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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Language：English   Publisher：Journal of Orthopaedics  

Background: Despite experiencing pain relief and improved activities of daily living after total hip arthroplasty (THA) for osteoarthritis of the hip, a Trendelenburg gait may be observed in some patients. The concentric and eccentric contraction patterns of hip muscles in a Trendelenburg gait are not well understood. Methods: This study included 89 patients (28 males and 61 females, mean age 66.5 ± 8.4 years, mean postoperative period 1.3 ± 0.4 years) after unilateral THA without functional impairment on the contralateral side. Gait analysis utilized a three-dimensional motion capture system to assess pelvis and hip angles, hip moment, and hip power. A Trendelenburg gait was defined as positive when nonoperative pelvic descent occurred at 30 % of the gait cycle, equivalent to mid-stance. Patients were classified into Trendelenburg gait-positive and -negative groups for statistical analysis. Unpaired t-test and chi-square test were used to compare the two groups. Multiple regression analysis was conducted to identify factors associated with the presence of a Trendelenburg gait. Results: A Trendelenburg gait was observed in 24 patients (27 %). Multiple regression analysis indicated that abduction (p < 0.01) and extension (p = 0.03) of hip joint power were significant determining of a Trendelenburg gait. Patients with a Trendelenburg gait exhibited reduced eccentric contraction of the hip abductor muscles and decreased concentric contraction of hip extensor muscles during early to mid-stance of their gait. Conclusion: Centrifugal contraction of hip abductor muscles and diminished eccentric contractility of hip extensor muscles appear crucial for hip stabilization mechanisms during gait after THA.

DOI： 10.1016/j.jor.2024.07.020

Web of Science

Scopus

PubMed

Language：English   Publisher：Journal of Translational Autoimmunity  

Objective: Dysregulated T cell homeostasis has long been implicated in the pathogenesis of rheumatoid arthritis (RA), in the joint of which peripheral helper T (Tph) cells accumulate and form ectopic lymphoid organs. We examined whether homeostatic signals are involved in the development of Tph cells. Methods: Human peripheral blood mononuclear cells were cultured with IL-7, the critical cytokine for T cell homeostasis. Development of Tph-like cells was assessed by flow cytometry, gene expression, and functional analysis. Chemotaxis of the Tph-like cells to RA synovial fluid (RASF) and the effect of RASF on the development of Tph-like cells was examined. Results: PD-1highCXCR5- Tph-like cells developed from human peripheral blood CD4 T cells after proliferation in response to IL-7. Signals from self-MHC recognition and CD28 co-stimulation were also involved. The IL-7-induced Tph-like (IL-7-Tph) cells produced CXCL13 and IL-21 and helped B cells produce IgG. Comprehensive gene expression analysis further supported the similarity with Tph cells in RA joint. IL-7-Tph cells exhibited chemotaxis toward synovial fluid from RA patients (RASF), and RASF promoted the development of IL-7-Tph cells, which were also induced from CD4 T cells residing in non-inflamed joints. Conclusions: Our results demonstrate an antigen-nonspecific developmental pathway of Tph cells triggered by homeostatic signals and promoted by the local environment of RA, which accounts for the accumulation of Tph cells in inflamed joints.

DOI： 10.1016/j.jtauto.2024.100258

Web of Science

Scopus

PubMed

Language：English   Publisher：Arthroplasty  

Purpose: In total knee arthroplasty (TKA), asymmetric tibial components have been developed alongside symmetric tibial components to enhance bony coverage at the tibia. In primary TKA and revision TKA for patients with significant bone defects, augmentation is employed to fill the bone defect. However, there have been no reports on bony coverage of the tibial component of the revision system in the cases of bone defects. Therefore, we simulated bone defects using CT and compared the bony coverage of asymmetric and symmetric tibial components in the revision TKA system. Methods: This study included 45 patients (50 knees involved) with medial osteoarthritis. Preoperative CT scans were used to simulate placement using ZedKnee. Three models were evaluated: Persona Revision PCCK (Zimmer) for the asymmetric component, NexGen LCCK (Zimmer) for the symmetric component, and the ATTUNE revision system (Depuy-Synthes). A 130-mm stem extension was utilized. Augmentations of each thickness were placed to simulate bone defects of 5, 10, and 15 mm. The coverage, overhang, and underhang rates were measured for each slice and compared among the models. Results: In terms of coverage, the rate was greater for PCCK at 0 mm, and only ATTUNE exhibited a significantly lower coverage at 5 and 10 mm. There was no significant difference in coverage at 15 mm. At 0 mm, PCCK demonstrated less posterior underhangs. At 5 and 10 mm, PCCK showed less anterior overhang but more anterior underhang. At 15 mm, PCCK had a less anterior overhang, with an overhang in the posterior region but less underhang. When overhang and underhang were combined and compared, the asymmetric component generally yielded superior results. Conclusion: In the cases of bone defects, asymmetric components demonstrated reduced anterior overhang and decreased posterior underhang, resulting in greater bone coverage. This may contribute to improved long-term outcomes in the revision TKA system.

DOI： 10.1186/s42836-024-00277-9

Web of Science

Scopus

PubMed

Language：English  

DOI： 10.2106/JBJS.23.01132

PubMed

Language：English   Publisher：Bone and Joint Journal  

Aims The Coronal Plane Alignment of the Knee (CPAK) classification has been developed to predict individual variations in inherent knee alignment. The impact of preoperative and postoperative CPAK classification phenotype on the postoperative clinical outcomes of total knee arthroplasty (TKA) remains elusive. This study aimed to examine the effect of postoperative CPAK classification phenotypes (I to IX), and their pre- to postoperative changes on patient-reported outcome measures (PROMs). Methods A questionnaire was administered to 340 patients (422 knees) who underwent primary TKA for osteoarthritis (OA) between September 2013 and June 2019. A total of 231 patients (284 knees) responded. The Knee Society Score 2011 (KSS 2011), Knee injury and Osteoarthritis Outcome Score-12 (KOOS-12), and Forgotten Joint Score-12 (FJS-12) were used to assess clinical outcomes. Using preoperative and postoperative anteroposterior full-leg radiographs, the arithmetic hip-knee-ankle angle (aHKA) and joint line obliquity (JLO) were calculated and classified based on the CPAK classification. To investigate the impact on PROMs, multivariable regression analyses using stepwise selection were conducted, considering factors such as age at surgery, time since surgery, BMI, sex, implant use, postoperative aHKA classification, JLO classification, and changes in aHKA and JLO classifications from preoperative to postoperative. Results The preoperative and postoperative CPAK classifications were predominantly phenotype I (155 knees; 55%) and phenotype V (73 knees; 26%), respectively. The change in the preoperative to postoperative aHKA classification was a significant negative predictive factor for KOOS-12 and FJS-12, while postoperative apex proximal JLO was a significant negative predictive factor for KSS 2011 and KOOS-12. Conclusion In primary TKA for OA, preoperative and postoperative CPAK phenotypes were associated with PROMs. Alteration in varus/valgus alignment from preoperative to postoperative was recognized as a negative predictive factor for both KOOS-12 and FJS-12. Moreover, the postoperative apex proximal JLO was identified as a negative factor for KSS 2011 and KOOS-12. Determining the target alignment for each preoperative phenotype with reproducibility could improve PROMs.

DOI： 10.1302/0301-620X.106B10.BJJ-2023-1425.R1

Web of Science

Scopus

PubMed

Language：English  

DOI： 10.7759/cureus.70790

PubMed

Language：English   Publisher：Bone and Joint Open  

Aims The aim of this study was to evaluate the suitability of the tapered cone stem in total hip arthroplasty (THA) in patients with excessive femoral anteversion and after femoral osteotomy. Methods We included patients who underwent THA using Wagner Cone due to proximal femur anatomical abnormalities between August 2014 and January 2019 at a single institution. We investigated implant survival time using the endpoint of dislocation and revision, and compared the prevalence of prosthetic impingements between the Wagner Cone, a tapered cone stem, and the Taperloc, a tapered wedge stem, through simulation. We also collected Oxford Hip Score (OHS), visual analogue scale (VAS) satisfaction, and VAS pain by postal survey in August 2023 and explored variables associated with those scores. Results Of the 58 patients (62 hips), two (two hips) presented with dislocation or reoperation, and Kaplan-Meier analysis indicated a five-year survival rate of 96.7% (95% CI 92.4 to 100). Mean stem anteversion was 35.2° (SD 18.2°) for the Taperloc stem and 29.8° (SD 7.9°) for the Wagner Cone stem; mean reduction from Taperloc to Wagner Cone was 5.4° (SD 18.8°). Overall, 55 hips (52 patients) were simulated, and the prevalence of prosthetic impingement was lower for the Wagner Cone (5.5%, 3/55) compared with the Taperloc (20.0%, 11/55) stem, with an odds ratio of 0.20 (p = 0.038). Among the 33 respondents to the postal survey (36 hips), the mean scores were VAS pain 10.9, VAS satisfaction 86.9, and OHS 44.7. A multivariable analysis revealed that reduction of stem anteversion from Taperloc to Wagner Cone was more favourable for VAS pain (p = 0.029) and VAS satisfaction (p = 0.002). Conclusion The mid-term survival rate for THA using the Wagner Cone stem was high, which may be supported by a reduction in prosthetic impingement. The reduction in excessive stem anteversion by using a tapered cone stem was associated with reduced pain and increased patient satisfaction.

DOI： 10.1302/2633-1462.510.BJO-2024-0144.R1

Web of Science

Scopus

PubMed

Language：Japanese   Publisher：西日本整形・災害外科学会  

<p>【目的】成人股関節疾患における股関節疾患の家族歴・既往歴を調査すること．【方法】2020年6月～2021年8月に当科を受診した股関節新患患者449例658股，変形性股関節症（OA）350例，大腿骨頭壊死症（ONFH）61例，大腿骨頭軟骨下脆弱性骨折（SIF）22例，Femoroacetabular impingement（FAI）7例，一過性大腿骨頭萎縮症（TOH）5例，急速破壊型股関節症（RDC）4例の股関節疾患家族歴・既往歴を調査した．【結果】股関節疾患家族歴は，OA 76例（22％），ONFH 3例（5％），SIF 1例（5％），FAI 1例（14％），TOH 0例，RDC 0例に認められた．股関節疾患既往歴は，OA 70例（20％），SIF 1例（5％）に認められ，全て発育性股関節形成不全（DDH）であった．【結論】他の成人股関節疾患に比べOAは股関節疾患家族歴，DDH既往歴を高頻度に有していた．</p>

DOI： 10.5035/nishiseisai.73.923

CiNii Research

Language：Japanese   Publisher：西日本整形・災害外科学会  

<p>【目的】寛骨臼形成不全に伴う前・初期変形性股関節症の自然経過と進行に関連する因子を検討すること．【方法】2005年から2012年に当科で股関節手術を施行された患者のうち，非手術側が前・初期股関節症で，5年以上経過観察が可能であった134例134関節（男性10例，女性124例）を対象とした．初回評価時年齢は14-82歳（平均51歳），経過観察期間は5-22年（平均13年）であった．THA施行あるいは進行期への病期進行をエンドポイントとして関節生存率と進行に関連する因子を調査した．【結果】前・初期股関節症は5年で8％，10年で22％，15年で40％がTHA施行あるいは進行期へ病期が進行していた．単変量・多変量解析の結果，初回評価時年齢が独立した予後因子であり，高齢であるほどTHA施行あるいは病期が進行しやすかった．【結語】前・初期股関節症は経年的にTHAあるいは病期進行の割合が増加し，高年齢がリスク因子であった．</p>

DOI： 10.5035/nishiseisai.73.696

CiNii Research

Language：Japanese   Publisher：西日本整形・災害外科学会  

<p>【背景】人工膝関節置換術（TKA）前後の冠状面アライメントが術後の患者立脚型アウトカムに影響するか否かを検討すること．【方法】当院でTKAを施行した症例を対象とし，TKA前後のCoronal Plane Alignment of the knee（CPAK）分類がKnee Society Score 2011, Knee Injury and Osteoarthritis Outcome Score-12に及ぼす影響を調査した．【結果】全下肢単純X線画像を用いてmedial proximal tibial angle（MPTA），lateral distal femoral angle（LDFA）を計測し，MPTA－LDFA＝arithmetic Hip-Knee-Ankle（aHKA），MPTA＋LDFA＝Joint Line Orientation（JLO）を算出した．CPAK分類は術前はphenotype（i）が最も多く，術後はMechanical Alignment法の目標であるphenotype（v）が最も多かった．術後aHKAは変化なし，術後JLOは内方傾斜またはNeutralに分類されると患者立脚型アウトカムは良いという結果になった．【結論】術後aHKAは術前と分類が変わる，術後JLOは外方傾斜になると患者立脚型アウトカムは低下していた．</p>

