The global rapid growth of the aging population has some likelihood to create a serious crisis on health-care and economy at an unprecedented pace. To extend Healthy Life Expectancy (HALE) in a number of countries, it is desired more than ever to investigate characteristic and prognosis of numerous diseases. This enlightenment and recent studies on patient-reported outcome measures (PROMs) will drive the increasing interest in the quality of life among the world. The demand for primary THAs by 2030 would rise up to 174% in USA. It is expected that the number of the elderly will surge significantly in the future, thus more septuagenarian and octogenarian are undergoing THA. Moreover, HALE of Japanese female near the age of 75 years, followed to Singapore, is still increasing. Therefore, concerns exist about the PROMs of performing THA in this age-group worldwide. Nevertheless almost the well-established procedure, little agreement has been reached to the elderly. We aimed to clarify the mid-term PROMs after THA over 75-year old. Between 2005 and 2013, we performed 720 consecutive primary cemented THAs through a direct lateral approach. Of these, 503 female patients (655 hips) underwent THA for treatment of osteoarthritis, with a minimum follow-up of 5 years, were retrospectively enrolled into the study. We excluded 191 patients (252 hips) aged less than 65-year at the time of surgery and 58 patients (60) because of post-traumatic arthritis or previous surgery (37), or lack of data (23). Thus, 343 hips remained eligible for our study, contributed by 254 patients. We investigated Quality-adjusted life year (QALY), EuroQol 5-Dimension 5-Level scale (EQ-5D) and the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ, which was a disease-specific and self-administered questionnaire, reflecting the specificity of the Japanese cultural lifestyle) in patients aged 75 years or older (154 hips, Group-E) compared with those aged 65 to 74 years (189 hips, Group-C) retrospectively. We evaluated the association between patients aged 75 years or older and the following potential risk factors, using logistic regression analysis: age, number of vertebral fractures (VFs), American Society of Anesthesiologists physical status (ASA-PS) and Charlson Comorbidity Index (CCI). A Introduction
Methods
Despite total knee arthroplasty (TKA) is a successful surgical procedure with end-stage knee osteoarthritis, approximately 20% of the patients who underwent primary TKA were still dissatisfied with the outcome. Thereby, numerous literatures have confirmed the relationship between soft tissue balancing and clinical result to improve this pressing issue. Recently, there has been an increased research interest in patient-reported outcome measures (PROMs) after TKA. However, there is little agreement on the association between soft tissue balancing and PROMs. Therefore, the purpose of this study was to determine whether intraoperative soft tissue balancing affected PROMs after primary TKA. We hypothesized that soft tissue balancing would be a predictive factor for postoperative PROMs at one-year post-surgery. The study included 20 knees treated for a varus osteoarthritic deformity using a cruciate-retaining TKA (Scorpio NRG) with a polyethylene insert thickness of 8 mm retrospectively. Following the osteotomy using the measured resection technique, the extension gap was measured with a femoral trial by using an electric tensor. This instrument could estimate the soft tissue balance applying continuous distraction force simultaneously from 0 to 40 lbf with an accuracy of the 0.1 lbf. We evaluated the association between a distraction force required for an extension gap of 8 mm, and the following potentially affected factors at one year postoperatively: knee flexion angle using a protractor with one degree increments; radiographic parameters of component alignment, namely the femoral and tibial component medial angle; and the Japanese Knee Osteoarthritis Measure (JKOM). This is a disease-specific and self-administered questionnaire, reflecting the specificity of the Japanese cultural lifestyle, consisting of 25 items scored from 0 to 100 points, with 100 points being worst.Purpose
Patients and Methods
Although the pre- or intraoperative flexion angle in TKA has been commonly considered as a predictor of the postoperative flexion angle, patients with well flexion intraoperatively cannot necessarily obtain deep flexion angle postoperatively. The reason why inconsistencies remains has been unsolved. The intraoperative compressive force between femoral and tibial components has the advantage of the sequential changes during knee motion. However, the relationship between the compressive force and the postoperative ROM has not yet been clarified. We aimed to evaluate the intraoperative femorotibial compressive force during passive knee motion, and determine the relationship between the compressive force and the postoperative flexion angle. A total of 11 knees in 10 patients who underwent primary cruciate-retaining (CR) TKA (The FINE Total Knee System; Teijin Nakashima Medical Co., Ltd., Okayama, Japan) for osteoarthritis were studied retrospectively, with a mean age of 76 years via a measured resection technique. We developed a customized measurement device mimicking the tibial component with this platform of six load sensors arranged in two rows (medial and lateral) by three tandem sets (anterior, center and posterior): anteromedial (AM), anterolateral (AL); centromedial (CM), centrolateral (CL); and posteromedial (PM), posterolateral compartment (PL) (Fig. 1). At the step of the implant trial, this device was placed on the tibia with compressive force recorded three times, while the knee was subsequently taken from 0° to full flexion manually in 15 seconds with the flexion angle of the knee recorded simultaneously by using an electric goniometer (Fig. 2). Eligibility were evaluated for ROM using a long-armed goniometer preoperatively and at 6 months postoperatively. A The mean compressive force at AM, AL, CM, CL, PM and PL was 0.7, 0.5, 1.3, 1.2, 3.4 and 2.6 kgf, with the peak force of 4.2, 2.5, 4.1, 2.5, 7.3 and 4.7 kgf, respectively. The mean pre- and postoperative extension and flexion angles were −11° and −6°; and 115° and 113°, respectively. There were no significant correlations between the mean force in any region of interest (AM to PL) and the postoperative flexion angle. The peak force in PM showed little correlation with the postoperative flexion angle ( The current results suggest the presence of less force on the lateral side in flexion. We speculate that lower compressive force at the lateral side is essential for deep flexion as it has been reported that the lateral structure has more laxity than the medial side during flexion in healthy knees. Measurement between the femoral and tibial compressive force can contribute an achievement of more flexion angle following CR-TKA.
