Language：English   Publisher：Journal of Orthopaedic Science  

Background: The location of the lateral boundary of the necrotic lesion to the weight-bearing portion of the acetabulum (Type classification) is an important factor for collapse in osteonecrosis of the femoral head (ONFH). Recent studies also reported the significance of the location of the anterior boundary of the necrotic lesion on the occurrence of collapse. We aimed to assess the effects of the location of both anterior and lateral boundaries of the necrotic lesion on collapse progression in ONFH. Methods: We recruited 55 hips with post-collapse ONFH from 48 consecutive patients, who were conservatively followed for more than one year. Using a plain lateral radiograph (Sugioka's lateral view), the location of the anterior boundary of the necrotic lesion to the weight-bearing portion of the acetabulum was classified as follows: Anterior-area I (two hips) occupying the medial one-third or less; Anterior-area II (17 hips) occupying the medial two-thirds or less; and Anterior-area III (36 hips) occupying greater than the medial two-thirds. The amount of femoral head collapse was measured by biplane radiographs at the onset of hip pain and each follow-up period, and Kaplan–Meier survival curves with collapse progression (≥1 mm) as the endpoint were produced. The probability of collapse progression was also assessed by the combination of Anterior-area and Type classifications. Results: Collapse progression was observed in 38 of the 55 hips (69.0%). The survival rate of hips with Anterior-area III/Type C2 was significantly lower. Among hips with Type B/C1, collapse progression occurred more frequently in hips with Anterior-area III (21 of 24 hips) than in hips with Anterior-area I/II (3 of 17 hips, P < 0.0001). Conclusions: Adding the location of the anterior boundary of the necrotic lesion to Type classification was useful to predict collapse progression especially in hips with Type B/C1.

DOI： 10.1016/j.jos.2023.01.011

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Language：English   Publisher：Journal of Orthopaedics  

Purpose: The dislocation rate after total hip arthroplasty for osteonecrosis of the femoral head is higher than that after total hip arthroplasty for osteoarthritis. However, few reports have investigated the factors contributing to dislocation after total hip arthroplasty for osteonecrosis of the femoral head. The aim of this study was to assess radiological factors associated with posterior dislocation after total hip arthroplasty for osteonecrosis of the femoral head. Methods: We retrospectively reviewed 179 cementless total hip arthroplasties for osteonecrosis of the femoral head using a posterolateral approach between 2002 and 2020 with a minimum follow-up period of 24 months. The following radiological factors were examined for a possible association with posterior dislocation after total hip arthroplasty: cup anteversion angle, cup inclination angle, femoral offset, and stem anteversion angle. Results: Posterior dislocation occurred in seven hips (3.9 %). Compared to hips without posterior dislocation, those with posterior dislocation exhibited a significantly smaller cup anteversion angle (p = 0.045) and a nonsignificantly greater decrease in femoral offset (p = 0.089). Based on receiver operating characteristic curve analyses, the cutoff values for predicting posterior dislocation were 9.9° for the cup anteversion angle and 8.1 mm for the decrease in femoral offset. Logistic regression analysis showed a significantly higher risk of posterior dislocation among hips with a cup anteversion angle less than 9.9° (odds ratio = 7.1, p = 0.022) or with a decrease in femoral offset over 8.1 mm (odds ratio = 5.0, p = 0.040). Conclusions: A small cup anteversion angle and a decreased femoral offset are suggested to be associated with posterior dislocation after total hip arthroplasty in patients with osteonecrosis of the femoral head.

DOI： 10.1016/j.jor.2023.11.015

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：Clinical Biomechanics  

Background: In the natural course of osteonecrosis of the femoral head, sclerotic changes at the boundary of necrotic lesion gradually occur until femoral head collapse. This study aims to examine the effects of bone mineral density at the lateral boundary of necrotic lesion on a subsequent femoral head collapse. Methods: We developed patient-specific finite element models of 9 hips with subsequent collapse and 10 hips without subsequent collapse. Cubic regions of interest were selected at both subchondral areas of the lateral boundary and the adjacent necrotic lesion. Bone mineral density values of the regions of interest were quantitatively measured, and a ratio of bone mineral density values (lateral boundary/necrotic lesion) was calculated. Stress values at the lateral boundary were also evaluated. Findings: The ratio of bone mineral density values was significantly higher in hips with subsequent collapse than that without subsequent collapse (p = 0.0016). The median equivalent stress and shear stress were significantly higher in hips with subsequent collapse than that without subsequent collapse (p = 0.0071, and p = 0.0143, respectively). The ratio of bone mineral density values showed a promising value in predicting the occurrence of subsequent femoral head collapse (AUC = 0.97). Interpretation: Our results indicated that bone mineral density value at the lateral boundary of necrotic lesion may be associated with the occurrence of subsequent femoral head collapse in pre-collapse stage osteonecrosis of the femoral head.

DOI： 10.1016/j.clinbiomech.2023.106156

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Language：English   Publisher：Journal of Orthopaedic Science  

Background: This study assessed the hip survival rate and patient-reported outcome measures (PROMs) of transtrochanteric curved varus osteotomy (CVO) for osteonecrosis of the femoral head (ONFH) compared with those of conservative management. Methods: The CVO group comprised 32 consecutive patients (39 hips) who underwent CVO for ONFH between 2000 and 2011. The conservative group consisted of 36 consecutive patients (37 hips) who were managed conservatively for at least 1 year after collapse and who had ONFH classified by the Japanese Investigation Committee of Health and Welfare as type B or C1, for which CVO is indicated. Kaplan–Meier analysis of hip survival used any ONFH-related therapeutic surgery as the endpoint. PROMs were evaluated for all patients with surviving hips and radiographs available at the latest follow-up. Result: The 10-year hip survival rate in the CVO group was 86.7%, which was significantly higher than the 51.0% 5-year survival rate in the conservative group (p < 0.0001). The Oxford Hip Score and UCLA Activity Score were significantly better in the CVO group without joint space narrowing than in the conservative group, with no significant differences between the CVO group with joint space narrowing and the conservative group. Conclusion: CVO could preserve hip joints more effectively than conservative follow-up after collapse, although the presence of joint space narrowing could reduce satisfaction levels even in patients with long-term hip survival.

DOI： 10.1016/j.jos.2024.03.010

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Language：English   Publisher：Elsevier B.V.  

股関節全置換術(THA)を施行された変形性股関節症(股OA)の日本人患者における患者申告アウトカム尺度(PROMs)の適用状況について検討した。PROMsを取り上げた文献をレビューし、ガイドラインの有無、質問票日本語版の妥当性、治療効果の評価方法などを評価項目とした。患者申告アウトカム(PROs)/PROMsに関するガイドラインとして、Consensus-based standards for the selection of health measurement instruments(COSMIN)チェックリスト、Standard protocol items:recommendations for interventional trials-PRO extension(SPIRIT-PRO extension)、the consolidated standards of reporting trials-PRO extension(CONSORT-PRO extension)が存在することが示され、方法論的な質や試験プロトコルが評価されていた。簡易36/12項目健康サーベイが多次元的評価に用いられており、EuroQol 5 dimension(EQ-5D)は患者選好性をベースとする有用性の評価に最も多く使用されていた。疾患特異的QOLの評価にはWestern Ontario and McMaster Universities変形性関節症指数、Oxford股関節スコア、股関節障害度・変形性関節症アウトカムスコア、Forgotten関節スコア-12、日本整形外科学会股関節疾患評価質問票が用いられていた。このほか、中枢神経感作症候群の評価には中枢神経感作尺度、「生きがい」の評価にはIkigai-9が活用されていた。THAを受けた股OA患者に対して、さまざまな手法によってQOLが評価されていることが明らかになった。

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：Scientific Reports  

This study aimed to clarify the clinical utility of the sourcil roundness index (SRI), a novel index for quantifying the asphericity of the acetabular concavity, by determining (1) the difference in the SRI between dysplastic and normal hips and (2) the correlation between the SRI and radiographic parameters of hip dysplasia. We reviewed standing anteroposterior pelvic radiographs of 109 dysplastic and 40 normal hips. The SRI was determined as the ratio of the distance from the medial edge of the sourcil to the most concave point of the acetabular sourcil (A) to the distance from the medial to the lateral edge of the sourcil (B). The formula for SRI is (A/B) × 100–50 (%), with an SRI of 0% indicating a perfectly spherical acetabulum, and higher SRI values indicating a more aspherical shape. The median SRI was greater in patients with hip dysplasia than in normal hips (5.9% vs. − 1.4%; p < 0.001). Furthermore, the median SRI was greater in the severe dysplasia subgroup (18.9%) than in the moderate (3.5%) and borderline-to-mild (− 1.3%) dysplasia subgroups (p < 0.05). Quantification of acetabular concavity asphericity by the SRI showed that dysplastic hips had a more lateral acetabular concave point than normal hips, and that the severity of hip dysplasia had an effect on the acetabular concavity asphericity.

