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Background: Restricted hip range of motion (ROM) has been proposed as a useful diagnostic tool for osteoarthritis. The relations between the intraoperative hip ROM under anesthesia in total hip arthroplasty (THA) and recovery of clinical mobility outcomes were unclear. This study evaluated the association between the intraoperative hip ROM under anesthesia in THA and the postoperative recovery of clinical mobility, including cutting toenails and putting on socks after THA.Methods: The study was performed as a prospective cohort study and included 93 hips in 85 patients who underwent primary anterior-based muscle-sparing THA in the supine position. The hip ROM was evaluated under anesthesia before skin incision and intraoperative stability test. The Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ) was evaluated. A questionnaire on whether and how patients could cut toenails and putting on socks was assessed. The relationship between hip ROM at intraoperative stability tests and JHEQ moving score, cutting toenails, and putting on socks scores were evaluated statistically.Results: We observed a week positive correlation between intraoperative hip ROM and the total of JHEQ mobility score. A moderate positive correlation was observed between external rotation angle with flexion 90°and cutting toenails and putting on socks score oh JHEQ. 94.6% and 96.8% of the patients could cut their toenails and putting on socks by themselves after surgery. The optimum cutoff range for high patient satisfaction for putting on socks and cutting toenails was 110° for flexion and 35°-40° for the external rotation angle in the intraoperative stability test.Conclusion: Hip ROM during intraoperative stability testing, especially the external rotation angle can predict postoperative outcomes and patient satisfaction for cutting toenails and putting on socks. We suggested that the capsule or capsular ligament release around the hip was increased to provide sufficient ROM without compromising stability. [ABSTRACT FROM AUTHOR]

Background: While periprosthetic fractures following total hip arthroplasty (THA) are a well-known phenomenon for orthopedic surgeons, fragility fractures following THA are also a significant, though less studied, concern. Furthermore, patients who have undergone THA have several additional risk factors for fragility fractures, including motor weakness, bone atrophy, and limping. The aims of this study were to evaluate the incidence of fragility fractures following THA and to clarify the characteristics of these fractures.Methods: This study included 5678 primary THA procedures in 4589 female patients. This study evaluated body morphology data, disease type leading to THA, Japanese Orthopaedic Association hip score, range of motion of the hip joint, and medical history. Distal radius and patella fractures were defined as fragility fractures. Risk factors for fragility fractures after THA were calculated by comparing the fragility fracture group with the non-fracture group.Results: Fifty-three fragility fractures were confirmed in 53 patients (distal radius fracture: 32 fractures in 32 patients, patella fracture: 21 fractures in 21 patients). In the univariate analysis, the following eight risk factors for fragility fractures were significantly different between the groups: height, weight, follow-up period, developmental dysplasia of the hip, primary osteoarthritis, abduction before THA, internal rotation before THA, and external rotation before THA. Medical histories were not significantly different between the groups. There was no difference in any study factor and in the time of occurrence between the radius fractures and patella fractures analyzed as fragility fractures.Conclusions: This study revealed that there are significant preoperative factors of fragility fractures following THA. These factors will serve as useful data for THA treatment strategies, preoperative explanations, and future studies. [ABSTRACT FROM AUTHOR]

Background: It remains unclear whether early surgical intervention can reduce mortality after surgery in hip fracture patients. The aim of this study was to investigate the association between time from injury to surgery and mortality rate within 90 days after hip fracture surgery.Methods: We retrospectively identified 1827 patients who underwent hip fracture surgery in a tertiary care center in Japan between April 2007 and March 2017. After applying exclusion criteria (patients with spontaneous fracture, multiple fractures, revision surgery, total hip arthroplasty, or a refusal to participate), 1734 patients were included. We extracted data concerning patients' age, race, sex, operative procedure, American Society of Anesthesiologists (ASA) score, days from injury to surgery (injury-surgery days), and days from admission to surgery (admission-surgery days), which could affect 90-day mortality after surgery. Variables associated with 90-day mortality were determined using multivariate logistic regression analysis.Results: The 90-day postoperative mortality rate was 3.5% (60 of 1734). Multivariable analysis showed that injury-surgery days were not associated with 90-day mortality (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.80 to 1.05; P = 0.19), and that older age (OR, 1.06; 95% CI, 1.02 to 1.10; P = 0.005), male sex (OR, 3.62; 95% CI, 1.86 to 7.03; P < 0.001) and high ASA score (OR, 2.10; 95% CI, 1.06 to 4.18; P = 0.034) significantly increased 90-day mortality. In addition, admission-surgery days were not associated with 90-day mortality (OR, 0.95; 95% CI, 0.83 to 1.09; P = 0.45).Conclusion: Our results demonstrated that time from injury to surgery was not associated with mortality within 90 days after surgery after adjusting for age, sex, operative procedure, and ASA score. [ABSTRACT FROM AUTHOR]

Background: In total hip arthroplasty (THA) surgery, hip muscle preservation is important in strengthening the stability of the hip and improving the activities of the patient. However, whether the type of femoral stem affects the recovery of the hip muscles remains unknown. The aim of this study was to compare the postoperative hip muscle recovery among femoral stem varieties after THA.Methods: The computed tomography (CT) images of 44 patients (44 hips) who underwent THA using an anterolateral approach were reviewed. Twenty-two patients received a fit-and-fill (FF) stem and 22 received the tapered-wedge (TW) stem. The volumes of the gluteus maximus (GMA), gluteus medius (GME), and obturator internus (OI) were measured on three-dimensional models reconstructed using preoperative and 6-month postoperative CT images. Relationships between muscle volume changes and factors including the femoral stem length were evaluated.Results: The GMA and GME volumes increased postoperatively by 8.2% and 8.3%, respectively, in the FF stem group and 7% and 6%, respectively, in the TW stem group, with no group differences. In contrast, the OI volume decreased postoperatively by 17.8% in the FF group and was preserved in TW group (p < 0.001). Moreover, OI volume was decreased in 19 patients (86%) in the FF group and in 11 patients (50%) in the TW group (p = 0.01). The normalized stem length was significantly associated with the postoperative change in OI volume (r = -0.45, p = 0.002).Conclusions: The TW stem showed a significant advantage over the FF stem in terms of OI preservation. Surgeons should pay close attention during surgery to avoid OI injury when using different femoral stem types. We suggest that a short and reduced lateral shoulder femoral stem is a better choice for the preservation of external rotation muscles. [ABSTRACT FROM AUTHOR]

