担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Scientific Reports  

Although bilateral simultaneous total knee arthroplasty (BSTKA) is an effective treatment for bilateral knee osteoarthritis, safety concerns and lack of precise patient selection criteria persist. This study aimed to determine the differences in perioperative parameters and complication rates between BSTKA and staged TKA in the Japanese population. We retrospectively reviewed 531 patients who underwent BSTKA or staged TKA between 2012 and 2021. Propensity score matching, performed on a 1:1 nearest neighbor basis for age, BMI, diagnosis, ASA score, and age-adjusted Charlson Comorbidity Index, yielded matched cohorts of 94 patients (188 knees) for each group. Outcome measures included operative time, perioperative blood loss, length of hospital stay, and nonmechanical complications after surgery. The BSTKA group had a shorter median operative time and hospital stay (111 min and 16 days) than the staged TKA group (159 min and 33 days) (p < 0.001). Overall complication rates were higher in the BSTKA group than in the staged TKA group (26% vs. 13%, p = 0.026), with anemia requiring transfusion being the most common. Cardiovascular complications were more frequent in the BSTKA group (4.3% vs. 0%, p = 0.043). These findings emphasize the importance of careful patient selection and risk assessment when considering BSTKA.

DOI： 10.1038/s41598-024-81821-0

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Bone and Joint Journal  

Aims This study aimed to determine clinical outcomes; relationships between postoperative anterior, lateral, and posterior acetabular coverage and joint survival; and prognostic factors for joint survival after transposition osteotomy of the acetabulum (TOA). Methods Data from 616 patients (800 hips) with hip dysplasia who underwent TOA between November 1998 and December 2019 were reviewed. The median follow-up period was 8.9 years (IQR 5 to 14). A medical notes review was conducted to collect demographic data, complications, and modified Harris Hip Score (mHHS). Radiological indicators of acetabular coverage included lateral centre-edge angle (LCEA), anterior wall index (AWI), and posterior wall index (PWI). The cumulative probability of TOA failure (progression to Tönnis grade 3 or conversion to total hip arthroplasty) was estimated using the Kaplan-Meier product-limited method. A multivariate Cox proportional hazards model was used to identify predictors for failure. Results Median mHHS improved from 68 preoperatively to 96 at the latest follow-up (p < 0.001). The overall joint survival rate was 97% at ten years and 70% at 20 years. For the postoperative LCEA subgroups, survival in the deficient group was lower than that in the excessive (p = 0.006) and normal (p = 0.007) groups. For the postoperative AWI subgroups, survival in the deficient group was lower than that in the excessive (p = 0.015) and normal (p < 0.001) groups. Multivariate analysis identified age (p = 0.010), Tönnis grade 2 (p < 0.001), roundness index (p = 0.003), fair joint congruity (p = 0.004), and postoperative AWI (p = 0.002) as independent risk factors. Conclusion Deficient postoperative AWI adversely affected joint survival after TOA, underscoring the importance of sufficient anterior acetabular coverage, along with precise surgical indications, to ensure successful hip joint preservation in the treatment of hip dysplasia.

DOI： 10.1302/0301-620X.106B12.BJJ-2024-0585.R1

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担当区分：責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Bone and Joint Journal  

Aims The aim of this study was to determine the clinical outcomes and factors contributing to failure of transposition osteotomy of the acetabulum (TOA), a type of spherical periacetabular osteotomy, for advanced osteoarthritis secondary to hip dysplasia. Methods We reviewed patients with Tönnis grade 2 osteoarthritis secondary to hip dysplasia who underwent TOA between November 1998 and December 2019. patient demographic details, osteotomy-related complications, and the modified Harris Hip Score (mHHS) were obtained via medical notes review. Radiological indicators of hip dysplasia were assessed using preoperative and postoperative radiographs. The cumulative probability of TOA failure (progression to Tönnis grade 3 or conversion to total hip arthroplasty) was estimated using the Kaplan-Meier product-limited method. A multivariate Cox proportional hazards model was used to identify predictors of failure. Results This study included 127 patients (137 hips). Median follow-up period was ten years (iQR 6 to 15). The median mHHS improved from 59 (IQR 52 to 70) preoperatively to 90 (IQR 73 to 96) at the latest follow-up (p < 0.001). The survival rate was 90% (95% Ci 82 to 95) at ten years, decreasing to 21% (95% Ci 7 to 48) at 20 years. Fair joint congruity on preoperative hip abduction radiographs and a decreased postoperative anterior wall index (AWi) were identified as independent risk factors for failure. The survival rate for the 42 hips with good preoperative joint congruity and a postoperative AWI ≥ 0.30 was 100% at ten years, and remained at 83% (95% Ci 38 to 98) at 20 years. Conclusion Although the overall clinical outcomes of TOA in patients with advanced osteoarthritis are suboptimal, favourable results can be achieved in selected cases with good preoperative joint congruity and adequate postoperative anterior acetabular coverage.