DOI： 10.1038/s41598-023-42630-z

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：Journal of Orthopaedic Research  

Articular surface irregularities are often observed in collapsed femoral heads with osteonecrosis, while the effects of the degree of collapse on the articular surface are poorly understood. We first macroscopically assessed the articular surface irregularities on 2-mm coronal slices obtained using high-resolution microcomputed tomography of 76 surgically resected femoral heads with osteonecrosis. These irregularities were observed in 68/76 femoral heads, mainly at the lateral boundary of the necrotic region. The mean degree of collapse was significantly larger for femoral heads with articular surface irregularities than for those without (p < 0.0001). Receiver operating characteristic analysis showed that the cutoff value for the degree of collapse in femoral heads with articular surface irregularities at the lateral boundary was 1.1 mm. Next, for femoral heads with <3-mm collapse (n = 28), articular surface irregularities were quantitatively assessed based on the number of automatically counted negative curvature points. Quantitative evaluation showed that the degree of collapse was positively correlated with the presence of articular surface irregularities (r = 0.95, p < 0.0001). Histological examination of articular cartilage above the necrotic region (n = 8) revealed cell necrosis in the calcified layer and abnormal cellular arrangement in the deep and middle layers. In conclusion, articular surface irregularities of the necrotic femoral head depended on the degree of collapse, and articular cartilage was already altered even in the absence of macroscopically determined gross irregularities.

DOI： 10.1002/jor.25539

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Language：English   Publisher：HIP International  

Background: No studies have compared patient satisfaction between periacetabular osteotomy (PAO) and total hip arthroplasty (THA) for osteoarthritis (OA) secondary to developmental dysplasia of the hip (DDH) in Asian cohorts. Methods: Multivariate analyses were applied to determine whether patient demographics and postoperative patient-reported outcomes were correlated with postoperative patient satisfaction in 737 DDH patients (251 PAO and 486 THA patients). Additionally, postoperative patient satisfaction, Oxford Hip Score (OHS), University of California-Los Angeles (UCLA) activity score, and sports participation were compared between propensity-matched PAO and THA patients for OA secondary to DDH (Kellgren-Lawrence grade II: 32 PAO and 16 THA patients, grade III: 20 PAO and 40 THA patients). Results: Of the 737 patients, 663 patients (90%) were postoperatively satisfied. Multivariate analysis demonstrated that THA was positively correlated with patient satisfaction. Furthermore, high postoperative OHS-pain, OHS-ADL, and UCLA scores were positively correlated with satisfaction. In propensity-matched PAO and THA patients, PAO elicited greater patient satisfaction than THA for KL grade II OA secondary to DDH, with comparable postoperative OHS (including the pain and ADL subscale), UCLA score, and sports participation rate. In contrast, THA resulted in better satisfaction and OHS-pain for KL grade III OA secondary to DDH, with comparable postoperative OHS-ADL, UCLA score, and sports participation rate in the 2 surgeries. Conclusions: Both PAO and THA procedures offer distinct patient satisfaction advantages based on preoperative OA severity. These findings can assist in the clinical decision-making process for the surgical treatment of middle-aged patients with symptomatic DDH.

DOI： 10.1177/11207000221114272

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Language：English   Publisher：Scientific Reports  

There are no reports on hip kinetics including contact forces and muscle activities during the golf swing after total hip arthroplasty (THA). The aim of this study was to identify the characteristics of three-dimensional dynamics during the golf swing. Ten unilateral primary THA patients participated in motion capture test of their driver golf swing. The driver swing produced approximately 20–30° of rotation in both lead and trail replaced hips. The mean hip contact forces (HCFs) of lead and trail replaced hips were 5.1 and 6.6 × body weight, respectively. Left and right THAs showed similar HCFs of lead and trail hips. More than 60% of the Percent maximum voluntary isometric contraction was found in bilateral iliopsoas muscles in all unilateral THA. Three factors [female sex, lower modified Harris Hip Score, and higher HCF of surgical side] were associated with the golf-related replacement hip pain. Golf is an admissible sport after THA because driver swings do not contribute excessive rotation or contact forces to hip prostheses. HCF could be reduced through swing adjustments, which may allow patients with golf-related replacement hip pain to develop a comfortable golf game free from pain.

DOI： 10.1038/s41598-023-35484-y

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Language：English   Publisher：Scientific Reports  

This study aimed to (1) set a reference value for anterior center edge angle (ACEA) for preoperative planning of periacetabular osteotomy (PAO), (2) investigate the effects of pelvic rotation and inclination from false profile (FP) radiographs on the measured ACEA, and (3) determine the “appropriate range of positioning” for FP radiograph. This single-centered, retrospective study analyzed 61 patients (61 hips) who underwent PAO from April 2018 and May 2021. ACEA was measured in each digitally reconstructed radiography (DRR) image of the FP radiograph reconstructed in different degrees of pelvic rotation. Detailed simulations were performed to determine the “appropriate range of positioning” (0.67 < ratio of the distance between the femoral heads to the diameter of the femoral head < 1.0). The vertical-center-anterior (VCA) angle was measured on the CT sagittal plane considering the patient-specific standing positions, and its correlation with the ACEA was investigated. The reference value of ACEA was determined by receiver operating characteristic (ROC) curve analysis. The ACEA measurement increased by 0.35° for every 1° pelvic rotation approaching the true lateral view. The pelvic rotation with the “appropriate range of positioning” was found at 5.0° (63.3–68.3°). The ACEA on the FP radiographs showed a good correlation with the VCA angle. The ROC curve revealed that an ACEA < 13.6° was associated with inadequate anterior coverage (VCA < 32°). Our findings suggest that during preoperative PAO planning, an ACEA < 13.6° on FP radiographs indicates insufficient anterior acetabular coverage. Images with the “appropriate positioning” can also have a measurement error of 1.7° due to the pelvic rotation.

DOI： 10.1038/s41598-023-35514-9

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Language：English   Publisher：(公社)日本整形外科学会  

絶対骨盤軸として用いられる上前腸骨棘(ASIS軸)の確度について検討した。膝関節全置換術を受けた60例(A群:男性17例、女性43例、平均75.7±8.2歳)と大腿頸部骨折患者50例(B群:男性14例、女性36例、平均81.2±8.1歳)のCTスキャンデータを収集した。三次元的に両大腿骨頭を通過するラインを骨盤の絶対参照軸と定義し、冠状面では大腿骨頭軸と六つの骨盤ランドマークを介した軸との誤差を求め、軸平面では四つの骨盤ランドマークを通過するラインの誤差を測定した。A群とB群にみられる冠状面での軸誤差は同等の結果となり、A群の誤差は寛骨臼上面、ティアドロップ基部、ASIS前面、閉鎖孔上面、閉鎖孔下面、坐骨結節遠位面の順に小さく、B群の誤差は寛骨臼上面、ティアドロップ基部、閉鎖孔上面、ASIS前面、閉鎖孔下面、坐骨結節遠位面の順に小さかった。軸平面での軸誤差はA群、B群ともに寛骨臼後面、寛骨臼前面、ASIS前面、坐骨結節後面の順に小さかった。軸誤差は測定ラインが大腿骨頭軸に近づくにつれて小さくなり、ASIS軸の誤差は中等量を示していた。ASISは必ずしも信頼に足る指標になるとは限らないと考えられた。