Background: Total hip arthroplasty (THA) for sequelae of Legg-Calve-Perthes disease (LCPD) involves specific concerns for deformity, leg length discrepancy (LLD), and relatively young age. Excellent long-term outcome has been proven after Alumina-Alumina (Al-Al) THA for relatively young patients, however, there was no study for Al-Al THA for LCPD sequelae. The aim of this study is to evaluate the results of Al-Al THA for LCPD sequelae and to compare the results with those for adult-onset ONFH, in which THA is necessitated in relatively young age and excellent long term outcome has been proven after Al-Al THA.Methods: Between 1997 and 2007, 41 Al-Al THA were performed in 37 patients with LCPD sequelae and followed-up for mean 10.4 years. Mean age at THA was 43.6 years. Using the propensity score matching, 41 THAs in 37 patients were identified from 339 hips in 256 patients with ONFH. The medical record and radiographic data was retrospectively reviewed.Results: During follow-up, no revision was performed in both group. Harris Hip Score increased from 66.7 ± 17.4 points to 96.8 ± 6.8 points in LCPD group and from 47.9 ± 18.4 to 96.6 ± 4.6 in ONFH group. LLD decreased significantly from 2.0 ± 1.2 cm to 0.2 ± 0.9 cm in LCPD group and from 0.5 cm to 0.1 cm in ONFH group. Postoperative LLD showed no difference in both groups. As for complication, rate of intraoperative femoral fracture was significantly higher in LCPD group than in ONFH group. Other postoperative complication showed no difference.Conclusions: Despite the higher rate of intraoperative femoral crack, outcomes of Al-Al THA for LCPD were comparable to those for ONFH. Similar to ONFH, Al-Al THA may be a reliable treatment option for LCPD. [ABSTRACT FROM AUTHOR]

Background: Avascular necrosis of the femoral head (AVN) is the most serious complication after unstable slipped capital femoral epiphysis (SCFE), and is often unsalvageable. We report a minimum 10 years of clinical results for transtrochanteric rotational osteotomy of the femoral head (TRO) for AVN.Methods: This study included 7 patients (7 hips) with a mean age at surgery of 13.3 years, and the follow-up period was 15.8 years. All patients had prior treatment via closed reduction and pinning of the unstable SCFE, and showed severely collapsed femoral heads. The direction of rotation was anterior in 3 hips and posterior in 4. The Merle d'Aubigné-Postel score (MDPS) was used for clinical assessment, and joint degeneration was assessed with the Kellgren and Lawrence classification (KL-grade).Results: The spherical intact area of the femoral head was moved to the weight-bearing portion, and subluxation was corrected via rotation combined with intentional varus positioning. The mean MDPS improved from 10.3 points to 15.6 points at 5 years, and it was maintained at 15.0 points by 10 years; 3 hips were excellent, 1 was good, 2 were fair, and 1 showed poor outcomes. No patient experienced re-collapse after TRO or required conversion to hip replacement or arthrodesis. After 10 years, degenerative changes became evident over time, and 2 hips progressed to KL-4 with a decreased MDPS.Conclusions: Although some joint degeneration is inevitable in the long-term, TRO is an effective salvage procedure for treating AVN after unstable SCFE. [ABSTRACT FROM AUTHOR]

Background: Several diseases may lead to advanced hip disease and cause disabling symptoms in adolescents. In literature there is no consensus which is the optimal surgical treatment for young adults with end-stage osteoarthritis. The purpose of this study was to assess the clinical and radiological outcomes of uncemented total hip arthroplasty for the treatment of end-stage hip arthritis in patients younger than 20 years at a minimum follow-up of ten years.Methods: We have retrospectively evaluated 24 patients who were 20 years or younger and underwent uncemented total hip arthroplasty. Minimum follow-up was 10 years. Clinical outcome was measured using the Harris Hip Score, Western Ontario McMaster, and the Short-Form 36. Hip calcification was evaluated using Brooker classification, while osteolysis was examined at the final follow-up according to the subdivision of Gruen.Results: The mean preoperative Harris Hip Score was 36.94 points and improved to 92.3, and the mean preoperative WOMAC score improved from 84.72 to 28.45 The Mental Component score-SF-36 improved from a preoperative mean of 26.23 points to 58.96, while the Physical Component score-SF-36 improved from a preoperative mean of 26.38-49.95. All components were stable and osseo-integrated. Radiolucent lines were not present in any hips. We noted the presence of 4 calcifications. No patient needed implant revision. The only complication was an intraoperative femoral fracture.Conclusion: Total hip arthroplasty is a safe and reliable procedure for the treatment of end-stage arthritis in the young that provides good to excellent mid-term results. [ABSTRACT FROM AUTHOR]

Background: The Harris-Galante total hip arthroplasty (THA) is a first-generation cementless THA with a porous coating for biological fixation of the implant. Many studies report excellent long-term results for the acetabular cup, but few long-term studies exist for the femoral stem because of relatively poor short-term and midterm results. Here we present the 21- to 27-year results of the cup and the stem of the Harris-Galante THA.Methods: From 1985 to 1991, 102 Harris-Galante THAs were inserted in 82 patients. At the time of the THA, the mean patient age was 54 years (range, 20-78 years). The primary diagnosis was secondary osteoarthritis due to developmental hip dysplasia (69 [68%] hips). The Japanese Orthopaedic Association (JOA) hip score and thigh pain were measures of clinical outcome. Radiographic review was performed retrospectively. Implant survival was evaluated by Kaplan-Meier analysis.Results: Of 102 hips, 35 hips were from 31 deceased patients, 5 patients (6 hips) were lost to follow-up, 12 hips were revised, and 49 hips were from patients living at the latest follow-up. Among the living patients, 36 hips had a clinical evaluation and 42 hips had a radiograph obtained more than 21 years. The JOA hip score improved from 42 points preoperatively to 83.5 points at the latest follow-up. Thigh pain was reported in 13 hips. One cup and four stems were loose at the latest radiographic review. Most cup revisions were related to acetabular osteolysis. Fifteen hips showed severe stress shielding. Kaplan-Meier analysis of survivorship with any revision, acetabular reoperation, stem revision, and stem loosening as the end point was 87.0%, 90.3%, 95.7% and 86.4%, respectively, at 24.6 years.Conclusions: Long-term implant survival and clinical results of the Harris-Galante THA were good. Acetabular osteolysis-related cup loosening was a problem of the cup. Loosening, thigh pain, and stress shielding were problems of the stem. [ABSTRACT FROM AUTHOR]