DOI： 10.1302/0301-620X.106B8.BJJ-2024-0196.R1

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Arthroplasty  

Background: This study aimed to determine the clinical outcomes, predictors of suboptimal functional improvement, and factors influencing patient satisfaction following conversion of a fused hip to total hip arthroplasty (THA). Methods: A retrospective analysis of clinical and radiographic data was performed on 83 patients (83 hips) who underwent fused hip conversion to THA. Implant survival and predictors of poor functional outcome (Harris hip score < 70) were analyzed. In addition, factors associated with patient dissatisfaction (visual analog scale < 25th percentile) were analyzed in 63 patients (63 hips) who completed a patient-reported outcome measures questionnaire. Results: The median Harris hip score improved from 55 (range, 18 to 77) to 78 (range, 36 to 100) at a mean follow-up of 10.2 ± 4.8 years (P < .001). Implant survival was 97.4% at 10 years and 91.3% at 20 years, with any revision as the endpoint. Multivariate analysis identified preoperative reliance on mobility aids as an independent predictor of poor functional outcome (P = .021). There were 48 of 63 patients (76%) satisfied (satisfaction visual analog scale ≥80) with the operated hip. Demographics and preoperative/postoperative clinical data did not differ between satisfied and unsatisfied patients. Among the patient-reported outcome measures, the Forgotten Joint Score-12 emerged as an independent discriminator of patient satisfaction. Conclusions: Conversion of a fused hip to THA provides functional improvement, favorable implant survival, and high patient satisfaction. However, patients dependent on mobility aids may experience suboptimal functional recovery, underscoring the need for careful preoperative counseling and patient selection.

DOI： 10.1016/j.arth.2024.07.015

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Scientific Reports  

Although bilateral simultaneous total knee arthroplasty (BSTKA) is an effective treatment for bilateral knee osteoarthritis, safety concerns and lack of precise patient selection criteria persist. The purpose of this retrospective study was to determine the complication rate and the role of frailty in patient selection for BSTKA. We analyzed data from 434 patients who underwent BSTKA between February 2012 and January 2021, examining demographic factors and preoperative blood test results. Complications occurred in 77 patients (18%), with anemia requiring transfusion being the most common (26 patients, 5.9%). In the univariate analysis, age ≥ 75 years, age-adjusted Charlson Comorbidity Index ≥ 5, age-adjusted 5-factor modified Frailty Index (aamFI-5) ≥ 3, hemoglobin ≤ 11.0 g/dL, albumin ≤ 3.5 g/dL, estimated glomerular filtration rate < 45 ml/dl/1.73 m², and D-dimer ≥ 2.0 μg/mL contributed to postoperative complications (p < 0.05). Multivariate analysis identified aamFI-5 ≥ 3 as an independent risk factor (p = 0.002). Our findings underscore the practical utility of aamFI-5 in predicting complications after BSTKA, providing valuable guidance to surgeons in the selection of BSTKA candidates and ultimately improving clinical outcomes.

DOI： 10.1038/s41598-024-65719-5

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.7759/cureus.53803

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Scientific Reports  

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

DOI： 10.1038/s41598-023-42630-z

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担当区分：責任著者   掲載種別：研究論文（学術雑誌）  

DOI： 10.1302/0301-620x.105b7.bjj-2022-1441.r1

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その他リンク： https://boneandjoint.org.uk/doi/10.1302/0301-620X.105B7.BJJ-2022-1441.R1/pdf

担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）  

DOI： 10.1302/0301-620x.105b7.bjj-2023-0056.r1

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その他リンク： https://boneandjoint.org.uk/doi/10.1302/0301-620X.105B7.BJJ-2023-0056.R1/pdf