Language：English   Publisher：Journal of Orthopaedic Science  

Background: This study aims to evaluate the accuracy of the axis connecting both anterior superior iliac spines (ASIS axis) as the absolute pelvic axis. No study has ever verified the accuracy of ASIS axis particularly on the AP pelvic radiograph, which cannot be specified on it. Methods: Sixty patients who underwent total knee arthroplasty and fifty patients with femoral neck fracture were recruited as subjects without hip deformities and their CT scan data were collected. We defined the line through both center of femoral heads as absolute reference axis of pelvis three-dimensionally. On the coronal plane, the errors between the femoral head axis and the axes through six pelvic landmarks in total, including ASIS were analyzed. On the axial plane, the errors of the lines through four landmarks were analyzed in the same way. Finally, on the coronal images, the mediolateral diameter of the obturator foramen and the mediolateral distance between the midline of the sacrum and the pelvic cavity were measured to evaluate bilateral symmetry of the pelvis. Results: The errors tended to be smaller as the axes were closer to the femoral head axis (axes connecting bilateral superior aspects of the acetabulum and the teardrops) and the ASIS axis errors were moderate. The obturator foramen based on the ASIS axis was more asymmetrical than the femoral head axis. Conclusion: Adjusting the pelvic tilt and rotation, surgeons should not always rely on the ASIS and refer to appropriate, close to the hip joint references in each case.

DOI： 10.1016/j.jos.2022.01.011

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DOI： 10.1093/jhps/hnac047

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Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：Journal of Arthroplasty  

Background: There is increasing interest in improving activity after total hip arthroplasty (THA) and periacetabular osteotomy (PAO). The present study evaluated whether there were differences in the subjective and objective activity levels of THA and PAO patients at mean 12-year follow-up (range 4-20) and what factors influence the objective activity levels. Methods: THA and PAO patients (30 patients each; mean age: 66 and 63 years, respectively), who had undergone surgery for osteoarthritis due to acetabular dysplasia, were included. Patients were retrospectively matched based on age, gender, body mass index, follow-up duration, and preoperative University of California, Los Angeles activity score (UCLA score). Patients were surveyed for the subjective activity levels using the Oxford Hip Score and UCLA score. Objective activity levels (the number of steps, upright time, and the number of sit-to-stand transitions) were made using an accelerometer. Results: There was no significant difference in subjective activity level between THA and PAO patients. The number of steps was significantly higher in PAO than in THA patients. Multivariable analyses revealed that THA and low Oxford Hip Score activities of daily living were negatively associated with the number of steps, that men and high UCLA score were negatively associated with upright time, and that high body mass index was negatively associated with sit-to-stand transitions in THA and PAO patients. Conclusion: This study suggested that although there was no difference in postoperative subjective activity level between THA and PAO patients, there was a difference in objective activity level. Providing guidance to these patients based on objective activity may lead to higher activity levels.

DOI： 10.1016/j.arth.2022.08.034

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Language：English   Publisher：Journal of Bone and Joint Surgery  

Background:Missing responses are common when Asian patients complete the Forgotten Joint Score-12 (FJS-12), which is widely used to evaluate total hip arthroplasty (THA). We aimed to provide orthopaedic researchers with a solution for handling missing values in such patient-reported outcome measures (PROMs).Methods:Patients who had undergone primary THA between 1998 and 2016 (n = 1,021) were investigated in 2020. The FJS-12 and 9 other PROMs, including questions related to Asian lifestyle activities, were administered. Risk factors for missing FJS-12 items were investigated. Partial respondents were matched with complete respondents; then, in each pair, the items not completed by the partial respondent were deleted from the responses of the complete respondent. Predictive mean matching (PMM) was performed in an attempt to recover the deleted items, using 65 sets of imputation models. After the missing values had been imputed, we explored patient characteristics that affected the FJS-12, using data from all complete and partial respondents.Results:A total of 652 patients responded to the survey (393 complete and 193 partial respondents). Partial respondents were older, more often female, and less active. Older respondents were more likely to skip items involving the bed, while those who reported a better ability to sit in the seiza style (traditional Japanese floor sitting) were more likely to skip items about chair sitting. The imputed FJS-12 value exhibited excellent reliability (intraclass correlation coefficient for agreement with the true scores, 0.985). FJS-12 values of complete respondents were significantly higher than those of respondents with 4 to 11 missing items (51.6 versus 32.8, p < 0.001). Older age was associated with higher FJS-12 values, which was revealed only via analysis of the multiply imputed data sets (p < 0.001).Conclusions:Analysis of only complete FJS-12 responses after THA resulted in a nonresponse bias, preferentially excluding older, female, and less active individuals and those with a traditional floor living style. Multiple imputation could provide a solution to scoring and analyzing PROMs with missing responses by permitting the inclusion of partial respondents.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

DOI： 10.2106/JBJS.21.01547

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Publisher：金原出版  

DOI： 10.18888/se.0000002376

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：Scientific Reports  

This study aimed to investigate the influence of bone marrow edema (BME) for the assessment of the boundaries of necrotic lesions using unenhanced and contrast-enhanced (CE) magnetic resonance (MR) images in patients with osteonecrosis of the femoral head (ONFH). We retrospectively reviewed 72 consecutive hips in 55 patients of ONFH that were Association Research Circulation Osseous (ARCO) stage III or higher and underwent both unenhanced and contrast-enhanced MR imaging between January 2005 and February 2016. The degree of extension of BMEs, and the boundaries of the necrotic lesions were compared using unenhanced and CE MR images on both mid coronal and mid oblique-axial slices. Forty-two percent of the coronal T1 images, 40% of the coronal fat-saturated T2 images, and 48% of the oblique-axial T1 images showed differences in the boundaries of necrotic lesion, by comparison with those of CET1-weighted MR images. The boundaries of necrotic lesions were clearly detected in all hips on CE coronal slices and 97% of all hips on CE oblique-axial slices. The BME grade in the difference group was significantly higher than in the non-difference group on the coronal plane (P = 0.0058). There were significant differences between the BME grade and duration from the onset of hip pain to MR imaging examination. Multivariate analyses revealed that the duration from the onset to MR imaging examination in both coronal (P = 0.0008) and oblique-axial slices (P = 0.0143) were independently associated with differences in the boundary of necrotic lesion between T1 and CET1-weighted MR images. Our findings suggest that unenhanced MR image may be insufficient for a precise assessment of the boundaries of the necrotic lesions for ONFH cases in the early phase of subchondral collapse due to the diffuse BME.

DOI： 10.1038/s41598-022-23427-y

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1038/s41598-022-23427-y.

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1111/os.13544

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Language：English   Publisher：Gait and Posture  

Background: In modern society, car usage is one of the most important activities of daily living. However, the three-dimensional (3D) mechanics of getting into and out of a car in total hip arthroplasty (THA) patients have not been studied. Research question: This study aimed to elucidate the hip kinematics and kinetics of unilateral THA patients while getting into and out of a car. Methods: 3D motion and ground reaction force data were collected for 40 unilateral primary THA and 30 control participants using motion capture of getting into and out of a car. Normalized joint power was used to determine the individual joint contribution and was calculated by dividing the power of each joint by the total lower-extremity power. These kinematic and kinetic data were compared between unilateral THA and control participants. Results: When getting into the car using the surgical side as the pivot limb, the peak flexion, abduction angle, and normalized power of the pivot hip were significantly lower, and the normalized power of the contralateral ankle was significantly higher. The peak flexion and abduction angle of the pivot hip were significantly lower, and normalized contralateral hip power was significantly higher when getting out of the car. In getting into and out of the car using the contralateral side as the pivot limb, there was no significant difference in the range of motion (RoM) and normalized joint power. Significance: The restoration of RoM and muscle strength in the surgical hip joint and adopting the normal side as the pivot limb may allow for a more appropriate balance in motion of getting into and out of a car, which will lead to safe mobility, assist in social participation, and improved quality of life. Level of evidence: Level III, therapeutic study.