Background: In non-Western countries including Japan, activities requiring deep flexion of the hip joint, such as seiza (kneeling with calves tucked under the thighs and buttocks resting on the heels) and using squat toilets are commonly practiced. The purpose of this study was to assess longitudinal changes in traditional health-related quality of life measures and measures of physical functions associated with lifestyle for Japanese patients pre-surgery and after total hip arthroplasty.Methods: Consecutive primary total hip arthroplasty patients between July 2003 and November 2006 were eligible. Patients were measured preoperatively and at 6 weeks, 1 year and 3 years postoperatively. Patients completed the EuroQol 5D, the Western Ontario and McMaster Universities Osteoarthritis Index and items related to Japanese lifestyle activities such as squatting. Changes in these scale scores across the four time points were tested, and we examined predictive factors of EuroQol 5D score at 3-year follow-up using multiple linear regression.Results: Of 1103 eligible patients, 576 completed questionnaires at all four time points. By 6 weeks post-surgery, reductions in pain and improvements in physical function and stiffness became highly significant, and improvements continued to 3 years postoperative. In contrast, improvements were far more limited for items related to Japanese lifestyle functions such as seiza and use of a Japanese squat toilet, even 3 years after surgery. Predictive factors of EQ5D at 3-year post THA were WOMAC pain and physical function, seiza, age and comorbidity measured at 3-year post THA.Conclusion: The rate of improvement in QOL requiring deep flexion of the hip joint was much slower than that in QOL related to Western lifestyle. Our study suggests a need for lifestyle modification for THA patients in the other countries where kneeling and squatting are commonly performed. [ABSTRACT FROM AUTHOR]

The advances in computer assistance technology have allowed detailed three-dimensional preoperative planning and simulation of preoperative plans. The use of a navigation system as an intraoperative assistance tool allows more accurate execution of the preoperative plan, compared to manual operation without assistance of the navigation system. In total hip arthroplasty using CT-based navigation, three-dimensional preoperative planning with computer software allows the surgeon to determine the optimal angle of implant placement at which implant impingement is unlikely to occur in the range of hip joint motion necessary for daily activities of living, and to determine the amount of three-dimensional correction for leg length and offset. With the use of computer navigation for intraoperative assistance, the preoperative plan can be precisely executed. In hip osteotomy using CT-based navigation, the navigation allows three-dimensional preoperative planning, intraoperative confirmation of osteotomy sites, safe performance of osteotomy even under poor visual conditions, and a reduction in exposure doses from intraoperative fluoroscopy. Positions of the tips of chisels can be displayed on the computer monitor during surgery in real time, and staff other than the operator can also be aware of the progress of surgery. Thus, computer navigation also has an educational value. On the other hand, its limitations include the need for placement of trackers, increased radiation exposure from preoperative CT scans, and prolonged operative time. Moreover, because the position of a bone fragment cannot be traced after osteotomy, methods to find its precise position after its movement need to be developed. Despite the need to develop methods for the postoperative evaluation of accuracy for osteotomy, further application and development of these systems are expected in the future. [ABSTRACT FROM AUTHOR]

Background: The muscle sparing total hip arthroplasty had generated a distinguishable interest, in both the patients and the surgeons, but its benefits are still often questioned. The main idea of this study was to compare the functional clinical outcome of the patients operated by the anterolateral approach with a muscle-sparing technique (modified Watson-Jones approach), and the patients operated by modified direct lateral approach without the muscle-sparing technique (Bauer/Hardinge approach).Methods: The patients (N = 130) were divided into two groups: 68 in a standard method group (STAND) and 62 patients in a muscle sparing surgery group (MSS). The hip flexibility, mobility, the strength of the hip abduction, the pain scale, Harris hip scores, the duration of the hospital stay and the overall satisfaction were measured seven days, three months, one year and three years (in 80 patients) after the surgery. There were no differences in any of the parameters between the groups prior to the procedure.Results: The statistically significant differences in first three follow-ups (up to one year) were determined between the groups in passive and active hip flexion ability but the hip abduction strength, which is a crucial parameter for functional recovery, and 50 m walk test remained better in MSS group even after three years. Patients, who underwent MSS suffered also less pain, stayed in hospital shorter and were more satisfied with the operation outcome.Conclusions: The functional recovery in patients treated with muscle sparing method was faster than in patients operated with conventional lateral approach. Based on the results, we could recommend anterolateral muscle sparing approach for a total hip replacement for its faster and fuller functional recovery. [ABSTRACT FROM AUTHOR]

The article presents case report of a patient who suffered pseudotumor and deep venous thrombosis due to crevice corrosion of the head-neck junction in metal-on-polyethylene total hip arthroplasty. It is stated that clinicians should be aware that adverse local tissue reactions (ALTRs) accompanied with inflammation can occur in a metal-onpolyethylene total hip arthroplasty (THA) due to corrosion of the head-neck junction.