DOI： 10.5035/nishiseisai.73.920

CiNii Research

Language：Japanese   Publisher：西日本整形・災害外科学会  

<p>内側人工膝関節単顆置換術（UKA）55膝について術前および術後1年で評価を行った．全下肢単純X線写真でmHKA，MPTA，LDFAを計測，aHKAとJLOを算出しCPAK分類にあてはめた．術後CPAK分類におけるaHKAとJLOの各群がKSSの術前後改善に及ぼす影響を検討し，関節面傾斜およびインプラントアライメントとの関連を評価した．KSSの変化とaHKAの関係については，Valgus群で有意に改善度が低く，LDFAの変化量に有意差を認めた．KSSの変化とJLOの関係については，Apex distal群で有意に改善が低く，同様にLDFAの変化量に有意差を認め，また大腿骨コンポーネントは有意に屈曲位設置であった．以上より，膝関節伸展位で大腿骨を不足なく骨切りすることが，KSS改善に重要と考えられた．</p>

DOI： 10.5035/nishiseisai.73.715

CiNii Research

Language：Japanese   Publisher：日本股関節学会  

Language：English   Publisher：Arthroplasty Today  

Background: Accurate cup placement in total hip arthroplasty (THA) for patients with dysplasia is challenging due to the distinctive bone deformities. This study aimed to compare the accuracy of cup placement position and orientation across robotic arm–assisted systems (R-THA), computed tomography–based navigation (N-THA), and manual procedure (M-THA) in THA for osteoarthritis secondary to dysplasia. Methods: A total of 167 patients (197 hips), including 88 R-THAs, 45 N-THAs, and 46 M-THAs, were analyzed. Propensity score matching was performed to align the patient backgrounds. Horizontal and vertical centers of rotation were measured for cup position, whereas radiographic inclination and anteversion were measured for cup orientation. The proportion of cases with cup placement within 3 mm and 5° from the target was compared. Results: R-THA had a significantly higher percentage of cup placement within 3 mm of the target compared to N-THA (78% vs 49%; P = .0041) and M-THA (78% vs 53%; P = .013). Similarly, R-THA was significantly more successful in placing the cup within 5° of the target compared to N-THA (84% vs 58%; P = .0049) and M-THA (91% vs 20%; P < .0001). Moreover, N-THA was significantly better at placing the cup within 5° of the target compared to M-THA (62% vs 14%; P < .0001), whereas there was no significant difference in the percentage of cup placement within 3 mm of the target (51% vs 51%; P = 1.0). Conclusions: Robotic arm–assisted system and computed tomography–based navigation improved accuracy in cup orientation compared to the manual procedure. Additionally, the robotic arm–assisted system further improved cup position accuracy.

DOI： 10.1016/j.artd.2024.101461

Web of Science

Scopus

PubMed

Language：English   Publisher：Skeletal Radiology  

Objective: Although some patients may experience collapse progression while others may not in post-collapse osteonecrosis of the femoral head (ONFH) with a necrotic lesion located within the weight-bearing part of the acetabulum (Type B/C1), few studies have focused on the natural course after collapse. This study aimed to clarify the correlation between necrotic volume (NV) and necrotic depth (ND) in predicting collapse progression in patients with post-collapse ONFH Type B/C1. Materials and methods: We retrospectively reviewed 54 hips with post-collapse ONFH Type B/C1 from 52 consecutive patients who were conservatively followed up for more than 1 year. We measured the amount of femoral head collapse using biplane radiographs at each follow-up period, and produced Kaplan–Meier survival curves with collapse progression (≥ 1 mm) as the endpoint. We compared NV and ND, which were calculated as the ratio of the distance from the articular surface of the femoral head to the deepest point of a necrotic lesion to the femoral head diameter in the mid-coronal slice of T1-weighted magnetic resonance imaging (MRI). Results: We observed collapse progression in 31 hips (57.4%). The NV and ND were significantly greater in hips with collapse progression than in those without collapse progression (p = 0.0127 and 0.0047, respectively). Necrotic volume was significantly correlated with ND　(rs = 0.56, p < 0.0001). Conclusion: This study suggests that necrotic depth on the mid-coronal slice of T1-weighted MRI can be a substitute for necrotic volume to predict collapse progression in ONFH Type B/C1.

DOI： 10.1007/s00256-024-04741-0

Web of Science

Scopus

PubMed

Language：English   Publisher：Journal of Experimental Orthopaedics  

Purpose: This study assessed rotational mismatch between components after total knee arthroplasty (TKA) in the supine and standing positions and aimed to investigate the effect of rotational mismatch in the standing position on postoperative patient-reported outcome measures (PROMs). Methods: Seventy-one patients (71 knees) who underwent TKA for medial knee osteoarthritis were used to investigate rotational mismatches between components. Rotational mismatches between components were examined on postoperative standing whole-leg and supine knee radiographs using a three-dimensional-to-two-dimensional model image registration technique, and the angles between the reference axes of the components were measured. Component alignment was evaluated using postoperative computed tomography images, and a questionnaire (2011 version of the Knee Society Score: [KSS 2011]) was mailed to investigate postoperative PROMs. Results: In the entire cohort, rotational mismatches in the supine and standing positions were similar (p = 0.9315). In 15% of patients, the mismatch was large (>5°) in the supine position but small (<5°) in the standing position (overestimated group). However, in 23% of patients, the mismatch was small (<5°) in the supine position and large (>5°) in the standing position (underestimated group). The underestimated group had severe preoperative varus deformity, resulting in external rotation of both femoral and tibial components. Rotational mismatch in the standing position (p = 0.0032) was a significant risk factor for unfavourable PROMs. Patients with a mismatch in the standing position had significantly lower scores than those without a mismatch (p = 0.0215), exceeding the minimal clinically important difference values. Conclusions: The underestimated group is clinically important because the surgical procedure and intraoperative assessment of component placement are performed in the supine position. In cases of severe preoperative varus deformity, care should be taken not to place the component in malrotation to avoid rotational mismatch in the standing position. Level of Evidence: Ⅳ, Case series.

DOI： 10.1002/jeo2.12069

Web of Science

Scopus

PubMed

Publisher：Journal of Bone and Joint Surgery  

Background:The incidence of developmental dysplasia of the hip (DDH) in Japanese newborns has reduced drastically following a primary prevention campaign initiated around 1972 to 1973; this perinatal education campaign promoted maintaining the hips of newborns in the naturally flexed-leg position. The purpose of the present study was to describe the life course epidemiology of hip osteoarthritis (OA) in adolescent and adult patients and to assess its association with exposure to the primary prevention campaign for DDH.Methods:We included new patients with hip OA diagnosed from January 1, 2022, to December 31, 2022, at 12 core hospitals (8 special-function hospitals and 4 regional medical care support hospitals). The trend in the percentage of hips with a history of DDH treatment in childhood was estimated with use of a centered moving average using the birth year of the patient. We compared the prevalence of severe subluxation (Crowe type II, III, or IV) between patients with secondary hip OA due to hip dysplasia who were born in or before 1972 and those who were born in or after 1973.Results:Overall, 1,095 patients (1,381 hips) were included. The mean age at the time of the survey was 63.5 years (range, 15 to 95 years). A total of 795 patients (1,019 hips; 73.8% of hips) were diagnosed with secondary OA due to hip dysplasia. Approximately 13% to 15% of hips among patients born from 1963 to 1972 had a history of DDH treatment in childhood; however, the percentage decreased among patients born in or after 1973. The prevalence of severe subluxation (Crowe type II, III, or IV) among patients born in or after 1973 was 2.4%, which was significantly less than that among patients born in or before 1972 (11.1%; odds ratio, 0.20; p < 0.001).Conclusions:As of 2022, secondary hip OA due to hip dysplasia is still responsible for most new cases of adolescent and adult hip OA seen in core hospitals in Japan. However, the perinatal education campaign initiated 50 years ago, which utilized a population approach and advocated for maintaining the hips of newborns in the naturally flexed-leg position, may have improved the environmental factors of DDH, as indicated by the apparently reduced need for treatment of DDH in childhood and the associated severe subluxation. This may result in a reduced need for challenging hip surgery later in life.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

DOI： 10.2106/JBJS.23.01044

Scopus

Language：English   Publisher：Taylor & Francis  

Language：English   Publisher：Archives of Orthopaedic and Trauma Surgery  

Introduction: The optimal lower-limb alignment after unicompartmental knee arthroplasty (UKA) remains controversial. This study aimed to investigate the optimal lower-limb alignment for functional improvement in the early post-UKA period. We hypothesized that a small change (Δ) in the arithmetic hip-knee-ankle (aHKA) angle during surgery would result in better postoperative knee function. Materials and methods: This single-centered, retrospective study analyzed 91 patients (91 knees) who underwent UKA from April 2021 and December 2022. Preoperative and postoperative standing whole-leg radiographs were used to evaluate the mechanical HKA angle and aHKA angle. The aHKA angle was calculated from the medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA). We defined restored aHKA angle as a postoperative aHKA angle within ± 3° of the preoperative aHKA angle. Functional improvement was evaluated using the preoperative and one-year postoperative Knee Society Scoring 2011 (KSS 2011). A multivariate regression analysis was performed to investigate the optimal lower-limb alignment for functional improvement. Result: Postoperative restored aHKA angle (p = 0.020) was the only significant factor for improved KSS 2011 scores. Postoperative restored aHKA angle was obtained in 64 patients (70%). ΔMPTA (p < 0.001) and ΔLDFA (p = 0.037) were significant factors associated with a postoperative restored aHKA angle. Conclusions: UKA restores the native knee, including resurfacing constitutional alignment and medial collateral ligament tension. Minimal change in the aHKA angle during UKA improves the functional outcomes of the knee during the early postoperative period, consistent with the minimally invasive surgical concept of UKA.

DOI： 10.1007/s00402-024-05309-2

Web of Science

Scopus

PubMed

Language：English   Publisher：Arthroscopy Techniques  

We present a knee osteotomy procedure that we have termed the interlocking open-wedge distal tibial tuberosity osteotomy. In this context, the term interlocking pertains to the manner in which the repositioned segments of the retro-tubercle seamlessly fit together as the transverse osteotomy opens to the intended corrective angle. This interlocking mechanism, serving as a distinctive feature, engenders a stable retro-tubercle configuration resembling a mortise-and-tenon joint. The distal end of the tibial tuberosity fits snugly behind the tibial diaphysis, augmenting stability and promoting the healing process. Consequently, poor union of the retro-tubercle caused by the widening of the retro-tubercle gap and an increase in posterior tibial slope are effectively prevented. In addition, the need for complementary hardware such as anteroposterior screw fixation, which is used to secure the retro-tubercle during the healing process, is notably eliminated. This elimination not only simplifies the surgical procedure but also eliminates potential complications that could arise from its use.

DOI： 10.1016/j.eats.2024.102939

Web of Science

Scopus

PubMed

Language：English   Publisher：Immunological Medicine  

Synovial tissue-resident macrophages (STRMs) maintain normal joint homeostasis in a steady state. However, it is unclear whether STRMs still play homeostatic roles or change the functions in the joint of rheumatoid arthritis (RA), where infiltrating peripheral blood monocyte-derived macrophages (PBMoMs) play proinflammatory roles. In the present study, we examined changes in the phenotypes and functions of STRMs in response to RA-related stimuli in vitro. STRMs were prepared from non-inflammatory osteoarthritis (OA) joint synovium, which is histologically indistinguishable from normal joint synovium. PBMoMs were prepared and used for comparison. After stimulation with plate-bound IgG, which mimics anti-citrullinated protein antibody immunocomplex formed in RA joints, or with combinations of RA-related inflammatory mediators, namely tumor necrosis factor-α (TNF-α) and prostaglandin E2 or interferon-γ, PBMoMs downregulated surface markers and genes associated with anti-inflammatory macrophages, and upregulated cytokine and marker genes of proinflammatory macrophages in RA. On the other hand, STRMs hardly changed the expression of surface molecules and marker genes but altered the pattern of cytokine gene expression after stimulation like PBMoMs. Furthermore, in vitro stimulated STRMs promote proinflammatory functions of cocultured synovial fibroblasts. Thus, STRMs might play proinflammatory roles in RA joints, while maintaining their phenotypes in the steady state.