DOI： 10.1016/j.gaitpost.2022.10.003

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Language：English   Publisher：Journal of Arthroplasty  

Background: Identifying factors associated with poor hip contact mechanics after periacetabular osteotomy (PAO) may help surgeons optimize acetabular corrections in individual patients. We performed individual-specific finite-element analyses to identify preoperative morphological and surgical correction factors for abnormal contact pressure (CP) after PAO. Methods: We performed finite-element analyses before and after PAO with reference to the standing pelvic position on individual-specific 3-dimensional hip models created from computed tomography images of 51 dysplastic hips. Nonlinear contact analyses were performed to calculate the joint CP of the acetabular cartilage during a single-leg stance. Results: The maximum CP decreased in 50 hips (98.0%) after PAO compared to preoperative values, and the resulting maximum CP was within the normal range (<4.1 MPa) in 33 hips (64.7%). Multivariate analysis identified the roundness index of the femoral head (P = .002), postoperative anterior center-edge angle (CEA; P = .004), and surgical correction of lateral CEA (Δlateral CEA; P = .003) as independent predictors for abnormal CP after PAO. A preoperative roundness index >54.3°, a postoperative anterior CEA <36.3°, and a Δlateral CEA >27.0° in the standing pelvic position predicted abnormal CP after PAO. Conclusion: PAO normalized joint CP in 64.7% of the patients but was less likely to normalize joint CP in patients with aspheric femoral heads. Successful surgical treatment depends on obtaining adequate anterior coverage and avoiding excessive lateral correction, while considering the physiological pelvic tilt in a weight-bearing position.

DOI： 10.1016/j.arth.2022.04.045

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Language：English   Publisher：Geriatric Orthopaedic Surgery and Rehabilitation  

Introduction: Lower-limb osteoarthritis (OA) in the elderly can be a risk factor for frailty, which is the preliminary of disability, but it may be reversible with appropriate interventions. We aimed to use the Kihon Check List (KCL) to assess multiple domains of frailty and to identify the characteristics of frailty in patients with hip or knee OA following total joint arthroplasty. Materials and Methods: This study included 136 ≥ 65-year-old patients (mean age: 73.0 years) who underwent total arthroplasty with end-stage hip and knee OA. We assessed frailty status, instrumental activities of daily living (IADL), and health-related quality of life (HRQoL) according to the KCL, functional ambulatory index (FAI) and EuroQol-5 Dimension (EQ5D), respectively, as well as the extent of pain preoperatively and at postoperative 6 months. Results: Using KCL, seventy-eight (57.4%) patients were frail preoperatively, but the prevalence significantly decreased to 52 patients (38.2%) at postoperative 6 months. Total arthroplasty intervention provided significant improvements in the total KCL scores, including the physical domain (P <.01), pain (P <.01), FAI scores (P <.01), and EQ5D (P <.01), but not the social domain. Multivariate logistic regression analysis identified age at surgery (OR:.93, 95% CI:.86-.99) and preoperative FAI score (OR: 1.10, 95% CI: 1.03-1.19) as independent predictors of postoperative frailty. Conclusions: Total arthroplasty procedures on patients with hip and knee OA reduced their KCL score, but social aspects were less improved than physical aspects in the shortterm. Older age and preoperative lower IADL score can be useful for accurately estimating less improvement of frailty in the early postoperative phase. Our results suggest that long term follow-up of OA is needed to provide comprehensive interventions, including in social aspects, especially for patients with lower activity.

DOI： 10.1177/21514593221126019

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Language：English   Publisher：Annals of the Rheumatic Diseases  

Objective Genome-wide association studies (GWAS) have identified >100 risk loci for systemic lupus erythematosus (SLE), but the disease genes at most loci remain unclear, hampering translation of these genetic discoveries. We aimed to prioritise genes underlying the 110 SLE loci that were identified in the latest East Asian GWAS meta-analysis. Methods We built gene expression predictive models in blood B cells, CD4 + and CD8 + T cells, monocytes, natural killer cells and peripheral blood cells of 105 Japanese individuals. We performed a transcriptome-wide association study (TWAS) using data from the latest genome-wide association meta-analysis of 208 370 East Asians and searched for candidate genes using TWAS and three data-driven computational approaches. Results TWAS identified 171 genes for SLE (p<1.0×10 -5); 114 (66.7%) showed significance only in a single cell type; 127 (74.3%) were in SLE GWAS loci. TWAS identified a strong association between CD83 and SLE (p<7.7×10 -8). Meta-analysis of genetic associations in the existing 208 370 East Asian and additional 1498 cases and 3330 controls found a novel single-variant association at rs72836542 (OR=1.11, p=4.5×10 -9) around CD83. For the 110 SLE loci, we identified 276 gene candidates, including 104 genes at recently-identified SLE novel loci. We demonstrated in vitro that putative causal variant rs61759532 exhibited an allele-specific regulatory effect on ACAP1, and that presence of the SLE risk allele decreased ACAP1 expression. Conclusions Cell-level TWAS in six types of immune cells complemented SLE gene discovery and guided the identification of novel genetic associations. The gene findings shed biological insights into SLE genetic associations.

DOI： 10.1136/annrheumdis-2022-222345

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PubMed

Publisher：Orthopedics  

Periacetabular osteotomy (PAO) is an effective joint-preserving procedure for developmental dysplasia of the hip. However, some patients report dissatisfaction after PAO. Because patient satisfaction is increasingly used as a health care quality metric, it is important to gain a better understanding of factors associated with patient satisfaction after PAO. The goal of this study was to investigate patient satisfaction among a cohort of Asian patients undergoing PAO. This study included 227 Asian patients who had undergone PAO at our institution between 1998 and 2016. The study participants completed a questionnaire assessing patient satisfaction, reasons for dissatisfaction, and postoperative Oxford Hip Score (OHS) and University of California, Los Angeles (UCLA), activity scale score. Based on their satisfaction levels, the participants were divided into 4 subgroups, and their demographic characteristics and postoperative patient-reported outcomes were compared. Of the 227 patients, 190 expressed satisfaction that correlated with OHS-pain, OHD-activities of daily living, and UCLA activity scale scores. Primary reasons for dissatisfaction after PAO were persistent pain (24 of 49, 49%), functional limitations (14 of 49, 29%), stiffness around the hip (4 of 49, 8%), unmet expectations (4 of 49, 8%), conversion to total hip arthroplasty (2 of 49, 4%), and complications (1 of 49, 2%). Multivariate analysis showed that preoperative Kellgren-Lawrence grades 1 and 3 were the significant predictive factors for satisfaction and dissatisfaction, respectively. The potential for lower patient satisfaction associated with Kellgren-Lawrence grade 3 because of persistent pain and functional limitations postoperatively suggests that consideration of preoperative severity of osteoarthritis could enhance patient satisfaction after PAO.

DOI： 10.3928/01477447-20220425-02

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PubMed

Language：English   Publisher：Bone and Joint Journal  

Aims although periacetabular osteotomies are widely used for the treatment of symptomatic dysplastic hips, long-term surgical outcomes and patient-reported outcome measures (proMs) are still unclear. accordingly, we assessed hip survival and proMs at 20 years after transpositional osteotomy of the acetabulum (Toa). Methods a total of 172 hips in 159 patients who underwent Toa were followed up at a mean of 21.02 years (16.6 to 24.6) postoperatively. Kaplan-Meier analysis was used to assess survivorship with an endpoint of total hip arthroplasty (Tha). proMs included the visual analogue scale (VaS) Satisfaction, VaS pain, oxford hip Score (ohS), and Forgotten Joint Score-12 (FJS-12). Thresholds for favourable outcomes for OHS (≥ 42) and FJS-12 (≥ 51) were obtained using the receiver operating characteristic curve with VAS Satisfaction ≥ 50 and VaS pain < 20 as anchors. Results Tha was performed on 37 hips (21.5%) by the latest follow-up. Kaplan-Meier analysis indicated that the hip survival rate at 20 years was 79.7% (95% confidence interval (CI) 73.7 to 86.3). Multivariate analysis showed that preoperative Tönnis grade significantly influenced hip survival. Tönnis grades 0, 1, and 2 were associated with 20-year survival rates of 93.3% (95% cI 84.8 to 100), 86.7% (95% cI 79.8 to 94.3), and 54.8% (95% cI 41.5 to 72.3), respectively. More than 60% of the patients exhibited favourable proMs. an advanced Tönnis grade at the latest follow-up and a higher BMI were both significantly associated with unfavourable ohS, but not with other proMs. conclusion This study demonstrated the durability of Toa for hips with Tönnis grades 0 to 1 at 20 years. While the presence of advanced osteoarthritis and higher BMI was associated with lower hip functions (ohS), it was not necessarily associated with worse patient satisfaction and joint awareness.