Background: Despite the theoretical advantages of ceramic-on-metal (CoM) bearings observed in laboratory settings, limited clinical data are available to support in vitro results. Our present study prospectively investigated the clinical results, serum metal ion levels, inflammatory factor levels, and liver-kidney function in a cohort of patients who received total hip arthroplasty (THA) with CoM bearings. Methods: The cohort comprised 82 THAs in 71 patients (41 men and 30 women), with a mean age of 54 (range 22-77) years. The mean follow-up was four years. All patients completed pre- and postoperative clinical assessment using the Harris Hip Score, Short Form-12, Western Ontario and McMaster Universities Osteoarthritis Index, and radiographic analysis. The serum metal ion levels of cobalt, chromium, molybdenum, and titanium were measured using high-resolution inductively coupled plasma mass spectrometry, and were compared with normal reference values. Inflammatory factors including C-reactive protein, erythrocyte sedimentation, and interleukin-6 levels, and liver-kidney function including alanine aminotransferase, aspartate aminotransferase, total bilirubin, creatinine, and blood urea nitrogen, were measured in our hospital clinical key laboratory. Results: At the end of the follow-up period, all clinical assessments showed a statistically significant improvement. Although the inflammatory factor levels and liver-kidney function were within normal ranges, the serum levels of metal ion were significantly elevated compared with normal values: cobalt, 2.8 μg/L; chromium, 2.2 μg/L; molybdenum, 0.9 μg/L; and titanium, 2.1 μg/L. Spearman's correlation analysis showed an association between cobalt, chromium, and titanium metal ion levels and BMI values. Conclusions: Our study demonstrated that the use of a CoM THA was clinically effective and that metal ion levels were significantly elevated at midterm follow-up. Whether the elevated metal ion levels may reduce adverse reactions is unknown, and long-term follow-up is needed. [ABSTRACT FROM AUTHOR]

Background: Cement implantation syndrome, which is characterized by hypotension, hypoxemia, and cardiac arrhythmia or arrest, has been reported in the literature. The purpose of the present study was to monitor the blood pressure changes that occur after cementing during primary total hip arthroplasty (THA). Methods: The present study examined 178 cases in which 204 joints were treated with primary THA. Study subjects had a mean age at the time of surgery of 64.5 years (range 35-89). Under general anesthesia, both hip components were cemented in place using an anterolateral approach. After cementing, systolic arterial blood pressure was measured at 1-min intervals for 5 min and then again at 10 min. The maximum regulation ratio (MRR) was calculated as follows: (maximum change in blood pressure − blood pressure before cement application) divided by blood pressure before cement application. Results: No major complications, such as cardiac arrest, occurred in most cases; blood pressure increased until 4 mins on the acetabular side and until 2 min on the femoral side, and then gradually returned to the level observed prior to cement application. On the acetabular side, the mean MRR was 11.2 % [standard deviation (SD): 15.9; range −26 to −80], whereas it was 6.4 % (SD: 14.9; range −31 to −65) on the femoral side. Correlations were detected between MRR classification on the acetabular side and the subject's age at the time of the operation or bleeding control status on the acetabular side. When bleeding control was judged as complete, the tendency for blood pressure to decrease was reduced. Conversely, when bleeding control was judged as good, blood pressure showed a greater tendency to decrease. Conclusion: In the present study, no episodes of major hypotension occurred. During THA involving the interface bioactive bone cement (IBBC) technique, when bleeding control on the acetabular side was judged as complete the tendency for blood pressure to decrease was reduced. [ABSTRACT FROM AUTHOR]

Background: Although 50 years have passed since Charnley started performing total hip arthroplasties, there are relatively few patient studies with a follow-up period of over 30 years. We studied radiograms of patients who had undergone Charnley total hip arthroplasty between 1975 and 1981 and evaluated the results at 26-35 years (mean 30.5 years) after the operation. Methods: The operations were performed in 87 joints of 82 patients (26 males and 56 females) aged 26-81 years (mean age 56 years) at the time of surgery. A monoblock-type Charnley stem with a 22-mm head was used in all patients. The stem had a matte satin surface finish and a flange or round-back shoulder. The socket was made of ultra-high-density polyethylene without a flange. All operations were performed by one surgeon using the original Charnley method in all patients, excluding the first five. Results: Thirty years after the operation, 48 patients have died, 5 had an infection, 9 were lost to follow-up, and 20 patients with 24 joints are still alive. In 77 patients (82 joints), after excluding the 5 with infection, the socket and stem survival rates were 54 and 75 % at 30 years after the operation when radiographic loosening or revision surgery was defined as the end point. With revision surgery as the end point, the rates were 68 and 82 %, respectively. Conclusions: These results were as favorable as those with surgical techniques (including the first-generation cement technique) and implants in the early period. Although new techniques and implants have since been introduced, their long-term results should exceed those in this study. The results of this study should provide a valuable index with which to compare the long-term studies of current total hip arthroplasty. [ABSTRACT FROM AUTHOR]

Background: Adverse reactions to metal debris (ARMD) after receiving metal-on-metal (MoM) hip implants is a recent concern. However, no epidemiologic study has examined ARMD for MoM hip implants in Japan. The purposes of this study were to research the incidence of ARMD and to identify poorly performing MoM hip implants in Japan. Methods: From 2000 to 2011, 7 companies provided 23,226 MoM implants in Japan. A questionnaire regarding ARMD was sent to 101 hospitals at which 62 % of the 23,226 MoM implants had been used. Results: Replies to the questionnaire were received from 82 hospitals. In these hospitals, surface hip replacement types (SRs) were used in 606 hips and stemmed types were used in 12,961 hips. ARMD were reported in 3 hips (0.5 %) with SRs and 160 hips (1.2 %) with stemmed types. ARMD in the 3 hips with SRs were asymptomatic and no revisions were performed. Among AMRD with stemmed implants, revision was performed in 83 hips and excision of an ARMD lesion was performed in 3 hips. The remaining 74 hips were asymptomatic and careful follow-up was continued. A significant difference in reoperation rate was evident between SRs (0 %) and stemmed types (0.7 %). Incidences of ARMD were significantly higher with Ultamet ( P = 0.005), Conserve ( P < 0.001), and Cormet ( P < 0.001) MoM bearing couples than with Metasul bearings. Conclusions: The incidence of ARMD in large surgical volume hospitals in Japan from 2000 to 2011 was estimated to be 0.5 % with SRs and 1.2 % with stemmed types. The reoperation rate was significantly higher with stemmed types than with SRs. Three brands of MoM stemmed implants were identified as showing a higher incidence of ARMD. [ABSTRACT FROM AUTHOR]