DOI： 10.1080/25785826.2023.2300853

Web of Science

Scopus

PubMed

Language：Japanese   Publisher：西日本整形・災害外科学会  

<p>【目的】脚長・オフセットがforgotten joint score（FJS）-12を含めた患者立脚型アウトカムに影響するか否かを明らかにすること．【対象】当科の初回THAで，対側健常な203例203股を対象とした．術前後の単純X線画像評価と術後の患者立脚型評価（FJS-12，Oxford hip score: HS，満足度）を行い，脚長・オフセットが及ぼす影響について多変量解析した．【結果】FJS-12が有意に低スコアを示す因子は，術後の脚長が健側より長いこと，術前の重度大転子高位例であった．脚長はOHS，満足度には有意な影響を認めず，オフセットは全てに有意な影響を認めなかった．【考察】THAの際に，安定性に懸念がある場合は過延長になるよりも，オフセットを延長する方が，FJS-12への負の影響は少ないと考えられた．</p>

DOI： 10.5035/nishiseisai.73.1

CiNii Research

Language：Japanese   Publisher：西日本整形・災害外科学会  

【目的】脚長・オフセットがforgotten joint score(FJS)-12を含めた患者立脚型アウトカムに影響するか否かを明らかにすること.【対象】当科の初回THAで,対側健常な203例203股を対象とした.術前後の単純X線画像評価と術後の患者立脚型評価(FJS-12,Oxford hip score:HS,満足度)を行い,脚長・オフセットが及ぼす影響について多変量解析した.【結果】FJS-12が有意に低スコアを示す因子は,術後の脚長が健側より長いこと,術前の重度大転子高位例であった.脚長はOHS,満足度には有意な影響を認めず,オフセットは全てに有意な影響を認めなかった.【考察】THAの際に,安定性に懸念がある場合は過延長になるよりも,オフセットを延長する方が,FJS-12への負の影響は少ないと考えられた.(著者抄録)

Language：Japanese   Publisher：(一社)日本関節病学会  

目的:個人で異なる生来のアライメントを予測するために提唱されたCoronal Plane Alignment of the Knee(CPAK)分類に基づくTKA術前後のphenotypeが,術後中期以降の患者立脚型アウトカムに影響するか否かを検討すること。方法:2013年から2019年に当院で変形性膝関節症に対して初回TKAをmechanical alignment(MA)法で施行した187名231膝(年齢74±8歳,術後経過期間4.2±1.8年)を対象とし,患者立脚型アウトカムとしてKSS 2011,KOOS-12,FJS-12を調査した。術前後全下肢正面X線画像よりMPTA,LDFAを計測,aHKA,JLOを算出,CPAK分類phenotypeを同定した。患者背景,術前後aHKA,JLOを因子として,ステップワイズ法を用いた多変量解析を行い,KSS 2011,KOOS-12に及ぼす影響を調査した。結果:術前CPAK分類はphenotype(I)が最も多く53%,術後CPAK分類はMA法の目標であるphenotype(V)が最も多く26%であった。多変量解析の結果,術前後でaHKAが変化しないことがすべての患者立脚型アウトカムへの有意な正の影響因子であり,術後JLOが内方傾斜またはニュートラルであることがKSS 2011への有意な正の影響因子であった。考察:TKA術前後のCPAK分類phenotypeは術後中期以降の患者立脚型アウトカムに影響していた。術後aHKAは術前と分類が変わる,術後JLOは外方傾斜になると患者立脚型アウトカムが低下するため,CPAK分類に基づく術前計画および再現のある達成は患者立脚型アウトカムのさらなる改善に有用であると示された。(著者抄録)

Language：English   Publisher：Elsevier B.V.  

膝関節全置換術(TKA)において、3Dシミュレーション解析を用いて円形と解剖学的楕円形の2種類のコンポーネントの明確な設定ランドマークについて検討した。内反型変形性膝関節症に対してTKAを施行された54例68膝関節(男性17関節、女性51関節、平均75.7±8.2歳)の術前CTデータを用いて膝蓋切除面の3Dシミュレーションを行った。オリジナルの膝蓋隆線の内外側位置を測定し、内側縁、膝蓋隆線および最大サイズの各設定時の円形・楕円形コンポーネントをアライメントとした。シミュレーション上での膝蓋切除厚は9.2±0.9mmで、実際の手術での値とほぼ一致しており、膝蓋隆線は切除面の内側縁から約40%の位置に局在していた。円形膝蓋コンポーネントのアライメントでは、内側縁、膝蓋隆線、最大サイズの順に内側に位置しており、コンポーネントサイズは内側縁、膝蓋隆線、最大サイズの順に小さかった。解剖学的楕円形膝蓋コンパートメントでは、内側縁の方が最大サイズより有意に内側に位置しており、コンポーネントサイズも有意に小さかった。コンポーネントでカバーされない内側骨幅の約4mmを解剖学的ランドマークとして設定するのが望ましいと考えられた。

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

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

Web of Science

Scopus

PubMed

Language：Japanese   Publisher：(一社)日本関節病学会  

目的:Adverse pelvic mobility(APM),Flatback deformity(FB),Stiff spinopelvic mobility(SPM)における三次元動態の特徴を解析することで,人工股関節置換術におけるCup設置の目標値を示すこと。方法:脊椎固定患者40人(腰椎単椎間,腰椎多椎間,腰仙椎単椎間,腰仙椎多椎間の各10人)を対象とした。座位起立動作の連続X線撮影を行い,イメージマッチング法を用いた三次元動態解析により骨盤前後傾と股関節屈伸角を算出し,CTより臥位の角度も測定した。APM(臥位-立位Δ骨盤傾斜>13°),FB(PI-LL mismatch≧10°),Stiff SPM(立位-座位Δ骨盤傾斜<10°)の有無で,座位起立動作中の骨盤・股関節動態を比較した。結果:APM有群(15人,38%)は無群と比べ,臥位-立位の骨盤後傾量は9°,股関節伸展量は5°大きく,立位の骨盤後傾は6°増加していたが,臥位と座位起立動作中の股関節動態に有意差はなかった。FB有群(24人,60%)は無群と比べ,臥位-立位の骨盤後傾量と股関節伸展量に有意差はなく,臥位と座位起立動作中の骨盤後傾は7～9°,股関節伸展角は6～9°増加していた。Stiff SPM有群(24人,65%)は無群と比べ,臥位-立位の骨盤後傾量と股関節伸展量,および臥位と立位の骨盤前後傾と股関節屈伸展角に有意差はないが,座位(座位起立動作の初期姿勢)と深座位(股関節最大屈曲角となる姿勢)の骨盤後傾は7～10°,股関節伸展は7～10°低下していた。考察:APMは骨盤後傾増加に応じたCup減捻を行うと後方脱臼リスク増加の可能性がある。FBは臥位FPPに対したCup前捻設置が必要であり,Stiff SPMは前傾増加に応じたCup約6°の増捻が目安となる。(著者抄録)

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

Web of Science

Scopus

PubMed

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

Language：Japanese   Publisher：日本関節病学会  

<p><b>目的：</b>個人で異なる生来のアライメントを予測するために提唱されたCoronal Plane Alignment of the Knee（CPAK）分類に基づくTKA術前後のphenotypeが，術後中期以降の患者立脚型アウトカムに影響するか否かを検討すること。</p><p><b>方法：</b>2013年から2019年に当院で変形性膝関節症に対して初回TKAをmechanical alignment（MA）法で施行した187名231膝（年齢74±8歳，術後経過期間4.2±1.8年）を対象とし，患者立脚型アウトカムとしてKSS 2011，KOOS-12，FJS-12を調査した。術前後全下肢正面X線画像よりMPTA，LDFAを計測，aHKA，JLOを算出，CPAK分類phenotypeを同定した。患者背景，術前後aHKA，JLOを因子として，ステップワイズ法を用いた多変量解析を行い，KSS 2011，KOOS-12に及ぼす影響を調査した。</p><p><b>結果：</b>術前CPAK分類はphenotype（Ⅰ）が最も多く53%，術後CPAK分類はMA法の目標であるphenotype（Ⅴ）が最も多く26%であった。多変量解析の結果，術前後でaHKAが変化しないことがすべての患者立脚型アウトカムへの有意な正の影響因子であり，術後JLOが内方傾斜またはニュートラルであることがKSS 2011への有意な正の影響因子であった。</p><p><b>考察：</b>TKA術前後のCPAK分類phenotypeは術後中期以降の患者立脚型アウトカムに影響していた。術後aHKAは術前と分類が変わる，術後JLOは外方傾斜になると患者立脚型アウトカムが低下するため，CPAK分類に基づく術前計画および再現のある達成は患者立脚型アウトカムのさらなる改善に有用であると示された。</p>

DOI： 10.11551/jsjd.43.24

CiNii Research

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

Scopus

PubMed

Language：Japanese   Publisher：日本関節病学会  

<p><b>目的：</b>Adverse pelvic mobility（APM），Flatback deformity（FB），Stiff spinopelvic mobility（SPM）における三次元動態の特徴を解析することで，人工股関節置換術におけるCup設置の目標値を示すこと。</p><p><b>方法：</b>脊椎固定患者40人（腰椎単椎間，腰椎多椎間，腰仙椎単椎間，腰仙椎多椎間の各10人）を対象とした。座位起立動作の連続X線撮影を行い，イメージマッチング法を用いた三次元動態解析により骨盤前後傾と股関節屈伸角を算出し，CTより臥位の角度も測定した。APM（臥位−立位Δ骨盤傾斜＞13°），FB（PI-LL mismatch≧10°），Stiff SPM（立位−座位Δ骨盤傾斜＜10°）の有無で，座位起立動作中の骨盤・股関節動態を比較した。</p><p><b>結果：</b>APM有群（15人，38%）は無群と比べ，臥位−立位の骨盤後傾量は9°，股関節伸展量は5°大きく，立位の骨盤後傾は6°増加していたが，臥位と座位起立動作中の股関節動態に有意差はなかった。FB有群（24人，60%）は無群と比べ，臥位−立位の骨盤後傾量と股関節伸展量に有意差はなく，臥位と座位起立動作中の骨盤後傾は7～9°，股関節伸展角は6～9°増加していた。Stiff SPM有群（24人，65%）は無群と比べ，臥位−立位の骨盤後傾量と股関節伸展量，および臥位と立位の骨盤前後傾と股関節屈伸展角に有意差はないが，座位（座位起立動作の初期姿勢）と深座位（股関節最大屈曲角となる姿勢）の骨盤後傾は7～10°，股関節伸展は7～10°低下していた。</p><p><b>考察：</b>APMは骨盤後傾増加に応じたCup減捻を行うと後方脱臼リスク増加の可能性がある。FBは臥位FPPに対したCup前捻設置が必要であり，Stiff SPMは前傾増加に応じたCup約6°の増捻が目安となる。</p>

DOI： 10.11551/jsjd.43.16

CiNii Research

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：English   Publisher：International Orthopaedics  

Purpose: Little is known about the changes and the factors in physical activity as following total hip arthroplasty (THA). There are potential discrepancies between subjective and objective measurements of physical activity. Thus, our porpose is to compare objective and subjective measurements of activity levels in patients undergoing THA preoperatively, three months and one year following surgery, and investigated the factors that predicts the objective activity level after THA. Methods: This prospective observational study included 42 patients with unilateral symptomatic hip osteoarthritis who underwent THA. The objective activity level (step counts, sit-to-stands, and upright time) by using a tri-axial accelerometer, PRO (Oxford hip score; OHS and University of California, Los Angeles activity score; UCLA score), and muscle volume around the hip joint by using preoperative computed tomography were measured. Results: The number of steps, OHS, and UCLA score before, at three months, and one year after THA averaged 5092, 6532, and 6545 steps, 30.3, 43.0, and 44.2 points, and 3.4, 4.8, and 4.6 points, respectively, with significant postoperative increases (P < 0.05). No significant difference was found between three months and one year postoperatively. In multivariate analysis, younger age and higher preoperative contralateral gluteal medius volume were the predictors of higher postoperative step counts (P < 0.05). Conclusions: Physical activity, including step counts, OHS, and UCLA score increased significantly until three months after unilateral THA. Early surgical intervention before contralateral muscle declines and preoperative rehabilitation including contralateral side may additionally improve postoperative activity levels.