DOI： 10.1302/0301-620X.104B7.BJJ-2021-1767.R1

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PubMed

Language：English   Publisher：International Journal of Computer Assisted Radiology and Surgery  

Purpose: This prospective randomized controlled study examined whether accelerometer-based navigation resulted in more accurate or precise cup orientation than a conventional mechanical guide. We used a simulation to evaluate how cup orientation affected potential hip range of motion (RoM) and freedom from prosthetic impingement. Methods: Sixty hips were randomly allocated 1:1 to accelerometer-based portable navigation or conventional guidance. Procedures were performed through a standard posterolateral approach and combined anteversion technique. Cup inclination, cup anteversion, and stem anteversion were measured using computed tomography (CT). Using CT-based simulation, we evaluated impingement-free potential RoM and the proportion of hips with potential RoM required for daily activities. Results: Absolute cup inclination and anteversion error averaged 4.3° ± 3.2° and 4.4° ± 2.9° for the navigation cohort and 5.6° ± 3.7° and 5.7° ± 4.2° for the conventional cohort, with no significant differences. Navigation resulted in significantly less variation in anteversion error than the conventional guide (p =.0049). Flexion, internal rotation (IR) at 90° of flexion, extension, and external rotation (ER) averaged 123° ± 12°, 46° ± 13°, 50° ± 10°, and 73° ± 23°, respectively, in the navigation cohort and 127° ± 10°, 52° ± 14°, 45° ± 10°, and 63° ± 12°, respectively, in the conventional cohort (p =.15,.15,.03, and.03, respectively). Flexion > 110°, IR > 30° at 90° of flexion, extension > 30°, and ER > 30° were achieved by 93%, 90%, 100%, and 100% of hips, respectively, in the navigation cohort and 97%, 93%, 97%, and 100% of hips, respectively, in the conventional cohort, with no significant differences. Conclusions: Cup anteversion with the navigation system was more precise, but not more accurate, than with the conventional guide. The navigation cohort exhibited greater potential extension and ER than the conventional cohort, but no significant difference in impingement within the potential RoM required for daily activities. Trial registration number: 29036. Date of registration: November 14, 2017.

DOI： 10.1007/s11548-022-02592-5

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Language：English   Publisher：Journal of Artificial Organs  

The impact of sports on long-term wear of highly cross-linked polyethylene (XLPE) after total hip arthroplasty (THA) is not fully understood. We investigated (1) the wear performance of the first-generation XLPE, and (2) whether sports participation influences the steady wear rate of XLPE. The femoral head penetration into the cup was measured digitally on radiographs of hips undergoing THA with XLPE. We retrospectively reviewed data that included age, gender, body mass index, follow-up period, preoperative diagnosis, types of XLPE, ball diameter, head material, inclination of the cup, physical function score, and sports participation. Statistical analyses were applied to determine whether sports affect the wear of XLPE and which factors were associated with the steady wear rate. Creep and steady wear rate were found to be 0.18 mm and 0.005 mm/year, respectively. Sports participation, regardless of impact, provided no significant difference in the steady wear rate. Multiple regression analysis demonstrated that sports did not increase the steady wear rate. Our findings showed excellent wear performance of the first-generation XLPE at a minimum of ten years after THA, without significant effect of sports participation on the liner wear.

DOI： 10.1007/s10047-021-01297-x

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Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：Journal of Orthopaedic Surgery and Research  

Background: To compare the degree of stem subsidence between two different femoral component designs and to determine the risk factors associated with stem subsidence after cementless total hip arthroplasty (THA) in Dorr type C femurs. Methods: We retrospectively reviewed 104 consecutive hips in 100 patients with Dorr type C proximal femoral morphology who underwent primary cementless THA using a fit-and-fill stem or a tapered wedge femoral stem at our institution between January 2012 and June 2021. A fit-and-fill stem was used in 55 hips and a tapered wedge stem was used in 49 hips. Radiologically, the distance between the apex of the major trochanter and the stem shoulder were measured at three different time points (immediately [0W], one week [1W], and six weeks [6W] after surgery) and the degrees of stem subsidence were assessed by comparing the distance between 0 and 1W, 1W and 6W, and 0W and 6W, respectively. Results: The mean degree of stem subsidence (0W vs. 1W) was 0.24 mm (standard deviation [SD] 0.36) in the fit-and-fill stem group, and 0.23 mm (SD 0.41) in the tapered wedge stem group. There was no significant difference between the two groups (P = 0.4862). However, the mean degrees of subsidence were significantly higher in the fit-and-fill stem group (1W vs. 6W, 0.38 mm [SD 0.68]; 0W vs. 6W, 0.65 mm [SD 0.87]) than in the tapered wedge stem group (1W vs. 6W, 0.16 mm [SD 0.32]; 0W vs. 6W, 0.24 mm [SD 0.38]) (P < 0.05 for both). In addition, the rates of > 3 mm subsidence (in which instability can be observed) were 18.2% (10 of 55 hips) and 2.0% (1 of 49 hips), respectively. There was also a significant difference between the two stems (P = 0.0091). Multivariate analysis demonstrated that fit-and-fill stem was a risk factor for > 3 mm subsidence after THA in Dorr type C femurs (P = 0.0050). Conclusion: Our findings suggest that the tapered wedge stem is more suitable for Dorr type C femurs than the fit-and-fill stem to avoid early postoperative subsidence in cementless THA.

DOI： 10.1186/s13018-022-03111-7

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PubMed

Language：English   Publisher：Human Molecular Genetics  

Osteonecrosis of the femoral head (ONFH) involves necrosis of bone and bone marrow of the femoral head caused by ischemia with unknown etiology. Previous genetic studies on ONFH failed to produce consistent results, presumably because ONFH has various causes with different genetic backgrounds and the underlying diseases confounded the associations. Steroid-associated ONFH (S-ONFH) accounts for one-half of all ONFH, and systemic lupus erythematosus (SLE) is a representative disease underlying S-ONFH. We performed a genome-wide association study (GWAS) to identify genetic risk factors for S-ONFH in patients with SLE. We conducted a two-staged GWAS on 636 SLE patients with S-ONFH and 95 588 non-SLE controls. Among the novel loci identified, we determined S-ONFH-specific loci by comparing allele frequencies between SLE patients without S-ONFH and non-SLE controls. We also used Korean datasets comprising 148 S-ONFH cases and 37 015 controls to assess overall significance. We evaluated the functional annotations of significant variants by in silico analyses. The Japanese GWAS identified 4 significant loci together with 12 known SLE susceptibility loci. The four significant variants showed comparable effect sizes on S-ONFH compared with SLE controls and non-SLE controls. Three of the four loci, MIR4293/MIR1265 [odds ratio (OR) = 1.99, P-value = 1.1 × 10-9)], TRIM49/NAALAD2 (OR = 1.65, P-value = 4.8 × 10-8) and MYO16 (OR = 3.91, P-value = 4.9 × 10-10), showed significant associations in the meta-analysis with Korean datasets. Bioinformatics analyses identified MIR4293, NAALAD2 and MYO16 as candidate causal genes. MIR4293 regulates a PPARG-related adipogenesis pathway relevant to S-ONFH. We identified three novel susceptibility loci for S-ONFH in SLE.