Purpose: The overall incidence of periprosthetic femoral fractures (PPF) is between 0.1 and 6 % of all total hip arthroplasties. Locking compression plates (LCP) have been used for the treatment of Vancouver B1 PPFs with variable results. The aim of this study is to examine the literature on locking plate failure rates, mode and reasons for failure. Methodology: A literature search was conducted for studies reporting the management of PPF of the femur with LCP fixation. The primary medical search engines used for the study were Ovid MEDLINE and EMBASE databases up to August 2012. Results: Twelve studies were identified, reporting overall union rates of 91 % in 135 fractures. Only 7 (5 %) fractures required revision surgery due to plate fracture (5) or pull out (2). Important trends in plate complications included: stress riser at the end of the plate, stress concentration in the fracture area due to rigid fixation, early loading and absence of cortical strut grafting for biological support when needed. Conclusion: LCP has been used successfully in the management of Vancouver B1 PPF. However, potential areas of improvement include, leaving the fracture site free of locking screws, therefore, not disturbing the soft tissue envelope around the fracture and also reducing plate stiffness. Adding cortical strut allografts to improve stability and bone quality, if needed, may also improve outcome. Limitations in the use of strut grafts or transverse fractures below the tip of the stem that cannot be controlled with single or double plating may require long stem revision to achieve axial stability. [ABSTRACT FROM AUTHOR]

The article describes two cases of patients who had cementless total hip arthroplasty. It states that the 48-year-old patient underwent cardiac transplantation caused by ischemic cardiomyopathy. According to the authors, the surgery could be used for femoral head's avascular necrosis after operation of the heart.

Background: The Oxford hip score (OHS) is one of the most widely used scoring systems to assess clinical outcome for patients with total hip arthroplasty (THA). Few studies have evaluated the OHS in non-Western patients with other cultural backgrounds, particularly Asians. Translation and transcultural adaptation of the OHS into the Korean was performed in accordance with international recommendations and the psychometric properties were tested. Methods: For testing the psychometric properties, 150 patients (mean age, 51 years) planning THA were recruited, and floor/ceiling effects and internal consistency were determined. Test-retest reliability and convergent validity were assessed by correlation with the SF-36, HOOS, and VAS for pain for 122, and responsiveness was evaluated for 100. Results: The Korean version had satisfactory internal consistency, test-retest reliability, convergent validity, and responsiveness without floor and ceiling effects. Conclusion: This study shows that the OHS developed in the West, with transcultural adaptation, is relevant for the patients undergoing THA in Korea. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to investigate early inflammatory response in the first 3 days after the implantation of hip prostheses, and to compare the early inflammation responses associated with the use of different combinations of bearing materials. Methods: 34 patients were enrolled, all of whom underwent unilateral total hip replacement and had identical hip prostheses, except for the bearing materials. These consisted of polyethylene on alumina ( n = 8), polyethylene on CoCr ( n = 11), or alumina on alumina ( n = 15). Blood samples were collected preoperatively in the morning of the day of surgery, and at 6 h, 1 day, 2 days, and 3 days postoperatively. CK, CRP, and IL-6 in peripheral blood were measured. Pain score was obtained at 2 days after surgery. Results: There were no significant differences in the pre- and postoperative background variables among the groups. Pain scores of different groups were not significantly different either ( P > 0.05). There were also no significant differences in the levels of CK, CRP, and IL-6 when patients with the three combinations of bearing materials were compared. Conclusions: We concluded that varying the bearing materials used in the hip prosthesis did not influence the early inflammatory response after prosthesis implantation. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate the pain patterns in patients with end-stage hip disease and to assess the response after total hip arthroplasty (THA). Methods: The pain patterns of patients undergoing THA for end-stage hip diseases were prospectively evaluated by requesting them to mark a map of body areas before and after surgery. Patients were excluded if they had coexisting pathology of the knee or spine. The pain measurements were quantified using visual analog scales, and factors that may contribute to different pain patterns were also evaluated. Results: Among 113 patients (113 hips) enrolled in the study, the groin, anterior thigh, buttock, anterior knee, and greater trochanter were the most common pain locations before THA. Pain over the lower back, shin, and calf areas, which were not generally considered referral pain areas from hip diseases, was present in 21.2, 7.1, and 2.7% patients, respectively. The presence of lower back pain (LBP) was statistically more common in patients with longer duration of hip symptoms. Regardless of the different pain patterns, 97.3% (110 of 113) of patients reported complete pain relief within 12 weeks after THA. Conclusions: The distribution of pain from end-stage hip diseases is versatile, and presence of pain in areas other than around the hip is not uncommon. LBP was more common in patients with longer duration of symptoms. THA satisfactorily resolves the pain in all areas soon after surgery. [ABSTRACT FROM AUTHOR]

Background: Stress shielding and nonphysiological load transfer after primary or revision total hip replacement (THR) prepare the ground for resorptive bone remodeling. The quality of the bone stock influences the risk of periprosthetic fractures and the severity of future revision surgeries. The question of whether or not bending stiffness and distal screw interlocking influence load transfer of a modular revision hip stem with a solid, hollow, and hollow-slotted stem extension led to the conception of this experimental study. The results were compared with a standard hip stem for primary THR. Methods: Revision stems were implanted in photoelastically coated composite femora. Cortical strain mapping was conducted before and after insertion of the implants under standardized loading conditions, considering the relevant muscle forces. Statistical analysis was based on a 95% confidence interval and a variance analysis for repeated measurements. Results: Significant stress shielding was observed after insertion of all types of hip stems compared with the intact femora. There was also a marked difference between strain alterations induced by standard and revision hip stems. With revision stems, the most distinct stress shielding effects were registered with the solid stem extension, particularly in the femoral diaphysis. Distal interlocking screws only had a local action on strain pattern and tended to enhance stress shielding at the midstem area when using the more flexible components. Conclusion: More flexible revision stems provide a cortical strain pattern of the femur closer to the preoperative status. This may reduce resorptive bone remodeling in the long term. However, any type of revision stem tested in this study caused higher stress shielding than the hip stem for primary THR, especially in the diaphyseal region medially and laterally. With sufficient proximal anchorage, the influence of distal interlocking screws on the femoral strain pattern was localized. [ABSTRACT FROM AUTHOR]