担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Arthroplasty  

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

DOI： 10.1016/j.arth.2022.04.045

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC Musculoskeletal Disorders  

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

DOI： 10.1186/s12891-022-05005-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Physiologic pelvic tilt can change acetabular orientation and coverage in patients with hip dysplasia. In this study, we aimed to clarify the impact of change in sagittal pelvic tilt on joint stress distribution in dysplastic hips. Methods: We developed patient-specific finite element models of 21 dysplastic hips and 21 normal hips. The joint contact area, contact pressure, and equivalent stress of the acetabular cartilage were assessed at three pelvic tilt positions relative to the functional pelvic plane: 10° anterior tilt, no tilt, and 10° posterior tilt. Findings: The mean contact area was 0.6–0.7 times smaller, the mean maximum contact pressure was 1.8–1.9 times higher, and the mean maximum equivalent stress was 1.3–2.8 times higher in dysplastic hips than in normal hips at all three pelvic positions. As the pelvis tilted from 10° anterior to 10° posterior, the mean contact area decreased, and the mean maximum contact pressure and median maximum equivalent stress increased. The latter two changes were more significant in dysplastic hips than in normal hips (total increment was 1.3 MPa vs. 0.4 MPa, P = 0.001, and 3.6 MPa vs. 0.4 MPa, P < 0.001, respectively). The mean equivalent stress increased in the anterosuperior acetabulum during posterior pelvic tilt in dysplastic and normal hips, while the change was not significant in the superior and posterosuperior acetabulum in both groups. Interpretation: Sagittal pelvic tilt alters the loading environment and joint stress distribution of the hip joint and may impact the degeneration process in dysplastic hips.

DOI： 10.1016/j.clinbiomech.2020.02.011

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Residual acetabular deficiency after periacetabular reorientation osteotomy can result in suboptimal outcome. The optimal algorithm of acetabular fragment correction to achieve normal anterolateral acetabular coverage is not well characterized. The aim of this study was to determine the prevalence of residual anterolateral deficiency after lateral acetabular rotation and to evaluate the ability of additional sagittal and axial rotation of the acetabulum to normalize the acetabular coverage in periacetabular osteotomy. Methods: We performed computed tomography-based simulated periacetabular osteotomy on 85 patients (85 hips) with hip dysplasia. The acetabular fragment was rotated laterally to achieve a lateral center-edge angle (CEA) of 30°. For hips with residual anterolateral deficiency, which were identified based on the reference interval of the anterior CEA, the acetabulum was further rotated in the sagittal or axial direction in 5-degree increments from 5° to 20°, and the ability of these two manoeuvres to restore a normal anterior CEA was assessed. Results: After lateral acetabular rotation, 16 hips (19%) had residual anterolateral deficiency, 67 hips (79%) had normal acetabular coverage, and 2 hips (2.4%) had acetabular overcoverage. A preoperative anterior CEA <37° predicted residual deficiency (sensitivity, 94%; specificity, 81%). Additional anterior sagittal rotation was more effective than posterior axial rotation in normalizing the anterior CEA, while minimizing the decrease in posterior CEA. The highest number of hips with normal anterior and posterior CEA was noted at 10° sagittal rotation (81%), which was followed by 15° sagittal rotation (63%). Conclusions: Normal anterolateral coverage was achieved in 79% of patients after rotating the acetabulum laterally. However, lateral rotation of the acetabulum may be insufficient to correct the anterolateral deficiency in patients with an anterior CEA of <37°. In them, additional 10°–15° anterior sagittal rotation may be appropriate to achieve sufficient anterolateral coverage while retaining posterolateral coverage.