DOI： 10.1007/s00264-023-06022-2

Web of Science

Scopus

PubMed

Language：English   Publisher：Modern Rheumatology  

Objectives: This study aimed to clarify the relationship between vitamin D status and complications after periacetabular osteotomy. Methods: A total of 46 hips of 39 patients (3 men and 36 women; mean age at surgery, 41.0 years; mean postoperative follow-up duration, 63 months) were reviewed to obtain the following information: patients’ serum 25-hydroxyvitamin D [25(OH)D] status, prevalence of postoperative delayed union of osteotomy sites in the greater trochanter (DUGT) and ischiopubic stress fractures (IPSFs), and risk factors. Results: The mean serum 25(OH)D level was 11.9 ng/ml. DUGT and IPSF were found in four (10.3%) and three (7.7%) patients, respectively. Serum 25(OH)D levels ≤ 11 ng/ml were significantly associated with DUGT in female patients (p = .02). Serum 25(OH)D levels ≤ 9 ng/ml and smoking were significantly associated with IPSF (p = 0.01 and 0.02, respectively). Overall, 21.7% of patients with serum 25(OH)D levels ≤ 11 ng/ml developed at least one complication; no complications occurred when serum 25(OH)D levels were >11 ng/ml. Conclusion: Severe vitamin D deficiency was highly prevalent in relatively young patients. Vitamin D deficiency and smoking were independent risk factors for postoperative complications. Proactive supplementation is advisable to reduce postoperative complications, especially in patients with serum 25(OH)D levels ≤ 11 ng/ml.

DOI： 10.1093/mr/roac120

Web of Science

Scopus

PubMed

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

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

Language：English   Publisher：Oxford University Press  

症候性股関節形成不全に対して寛骨臼移動術(periacetabular osteotomy)を施行した患者におけるビタミンDの状態と術後合併症との関連を明らかにする目的で、39例(男性3例、女性36例、平均手術時年齢41.0歳、平均術後フォローアップ期間63ヵ月)の46股関節を後ろ向きに検討した。術前の平均血清25(OH)D値は11.9ng/mLであった。大転子癒合不全・癒合遅延(DUGT)と恥坐骨疲労骨折(IPSF)はそれぞれ4例(10.3%)、3例(7.7%)に認められた。血清25(OH)D値≦11ng/mLは女性患者のDUGTと有意に関連し(p=0.02)、血清25(OH)D値≦9ng/mLおよび喫煙はIPSFと有意に関連した(それぞれp=0.01、0.02)。血清25(OH)D値≦11ng/mLの患者の21.7%が一つ以上の合併症を発症したのに対し、>11ng/mLの患者では合併症を認めなかった。

Language：English   Publisher：Scientific Reports  

No report has clarified the frequency and interacting factors affecting sleep disturbance among Asian patients at midterm after total knee arthroplasty (TKA). This study aimed to evaluate the frequency of sleep disturbance at midterm after TKA in a Japanese cohort and to identify intervening factors for sleep. We hypothesized that residual knee pain and decreased functional capability negatively interact with sleep quality after TKA. A total of 209 Japanese participants (average age: 77.1 ± 8.3 years; postoperative follow-up period: 4.5 ± 1.9 years) who underwent primary TKA for knee osteoarthritis were included in this study. Sleep quality, satisfaction, pain, functional capability, joint awareness, and mental condition were evaluated using the Pittsburgh Sleep Quality Index (PSQI), Knee Society Score (KSS) 2011, Forgotten Joint Score (FJS)-12, and 12-Item Short-Form Health Survey (SF-12) Mental Component Summary (MCS). Multivariable analysis was performed to determine the influencing factors on PSQI. The scores for the PSQI, satisfaction with pain level while lying in bed, pain during level walking, functional activity category in the KSS 2011, awareness of the artificial joint in bed at night in the FJS-12, and SF-12 MCS were 6.7 ± 3.0, 5.8 ± 1.8, 1.6 ± 2.3, 62 ± 22, 1.5 ± 1.4, and 56 ± 9.3 on average, respectively. Sleep disturbance (PSQI ≥ 5.5) occurred in 54% of the Japanese participants. Multivariable analysis revealed that high functional capability was a significant factor associated with sleep quality improvement (p < 0.05). Decreased functional capability, not residual knee pain, negatively interacted with sleep quality. The sleep disturbance rate was high during the middle postoperative period after TKA in the Japanese cohort.

DOI： 10.1038/s41598-023-45603-4

Web of Science

Scopus

PubMed

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

Language：Japanese   Publisher：西日本整形・災害外科学会  

<p>【目的】特発性大腿骨頭壊死症（ONFH）の予後因子として海外では壊死体積や壊死のサイズが頻用される一方，日本ではType分類が重視され，Type B/C1では圧潰進行が静止する場合もあるとの報告があるが，一定の見解は得られていない．今回Type B/C1での圧潰進行に関連する因子を検証した．【方法】2010年1月－2017年8月に当科を受診したONFH症例の中で，発症後1年以上保存的に経過観察し得たType B/C1の39例41股を対象とした．単純X線で発症時から各受診時の圧潰幅を計測し，1mm以上の圧潰進行の頻度を調査した．また単純MRIを用い壊死体積（％），サイズを表すCombined Necrotic Angle，深さを表すNecrotic Depth Ratioを評価し，圧潰進行の有無と比較した．【結果】41股中25股（60.9％）で1mm以上の圧潰進行を認めた．圧潰進行群では圧潰非進行群と比べ，壊死体積，Combined Necrotic Angle，Necrotic Depth Ratioはいずれも有意に高値であった．【考察】Type B/C1で壊死体積やサイズ，壊死の深さを加味することで圧潰進行の予測に有用であった．</p>

DOI： 10.5035/nishiseisai.72.445

CiNii Research

Language：Japanese   Publisher：西日本整形・災害外科学会  

<p>【目的】寛骨臼移動術（TOA）などの関節温存術は，前初期変形性股関節症（OA）に推奨される治療法だが，中年期以降の患者において保存治療症例と比較された報告はなく，その有効性には結論が出ていない．本研究の目的は，中年期の初期OA患者においてTOAが保存治療と比較して股関節予後を改善するか検討することである．【方法】寛骨臼形成不全に伴う初期OAの中年期（45-64歳）患者で5年以上経過観察された患者のうち，TOAを施行されたTOA群77例（女性68例，平均年齢：51歳，平均観察期間：13年）と，対側手術から1年以上保存治療が行われた保存治療群64例（女性59例，平均年齢：53歳，平均観察期間：13年）において関節生存率を比較検討した．【結果】THA移行での関節生存率は，TOA群92％，保存治療群64%と，TOA群は保存治療群よりも関節生存率が有意に高かった．【考察】寛骨臼移動術は中年期の初期OA患者の股関節予後を改善する．</p>

DOI： 10.5035/nishiseisai.72.399

CiNii Research

Language：Japanese   Publisher：西日本整形・災害外科学会  

<p>【背景】人工膝関節全置換術（TKA）において，大腿骨前方切除面の‘Grand piano sign’が回旋設置を確認する指標として提唱されているが，これは内側型変形性膝関節症（OA）で提唱された指標であり，外側型膝OAでも同様であるか，検討したものはない．【方法】外側型膝OAでTKAを施行した30例の術前CTを用いて，三次元術前計画ソフト（Zed Knee）内でsurgical epicondylar axis（SEA）に平行（NR），3°内旋（IR），3°外旋（ER）での前方切除面をsimulationし，内側顆/外側顆の高さの比率（M/L比）を検討した．【結果】M/L比は，NRで0.59±0.11，IRで0.68±0.12と増大，ERで0.49±0.09と減少し，数値・傾向とも過去の内側型OAの報告と同様であった．【考察】外側型膝OAにおいても‘Grand piano sign’は有用な指標となり得た．</p>

DOI： 10.5035/nishiseisai.72.433

CiNii Research

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

Web of Science

Scopus

PubMed

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

Language：English   Publisher：Journal of Clinical Medicine  

There are no studies that have investigated the characteristics of car use across THA patients, including those who do not drive. This study aimed to evaluate, in THA patients, (1) postoperative car usage, (2) comfort while entering and exiting a car, and (3) whether lower limb muscle strength affects action comfort. One hundred seventy-two post-THA patients completed the questionnaire in 2020, along with assessments of hip abductor and knee extensor muscle strength before surgery and at discharge. Patients whose overall comfort level was judged as comfortable were defined as the comfort group; others were placed in the discomfort group. Of the 172 patients, 161 reported car usage at a mean of 5.6 years after THA. Of these, 114 and 47 patients were placed in the comfort and discomfort groups, respectively. Patients in the discomfort group were three times more likely to experience discomfort using the contralateral side door than the surgical side door, and about twice as many patients experienced discomfort when entering as when exiting. Lower preoperative contralateral hip abductor muscle strength was the only independent predictor for discomfort. The take-home messages were that prevention of contralateral-side weakness may improve comfort during the action after THA.

DOI： 10.3390/jcm12175515

Web of Science

Scopus

PubMed

Language：Japanese   Publisher：西日本整形・災害外科学会  

【目的】寛骨臼移動術(TOA)などの関節温存術は,前初期変形性股関節症(OA)に推奨される治療法だが,中年期以降の患者において保存治療症例と比較された報告はなく,その有効性には結論が出ていない.本研究の目的は,中年期の初期OA患者においてTOAが保存治療と比較して股関節予後を改善するか検討することである.【方法】寛骨臼形成不全に伴う初期OAの中年期(45-64歳)患者で5年以上経過観察された患者のうち,TOAを施行されたTOA群77例(女性68例,平均年齢:51歳,平均観察期間:13年)と,対側手術から1年以上保存治療が行われた保存治療群64例(女性59例,平均年齢:53歳,平均観察期間:13年)において関節生存率を比較検討した.【結果】THA移行での関節生存率は,TOA群92%,保存治療群64%と,TOA群は保存治療群よりも関節生存率が有意に高かった.【考察】寛骨臼移動術は中年期の初期OA患者の股関節予後を改善する.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

【背景】人工膝関節全置換術(TKA)において,大腿骨前方切除面の'Grand piano sign'が回旋設置を確認する指標として提唱されているが,これは内側型変形性膝関節症(OA)で提唱された指標であり,外側型膝OAでも同様であるか,検討したものはない.【方法】外側型膝OAでTKAを施行した30例の術前CTを用いて,三次元術前計画ソフト(Zed Knee)内でsurgical epicondylar axis(SEA)に平行(NR),3°内旋(IR),3°外旋(ER)での前方切除面をsimulationし,内側顆/外側顆の高さの比率(M/L比)を検討した.【結果】M/L比は,NRで0.59±0.11,IRで0.68±0.12と増大,ERで0.49±0.09と減少し,数値・傾向とも過去の内側型OAの報告と同様であった.【考察】外側型膝OAにおいても'Grand piano sign'は有用な指標となり得た.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

【目的】特発性大腿骨頭壊死症(ONFH)の予後因子として海外では壊死体積や壊死のサイズが頻用される一方,日本ではType分類が重視され,Type B/C1では圧潰進行が静止する場合もあるとの報告があるが,一定の見解は得られていない.今回Type B/C1での圧潰進行に関連する因子を検証した.【方法】2010年1月-2017年8月に当科を受診したONFH症例の中で,発症後1年以上保存的に経過観察し得たType B/C1の39例41股を対象とした.単純X線で発症時から各受診時の圧潰幅を計測し,1mm以上の圧潰進行の頻度を調査した.また単純MRIを用い壊死体積(%),サイズを表すCombined Necrotic Angle,深さを表すNecrotic Depth Ratioを評価し,圧潰進行の有無と比較した.【結果】41股中25股(60.9%)で1mm以上の圧潰進行を認めた.圧潰進行群では圧潰非進行群と比べ,壊死体積,Combined Necrotic Angle,Necrotic Depth Ratioはいずれも有意に高値であった.【考察】Type B/C1で壊死体積やサイズ,壊死の深さを加味することで圧潰進行の予測に有用であった.(著者抄録)

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

Language：Japanese   Publisher：日本股関節学会  

2018年7月～2020年10月に寛骨臼移動術を施行したlateral center-edge angle(LCEA)<20°の症候性股関節形成不全(DDH)40例40関節(全例女性、平均年齢37.8歳)の術前に撮影した臥位と立位の骨盤正面X線像を用いて骨頭被覆、および寛骨臼と骨頭の位置関係について検討し、LCEA≧25°の正常健常者16例16関節(全例女性、平均年齢35.6歳)と比較した。DDH患者・正常健常者ともにLCEAとanterior wall indexは臥位から立位で減少し、posterior wall indexは臥位から立位で増加した。寛骨臼と骨頭の位置関係として、最小関節裂隙幅とmodified lateralization distanceはDDH患者では臥位から立位で減少したが、正常健常者では変わらなかった。DDH患者では臥位から立位で骨頭が寛骨臼に対して内側上方に移動する一方、正常健常者では移動しなかった。

Language：English   Publisher：Knee Surgery, Sports Traumatology, Arthroscopy  

Purpose: The “Grand-piano sign” is a popular indicator of the appropriate rotational alignment of the femoral component during total knee arthroplasty (TKA). The aim of the study was to investigate the shape of the anterior femoral resection surface of varus and valgus knees. Methods: A cohort of 80 varus knees and 40 valgus knees (hip–knee–ankle angle > 2° for varus and < − 2° for valgus knees) matched for age, sex, height, body weight, and KL grade was made using propensity score matching. Virtual TKA was performed using 3 patterns of components (anterior flange flexion angles of 3°, 5°, and 7°). The anterior femoral resection surface was evaluated for 3 patterns of rotational alignments: parallel to the surgical epicondylar axis (NR, neutral rotation), 3° internal rotation (IR), and 3°external rotation (ER) relative to the surgical epicondylar axis. In each anterior femoral resection surface, the vertical height of medial and lateral condyles was measured, and the ratio of the medial to the lateral height (M/L ratio) was evaluated. Results: The M/L ratio in NR for both varus and valgus knees was 0.57 to 0.64, with no significant difference between the cohorts (p value > 0.05). The M/L ratio showed a similar pattern of increasing at IR and decreasing at ER in both varus and valgus knees. The variation in the M/L ratio with malrotation in valgus knees was smaller than in varus knees. Conclusion: During TKA, the anterior femoral resection surface was similar in varus and valgus knees; however, the variation with malrotation was smaller in valgus knees than in varus knees. TKA for valgus knees requires precise surgical technique and careful intraoperative assessment. Level of evidence: IV, Case series.