Background: The effect of body mass index (BMI) on the outcome of total hip arthroplasty (THA) remains controversial. The purpose of this study was to examine whether revision rate and postoperative outcomes following THA were influenced by BMI. Materials and methods: We retrospectively evaluated 714 patients (751 hips) who underwent primary THA in our department between March 1991 and April 2006. They were followed prospectively for 5-20 years with 24 deaths (24 hips) and 33 losses (34 hips). Patients were separated into three groups based on BMI: underweight, normal and obese groups. A survival analysis was performed using revision as the endpoint, and a case-matched study that was matched for age, gender, and laterality was designed; outcomes were assessed with the Harris Hip score, 36-item short-form health survey, complication rate and radiological examination. Results: The preoperative scores were lower for the obese group, and the postoperative scores were higher for the normal group. Patients in the obese group obtained the greatest overall improvement in clinical scores from admission to the last follow-up. We found a significantly higher complication rate in the obese group and underweight group. It appears that being underweight was associated with an increased dislocation rate, and obese patients were more likely to have osteolysis, deep vein embolism, and pulmonary thrombosis. The log rank test for survival showed no significant differences among the three groups. Conclusions: Abnormal BMI does not prevent functional rehabilitation after THA; however, patients with abnormal BMI have to face higher complication rates and poorer clinical outcomes following this operation. [ABSTRACT FROM AUTHOR]

The article describes two cases of revision total hip replacement therapy (THR) involving the use of intramedullary and onlay cortical strut allografts with a cementless interlocking distal femoral long stem to achieve favorable fixation stability. It states that the use of either a megaprosthesis or a segmental cortical allograft as an allograft-prosthesis composite is the accepted reconstruction method for severe proximal femoral bone deficiency after repeated re-THR.

Background: Total hip arthroplasty (THA) for the treatment of severe dislocation of the hip is a technically demanding procedure. In most previous reports, techniques and clinical outcomes using cementless prostheses are widely reported, but there have been few reports on the technique and outcomes using cemented prostheses. The purpose of this study was to evaluate the outcomes of a cemented THA with a simultaneous subtrochanteric femoral shortening transverse osteotomy in patients with Crowe type III or IV developmental dysplasia of the hip. Methods: We retrospectively reviewed 15 hips in 11 patients who underwent cemented THA with subtrochanteric femoral shortening transverse osteotomy and with placement of the acetabular component at the level of the anatomic hip center. Patients were evaluated preoperatively and postoperatively with the Merle d'Aubigné and Postel hip score. Radiographic examination was performed to evaluate the level of the femoral osteotomy site, of the radiographic leg lengthening, and of bone union. Results: The clinical evaluation by the Merle d'Aubigné and Postel hip score was improved from 8.1 ± 2.5 preoperatively to 15.1 ± 1.3 at the time of final follow-up. Radiographic evidence of bone union at the osteotomy site appeared at more than 6 months after operation. Moreover, there were 3 (20%) nonunions that needed reoperation. No acetabular and femoral components exhibited radiological loosening at the time of final follow-up. In addition, one delayed union causing thigh pain was treated with low-intensity pulsed ultrasound that accelerated bone formation. Conclusion: Our results in this study indicate that we should prevent instability at the transverse osteotomy site and an adequate intercalary cortical bone graft is needed to prevent nonunion in cemented THA combined with a subtrochanteric femoral shortening transverse osteotomy. We should apply this procedure with caution in patients, especially those who show less potential bone formation activity. [ABSTRACT FROM AUTHOR]

Background: Total hip replacement in developmental dysplasia of the hip is a demanding procedure and usually requires dedicated devices and special surgical techniques. Nevertheless, the described techniques have shown variable outcomes. The aim of this study was to assess the 11-year outcomes of an off-the-shelf modular neck prosthesis in dysplastic patients and to evaluate the ability of the modular neck system to adequately restore femoral offset, abductor muscles lever arm and leg length. Methods: We retrospectively evaluated 61 modular neck prostheses implanted in 47 patients between June 1995 and March 2004. The preoperative diagnosis was developmental dysplasia of the hip in all cases. The clinical outcomes were assessed using the Harris hip score and the Western Ontario and McMaster Universities score. The femoral offset, abductor muscles lever arm, height and medialization of the hip center of rotation, and differences in leg length were evaluated on postoperative radiographs. Prosthesis survival was calculated according to the Kaplan-Meier method considering any reason for revision as failure. The average follow-up was 117.2 months (range 57-162 months). Results: The cumulative survival at 11 years was 97.5%. One prosthesis failed 5 years after surgery because of a ceramic liner fracture due to an inappropriate obstetric maneuver during labour. At the latest follow-up the mean Harris hip score was 74.7 (range 23-91). Leg length discrepancy was avoided in the majority of cases; femoral offset was almost always restored. Conclusions: The results of this series support the use of modular neck prostheses as an effective alternative in the treatment of developmental dysplasia of the hip. The modularity was very efficient in restoring offset, leg length and maintaining stability with a good mid-long-term follow-up. Unlike other proposed surgical techniques, these good results are achievable by a standard surgical technique and with an off-the-shelf prosthesis. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the causes and frequency of the squeaking sound in ceramic-on-ceramic THA. Materials and methods: This study included 61 hips of 50 patients who underwent ceramic-on-ceramic THA in our hospital from March 1999 to April 2005. The average age at the time of operation was 57.6 years. The average duration of follow-up was 69.5 months. Three different acetabular components were used: Osteonics (Stryker, USA: 24 cases), Bicontact (Aesculap, Germany: 27 cases) and ABG (Howmedica, UK: 10 cases). Results: Fourteen (22.9%) of the 61 cases had a squeaking sound, and this sound started a mean of 47.57 months after the operation. Except in one case, the squeaking sound remained until the last follow-up. There was no difference in acetabular component position between the squeaking and nonsqueaking groups. The squeaking sound was found to be related to the BMI (body mass index) and cup design. It occurred frequently in patients with high BMI who had received a total hip arthroplasty using an Osteonics cup. Among 11 of the patients, squeaking occurred while squatting, and in 3 patients while walking. Six patients suffered from mild restrictions on their activities of daily living, and 8 had more than moderate restrictions with squeaking sounds. Conclusion: A squeaking sound in THA using ceramic-on-ceramic surfaces is not a rare complication, and often affects the patient's behavior. [ABSTRACT FROM AUTHOR]