DOI： 10.1016/j.jos.2019.12.014

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1097/CORR.0000000000000898

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Although lateralized head sign (LHS) is considered indicative of structural instability, it lacks reproducibility, and its usefulness in diagnosing adult hip dysplasia is unknown. In this study, we proposed a modified LHS and aimed to determine its reliability and accuracy in diagnosing adult hip dysplasia. Methods: We reviewed anteroposterior pelvic radiographs of 94 patients (134 hips) with hip dysplasia. As controls, 133 normal hips were evaluated. We defined the modified lateralization distance (LD) as the horizontal distance between the medial aspect of the femoral head to the acetabular fossa. The sensitivity, specificity, and cutoff value of modified LD in diagnosing hip dysplasia were calculated using receiver operating characteristic curve analysis. Results: The sensitivity and specificity of the modified LD (79% and 87%, respectively) were higher than those of the conventional LD (63% and 80%, respectively). Diagnostic accuracy was further improved when patients were divided on the basis of sex. The sensitivity and specificity of the modified LD in men were 89% and 97%, respectively, with a cutoff value of 12 mm, while in women, they were 80% and 96%, respectively, with a cutoff value of 9.7 mm. Therefore, we defined the modified LHS as presentation with a modified LD ≥ 12 mm in men and ≥10 mm in women. Between three observers, the kappa value for intraobserver reliability was ≥0.9, while that for interobserver reliability was >0.8. The mean sensitivity and specificity of the modified LHS in diagnosing hip dysplasia were 85% and 99%, respectively. Conclusions: Modified LHS—a horizontal distance between the medial aspect of the femoral head and the acetabular fossa ≥12 mm in men and ≥10 mm in women—is a clinically useful marker in detecting lateral femoral head subluxation indicative of hip dysplasia or structural hip instability.

DOI： 10.1016/j.jos.2019.05.015

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background We aimed to determine correlations between the hip joint center position and pelvic dimensions and whether the three-dimensional position of the original hip joint center could be estimated from pelvic landmarks in dysplastic and normal hips. Methods We reviewed the pelvic CT scans of 70 patients (70 hips) with hip dysplasia. Seventy-seven normal hips were used as controls. The hip joint center coordinates (Cx, Cy, and Cz) and pelvic dimensions were measured with reference to the anterior pelvic plane coordinate system. Multiple regression formulas were used to estimate the original hip joint center. Results The hip center for both dysplastic and normal hip was highly correlated with the distance between the anterior superior iliac spine (ASIS) in the coronal plane (r = 0.76 and 0.84), the distance from the ASIS to the pubic tubercle in the sagittal plane (r = 0.81 and 0.76), and distance from the pubic tubercle to the most posterior point of the ischium on the transverse plane (r = 0.76 and 0.78). The hip joint center could be estimated within a 5-mm error for more than 80% of hips on their respective axes in both dysplastic and normal hips. Conclusions The three-dimensional position of the original hip joint center was correlated with pelvic dimensions, and can be estimated with substantial accuracy using pelvic landmarks as references. Although these results are preliminary, this estimation method may be useful for surgeons planning total hip arthroplasties.

DOI： 10.1016/j.jos.2017.08.013

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1155/2017/4937151

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.arthro.2016.01.060

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s11999-014-4084-x

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s11999-012-2370-z

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1302/0301-620X.93B11.27314

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s11999-010-1746-1

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.2106/JBJS.I.00046

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The purpose of this study was to examine intraarticular pathology in patients younger than 20 years with symptomatic developmental dysplasia of the hip. METHODS: We performed hip arthroscopy during corrective osteotomy in 23 hips in 22 patients. All patients were female, and the average age at operation was 16.4 years. Eighteen hips were in a prearthritic stage, and 5 hips were in an early stage. The presence and location of cartilage degeneration and labral tears were evaluated. Second-look arthroscopy was performed in 13 hips in 12 patients. RESULTS: Fourteen hips (77.8%) in the prearthritic stage had cartilage degeneration. Cartilage lesions were more frequent in the acetabulum than in the femoral head (72.2% vs 16.7%). Sixty-one percent of acetabular lesions were located at the anterosuperior area. Labral tears were observed in 77.8% of hips in prearthritic stages located at the anterosuperior (72.2%) and superior (44.4%) areas. The degree of cartilage and labral lesions in the early stage was more severe than in the prearthritic stage. On second-look arthroscopy, there were no changes in the state of the cartilage and labrum in the majority (84.6%) of hips. CONCLUSIONS: The incidence of intraarticular lesions in developmental dysplasia of the hip was high, even in the prearthritic stage. These lesions tended to originate in the anterosuperior area of the acetabulum and were generally progressive. LEVEL OF EVIDENCE: Therapeutic study, level IV.