DOI： 10.1007/s00167-023-07365-4

Web of Science

Scopus

PubMed

Language：Japanese   Publisher：日本股関節学会  

後方アプローチで人工股関節全置換術(THA)を行い、1年以上経過した関節リウマチ(RA)21例25関節(RA-THA群)と、変形性股関節症(OA)246例308関節(OA-THA群)の患者立脚型評価(PROMs)を比較した。PROMsとしてVAS satisfaction、Oxford hip score、Forgotten Joint Score-12、UCLA activity scaleを用いた。その結果、いずれのPROMsでも有意な群間差を認めず、RA-THA群では活動性に課題が残るもののOA-THA群に劣らない良好なPROMsが達成された。RA-THAでは除痛効果や歩行能力改善、疾患活動性のコントロールが良好なPROMs達成の要因と考えられ、疾患活動性をコントロールし骨破壊が進む前に手術をすることで良好なPROMsが得られる可能性が示された。

Language：Japanese   Publisher：(一社)日本関節病学会  

目的:寛骨臼形成不全(DDH)に対するperiacetabular osteotomy(PAO)の至適な骨片の移動方向・移動量については定まった指標がない。本研究の目的は,PAOにおいて,股関節の力学的環境を最適化する骨片の移動方向・移動量を明らかにすることである。方法:DDH患者(LCE角<25°)の32例32股(全例女性,平均年齢40歳,平均LCEA9°)を対象とした。股関節CT DICOM dataを用い,立位骨盤傾斜を再現した上で有限要素解析を行った。LCEA30°・35°・40°に前方回転0°・5°・10°・15°を追加した12通りのPAOシミュレーションを行い,片脚立位想定時の寛骨臼軟骨の接触面積・最大接触圧力(Max CP)を算出した。正常ボランティア16例16股の結果からMax CPの正常範囲は4.1MPa未満とした。結果:前方回転(-)よりも前方回転(+)で接触面積は増加し,Max CPは減少した。12通りのPAOシミュレーションの中で,Max CPが正常化する割合はLCE角30°+前方回転15°のときで87.5%(27/32股)と最も多く,続いてLCE角35°+前方回転15°のときで84.4%(27/32股)であった。考察:PAOの際,寛骨臼の側方回転に前方回転を追加することで接触面積は増大し,接触圧力は減少した。症例により骨片の至適位置は異なるが,LCE角30°～35°に前方回転を15°追加した際,Max CPは最も正常化しやすいことが示唆された。(著者抄録)

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

Web of Science

Scopus

PubMed

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

Web of Science

Scopus

PubMed

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

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

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

Web of Science

Scopus

PubMed

Language：English   Publisher：Oxford University Press  

脛骨の楔状開大型骨切り術または人工膝関節置換術を受けた60歳以上の患者を対象に、患者立脚型評価法(KOOS)を用いて短期治療成績を評価した。炎症性および外傷性関節炎の症例は除外した。患者を術式に応じて高位脛骨骨切り術(HTO)群162例と人工膝関節置換術(TKA)群134例の2群に分類した。患者背景に有意な群間差を認めたため、傾向スコアマッチング法により55組の患者群を選出した。マッチング後は年齢、性別、BMI、術前のKOOSスコアに有意な群間差はなかった。いずれの群においても術前に比べて術後1年におけるKOOSの5項目(症状、疼痛、ADL、スポーツ・娯楽活動、QOL)の平均値は有意に上昇した。術後1年の上記5項目はいずれもHTO群とTKA群の間に有意差はなく、症状に関するKOOSスコアはHTO群で78.8、TKA群で79.2で、ADLおよびQOLの項目に関しても同等であった。疼痛はTKA群(83.4)の方がHTO群(79.4)より高く、スポーツ・娯楽活動はHTO群(53.3)の方がTKA群(47.9)より高かったが、いずれも統計的に有意でなかった(それぞれP=0.20とP=0.29)。

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：Modern Rheumatology  

Objectives: The purpose of the present study was to evaluate improvement in the Knee Injury and Osteoarthritis Outcome Score (KOOS) after open-wedge high tibial osteotomy (HTO) in comparison with total knee arthroplasty (TKA) in cohorts over age 60 matched by pre-operative age, gender, body mass index (BMI), hip-knee-ankle angle (HKAA), KOOS sub-scores, and osteoarthritis (OA) grade. Methods: Propensity score matching was performed between 162 HTO patients and 134 TKA patients. When calculating the propensity score by multivariate logistic regression analysis, the following pre-operative confounders were included: age, gender, BMI, HKAA, KOOS sub-scores, and OA grade. Consequently, a total of 55 patients were included in each group. The Student's t-test was used to analyse differences in the post-operative KOOS sub-scores between groups. Results: After propensity score matching, all matched pre-operative valuables were identical, with no significant differences between the HTO and TKA groups. None of the post-operative KOOS sub-scores at 1 year after surgery showed a significant difference between the HTO and TKA groups. Both groups demonstrated significant and comparable post-operative improvement in every KOOS sub-score. Conclusions: In patients over age 60, there was no significant difference in short-term pain relief and improvements in activity and quality of life between HTO and TKA after propensity score matching including pre-operative age, KOOS sub-scores, and OA grade. HTO is a joint preservation procedure that is valid for knee OA even in individuals over age 60.

DOI： 10.1093/mr/roac052

Web of Science

Scopus

PubMed

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

Language：Japanese   Publisher：西日本整形・災害外科学会  

<p>【目的】当院における関節リウマチ（RA）に対する人工膝関節全置換術（TKA）の患者背景の変遷を調査し，長期患者立脚評価を行った．【対象と方法】2001年～2015年に当院で施行されたTKA数の推移を調査した．同期間に施行されたRAに対するTKA（RA-TKA）158例で術前の患者背景を解析した．同158例から現在の年齢が80歳以下である52例72膝を抽出し，Knee Society Score（KSS）を送付した．返答のあった28例38膝でKSSの各項目（膝の症状，満足度，手術に関する期待度）における点数，各項目に影響を与えうる因子に関して統計解析を行った．【結果】RA-TKAの症例数は減少し，TKA患者の術前の血液検査で炎症所見は有意に低下傾向であった．術後平均14年のRA-TKAのKSSのスコアは，当院にて施行された変形性膝関節症に対するTKAの術後平均4年成績と同等であった．【考察】薬物療法の変遷の影響と思われるRA-TKA数の減少傾向を認めた．術後長期のKSSは比較的良好であったが，その影響因子の解明が今後の課題である．</p>

DOI： 10.5035/nishiseisai.72.212

CiNii Research

Language：Japanese   Publisher：西日本整形・災害外科学会  

<p>【はじめに】本研究の目的は，当院で施行した寛骨臼移動術（TOA）の術後20年以上の長期成績を調査し，関節温存に関連する影響因子を明らかにすることである．【方法】1996-2005年に当院でTOAを施行した患者で追跡可能であった159例172股（平均観察期間21年）を対象とした．THA conversionをエンドポイントとしたときの累積温存率を，Kaplan-Meier生存分析を用いて調査した．関節温存に関連する影響因子は，単変量および多変量Cox回帰分析を用いて調査した．【結果】31例33股がTHA conversionとなり，術後20年の累積温存率は79.7％であった．多変量解析では，術前病期が唯一の有意な影響因子であり，リスク比は2.69（p＝0.003）だった．一方，年齢は影響因子ではなかった（p＝0.153）．手術時年齢を考慮して術前病期別に比較したところ，前・初期では45歳未満が89.8％，45歳以上が86.2％と年齢に関わらず（p＝0.62），良好な結果を示した．一方で，進行期では45歳未満が66.7％，45歳以上51.1％と年齢に関わらず（p＝0.75），前・初期よりも関節温存率は低かった．【考察】寛骨臼形成不全に対するTOAにおいて，長期での良好な関節温存を得るためには，術前病期が前期・初期であることが重要であり，手術時の年齢は影響しなかった．</p>

DOI： 10.5035/nishiseisai.72.24

CiNii Research

Language：Japanese   Publisher：西日本整形・災害外科学会  

<p>【目的】Dorr type Cに対するTHAにおけるステム沈下（Subsidence）に関してFit-and-fill stemとTaper wedge stemで比較検討すること．【方法】Dorr type Cに対してPrimary THAを行ったFit-and-fill stem群48例，Taper wedge stem群43例を対象とした．患者背景として疾患，性別，年齢，BMIを調査した．Subsidence量は術直後と術後1週，術後1週と術後6週，術直後と術後6週の3ポイントでX線を用いて評価した．【結果】両群間で患者背景に有意差は認めなかった．術直後から術後6週，術後1週から術後6週でのSubsidence量は，Fit-and-fill stem群に比べTaper wedge stem群の方が有意に小さかった．また，3 mmを超えるSubsidenceは，Fit-and-fill stem群で8例，Taper wedge stem群で1例に認め有意にFit-and-fill stem群で多かった．多変量解析の結果，ステムの種類が3 mmを超えるSubsidenceに影響を与える独立した因子であった．【結語】本研究結果からDorr type CにはFit-and-fill stemよりTaper wedge stemの方が適していると考えられた．</p>

DOI： 10.5035/nishiseisai.72.292

CiNii Research

Language：English  

DOI： 10.1093/jhps/hnac047

Web of Science

PubMed

Language：Japanese   Publisher：西日本整形・災害外科学会  

【目的】当院における関節リウマチ(RA)に対する人工膝関節全置換術(TKA)の患者背景の変遷を調査し,長期患者立脚評価を行った.【対象と方法】2001年～2015年に当院で施行されたTKA数の推移を調査した.同期間に施行されたRAに対するTKA(RA-TKA)158例で術前の患者背景を解析した.同158例から現在の年齢が80歳以下である52例72膝を抽出し,Knee Society Score(KSS)を送付した.返答のあった28例38膝でKSSの各項目(膝の症状,満足度,手術に関する期待度)における点数,各項目に影響を与えうる因子に関して統計解析を行った.【結果】RA-TKAの症例数は減少し,TKA患者の術前の血液検査で炎症所見は有意に低下傾向であった.術後平均14年のRA-TKAのKSSのスコアは,当院にて施行された変形性膝関節症に対するTKAの術後平均4年成績と同等であった.【考察】薬物療法の変遷の影響と思われるRA-TKA数の減少傾向を認めた.術後長期のKSSは比較的良好であったが,その影響因子の解明が今後の課題である.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