DOI： 10.1093/hmg/ddab306

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PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jor.2022.02.021

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PubMed

Publisher：メジカルビュー社  

DOI： 10.18885/jjs.0000000888

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.2106/JBJS.20.00493

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PubMed

Language：English   Publisher：(一社)理学療法科学学会  

日本人コホートにおける人工股関節全置換術(THA)後の患者満足度を判定すると共に、患者満足度に有意な影響を及ぼす因子を同定した。2012年1月～2016年1月に当施設で変形性関節症に対して初回THAを施行した患者に質問紙調査を実施し、回答が得られた285例(男性33例、女性252例、平均69.1±9.9歳)を評価した。89例で筋力、26例で日歩数を判定した。術後満足度、Oxford hip score-activities of daily living(OHS-ADL)、University of California Los Angeles activity score(UCLA AS)に関連する因子を同定した。OHS-ADLと日歩数との関連を検討した。患者の94.7%がTHAに満足したと回答した。OHS-ADLとUCLA ASは患者満足度と有意に関連していた。若年と股関節外転筋力は高OHS-ADLおよびUCLA ASと有意に関連していた。平均日歩数はOHS-ADLと有意に関連していた。

Language：English   Publisher：International Orthopaedics  

Purpose: Stem subsidence is a known cause of early failure in cementless total hip arthroplasty (THA). The aim of this study was to determine the usefulness of pneumatic femoral broaching in preventing post-operative subsidence of a proximally porous-coated, taper-wedge stem. Methods: We reviewed 169 cases of primary THA with a single taper-wedge stem. Eighty THAs performed using pneumatic broaching were compared with 89 THAs performed using manual broaching in terms of postoperative canal fill ratio (CFR) at three levels, stem subsidence at one year post-operation, and stem fixation at latest follow-up (median, 24 months). Results: The median CFRs were higher in the pneumatic group than in the manual group at all levels (p < 0.05). The median stem subsidence at one year after THA was lower in the pneumatic group than in the manual group (0.2 mm vs. 0.6 mm, p = 0.007). A multivariate analysis determined a decreased CFR at 60 mm below the lesser trochanter and the manual broaching as independent factors affecting post-operative stem subsidence. At the latest follow-up, all stems showed stable fixation by bone ingrowth in both groups. Conclusion: Our results showed that the pneumatic broaching device was useful in maximizing the mediolateral canal filling and initial stability and minimizing the subsidence of taper-wedge stems.

DOI： 10.1007/s00264-021-05196-x

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PubMed

Language：English   Publisher：Clinical Biomechanics  

Background: Dislocation after total hip arthroplasty is a frequent cause of revision surgery. This study was performed to determine the optimal implant alignment in total hip arthroplasty by simulating the postoperative range of motion. Methods: All operations were performed via posterolateral approach using combined anteversion of the stem and cup technique. Maximum range of motion without implant impingement was simulated in 79 replaced hips using postoperative computed tomography and the achievement of the required range of motion defined by previous studies was assessed. Optimal cup and stem alignment for impingement-free range of motion were statistically determined using the receiver operator coefficient curve. Findings: Cup inclination and anteversion, stem anteversion, and combined anteversion were 37.6°, 20.1°, 26.2°, and 46.3°, respectively. Maximum range of motion in flexion, extension, internal rotation at 90° of flexion, and external rotation were 131.8°, 42.3°, 56.4°, and 64.5°, respectively. Flexion >110°, extension >30°, internal rotation >30° at 90° of flexion, and external rotation >30° were fulfilled by 96%, 86%, 92%, and 96% of all replaced hips, respectively. Optimal implant alignment for impingement-free range of motion was 34°–43° of cup inclination, 18°–26° of cup anteversion, 17°–29° of stem anteversion, and 35°–56° of combined anteversion. Both cup and stem anteversion showed significant relationship with postoperative range of motion. Interpretation: Surgeons could gain valuable insights into optimal cup and stem alignment to perform postoperative range of motion simulations.

DOI： 10.1016/j.clinbiomech.2021.105555

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PubMed

Language：English   Publisher：BMC Musculoskeletal Disorders  

Background: The ideal acetabular position for optimizing hip joint biomechanics in periacetabular osteotomy (PAO) remains unclear. We aimed to determine the relationship between acetabular correction in the coronal plane and joint contact pressure (CP) and identify morphological factors associated with residual abnormal CP after correction. Methods: Using CT images from 44 patients with hip dysplasia, we performed three patterns of virtual PAOs on patient-specific 3D hip models; the acetabulum was rotated laterally to the lateral center-edge angles (LCEA) of 30°, 35°, and 40°. Finite-element analysis was used to calculate the CP of the acetabular cartilage during a single-leg stance. Results: Coronal correction to the LCEA of 30° decreased the median maximum CP 0.5-fold compared to preoperatively (p < 0.001). Additional correction to the LCEA of 40° further decreased CP in 15 hips (34%) but conversely increased CP in 29 hips (66%). The increase in CP was associated with greater preoperative extrusion index (p = 0.030) and roundness index (p = 0.038). Overall, virtual PAO failed to normalize CP in 11 hips (25%), and a small anterior wall index (p = 0.049) and a large roundness index (p = 0.003) were associated with residual abnormal CP. Conclusions: The degree of acetabular correction in the coronal plane where CP is minimized varied among patients. Coronal plane correction alone failed to normalize CP in 25% of patients in this study. In patients with an anterior acetabular deficiency (anterior wall index < 0.21) and an aspherical femoral head (roundness index > 53.2%), coronal plane correction alone may not normalize CP. Further studies are needed to clarify the effectiveness of multiplanar correction, including in the sagittal and axial planes, in optimizing the hip joint’s contact mechanics.

DOI： 10.1186/s12891-022-05005-5

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PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1038/s41598-022-04936-2

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PubMed

Language：English   Publisher：Clinical Orthopaedics and Related Research  

Background Inappropriate sagittal plane correction can result in an increased risk of osteoarthritis progression after periacetabular osteotomy (PAO). Individual and postural variations in sagittal pelvic tilt, along with acetabular deformity, affect joint contact mechanics in dysplastic hips and may impact the direction and degree of acetabular correction. Finite-element analyses that account for physiologic pelvic tilt may provide valuable insight into the effect of PAO on the contact mechanics of dysplastic hips, which may lead to improved acetabular correction during PAO.

DOI： 10.1097/CORR.0000000000001893

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Language：English   Publisher：The Society of Physical Therapy Science  

<p> [Purpose] To determine patient satisfaction after total hip arthroplasty in a Japanese cohort and to identify factors that significantly influence patient satisfaction. [Participants and Methods] This study included 285 patients who underwent primary total hip arthroplasty for osteoarthritis. Postoperative satisfaction, Oxford hip score, short form-12 mental component summary score, and University of California Los Angeles activity score were investigated. Muscle strength and daily step counts were determined using a hand-held dynamometer (μ-Tas F1) and activity monitor (ActivPAL) in 89 and 26 patients, respectively. Factors associated with postoperative satisfaction, Oxford hip score-activities of daily living, and University of California Los Angeles activity score were identified. The relationship between the Oxford hip score-activities of daily living and daily step counts was examined. [Results] Overall, 94.7% of the patients reported satisfaction with total hip arthroplasty. The Oxford hip score-activities of daily living and University of California Los Angeles activity score were significantly associated with patient satisfaction. Younger age and hip abductor strength were significantly associated with a higher Oxford hip score-activities of daily living and University of California Los Angeles activity score. The average daily step count was significantly correlated with the Oxford hip score-activities of daily living. [Conclusion] Self-reported physical activity levels significantly influenced patient satisfaction and were correlated with objective muscle strength and daily step count measurements. These findings can guide total hip arthroplasty patient counseling on the importance of muscle strength and activity levels.</p>

DOI： 10.1589/jpts.34.76

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CiNii Research

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DOI： 10.1016/j.jos.2019.05.015

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DOI： 10.1016/j.arth.2019.12.039

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DOI： 10.1016/j.clinbiomech.2020.02.011