DOI： 10.1097/BPO.0b013e318190a0be

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Orthopaedic Science  

DOI： 10.1016/j.jos.2025.10.006

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記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞寛骨臼移動術は,外側から大転子を切骨反転して進入し,寛骨臼を球状に骨切りすることを特徴とする.骨切りラインは腸骨内板を通過し,骨移植を行わないことを基本とするが,当科では腸骨内板を温存することで骨盤輪の安定性を保持し,閉鎖動脈損傷のリスクを低減しつつ,早期荷重を可能とする工夫を行ってきた.一方で,大きな矯正を必要とする重度寛骨臼形成不全では骨頭が上方化しやすいため,同種骨移植を併用して良好な矯正を得る戦略を採用している.本稿では,現在筆者が行っている寛骨臼移動術の手技と工夫について述べる.

記述言語：日本語   出版者・発行元：(株)医学書院  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

<jats:title>ABSTRACT</jats:title>
<jats:p>Periacetabular osteotomy (PAO) is a widely used surgical technique for symptomatic developmental dysplasia of the hip (DDH). However, the incidence of posterior column fractures after PAO and the risk factors are not adequately investigated. Identification rates have been improved by using oblique radiographs, but few reports have examined the incidence of posterior column fractures using early postoperative computed tomography (CT) scans. This study aimed to investigate the incidence and risk factors for postoperative posterior column fracture following PAO using early postoperative CT scans. This study included 80 hips from patients who underwent PAO for symptomatic DDH. Radiographic parameters such as lateral center-edge angle (LCEA), anterior center-edge angle (ACEA), acetabular roof obliquity (ARO), and the thickness of the posterior column before and after surgery were evaluated using preoperative and early postoperative (within 1 month) CT images. Statistical analyses were conducted to identify risk factors associated with postoperative posterior column fracture. Postoperative CT scans revealed that postoperative posterior column fracture occurred in 42% of cases. A preserved posterior column thickness of &amp;lt;13 mm was identified as a significant risk factor for postoperative posterior column fracture. In conclusion, Posterior column fractures are a relatively common complication following PAO, with a higher incidence than previously reported. A preserved posterior column thickness of &amp;lt;13 mm is a critical risk factor for postoperative posterior column fracture. These results suggest that early weight-bearing should be approached with caution and that accurate osteotomy techniques using computer-assisted surgery are needed.</jats:p>

DOI： 10.1093/jhps/hnaf059

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Orthopaedic Science  

Background: Femoroacetabular impingement (FAI) causes hip pain and osteoarthritis (OA). However, its prevalence and characteristics in the Japanese population remain unclear. Therefore, this large-scale nationwide epidemiological study aimed to determine the current aetiologies of hip disorders in Japan, focusing on the prevalence and clinical features of primary FAI. Methods: A total of 2402 patients presenting with groin pain were prospectively enrolled from 16 hip-specialised institutions across Japan. Diagnoses were based on standardised clinical and radiographic evaluations, including the Japanese Hip Society criteria for primary FAI. Centralised radiographic assessment was also conducted using dedicated measurement software. Results: Secondary OA due to hip dysplasia was the most common diagnosis (52.9 %), followed by primary OA (16.8 %), osteonecrosis of the femoral head (8.5 %), and primary FAI (6.2 %). Patients with FAI were predominantly younger males. Cam-type FAI was the most frequently identified FAI subtype. Centralised radiographic assessment revealed discrepancies compared with institutional diagnoses, in which 12.8 % of patients initially diagnosed with FAI showed signs of advanced OA, the percentage of hips with a lateral center-edge angle <25° was higher in the centralised measurements (13.8 % vs. 6.4 %; P < 0.001), and the percentage of hips with an alpha angle ≥55° was reduced (40.3 % vs. 67.7 %; P = 0.0393). Conclusion: This nationwide study identified secondary OA due to hip dysplasia as the most common (52.9 %), with primary FAI identified in 6.2 % of cases, predominantly affecting younger males with cam-type morphology. Standardised radiographic assessment revealed an underdiagnosis of hip dysplasia and OA and a potential overdiagnosis of cam-type FAI, emphasising the need for accurate diagnosis to guide appropriate treatment decisions.