【はじめに】本研究の目的は,当院で施行した寛骨臼移動術(TOA)の術後20年以上の長期成績を調査し,関節温存に関連する影響因子を明らかにすることである.【方法】1996-2005年に当院でTOAを施行した患者で追跡可能であった159例172股(平均観察期間21年)を対象とした.THA conversionをエンドポイントとしたときの累積温存率を,Kaplan-Meier生存分析を用いて調査した.関節温存に関連する影響因子は,単変量および多変量Cox回帰分析を用いて調査した.【結果】31例33股がTHA conversionとなり,術後20年の累積温存率は79.7%であった.多変量解析では,術前病期が唯一の有意な影響因子であり,リスク比は2.69(p=0.003)だった.一方,年齢は影響因子ではなかった(p=0.153).手術時年齢を考慮して術前病期別に比較したところ,前・初期では45歳未満が89.8%,45歳以上が86.2%と年齢に関わらず(p=0.62),良好な結果を示した.一方で,進行期では45歳未満が66.7%,45歳以上51.1%と年齢に関わらず(p=0.75),前・初期よりも関節温存率は低かった.【考察】寛骨臼形成不全に対するTOAにおいて,長期での良好な関節温存を得るためには,術前病期が前期・初期であることが重要であり,手術時の年齢は影響しなかった.(著者抄録)

Language：Japanese   Publisher：(公社)福岡県理学療法士会  

股関節全置換術(THA)後のトレンデレンブルグ歩行の有無を評価し、それに影響を与える要因について検討した。2020年1月～2021年4月までに変形性股関節症に対して片側初回THAを施行し、対側に機能制限のない12ヵ月以上経過した40名(男性9名、女性31名、年齢45～79歳)を対象とした。トレンデレンブルグ歩行陽性判定の定義は、歩行周期のうち立脚中期で対側の骨盤が下制するものとし、立脚中期は歩行周期100%のうち30%とし、歩行周期30%での骨盤傾斜角度からトレンデレンブルグ歩行の判定を行った。トレンデレンブルグ歩行の有無では、陽性は11名(27.5%)で、陰性は29名(72.5%)であった。歩行周期30%における両群の術側骨盤傾斜角度は陽性群では骨盤挙上角度(対側骨盤下制)2.3±1.6°、陰性群では骨盤下制角度(対側骨盤挙上)3.4±1.1°であった。トレンデレンブルグ歩行の有無に対する重回帰分析を行った。その結果、歩行周期10～30%における股関節外転モーメントパワー、股関節伸展モーメントパワーが有意な影響因子として示された。股関節外転運動の遠心性収縮活動と股関節伸展運動の求心性収縮活動が歩行動作における股関節安定化に重要であることが示唆された。

Language：Japanese   Publisher：西日本整形・災害外科学会  

【目的】Dorr type Cに対するTHAにおけるステム沈下(Subsidence)に関してFit-and-fill stemとTaper wedge stemで比較検討すること.【方法】Dorr type Cに対してPrimary THAを行ったFit-and-fill stem群48例,Taper wedge stem群43例を対象とした.患者背景として疾患,性別,年齢,BMIを調査した.Subsidence量は術直後と術後1週,術後1週と術後6週,術直後と術後6週の3ポイントでX線を用いて評価した.【結果】両群間で患者背景に有意差は認めなかった.術直後から術後6週,術後1週から術後6週でのSubsidence量は,Fit-and-fill stem群に比べTaper wedge stem群の方が有意に小さかった.また,3mmを超えるSubsidenceは,Fit-and-fill stem群で8例,Taper wedge stem群で1例に認め有意にFit-and-fill stem群で多かった.多変量解析の結果,ステムの種類が3mmを超えるSubsidenceに影響を与える独立した因子であった.【結語】本研究結果からDorr type CにはFit-and-fill stemよりTaper wedge stemの方が適していると考えられた.(著者抄録)

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

Language：English   Publisher：BMJ Open  

Introduction In patients with chronic pain, oral analgesics are essential treatment options to manage pain appropriately, improve activities of daily living abilities and achieve a higher quality of life (QOL). It is desirable to select analgesics for elderly patients based on comparative data on analgesic effect and risk of adverse events; however, there are few comparative studies so far. The purpose of this study is to determine whether the efficacy and safety of acetaminophen are non-inferior to non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of chronic pain associated with osteoarthritis of the hip and knee in elderly patients. Methods and analysis This study is a multicentre, randomised controlled, double-blind, parallel-group study to compare the analgesic effect and adverse events between acetaminophen or NSAIDs (loxoprofen or celecoxib). A total of 400 elderly patients with osteoarthritis of the hip and knee will be recruited from five institutions in Japan. Patients of 65 years or older with osteoarthritis-related pain will be registered and randomly assigned to acetaminophen, loxoprofen or celecoxib with 2:1:1 allocation. The primary endpoint is change in the Brief Pain Inventory (BPI) item 3 (worst pain) score from baseline to week 8. The secondary endpoints are BPI item 3 score change from baseline to week 4, health-related QOL measured by Short Form-8 Health Survey, and occurrence of adverse events including gastrointestinal disorders and abnormal liver function. Data will be analysed in accordance with a predefined statistical analysis plan. Ethics and dissemination This study protocol was approved by the Kyushu University Hospital Certified Institutional Review Board for Clinical Trials on 28 January 2021 (KD2020004) and the chief executive of each participating hospital. The results of the study will be submitted to international peer-reviewed journals, and the main findings will be presented at international scientific conferences. Trial registration number jRCTs071200112.

DOI： 10.1136/bmjopen-2022-068220

Web of Science

Scopus

PubMed

Language：English   Publisher：Modern Rheumatology Case Reports  

To our knowledge, only one previous report described the treatment of osteochondral autograft for steroid-induced osteonecrosis of the humeral head (ONHH) in a middle-aged patient. The present report describes a 20-year-old man who was found to have avascular osteonecrosis of the right humeral head after corticosteroid pulse treatment, followed by oral corticosteroid therapy. The patient complained of serious right shoulder pain and limited range of motion (ROM). Anteroposterior (AP) radiographs of the right shoulder revealed a crescent sign at the humeral head, indicating subchondral bone collapse with a linear sclerotic change and normal articular surface of the glenoid. The case was categorized as Stage 3 according to the Cruess classification. In general, Cruess classification Stage 3 is treated with humeral head replacement and shoulder arthroplasty. The patient underwent surgical treatment involving osteochondral autograft transplantation. Autografts were harvested from the right knee. At the 1.5-year follow-up, the patient was pain-free and showed an improved active ROM. Furthermore, AP radiographs demonstrated that the glenohumeral joint space was maintained, and no progression of humeral head collapse was observed. This case may be helpful in decision-making if young patients with ONHH require surgical treatment. Furthermore, osteochondral autograft transplantation may be an effective treatment for ONHH.

DOI： 10.1093/mrcr/rxac037

Web of Science

Scopus

PubMed

Publisher：金原出版  

DOI： 10.18888/se.0000002416

CiNii Research

Language：English   Publisher：Oxford University Press  

症例は20歳男性で、重度の右肩関節痛と可動域(ROM)制限を訴えた。1年前に皮膚筋炎と診断されてステロイドパルス療法を開始されたが、その後、両側肩関節痛、股関節痛、軽度膝関節痛をきたした。両側上腕骨頭、大腿骨頭、大腿顆に生じた骨壊死と診断され、肩関節のUCLAスコアは17点、JOAスコアは48点を示し、肩関節前後方向X線検査では上腕骨頭にcrescent sign、CTにて軟骨下骨挫滅を認め、右上腕骨頭のステロイド誘発性骨壊死と診断した。本例は若年で忍容性が高いと判断し、人工関節置換術ではなく自家骨を用いた骨軟骨カラム移植を行う方針とした。術中所見では長軸に沿って22mm、短軸に沿って20mmの範囲で軟骨下骨の挫滅が認められ、内側滑車と外側滑車の非荷重領域より計三つの自家骨を採取し、骨壊死部に埋入した。術後、右上肢に三角巾をかけて固定し、2週後に振り子運動、3週後にROM運動を許可した。1年後のCTでは自家骨の完全癒合がみられ、1年半後、無痛状態を維持しておりROM改善が得られていた。

Language：Japanese   Publisher：日本関節病学会  

<p><b>目的</b>：寛骨臼形成不全（DDH）に対するperiacetabular osteotomy（PAO）の至適な骨片の移動方向・移動量については定まった指標がない。本研究の目的は，PAOにおいて，股関節の力学的環境を最適化する骨片の移動方向・移動量を明らかにすることである。</p><p><b>方法</b>：DDH患者（LCE角<25°）の32例32股（全例女性，平均年齢40歳，平均LCEA 9°）を対象とした。股関節CT DICOM dataを用い，立位骨盤傾斜を再現した上で有限要素解析を行った。LCEA 30°・35°・40°に前方回転0°・5°・10°・15°を追加した12通りのPAOシミュレーションを行い，片脚立位想定時の寛骨臼軟骨の接触面積・最大接触圧力（Max CP）を算出した。正常ボランティア16例16股の結果からMax CPの正常範囲は4.1MPa未満とした。</p><p><b>結果</b>：前方回転（−）よりも前方回転（＋）で接触面積は増加し，Max CPは減少した。12通りのPAOシミュレーションの中で，Max CPが正常化する割合はLCE角30°＋前方回転15°のときで87.5%（27/32股）と最も多く，続いてLCE角35°＋前方回転15°のときで84.4%（27/32股）であった。</p><p><b>考察</b>：PAOの際，寛骨臼の側方回転に前方回転を追加することで接触面積は増大し，接触圧力は減少した。症例により骨片の至適位置は異なるが，LCE角30°～35°に前方回転を15°追加した際，Max CPは最も正常化しやすいことが示唆された。</p>

DOI： 10.11551/jsjd.42.36

CiNii Research

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

Web of Science

Scopus

PubMed

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

Language：English   Publisher：Knee Surgery, Sports Traumatology, Arthroscopy  

Purpose: To identify the factors impacting changes in valgus laxity between before and after open-wedge high tibial osteotomy (OW-HTO) using quantitative valgus stress radiographs. Methods: A total of 40 knees from 38 patients who underwent OW-HTO were assessed. The study population comprised 14 men and 24 women, with a mean age of 61.5 years. Valgus stress radiographs before and 1 year after OW-HTO were performed using a Telos device. The difference between pre- and postoperative joint line convergence angle (JLCA) was expressed as ΔJLCA (post–pre). As indicators of the proximal detachment of superficial medial collateral ligament (sMCL) on radiographs, two distances were defined: the distance from the level of the osteotomy starting point to the tangent line of the proximal tibial plateau (Distance A), or to the medial edge of the proximal tibial plateau (Distance B). Correlations between ΔJLCA and radiographic parameters or KOOS sub-scores were assessed using Spearman’s rank correlation coefficient analysis. Receiver operator curves were generated to evaluate the predictive strength of the significant factor for an increase in ΔJLCA > 1°. Results: Pre-operative OA severity consisted of Kellgren–Lawrence grade 2 (n = 18), 3 (n = 16), and 4 (n = 6). The average ΔJLCA (post–pre) was 0.5°, and ranged from − 1.4° to + 3.0°. The maximum systemic measurement error and limits of agreement were 0.07° and 0.20°, respectively. There were significant correlations between ΔJLCA and Distance A (36.9 ± 3.9 mm, R = − 0.46, p = 0.002), between ΔJLCA and Distance B (39.9 ± 4.0 mm, R = − 0.49, p = 0.001). The cut-off value for Distance A was determined to be 35 mm below the tibial plateau; the AUC was 0.804, with a sensitivity of 0.75 and a specificity of 0.82. Distance B correlated strongly with Distance A (R = 0.96, p < 0.001). There was no significant correlation between ΔJLCA and KOOS sub-scores 1 year after OW-HTO. Conclusions: Transverse osteotomy closer to tibial plateau was associated with larger valgus joint laxity postoperatively. This finding implies that sMCL proximal detachment, which was related to the level of the osteotomy starting point on the proximal tibia, potentially affected postoperative valgus laxity. Level of evidence: IV.

DOI： 10.1007/s00167-021-06810-6

Web of Science

Scopus

PubMed

Language：English   Publisher：Frontiers in Bioengineering and Biotechnology  

Objectives: The study aimed to elucidate target cup orientation and stem anteversions to avoid impingement between the liner and stem neck even at hip rotation with adduction during the deeply flexed posture. Methods: A computer simulation analysis was performed on 32 total hip arthroplasty patients applying patient-specific orientation of the components and in vivo hip kinematics obtained from three-dimensional analysis of the squatting motion. The anterior/posterior liner-to-neck distance and impingement were evaluated based on a virtual change in internal/external rotation (0°–60°) and adduction/abduction (0°–20°) at actual maximum flexion/extension during squatting. Cutoff values of cup orientations, stem anteversion, and combined anteversion to avoid liner-to-neck impingements were determined. Results: The anterior liner-to-neck distance decreased as internal rotation or adduction increased, and the posterior liner-to-neck distance decreased as external rotation or adduction increased. Negative correlations were found between anterior/posterior liner-to-neck distances at maximum flexion/extension and internal/external rotation. Anterior/posterior liner-to-neck impingements were observed in 6/18 hips (18/56%) at 45° internal/external rotation with 20° adduction. The range of target cup anteversion, stem anteversion, and combined anteversion to avoid both anterior and posterior liner-to-neck impingements during squatting were 15°–18°, 19°–34°, and 41°–56°, respectively. Conclusion: Simulated hip rotations caused prosthetic impingement during squatting. Surgeons could gain valuable insights into target cup orientations and stem anteversion based on postoperative simulations during the deeply flexed posture.

