women; mean age 61.4 years (48 to 78)) and nine healthy volunteers
(control group, six men, three women; mean age 30.0 years (26 to
38)) underwent proton magnetic resonance spectroscopy to assess
the changes of N-acetyl aspartate in the thalamus. Objectives
Methods
In revision total hip arthroplasty (THA), it is essential to cope with the bone stock loss. The acetabular bone loss is reconstructed by bulk bone grafts, bone chips, bone cement or jumbo cup. The impaction bone-grafting (IBG) technique is a technique that can restore acetabular bone loss, while enough bone allografts are not easy to obtain and the quality is not always sufficient. Thus we mixed hydroxyapatite (HA) granules into bone chips to supplement the volume and the mechanical strength of allografts. To investigate the dynamic migration of cemented cup fixed with IBG, we made acetabular bone defect models and the migration of the cup was traced by a high-speed photography camera. Composite test blocks were used as synthetic acetabulum models. A hemisphere defect of 60mm in diameter was made. We tested 4 different bone/HA ratio; 100%/0%, 75%/25%, 50%/50% and 0%/100%. Each group consisted of 6 specimens. The grafted materials were impacted using impactors. Then, a 46 mm polyethylene cup was fixed with bone cement. The specimens were clamped to the MTS mechanical tester at an angle of 20 degrees. A dynamic load of 150 N to 1500 N with a frequency of 1 Hz was applied for 15 minutes, followed by a dynamic load of 300 N to 3000 N for the same time period. Then the load was released for 15 minutes. The cup migration was traced by the camera during loading and releasing. This camera captures 15 images per second thus it enables us to trace the migration of the cup during cyclic loading. The cup migration at the end of 3000N loading was measured. Elastic recoil was defined as the difference between the migration at the end of 3000N loading and that when the load reached to 0N. Visco-elastic recoil was defined as the difference between the migration at the release of loading and that after 15 minutes. Data were investigated by Pearson’s correlation coefficient test. A strong negative correlation (r = −0.71) was observed significantly between the amount of the migration and bone/HA ratio. In elastic recoil, statistically significant correlation was (r = −0.55) observed. In visco-elastic recoil, there is no correlation between the amounts of the visco-elastic recoil and bone/HA ratio. In the reconstruction of bone defects, initial stability of the cup is a first step to expect the long term survival. The initial stability depends on the mechanical properties of the grafted materials. To supplement the volume and mechanical strength of bone allografts, we added HA granules to the bone chips. In the current study, the cup migration was smaller by adding HA granules. Elastic recoil was affected, while visco-elastic recoil was not affected. These results indicated that the mixture of HA granules to bone chips stabilized the cup during loading period and load releasing period.
We usually plan surgery for total hip arthroplasty (THA)using pre-operative X-ray templates. However, the technique provides only two dimensional (2D) images and therefore has limitations for planning three-dimensional (3D) objects. Recently it has become possible to describe 3D images using computer programs that use free down loaded computer software (Hip-op) that enable comparison between 3D templates obtained by computed tomography (CT) and 2D conventional X-ray templates. Six hip joints in 6 patients (1 male, 5 females; age range at the time of operation, 49–77 years) were evaluated. Five of the patients suffered from secondary osteoarthritis of the hip (secondary OA), while the remaining patient suffered from osteonecrosis of the femoral head (ONFH). All the patients underwent THA using a cement less femoral stem (ANCA-FIT Wright Medical Technology, Arlington, Tennessee, USA). Pre-operative planning was performed using Hip-op software (Rizzoli Institute, Bologna, Italy). After the THA surgery, we carried out a repeat CT scan that was used to analyze stem fitting in the femur. In all the patients it proved easy to obtain the pre-operative template. In 4 patients, the correct stem size was selected pre-operatively, while in the other 2 patients, the planned stem size was one size smaller than that actually implanted. In the 4 patients in whom the correct stem was selected, 2 had their template correctly assessed by conventional 2D images, 1 patient’s template was one size smaller than the implant, while the remaining patient’s template was two sizes smaller than the implant. In the 2 patients who received implants one size smaller than the CT template, 1 patient had the stem inserted in the virus position while in the other patient a fracture occurred during implantation Preoperative planning for THA using a CT-based computer templating system proved to be a useful technique for the orthopedic surgeons.