DOI： 10.1016/j.jos.2025.08.014

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Osteoporosis International  

Purpose: This study aimed to calculate short- to mid-term projections of the number of bipolar hemiarthroplasty (BHA) and open reduction and internal fixation (ORIF) procedures for femoral fractures in Japan from 2025. Methods: We conducted a nationwide population-based modeling study to predict the number of BHA and ORIF procedures to be performed for femoral fractures in Japan between 2025 and 2035. BHA and ORIF data between 2018 and 2022 were obtained from the National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data. Population data were sourced from the Population Census and the National Institute of Population and Social Security Research. Poisson regression models were fitted by sex and 10-year age strata (aged ≥ 40 years), with procedure year as an explanatory variable and population size as an offset. Results: The projected numbers of BHA in women and men are 61,799 (prediction interval [PI], 60,154–63,507) and 20,715 (PI, 19,697–21,802) in 2025, 72,545 (PI, 68,921–76,414) and 26,179 (PI, 23,770–28,894) in 2030, and 82,713 (PI, 76,127–88,804) and 31,743 (PI, 27,452–36,845) in 2035, respectively. The projected numbers of ORIF in women and men are 95,525 (PI, 93,556–97,554) and 25,545 (PI, 24,411–26,741) in 2025, 94,731 (PI, 91,031–98,653) and 26,050 (PI, 23,847–28,492) in 2030, and 91,422 (PI, 86,149–97,170) and 26,046 (PI, 22,770–29,868) in 2035, respectively. Conclusion: The projected increases in BHA and generally stable ORIF numbers with fluctuations through 2035, with more reliable short-term estimates, will inform timely healthcare planning. Mini abstract. This modeling study projected the number of femoral fracture surgeries in Japan between 2025 and 2035. The number of bipolar hemiarthroplasty procedures in Japan is projected to increase over the next decade. In contrast, the number of open reduction and internal fixation procedures is projected to remain stable, with fluctuations.

DOI： 10.1007/s00198-025-07655-2

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記述言語：日本語   出版者・発行元：(株)全日本病院出版会  

人工股関節再置換術(Revision THA)は,初回THAと骨欠損,瘢痕組織,骨質脆弱化などにより展開が困難で,術後脱臼や神経麻痺,骨折などの合併症リスクが高まる高度な手術である.標準的手技である後側方アプローチは,優れた展開性を有し,視野の拡大や近位・遠位への延長,必要に応じてextended trochanteric osteotomy等への移行が可能であるため,Revision THAにおいて汎用されている.一方で初回THAに比べ術後脱臼のリスクが高いことが報告されており,術中の適切な工夫が重要である.本稿では,Revision THAにおける後側方アプローチの具体的手技として,皮膚切開のバリエーション,筋層および関節包の展開,さらに拡大展開のための工夫を詳述する.加えて,坐骨神経麻痺,出血,骨折,術後脱臼などの合併症を予防するための要点を解説し,術前計画から展開,修復まで一貫した戦略の重要性を述べる.(著者抄録)

記述言語：日本語   出版者・発行元：金原出版(株)  

＜文献概要＞銀は耐性菌を作りにくく広い抗菌スペクトルと強い抗菌性を有した無機系抗菌剤であり,古くより様々な医療材料にも使用されている。近年,整形外科領域においてインプラント関連感染症は増加傾向にあるとされており,銀コーティングインプラントによる手術部位感染予防が期待されている。銀コーティングは細菌の付着・増殖を抑制し,感染率を低下させる効果が示唆されている。特に腫瘍用巨大補綴材では局所銀アレルギーのリスクがあるものの,適切な条件下では安全性が確保されており,臨床での感染率低下が確認されている。一方で,抗菌性・安全性・骨固着能を兼ね備えた臨床使用可能な銀コーティングインプラントは限られており,今後はコーティング技術の確立,適用範囲の拡大,感染症例への治療効果の検証が求められる。大規模な臨床研究を通じた長期的な有効性・安全性の評価が必要である。

記述言語：日本語   出版者・発行元：金原出版(株)  

＜文献概要＞股関節形成不全(HD)は,寛骨臼による骨頭被覆不足を特徴とし,関節接触圧の異常分布や股関節不安定性を引き起こし,変形性股関節症の主要な原因となる疾患である。近年,有限要素モデル(FEM)を用いた研究により,患者ごとの荷重肢位における機能的骨盤傾斜が股関節形態および力学的環境に与える影響が明らかになった。この知見は,HDに対する骨盤矯正骨切り術において,特に立位での骨盤傾斜や患者特異的形態因子を考慮した矯正計画が必要であることを示唆している。さらに,冠状面および矢状面での寛骨臼矯正が重要であり,lateral center-edge angleを30°～35°に矯正し,15°の前方回転を加える位置が股関節力学を最適化するターゲットゾーンであることが報告されている。これらの力学的基礎研究の成果は,HDに対する骨盤矯正骨切り術の治療戦略を改善し,術後成績のさらなる向上に寄与する可能性がある。