DOI： 10.3389/fbioe.2022.1023721

Web of Science

Scopus

PubMed

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

Web of Science

Scopus

PubMed

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

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

Language：English   Publisher：Clinical Anatomy  

It is important to investigate anatomical differences of the femur and tibia three-dimensionally between varus and valgus knees to enhance surgical approaches and better understand structural factors related to specific patterns of osteoarthritis progression. Three-dimensional femoral and tibial bone models were reconstructed from transverse computed-tomography scans in varus osteoarthritis (43 knees), valgus osteoarthritis (40 knees), and healthy (32 knees) groups. Different coordinate systems were defined in each femoral bone model (“Knee” and “Hip” Coordinate System). Femoral neck inclination, lateral bowing, anterior bowing, and neck anteversion were measured and compared between knee and hip coordinate systems. Those parameters were also compared between varus, valgus, and healthy groups. The tibial anterior and lateral bowing, external torsion and the fibular axis relative to the tibial mechanical axis were measured and compared between varus and valgus groups. Femoral neck anteversion was significantly 1–2° greater in the hip coordinate system compared to the knee coordinate system. Femoral neck anteversion was significantly smaller in varus knees than in healthy or valgus knees, with average difference of approximately 5°. The knee and hip joint are often rotated externally relative to the trunk axis in patients with varus osteoarthritis, perhaps maintaining the geometric relations between pelvis and proximal femur (including peripheral hip muscles) regardless of knee deformities. The fibular axis was inclined slightly valgus and posteriorly in two groups. The results may inform hypotheses on, and future studies of, skeletal morphologic development and factors contributing to the progression of knee osteoarthritis.

DOI： 10.1002/ca.23862

Web of Science

Scopus

PubMed

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

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

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

Language：English   Publisher：Arthroplasty Today  

Background: The purpose of this study was to investigate the size differences of 19 different femoral component placements from the standard position in total knee arthroplasty using 3-dimensional virtual surgery. Methods: Three-dimensional bone models were reconstructed from the computed tomography data of 101 varus osteoarthritic knees. The distal femoral bone was cut perpendicular to the femoral mechanical axis (MA) in the coronal plane. Twenty different component placements consisting of 5 cutting directions (perpendicular to MA, 3° and 5° extension relative to MA [3°E-MA and 5°E-MA, respectively], and 3° and 5° flexion relative to MA [3°F-MA and 5°F-MA, respectively]) in the sagittal plane, 2 rotational alignments (clinical epicondylar axis [CEA] and surgical epicondylar axis [SEA]), and 2 rotational types of anterior reference guide (central [CR] and medial [MR]) were simulated. Results: The mean anteroposterior dimension of femur ranged from 54.3 mm (5°F-MA, SEA, CR) to 62.5 mm (5°E-MA, CEA, MR). The largest and smallest differences of anteroposterior dimension from the standard position (3°F-MA, SEA, and CR) were 7.1 ± 1.3 mm (5°E-MA, CEA, and MR) and −1.2 ± 0.2 mm (5°F-MA, SEA, and CR), respectively. Multiple regression analysis revealed that flexion cutting direction, SEA, and CR were associated with smaller component size. Conclusions: The femoral component size can be affected easily by not only cutting direction but also the reference guide type and the target alignment. Our findings could provide surgeons with clinically useful information to fine-tune for unintended loose or tight joint gaps by adjusting the component size.

DOI： 10.1016/j.artd.2022.07.008

Web of Science

Scopus

PubMed

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

Web of Science

Scopus

PubMed

Web of Science

Language：Japanese   Publisher：西日本整形・災害外科学会  

<p>内側楔状開大式高位脛骨骨切り術（Open wedge high tibial osteotomy以下OW-HTO）後の満足度・期待度を評価した報告は少ない．今回当科でのOW-HTO術後の満足度・期待度を調査し，影響因子を探索した．当院で2014年8月～2019年12月の期間中にOW-HTO手術を受けた80膝に対し，2011 Knee Society scoreアンケートを送付した．手術時年齢，手術時BMI，術前可動域，術前K-L分類，術中開大角，術前後X線計測値（％MA，HKA angle，MPTA，JLCA），62.5-術後％MAの絶対値（outlier）を計測し，KSSの満足度スコア，期待度スコアに相関する因子を評価した．計54膝の返信（67.5％）を得られ，術後フォロー期間は平均3.6年であった．62.5-術後％MAの絶対値が大きいほど，術後の期待度除痛スコアが有意に低かった（p＝0.01）．術後％MAが62.5％から10％以上外れているoutlier群とそうでない群の群間比較にて期待度除痛スコアに有意差がみられた（p＝0.0292）．術後％MAのoutlierは，OW-HTO術後の期待する除痛に影響する重要な指標である．</p>

DOI： 10.5035/nishiseisai.71.584

CiNii Research

Language：Japanese   Publisher：西日本整形・災害外科学会  

<p>【はじめに】大腿骨骨切り後の人工股関節置換術（以下THA）は，通常の初回THAと比較して骨折の合併に注意が要することが報告されている．骨切り時に挿入した固定材料の抜去（抜釘）が骨折合併に影響するかを検討した報告は渉猟する限りない．骨切り後THA症例における骨折合併に影響する因子を，抜釘の有無を含めて検討することを本研究の目的とした．【対象と方法】2008年-2020年の間にPerfix HA 910を用いて施行された骨切り後THA101股を対象とした．術中骨折または術後1ヶ月以内の外傷のない骨折を骨折合併ありとした．THA時の年齢，骨切りからTHAまでの期間，同時抜釘の有無，先行骨切り術について調査し，骨折合併に影響する因子を解析した．【結果】骨折合併は7関節（6.9％）に認めた．多変量解析の結果，同時抜釘ありと骨切りからTHAまでの期間が骨折合併に有意な影響を及ぼす因子として同定された．【結語】本研究結果より，抜釘を伴う骨切り後THAは骨折を合併しやすいことが示唆された．大腿骨骨切り後症例に対しては，将来のTHAを考慮すると，事前に抜釘しておくことが薦められる．</p>

DOI： 10.5035/nishiseisai.71.494

CiNii Research

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

Web of Science

Scopus

PubMed

Language：Japanese   Publisher：西日本整形・災害外科学会  

【はじめに】大腿骨骨切り後の人工股関節置換術(以下THA)は,通常の初回THAと比較して骨折の合併に注意が要することが報告されている.骨切り時に挿入した固定材料の抜去(抜釘)が骨折合併に影響するかを検討した報告は渉猟する限りない.骨切り後THA症例における骨折合併に影響する因子を,抜釘の有無を含めて検討することを本研究の目的とした.【対象と方法】2008年-2020年の間にPerfix HA 910を用いて施行された骨切り後THA101股を対象とした.術中骨折または術後1ヵ月以内の外傷のない骨折を骨折合併ありとした.THA時の年齢,骨切りからTHAまでの期間,同時抜釘の有無,先行骨切り術について調査し,骨折合併に影響する因子を解析した.【結果】骨折合併は7関節(6.9%)に認めた.多変量解析の結果,同時抜釘ありと骨切りからTHAまでの期間が骨折合併に有意な影響を及ぼす因子として同定された.【結語】本研究結果より,抜釘を伴う骨切り後THAは骨折を合併しやすいことが示唆された.大腿骨骨切り後症例に対しては,将来のTHAを考慮すると,事前に抜釘しておくことが薦められる.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

内側楔状開大式高位脛骨骨切り術(Open wedge high tibial osteotomy以下OW-HTO)後の満足度・期待度を評価した報告は少ない.今回当科でのOW-HTO術後の満足度・期待度を調査し,影響因子を探索した.当院で2014年8月～2019年12月の期間中にOW-HTO手術を受けた80膝に対し,2011 Knee Society scoreアンケートを送付した.手術時年齢,手術時BMI,術前可動域,術前K-L分類,術中開大角,術前後X線計測値(%MA,HKA angle,MPTA,JLCA),62.5-術後%MAの絶対値(outlier)を計測し,KSSの満足度スコア,期待度スコアに相関する因子を評価した.計54膝の返信(67.5%)を得られ,術後フォロー期間は平均3.6年であった.62.5-術後%MAの絶対値が大きいほど,術後の期待度除痛スコアが有意に低かった(p=0.01).術後%MAが62.5%から10%以上外れているoutlier群とそうでない群の群間比較にて期待度除痛スコアに有意差がみられた(p=0.0292).術後%MAのoutlierは,OW-HTO術後の期待する除痛に影響する重要な指標である.(著者抄録)

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

Language：Japanese   Publisher：日本股関節学会  

セメントレスステムでは、モジュラーネックの一部の機種を除いてステム前捻角が大腿骨の髄腔形状に規定されやすいが、楔形形状をしたtaper wedge型ステムは、髄腔占拠をコンセプトとするfit-and-fill型ステムに比べて前捻角の自由度が大きいと考えられる。また、同じtaper wedge型でも機種によってステムデザインは異なり、デザインが異なると前捻角の自由度も異なる可能性が考えられる。今回、当科で寛骨臼形成不全に伴う変形性股関節症に対してTHAを施行した37例37関節を対象とし、使用ステム別にInitia(taper wedge型)群、J-Taper(taper wedge型)群、PerFix910(fit and fill型)群に分け、「前捻角自由度」「後傾変化量」「外反変化量」「深度変化量」を比較検討した。結果、前捻角自由度はInitia群>J-Taper群>PerFix910群の順に大きく、各群間に有意差を認めた。後傾変化量はtaper wedge型の2群がPerFix910群に比べて有意に大きかった。外反変化量と深度変化量に有意な群間差は認められなかった。

Language：Japanese   Publisher：日本股関節学会  

当院で寛骨臼移動術(TOA)を施行した発育性股関節形成不全(DDH)34例35関節(男性2関節、女性33関節、平均年齢40±12歳)を対象に、機能的骨盤傾斜がTOA後の股関節接触圧力に与える影響について検討した。その結果、TOA後は97%の症例で最大接触圧力が減少し、63%の症例で正常化していた。17%の症例では臥位から立位で10°以上骨盤が後傾しており、TOA後の最大接触圧力も臥位と立位で大きく異なっていた。以上、今回の結果から、矢状面骨盤傾斜の変化はperiacetabular osteotomy(PAO)後の股関節の力学的環境に影響を与えることから、骨形態や生体力学的な評価についてはPAO後においても荷重時の骨盤傾斜を考慮すべきであることが示唆された。

Language：English   Publisher：BMC Musculoskeletal Disorders  

Background: The coronal whole-leg radiograph is generally used for preoperative planning in total knee arthroplasty. The distal femoral valgus angle (DFVA) is measured for distal femoral bone resection using an intramedullary guide rod. The effect of coronal and sagittal femoral shaft bowing on DFVA measurement in the presence of malrotation or knee flexion contracture has not been well reported. The objectives of this study were: (1) to investigate the effects of whole-leg malrotation and knee flexion contracture on the DFVA in detail, (2) to determine the additional effect of coronal or sagittal femoral shaft bowing. Methods: We studied 100 consecutive varus and 100 valgus knees that underwent total or unicompartmental knee arthroplasty. Preoperative CT scans were used to create digitally reconstructed radiography (DRR) images in neutral rotation (NR, parallel to the surgical epicondylar axis), and at 5° and 10° external rotation (ER) and internal rotation (IR). The images were also reconstructed at 10° femoral flexion. The DFVA was evaluated in each DRR image, and the angular variation due to lower limb malposition was investigated. Results: The DFVA increased as the DRR image shifted from IR to ER, and all angles increased further from extension to 10° flexion. The DFVA variation in each position was 1.3° on average. A larger variation than 2° was seen in 12% of all. Multivariate regression analysis showed that sagittal femoral shaft bowing was independently associated with a large variation of DFVA. Receiver operating characteristic analysis showed that more than 12° of sagittal bowing caused the variation. Conclusion: If femoral sagittal bowing is more than 12°, close attention should be paid to the lower limb position when taking whole-leg radiographs. Preoperative planning with whole-leg CT data should be considered.