Background: Impaction bone grafting allows restoration of the acetabular bone stock in revision hip arthroplasty. The success of this technique depends largely on achieving adequate initial stability of the component. To obtain well-compacted, well-graded allograft aggregates, we developed an ex vivo compaction device to apply it in revision total hip arthroplasty on the acetabular side, and characterized mechanical properties and putative osteoconductivity of allograft aggregates. Methods: Morselized allograft bone chips were compacted ex vivo using the creep technique and subsequent impaction technique to form the bone aggregates. Impaction allograft reconstruction of the acetabulum using an ex vivo compaction device was performed on eight hips. The mechanical properties and three-dimensional micro-CT-based structural characteristics of the bone aggregates were investigated. Results: In clinical practice, this technique offered good reproducibility in reconstructing the cavity and the segmental defects of the acetabulum, with no migration and no loosening of the component. In vitro analysis showed that the aggregates generated from 25 g fresh-frozen bone chips gained compression stiffness of 13.5-15.4 MPa under uniaxial consolidation strain. The recoil of the aggregates after compaction was 2.6-3.9%. The compression stiffness and the recoil did not differ significantly from those measured using a variety of proportions of large- and small-sized bone chips. Micro-CT-based structural analysis revealed average pore sizes of 268-299 μm and average throat diameter of pores in the bone aggregates of more than 100 μm. These sizes are desirable for osteoconduction, although large interconnected pores of more than 500 μm were detectable in association with the proportion of large-sized bone chips. Cement penetration into the aggregates was related to the proportion of large-sized bone chips. Conclusion: This study introduces the value of an ex vivo compaction device in bone graft compaction in clinical applications. In vitro analysis provided evidence that compaction of sequential layers of well-compacted, well-graded bone aggregates, i.e., the aggregates comprising smaller sized chips at the host bone side and larger sized chips at the component side, may have the advantages of initial stability of the acetabular component and biological response of the grafted aggregates. [ABSTRACT FROM AUTHOR]

Abstract Background  There has been increasing interest in performing total hip arthroplasty (THA) with minimally invasive surgery (MIS). This study was conducted to examine the effectiveness of MIS-THA using the new two-incision technique versus the one-incision technique. Methods  A consecutive series of 113 patients who underwent MIS-THAs (63 one-incision cases, 50 two-incision cases) were studied. One-incision THA was performed with a posterolateral approach. For the two-incision, the first incision for cup insertion was made over the anterolateral side of the hip. Intermuscular dissection was performed between the gluteus medius and the tensor fascia lata. The second incision, for stem insertion, was made on the posterolateral side of the hip along the fiber of the gluteus maximus. Intermuscular dissection was made between the gluteus medius and the piriformis. Results  Postoperative rehabilitation was significantly more rapid in the new two-incision group compared to the group with one incision. Postoperatively, the Harris Hip Score and the Western Ontario and the McMaster Universities Osteoarthritis Index score were significantly different between the two groups, especially the functional sections. Conclusions  The findings of this study show that our new two-incision MIS-THA is an excellent surgical modality that allows early rehabilitation. [ABSTRACT FROM AUTHOR]

Abstract  Cementless total hip replacement (THR) is rapidly being accepted as the surgery for arthritic diseases of the hip joint. The bone-ingrowth rate in porous-type cementless implants was about 90% over 10 years after surgery, showing that biological fixation of cementless THR was well maintained on both the stem and cup sides. As for the stress shielding of the femur operated using a distal fixation-type stem, severe bone resorption was observed. The severe bone resorption group showed continuous progression for more than 10 years after surgery. Stem loosening directly caused by stress shielding has been considered less likely; however, close attention should be paid to bone resorption-associated disorders including femoral fracture. Cementless cups have several specific problems. It is difficult to decide whether a cup should be placed in the physiological position for the case of acetabular dysplasia by bone grafting or at a relatively higher position without bone grafting. The bone-ingrowth rate was lower in the group with en bloc bone grafting, and the reactive line was frequently noted in the bone-grafted region. Although no data indicated that en bloc bone grafting directly led to poor outcomes, such as loosening, cup placement at a higher site without bone grafting is now selected by most operators. The polyethylene liner in a cementless cup is thinned due to the metal cup thickness; however, it has been suggested that the apparent relation between the cup size and the wear rate was absent as long as a cementless cup is used. Comparative study indicated cementless THR was inferior with regard to the yearly polyethylene wear rate and incidence of osteolysis on both the stem and cup sides. Meta-analysis study on the survival rate between cement and cementless THR reported that cemented THR was slightly superior. It should be considered that specific problems for cementless THR, especially with regard to polyethylene wear, do occur. [ABSTRACT FROM AUTHOR]

Abstract Background  After total hip arthroplasty, the femoral head penetrates the liner because of polyethylene wear and the so-called bedding-in phenomenon. The head moves three-dimensionally, but few reports have evaluated such movement radiographically. Moreover, even fewer reports have evaluated it in a standing position, although the load stress influences the movement. The purpose of the present study was to evaluate the head movement in the liner three-dimensionally using standing images. Method  The distance between the centers of the metal shells and femoral heads were measured in 29 unilateral hips implanted with porous-coated acetabular components. Standing anteroposterior and lateral radiographs obtained approximately 2 years after operation were photographed by a digital camera, and the data were used. The measured distances divided by the time after operation and enlargement ratio of the radiographs gave linear penetration rates in the frontal and sagittal planes, and three-dimensional linear penetration rates were calculated from the penetration vectors. Frontally evaluated and three-dimensionally calculated penetration rates were compared, and the correlation of age and other factors with the penetration rate was evaluated. Results  Linear penetration rates were 0.14 ± 0.11 mm/year frontally, 0.18 ± 0.08 mm/year sagittally, and 0.21 ± 0.10 mm/year three-dimensionally. The mean three-dimensional penetration rate was 42% greater than the frontal rate. An inverse correlation was observed between age and the sagittal penetration rate (r = −0.621), and between age and the three-dimensional penetration rate (r = −0.388). The sagittal and three-dimensional penetration rates were significantly higher (P = 0.0008 and 0.0010, respectively) in patients aged Conclusions  The average three-dimensional penetration rate during the first 2 years after operation was markedly greater than the frontal two-dimensional penetration rate that was conventionally applied for postoperative evaluation. Three-dimensional evaluation using both frontal and sagittal radiographs is necessary to avoid undervaluation of the head movement after total hip arthroplasty. [ABSTRACT FROM AUTHOR]