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Orthopaedic Science  

Background: STRATAFIX, a recently introduced barbed suture device, incorporates self-anchoring, knotless sutures with higher tensile strength and enhanced tissue-holding capacity compared to traditional braided absorbable sutures. This study aimed to compare the efficacy of barbed sutures and interrupted sutures in capsular and fascial closure during total hip arthroplasty. Methods: We retrospectively reviewed the records of patients who underwent total hip arthroplasty between April 2017 and March 2021. Overall, 547 patients were evaluated, comprising 77 men and 470 women (mean age: 64.5 years). Among them, 330 patients were in the interrupted suture (control) group, while 217 were in the barbed suture (BS) group. Data on surgical time, perioperative hemoglobin, length of hospital stay, complications such as transfusions and delayed wound healing, and dislocation rates were collected during the latest outpatient follow-up and compared between the two groups. Results: No differences were observed in intraoperative blood loss between the groups. However, the BS group exhibited significantly longer operative time, as well as significantly lower postoperative blood loss, total blood loss, and postoperative hemoglobin drop compared to the control group. Dislocation was reported in two cases within the control group, whereas no instances were recorded in the BS group. Conclusion: The use of barbed sutures demonstrated effectiveness in reducing perioperative blood loss for capsular and fascial closure during total hip arthroplasty.

DOI： 10.1016/J.JOS.2024.07.007

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.7759/CUREUS.70390

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1002/ccr3.9049

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記述言語：日本語   出版者・発行元：一般社団法人 日本アレルギー学会  

<p>【背景・目的】アトピー性皮膚炎患者が最も困っている症状である痒みに着目した治療には適切な痒み評価が必要である．痒み治療や研究に精通した医師および研究者で構成されるアトピー性皮膚炎痒みコンセンサス会議において，痒み評価の課題および最適な痒み評価法を協議した．</p><p>【方法】2歳未満，2～6歳，7～14歳，15歳以上の年齢区分について，最適な痒み評価法のコンセンサス案を作成した．会議参加者の80%以上の同意をもってコンセンサスが得られたと定義した．</p><p>【結果】参加者20名（皮膚科医8名，小児科医7名，研究者5名）の投票の結果，同意率95％で現状の最適な痒み評価法のコンセンサスが得られた．また，乳幼児は主観評価が困難であるため，養育者が代わりに行う痒み評価のチェックリストを作成した．</p><p>【結語】患者本人による評価尺度を用いた痒みの主観評価あるいは乳幼児では養育者によるチェックリストを用いた評価と，医師による皮膚病変などの客観評価を組み合わせた評価が推奨される．今後，より客観的な痒み評価指標の確立が期待される．</p>

DOI： 10.15036/arerugi.73.171

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記述言語：日本語   出版者・発行元：日本股関節学会  

当院で変形性股関節症に対し人工股関節全置換術(THA)を行った女性156例を対象に、術後早期における2ステップテストの有用性について検討した。その結果、THA後早期患者の2ステップ値は、全年代で健常者の平均値まで到達できておらず、継続した移動機能改善運動の実施が必要であることが示唆された。また、歩行速度改善のためには2ステップ値のカットオフ値0.855が目標の一つになることが明らかになった。今回の結果から、THA後早期患者における2ステップテストは有用で、THA後リハビリテーションにおける理学療法プログラム作成の一助になると考えられた。

出版者・発行元：Bone and Joint Journal  

Aims To clarify the mid-term results of transposition osteotomy of the acetabulum (TOA), a type of spherical periacetabular osteotomy, combined with structural allograft bone grafting for severe hip dysplasia. Methods We reviewed patients with severe hip dysplasia, defined as Severin IVb or V (lateral centre-edge angle (LCEA) < 0°), who underwent TOA with a structural bone allograft between 1998 and 2019. A medical chart review was conducted to extract demographic data, complications related to the osteotomy, and modified Harris Hip Score (mHHS). Radiological parameters of hip dysplasia were measured on pre- and postoperative radiographs. The cumulative probability of TOA failure (progression to Tönnis grade 3 or conversion to total hip arthroplasty) was estimated using the Kaplan–Meier product-limited method, and a multivariate Cox proportional hazard model was used to identify predictors for failure. Results A total of 64 patients (76 hips) were included in this study. The median follow-up period was ten years (interquartile range (IQR) five to 14). The median mHHS improved from 67 (IQR 56 to 80) preoperatively to 96 (IQR 85 to 97) at the latest follow-up (p < 0.001). The radiological parameters improved postoperatively (p < 0.001), with the resulting parameters falling within the normal range in 42% to 95% of hips. The survival rate was 95% at ten years and 80% at 15 years. Preoperative Tönnis grade 2 was an independent risk factor for TOA failure. Conclusion Our findings suggest that TOA with structural bone allografting is a viable surgical option for correcting severely dysplastic acetabulum in adolescents and young adults without advanced osteoarthritis, with favourable mid-term outcomes.