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DOI： 10.1016/j.jbspin.2019.09.004

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DOI： 10.1080/14397595.2018.1558917

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DOI： 10.1002/jor.24674

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DOI： 10.1186/s13256-019-2192-7

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DOI： 10.1016/j.ejrad.2019.01.002

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DOI： 10.1016/j.jos.2019.05.016

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00256-019-3158-y

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DOI： 10.1016/j.jos.2019.02.014

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Background: In total hip arthroplasty (THA), placing the cup in an anatomic position is not always possible in case of deformities related to developmental dysplasia of the hip (DDH). Thus far, the influence of a hip center on the abductor moment after THA has not been clearly elucidated. Therefore, we performed a retrospective study to assess 1) how abductor muscle moment recovers postoperatively in THA and 2) whether acetabular cup position affects the recovery of abductor moment. Hypothesis: A high hip center affects the recovery of abductor moment of a dysplastic hip after THA. Patients and methods: We evaluated 100 patients, who underwent unilateral primary THA, at 12 months postoperatively. The study included 86 women and 14 men, with a mean age of 65.5 ± 9.9 years (range, 40 to 86 years). Patients with secondary osteoarthritis due to DDH were included (Crowe 1: 76; Crowe 2: 15, Crowe 3: 9, and Crowe 4: none). A cementless straight stem was implanted in all hips. Hip abductor moment was measured using a belt-stabilized handheld dynamometer. The ratio of moment of the affected side to that of the contralateral side was calculated as moment ratio. The horizontal and vertical centers of rotation (H-COR and V-COR) (with respect to the inter teardrop line) and vertical shift (V-shift) (difference in V-COR between the affected hip and the contralateral normal hip) were determined. Results: At 6 and 12 months postoperatively, the abductor moment ratios were 95.1 and 94.7%, respectively. Significant negative correlation was observed between the postoperative abductor moment ratio and V-COR at 6 months postoperatively (r = −0.2436, p = 0.0238). Significant delay in the recovery of abductor moment ratio was observed in the groups with higher hip center (V-shift > 15 mm) (odds ratio = 12.7; 95% CI, 2.11–232.1, p = 0.0034) at 6 months postoperatively, which was fully recovered at 12 months postoperatively. Discussion: Superior placement of a hip center, more than 15 mm above the true hip center, delayed the recovery of abductor muscle moment after THA. Level of evidence: III, retrospective comparative study.

DOI： 10.1016/j.rcot.2018.09.138

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DOI： 10.1002/jor.24124

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DOI： 10.1016/j.otsr.2018.06.022

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DOI： 10.1002/jor.24066

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DOI： 10.3928/01477447-20180806-04

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DOI： 10.1007/s00264-018-3836-8

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DOI： 10.1007/s00264-018-3897-8

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DOI： 10.1016/j.jor.2018.01.044

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DOI： 10.1016/j.arth.2017.08.035

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DOI： 10.1186/s13018-018-0714-4

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DOI： 10.1016/j.jos.2018.02.001

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DOI： 10.1007/s00264-018-4154-x

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DOI： 10.1038/s41598-017-14778-y

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DOI： 10.1016/j.otsr.2017.06.012

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DOI： 10.1177/0363546517707942

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DOI： 10.1016/j.arth.2017.04.034

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DOI： 10.1007/s00402-017-2720-0

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DOI： 10.1016/j.jos.2017.02.009

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DOI： 10.1007/s00296-016-3624-y

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DOI： 10.1080/14397595.2016.1222663

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DOI： 10.1016/j.otsr.2016.10.019

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DOI： 10.1016/j.ijscr.2017.06.010

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DOI： 10.1016/j.rcot.2017.07.014

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DOI： 10.1007/s00256-016-2462-z

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DOI： 10.1016/j.jos.2016.06.014

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DOI： 10.1186/s40064-016-3576-4

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DOI： 10.1007/s00256-016-2443-2

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DOI： 10.1007/s00264-015-2992-3

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DOI： 10.1016/j.arthro.2016.01.060

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DOI： 10.1007/s00264-015-3020-3

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DOI： 10.1016/j.jmbbm.2015.12.022

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DOI： 10.1016/j.arth.2015.11.034

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DOI： 10.1016/j.rcot.2016.12.011

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DOI： 10.1007/s00256-016-2328-4

Language：Others   Publishing type：Research paper (scientific journal)  

Background: During transtrochanteric rotational osteotomy (RO), it is important to preserve the posterior column artery (PCA), which is generally located in the adipose tissue underneath the quadratus femoris muscle (QF). If there is a defect in the QF, the risk of injuring the PCA, subsequently resulting in total necrosis of the femoral head, may increase. Therefore we investigated (1) the frequency of defects of the QF at the time of RO, (2) clinical outcome of RO based upon a defect of the QF. Hypothesis: The presence of defects of the QF at the time of RO could be detected pre-operatively by magnetic resonance imaging. Methods: RO was performed in 124 hips between 2001 and 2010. In all, 95 of the hips were in male patients and 29 in female patients. The mean age was 45.4 years (range: 11-61 years) at the time of surgery and MRI was performed before RO in all cases. We retrospectively evaluated the progression of a collapse through 3 years after RO. Results: MRI showed a defect in the QF in four hips (3.2 %) (two males, two females), all of which were confirmed intraoperatively. Among the four patients, one (25 %) underwent total hip arthroplasty because of varus deformity of the osteotomy site due to total necrosis of the femoral head 1 year after RO. The 120 hips with a normal QF showed no evidence of total necrosis or progression of necrosis of the femoral head, indicating that the presence of defects of the QF may increase the risk of poor survivorship of this procedure. Conclusions: Defects of the QF have been reported to occur in 1-2 % of all patients, whereas in our study the incidence in ON was approximately 3 %. In ON patients with QF defects, pre-operative MRI evaluation of the QF appears to be important when planning RO, followed by a carefully performed surgical procedure. Level of evidence: IV retrospective case series without control group.

DOI： 10.1016/j.rcot.2016.02.016

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.otsr.2016.01.017

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.3109/14397595.2015.1092914

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.chemosphere.2015.11.091

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00256-015-2258-6

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.ijscr.2016.05.009

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.ijscr.2016.07.020

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.2174/1874325001610010206

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1186/s40064-015-1458-9

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.bone.2015.09.009

Language：English   Publishing type：Research paper (scientific journal)  

Osteonecrosis of the femoral head is considered to occur early during the course of corticosteroid treatment. However, it remains unclear exactly how early it can develop after initiation of corticosteroid treatment. We report a case of osteonecrosis of the femoral head in which abnormal findings were observed on short-tau inversion recovery (STIR) sequence image performed 2 weeks and 4 days after initiation of high-dose corticosteroid therapy. A 45-year-old man with hemophagocytic syndrome was started on prednisolone, with a maximum dose of 40 mg/day. On day 13 after initiation of this corticosteroid therapy, he transiently experienced left hip pain with no apparent cause. STIR sequence image 5 days after the onset of pain revealed high-intensity bone marrow lesions at the femoral neck of both hips. At 3 months after initiation of corticosteroid therapy, T1-weighted magnetic resonance imaging revealed concave-shaped low-intensity bands, which corresponded to the preceding high-intensity lesions on both hips. Because of the subsequent progression to collapse of the left femoral head, he underwent prosthetic replacement surgery. The high-intensity lesions on STIR sequence image indicate the possibility that osteonecrosis can occur within 3 weeks after initiation of high-dose corticosteroid therapy.

DOI： 10.1007/s00296-015-3346-6

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00296-015-3304-3.