Abstract Background  Venous thromboembolism (VTE) is a critical complication after hip replacement surgery, so both early diagnosis and prophylaxis are important. The purpose of this study was to clarify the rapid changes of the fibrin monomer complex (FMC) and soluble fibrin (SF) during the perioperative period of hip replacement surgery. Methods  The subjects were 32 patients (7 men, 25 women) who underwent elective hip replacement surgery between November 2004 and January 2006. Their ages ranged between 34 to 82 years (mean 56.8 years). According to their thromboembolic risk, the patients received different prophylaxis: unfractionated heparin (4 patients), danaparoid sodium (14 patients), or mechanical therapy only (14 patients). Results  FMC and SF became rapidly elevated during the operation and just after surgery but declined to preoperational levels 3 days after surgery; they were higher in lupus anticoagulant (LA)-positive patients. In contrast, FDP and D-dimer had gradually become elevated 3 and 7 days after surgery. According to venous ultrasonography and lung perfusion scintigraphy, VTE occurred in 7 patients overall (21.9%). The incidence of VTE was 7.1% in the danaparoid group, whereas it was 35.7% in the mechanical therapy group. We also found that danaparoid sodium rapidly decreased FMC and SF within 3 days. Conclusions  FMC and SF were rapidly elevated during hip replacement surgery and differentiated in LA-positive and LA-negative patients. [ABSTRACT FROM AUTHOR]

Abstract Background  The deformation behavior of threaded and press-fit acetabular cups in correlation with the applied torques and forces to insert the cups has not been widely investigated. The aim of this experimental study was to analyze the deformation behavior of threaded (BICON-PLUS) and press-fit (EP FIT PLUS and Metal shell) acetabular cup designs during insertion and extraction with regard to the possibility of cup failure. Methods  The experiments were carried out using artificial bone and human acetabular bone. The torque needed to insert the threaded cups and the force applied to the press-fit cups was measured. The force and torque were applied manually by a surgeon using common surgical instruments. The strain of the cups was assessed by tangentially and radially applied strain gauges during the insertion process, the implanted state, and extraction. These measurements were used to calculate the change in diameter of the acetabular cups and the strains at the notches of the threaded acetabular cup. Results  The results showed that maximum strains and applied torques and force occurred during cup insertion. In the case of the threaded cup, an average maximum insertion torque of 114 Nm was measured using bone substitute, whereas only 47 Nm was assessed using human acetabulum. A maximum change in diameter of 8 μm was calculated during the implanted state for the threaded cup. The impact forces for both press-fit cups ranged from approximately 1.0 to 8.9 kN. The change in diameter was 8 μm for the Metal shell and 4 μm for the EP FIT PLUS. In all cases, no permanent cup deformation was detected. Conclusions  The observed deformations suggest that implant failure of the analyzed acetabular cups is unlikely during insertion, the implanted state, or extraction under normal conditions. [ABSTRACT FROM AUTHOR]

Abstract Background  Control of the mediolateral displacement of the center of gravity (COG) is considered to be important for efficient walking. Few studies have been published on the relation between walking efficiency and the lateral displacement of the trunk, pelvis, or COG in patients soon after total hip arthroplasty (THA). The present study was undertaken to examine the effects of lateral displacement on walking efficiency after THA. Methods  The subjects of this study were 15 women who had undergone unilateral THA 4 weeks before and 14 healthy women as controls. Using a force plate and a three-dimensional motion analyzer, we measured (1) gait speed, stride length, cadence; (2) lateral trunk displacement (LTD) and lateral pelvis displacement (LPD); (3) lateral displacement of the center of gravity; and (4) the total internal work done per unit mass and distance walked (a negative index of walking efficiency) (WE−1). Results  Compared with healthy persons, THA patients showed significantly increased amplitude of LTD and greater WE−1 (P −1 value of the THA group was 21.4% higher than that of the control group. The results suggest that the patients need more energy to progress their body forward in a gait cycle, indicating reduced walking efficiency. In THA patients, the stepwise multiple regression analysis selected LTD as the sole significant variable affecting WE−1 (R2 = 0.72, P Conclusions  These results suggest that trunk compensation strategy for hip abductor weakness in patients soon after THA can lead to increased energy expenditure. [ABSTRACT FROM AUTHOR]

Abstract Background  This study followed patients for a minimum of 7 years after primary total hip arthroplasty using cementless acetabular components and evaluated their outcomes. Methods  We followed 73 patients (75 hips), who had undergone total hip arthroplasty with cementless nonporous coated acetabular components (3M AcSys Shearer Cup) for a mean of 9.8 years (range 7–13 years). There were 61 women and 12 men with a mean age of 53 years (range 27–69 years) at surgery. The diagnosis was primary osteoarthritis in 9 hips, osteoarthritis secondary to developmental dysplasia in 58 hips, osteonecrosis of the femoral head in 6 hips, and rheumatoid arthritis in 2 hips. Results  Three cups were revised because of aseptic loosening, and one cup was revised following removal of the prosthesis due to deep infection. Radiographic loosening was observed in 22 hips at the latest follow-up. The survival rate at 10 years was 94.7% with revision as the endpoint and 72% with radiographic loosening as the endpoint. The Merle d'Aubign� and Postel hip score showed significant improvement postoperatively and was maintained well even in cases showing radiographic loosening. Conclusions  The intermediate radiological results with the AcSys Shearer Cup were unsatisfactory because of the high loosening rate, although the revision rate was low. The nonporous outer surface and the poor fixation mechanism between the metal shell and liner may have contributed to the high failure rate. Regular radiological review is recommended when this cup is used because early loosening is often painless. [ABSTRACT FROM AUTHOR]