DOI： 10.1186/s12891-022-05542-z

Web of Science

Scopus

PubMed

Language：English   Publisher：Journal of Arthroplasty  

Background: The relative impact of soft tissue balance and knee laxity on clinical outcomes after total knee arthroplasty (TKA) is not fully understood. We analyzed associations among knee laxity, kinematics, and patient-reported outcomes. Methods: Knee Society Scores were recorded in 67 patients before and after primary TKA for osteoarthritis with varus deformity (N = 78). Varus and valgus laxity was measured in 78 knees using stress radiographs. Knee kinematics were measured fluoroscopically during stair ascent in 16 knees. Results: On average, varus laxity decreased significantly, and valgus laxity increased significantly after TKA, although the net combined varus-valgus laxity did not change significantly. Postoperatively, the magnitude of valgus laxity correlated significantly with greater patient symptoms and satisfaction scores. Patients with medial pivot kinematics scored higher on patient satisfaction and standard activities. Conclusion: We found that postoperative valgus laxity and medial pivot kinematics were significantly associated with better clinical outcomes. These results emphasize the importance of careful preoperative planning and attention to intraoperative alignment and ligament balancing.

DOI： 10.1016/j.arth.2022.02.088

Web of Science

Scopus

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

Web of Science

Scopus

PubMed

Publisher：南江堂  

DOI： 10.15106/j_seikei73_541

CiNii Research

Language：English   Publisher：BMC Musculoskeletal Disorders  

Background: In performing primary constrained total knee arthroplasties (TKA) to imbalanced knees, the offset stem is sometimes compelled to use, although this is associated with surgical difficulties. We developed a modified procedure which might be able to fit the anteroposterior (AP) and mediolateral (ML) position of the femoral component simultaneously with the straight stem. Purposes of this study were to evaluate usefulness of the modified procedure both in computer simulations and actual surgeries. Methods: We included 32 knees that had undergone primary TKA using constrained implants because of the coronal imbalance. In the component-first procedure, the distal femur was prepared to fit the AP and ML position of the femoral component simultaneously at first, as in primary TKA. Finally, the stem hole is created based on the femoral component position (the component-first procedure). The femoral component and extension stem were simulated using the three-dimensional planning software (ZedKnee) following the component-first procedure. We investigated the suitability of the straight stem through computer simulation and evaluation of actual surgeries. Clinical and radiographical outcomes were also evaluated at the latest follow-up. Results: The component-first procedure enabled the AP and ML position of the femoral component to be fitted simultaneously with the straight stem in simulations and actual surgeries in all cases. The stem diameter was not significantly different between simulations and actual surgeries (13.9 and 13.7 mm on average, respectively, p = 0.479) and almost similar from intraclass correlation coefficient analysis (kappa value 0.790). Clinical and radiographical outcomes were almost similar to primary TKA cases and there was no case of component loosening, cortical bone hypertrophy around the stem and stem-tip pain. Conclusions: Our improved surgical procedure may facilitate use of the constrained implant for more cases of primary TKA in imbalanced knees without the usual surgical difficulties. Trial registration: Retrospectively registered.

DOI： 10.1186/s12891-022-05367-w

Web of Science

Scopus

PubMed

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

遠距離X線像と実大X線像を用いた脚部アライメントにおける測定角度の精度を比較検討した。アライメントを内反10°および15°に設定したモデルを作成し、股関節-膝関節-足関節角(HKAA)、機能軸(MA)長、MA率(%MA)をそれぞれ遠隔X線撮影と実大X線撮影によって測定した。HKAAに関して標準遠距離X線撮影では精度の高い測定値が得られており、内反10°、15°のいずれでも真値との差は最小にとどまっていた。実大X線撮影では修正法においてHKAAの測定精度は遠距離X線撮影とほぼ同等であったが、標準法では真値との間に有意な誤差が生じていた。MA長の評価では、実大X線像は標準法でも修正法でも測定精度は高かったが、遠距離X線像は内反10°で61.5mm、15°で58.9mmの誤差が認められ、被写体との距離が長くなるのに伴い誤差も大きくなっていた。%MAは修正実大X線像において内反10°で2.0%、15°で2.4%の誤差がみられ、遠距離X線像と標準実大X線像の測定精度は高かった。

Language：Japanese   Publisher：国家公務員共済組合連合会  

人工股関節全置換術(THA)の術中カップ設置角度計測に、これまで各関節の動態解析法として用いられてきたイメージマッチング法を導入し、コンピュータ上でカップ設置角度を具体的に数値化する方法を開発し、その計測精度を、当院で変形性股関節症、特発性大腿骨頭壊死症、大腿骨頭軟骨下脆弱性骨折に対して、セメントレス寛骨臼カップ(SQRUMカップ、京セラ製)を用いてTHAを行った50例50股関節を対象に検討した。イメージマッチング解析から得られた設置角度[RA(Radiographic anteversion)、RI(Radiographic inclination)]と、術後CTから計測した設置角度、すなわち最終的な設置角度との誤差を絶対値で評価した結果、RAで平均2.5°、RIで平均0.1°と、イメージマッチング解析は非常に高い精度で再現できていることが確認できた。

Language：English   Publisher：Journal of Orthopaedic Science  

Background: The purpose of the present study was to evaluate the accuracy of the measurements associated with leg alignment on a teleoroentgenogram and an orthoroentgenogram. Methods: The models being irradiated were manufactured and represented 10° varus and 15° varus leg alignment, in which the true values of hip-knee-ankle angle (HKAA), mechanical axis (MA) length, and percentage of MA (%MA) were already known. HKAA, MA length, and %MA were measured in various radiographic conditions of the teleoroentgenogram and orthoroentgenogram. Then, the differences between the radiographic measurement values and the corresponding true values were analyzed. Results: Regarding HKAA, the teleoroentgenogram provided accurate angular measurements with minimal differences between the measurement and true value in both the 10° and 15° varus models, irrespective of the radiographic condition. In the orthoroentgenogram, the modified method measured accurate HKAA; however, the standard method showed significant angular measurement errors with a 0.6° and 1.0° difference from the true value in the 10° and 15° varus models, respectively. This angular measurement error of HKAA in the standard orthoroentgenogram became significantly larger with object-to-image distance. Regarding MA length, the orthoroentgenogram exhibited accurate length measurements. In contrast, the teleoroentgenogram showed a significant length measurement error for the MA length. Regarding %MA, significant differences from the true values of 2.0% and 2.4% were observed in the modified orthoroentgenograms of the 10° and 15° varus models, respectively. The teleoroentgenogram and standard orthoroentgenogram reproduced the accurate measurement value of %MA in the 10° and 15° varus models. Conclusion: A teleoroentgenogram is a reliable modality for accurate angular measurements such as HKAA and %MA. An orthoroentgenogram has the potential to measure both HKAA and length accurately if the radiographic condition was modified; however, measurement error in %MA may occur.

DOI： 10.1016/j.jos.2021.02.011

Web of Science

Scopus

PubMed

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

Web of Science

Scopus

PubMed

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

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

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

Publisher：Journal of Orthopaedics  

Purpose: In total hip arthroplasty (THA) for patients with previous femoral osteotomy, we hypothesized that a tapered cone stem may be an option due to the altered morphology of the proximal femur. The purpose of this study was to assess the short-term results of THA after femoral osteotomy using a tapered cone stem, and to identify issues that require further attention. Methods: Twenty-two hips in 21 consecutive patients who underwent THA after femoral osteotomy using a Wagner Cone tapered cone stem were retrospectively reviewed, with a mean follow-up period of 34.4 (range, 24–50) months. Clinical information was obtained from medical records. On preoperative radiographs, the Dorr type was classified based on the anteroposterior cortical index. On postoperative radiographs, the degree of stem subsidence and the stem location with the highest canal fill ratio were assessed. Results: The mean Harris hip score significantly improved from 55.2 at baseline to 84.8 at final follow-up. Radiologically, stem subsidence (>3 mm) was observed in seven hips, and it stabilized within 1 year after THA in all cases. In five of seven hips with stem subsidence, the highest postoperative canal fill ratio was observed in the distal third of the stem. The proportions of males and Dorr type A were significantly higher among hips with stem subsidence than among those without. During the follow-up period, no hips showed implant loosening or required revision surgery. Conclusions: The occurrence of stem subsidence should be noted when using Wagner Cone stems for Dorr type A femurs after femoral osteotomy.

DOI： 10.1016/j.jor.2022.02.021

Web of Science

Scopus

PubMed

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

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

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

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

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

Web of Science

Scopus

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：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

PubMed

CiNii Research

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Event date： 2024.4

Language：Japanese  

Country：Japan  

Event date： 2024.4

Language：Japanese  

Country：Japan  

Event date： 2024.4

Language：Japanese  

Country：Japan  

Event date： 2024.4

Language：Japanese  

Country：Japan  

Event date： 2024.4

Language：Japanese  

Country：Japan  

Event date： 2024.4

Language：Japanese   Presentation type：Oral presentation (general)  

Country：Japan  

Event date： 2024.4

Language：Japanese  

Country：Japan  

Event date： 2024.4

Language：Japanese  

Country：Japan  

Event date： 2024.4

Language：Japanese  

Country：Japan  

Event date： 2024.4

Language：Japanese  

Country：Japan  

Event date： 2024.4

Language：Japanese  

Country：Japan  

Event date： 2024.4

Language：Japanese  

Country：Japan  

Event date： 2024.4

Language：Japanese  

Country：Japan  

Event date： 2024.4

Language：Japanese  

Country：Japan  

Event date： 2024.4

Language：Japanese  

Country：Japan  

Event date： 2021.10

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：奈良   Country：Japan  

Event date： 2021.7 - 2022.7

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：福岡   Country：Japan  

Event date： 2021.7

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：横浜   Country：Japan  

Event date： 2020.11 - 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.10

Language：Japanese   Presentation type：Oral presentation (general)  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：English  

Country：United States  

Event date： 2020.7

Language：English  

Country：United States  

Event date： 2020.7

Language：English  

Country：United States  

Event date： 2020.7

Language：English  

Country：United States  

Event date： 2020.7

Language：English  

Country：United States  

Event date： 2020.7

Language：English  

Country：United States  

Event date： 2020.7

Language：English  

Country：United States  

Event date： 2020.7

Language：English  

Country：United States  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.7

Language：Japanese  

Country：Japan  

Event date： 2020.6 - 2020.8

Language：Japanese   Presentation type：Oral presentation (general)  

Country：Japan  

Event date： 2020.7

Language：English  

Country：Canada  

Event date： 2020.7

Language：English  

Country：France  

Event date： 2020.7

Language：English  

Country：Canada  

Event date： 2020.7

Language：English  

Venue：San Francisco, USA   Country：United States  

Event date： 2020.7

Language：English  

Country：Spain  

Event date： 2010.3

Language：English  

Country：United States  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese   Publisher：(株)南江堂  

＜文献概要＞はじめに　イメージマッチング法は,X線画像とcomputer-aided-design(CAD)モデルもしくはdigitally reconstructed radiography(DRR)を用いてin vivoで人工関節もしくは生体関節の三次元運動を解析する手法である(図1).手術手技やインプラント形状が人工膝関節置換術(total knee arthroplasty:TKA)の動態に及ぼす影響などがこれまで明らかにされており,TKAの術後評価やインプラント開発において有用な手法となっている.金属インプラント間の相対関係をあらわす6自由度パラメータに加え,ポリエチレンインサートのCADを用いて,大腿骨コンポーネントとインサート間の接触位置や後十字靱帯置換型におけるポストカム機構やポスト前方の接触状態を検討することも可能である(図2).健常膝や変形性膝関節症(膝OA)などの生理的,病的動態に関する検討のみならず,股関節や肩関節などにも応用されている.撮影機器や画像位置合わせのアルゴリズム,対象とする骨・関節によって測定精度は異なるが,おおむねin-plane(投影面)translationで1mm,rotationで1°以下と報告されている.本稿では,イメージマッチング法により,(1)健常膝と変形膝,(2)TKA,(3)人工股関節置換術(total hip arthroplasty:THA),(4)大腿骨頭前方回転骨切り術(anterior rotational osteotomy:ARO),(5)健常肩と腱板断裂肩においてわれわれが明らかにしてきた最新の知見を提示する.