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00296-015-3304-3

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1097/RLU.0000000000000886

Language：English   Publishing type：Research paper (scientific journal)  

Introduction: This study examined the outcomes of applying transtrochanteric rotational osteotomy (TRO) for posttraumatic osteonecrosis of the femoral head (ON). Patients and Methods: We retrospectively reviewed 28 hips in 28 patients (male, n = 17; female n = 11) with a mean age of 34.8 years (12–61 years) at the time of TRO. Transtrochanteric anterior rotational osteotomy (ARO) was used when the lesion was localized on the anterior aspect of the femoral head, and transtrochanteric posterior rotational osteotomy (PRO) was indicated in patients with lesions limited to the posterior aspect of the femoral head. The mean follow-up period was 12.3 years (5.0–21.3 years). We investigated the patients’ clinical and radiological factors, including age, sex, body mass index, preoperative Harris Hip Score (HHS), type of antecedent trauma, preoperative stage, and postoperative intact ratio (the ratio of the intact articular surface of the femoral head to the weight-bearing surface of the acetabulum). We divided the patients into a hip-survival group and a conversion-to-total hip arthroplasty (THA) group and then compared these factors between the two groups. Results: At the final follow-up, 22 hips had survived with a mean HHS of 85.8. The remaining six hips underwent THA at a mean of 10.2 years after TRO. The preoperative stage was correlated with hip survival. Furthermore, the postoperative intact ratio was significantly lower in the conversion-to-THA group. Based on the receiver operating characteristic curve, a ratio of less than 33.6 % was found to be associated with the need to convert to THA. Conclusions: TRO to correct posttraumatic ON resulted in favorable midterm results. The possible risk factors for conversion to THA were an advanced preoperative stage and a postoperative intact ratio of less than 33.6 %.

DOI： 10.1007/s00402-015-2282-y

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00776-014-0541-3

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.2188/jea.JE20140162

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1093/rheumatology/keu253

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.4137/CCRep.S18171

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1111/iep.12060

Language：English  

DOI： 10.1007/978-3-642-35767-1_33

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00264-013-2131-y

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00256-014-1835-4

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1186/1752-1947-8-447

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1097/MNM.0000000000000166

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00264-014-2375-1

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00264-013-2091-2

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.3109/17453674.2013.859421

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00402-013-1847-x

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00264-013-2047-6

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00402-013-1863-x

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00264-013-1921-6

Language：Japanese  

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.2214/AJR.12.9615

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.bone.2012.12.050

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00256-012-1525-z

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s10165-012-0618-9

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00776-013-0456-4

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00776-012-0347-0

Language：English   Publishing type：Research paper (other academic)  

DOI： 10.4028/www.scientific.net/KEM.529-530.279

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1002/jor.22148

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00256-012-1368-7

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1093/rheumatology/ker197

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1259/bjr/44936440

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1111/j.1365-2613.2011.00798_2.x

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00776-012-0238-4

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00776-012-0205-0

Language：English   Publishing type：Research paper (scientific journal)  

Background Acetabular retroversion is observed in hips after various pediatric hip diseases. This study sought to examine the frequency of acetabular retroversion in both affected and unaffected hips after Legg-Calvé- Perthes disease and its correlation with the prominence of the ischial spine. Methods We retrospectively investigated the version and morphological features of the acetabulum using pelvic radiographs after Legg-Calvé-Perthes disease (107 affected hips treated non-operatively and 72 unaffected hips from the contralateral side). The diagnosis of acetabular retroversion was made based on the presence of a positive cross-over sign on anteroposterior pelvic radiographs. The correlation between the presence of a positive cross-over sign and modified Stulberg classes, the onset age of Legg-Calvé-Perthes disease, radiographic parameters for acetabular dysplasia and the prominence of the ischial spine were examined. Results The prevalence of a positive cross-over sign was 49.5 % (45 of 91 hips) in affected hips and 45.8 % (33 of 72 hips) in unaffected hips. Hips with a positive cross-over sign were significantly coexistent bilaterally. The prevalence of prominence of the ischial spine in the positive cross-over sign group was 71.4 % in the affected side and 81.8 % in the unaffected side, indicating a significant correlation between the cross-over sign and the prominence of the ischial spine in both affected and unaffected hips. The positive cross-over sign did not have any correlation with the parameters for acetabular dysplasia and the onset age, however, had a significant correlation with the severity of the femoral head deformity. Conclusions High prevalence of acetabular retroversion in both affected and unaffected hips after Legg-Calvé-Perthes disease was demonstrated. Symmetric acetabular deformity and the coexistence of prominence of the ischial spine suggested the effects of the Legg-Calvé-Perthes disease lesions on the skeletal development of the whole pelvis. Further follow-up is needed to clarify the pathological significance of acetabular retroversion after Legg-Calvé-Perthes disease.

DOI： 10.1007/s00776-012-0213-0

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1302/0301-620X.93B11.27314

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1002/art.30484

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1097/BPO.0b013e318223b4f3

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1111/j.1365-2613.2011.00773.x

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.clinimag.2010.05.005

Language：Japanese  

Language：Japanese  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1302/0301-620X.93B225476

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00776-011-0059-x

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.2214/AJR.09.3271

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1177/0961203310361896

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1302/0301-620X.92B6.23621

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.2106/JBJS.I.00046

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1093/rheumatology/keq044

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00256-009-0750-6

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00256-009-0706-x

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1097/BPO.0b013e31819bc746

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.3899/jrheum.080324

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.3899/jrheum.080416

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1080/08923970701812647

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s11999-008-0189-4

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1080/17453670610013042

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.arth.2005.08.007

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00402-005-0053-x

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1093/rheumatology/keh505

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.prp.2004.10.003

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1002/art.20517

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.2106/00004623-200303000-00036

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.2106/00004623-200207000-00018

Event date： 2023.10

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：福岡   Country：Japan  

Event date： 2023.10

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Venue：福岡   Country：Japan  

Event date： 2023.10

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：つくば   Country：Japan  

Event date： 2023.9

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：web   Country：Japan  

Event date： 2022.10

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Venue：山形   Country：Japan  

Event date： 2022.7

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：web   Country：Japan  

Event date： 2022.6

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：福岡   Country：Japan  

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Language：Japanese   Presentation type：Oral presentation (general)  

Venue：福岡   Country：Japan  

Event date： 2021.11

Language：Japanese  

Venue：web   Country：Japan  

Event date： 2021.9

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：web   Country：Japan  

Event date： 2021.9

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：web   Country：Japan  

Event date： 2020.10

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：三重   Country：Japan  

Event date： 2019.10

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

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Event date： 2019.10

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：横浜   Country：Japan  

Event date： 2018.5

Language：Japanese  

Country：Japan  

Event date： 2018.5

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Country：Japan  

Event date： 2018.3

Language：Japanese  

Country：United States  

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Country：United States  

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Language：Japanese   Presentation type：Oral presentation (general)  

Venue：北九州   Country：Japan  

Event date： 2017.10 - 2018.10

Language：English  

Country：Germany  

Event date： 2017.10

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：東京   Country：Japan  

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Country：United States  

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Country：Belgium  

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Venue：福岡   Country：Japan  

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Presentation type：Symposium, workshop panel (public)  

Venue：鹿児島   Country：Japan  

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Language：Japanese   Publisher：(株)メジカルビュー社  

＜文献概要＞大腿骨頭回転骨切り術後の大腿骨近位部は,解剖学的形態が通常とはまったく異なっており,骨切り既往のない人工股関節全置換術(total hip arthroplasty;THA)と比べると手術の難易度が高くなる。手術では骨切り後の特徴を考慮して処置を行うことが肝要であり,ステムの設置位置不良の原因となる骨癒合部の硬化骨を切除すること,屈曲内旋時にインピンジメントの原因となる転子部前方に張り出した骨や肥厚変性した前方関節包を切除すること,および意図的内反による脚短縮に対する脚長補正を適切に行うこと,が重要である。以上の点を踏まえて施行されたTHAの成績は,手術時間の延長や術中出血量の増加はあるものの,通常のTHAと変わらぬ成績が得られることが報告されている。

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Language：Japanese   Publishing type：Internal/External technical report, pre-print, etc.  

Type：Peer review 

Number of peer-reviewed articles in foreign language journals：5

Type：Peer review 

Number of peer-reviewed articles in foreign language journals：2

Type：Peer review 

Number of peer-reviewed articles in foreign language journals：3

Type：Peer review 

Number of peer-reviewed articles in foreign language journals：3