DOI： 10.1302/0301-620X.105B7.BJJ-2023-0056

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出版者・発行元：Bone and Joint Journal  

Aims The aims of this study were to validate the Forgotten Joint Score-12 (FJS-12) in the postoperative evaluation of periacetabular osteotomy (PAO), identify factors associated with joint awareness after PAO, and determine the FJS-12 threshold for patient-acceptable symptom state (PASS). Methods Data from 686 patients (882 hips) with hip dysplasia who underwent transposition osteotomy of the acetabulum, a type of PAO, between 1998 and 2019 were reviewed. After screening the study included 442 patients (582 hips; response rate, 78%). Patients who completed a study questionnaire consisting of the visual analogue scale (VAS) for pain and satisfaction, FJS-12, and Hip disability and Osteoarthritis Outcome Score (HOOS) were included. The ceiling effects, internal consistency, convergent validity, and PASS thresholds of FJS-12 were investigated. Results The median follow-up was 12 years (interquartile range 7 to 16). The ceiling effect of FJS-12 was 7.2%, the lowest of all the measures examined. FJS-12 correlated with all HOOS subscales (ρ = 0.72 to 0.77, p < 0.001) and pain and satisfaction-VAS (ρ = -0.63 and 0.56, p < 0.001), suggesting good convergent validity. Cronbach’s α was 0.95 for the FJS-12, which indicated excellent internal consistency. The median FJS-12 score for preoperative Tönnis grade 0 hips (60 points) was higher than that for grade 1 (51 points) or 2 (46 points). When PASS was defined as pain-VAS < 21 and satisfaction-VAS ≥ 77, the FJS-12 threshold that maximized the sensitivity and specificity for detecting PASS was 50 points (area under the curve (AUC) = 0.85). Conclusion Our results suggest that FJS-12 is a valid and reliable assessment tool for patients undergoing PAO, and the threshold of 50 points may be useful to determine patient satisfaction following PAO in clinical settings. Further investigation of the factors influencing postoperative joint awareness may enable improved prediction of treatment efficacy and informed decision-making regarding the indication of PAO.

DOI： 10.1302/0301-620X.105B7.BJJ-2022

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：American Journal of Case Reports  

Patient: Female, 60-year-old Final Diagnosis: Septic arthritis of the ankle Symptoms: Erythematous • swollen • tender Clinical Procedure: — Specialty: Infectious Diseases Objective: Background: Case Report: Conclusions: Rare disease The incidence of septic arthritis of a native joint caused by group B streptococcus (GBS, Streptococcus agalacti-ae) has been on the rise in non-pregnant women. GBS commonly colonizes the female genital tract. However, only a few reports have discussed serious cases of GBS infection, endocarditis, and joint infection associated with the Papanicolaou (Pap) smear test, which is routinely conducted to detect cervical cancer. Specifically, to the best of our knowledge, there have been few reports about arthroscopic treatment for septic arthritis of the ankle caused by GBS. A 60-year-old woman, who had previously completed the treatment of total laparoscopic hysterectomy with bilateral adnexectomy and postoperative chemotherapy for ovarian cancer, underwent a routine Pap smear test. Four weeks later, she suddenly presented with high fever and abdominal pain. The pain and swelling in her left ankle gradually worsened. Finally, septic arthritis of the ankle was diagnosed, and thus the patient underwent emergent arthroscopic irrigation and debridement. GBS was isolated from both the ankle fluid and blood culture. After surgical intervention and intravenous antibiotic administration, the patient’s symptoms gradually improved. Four months later, the patient had no ankle pain or restriction of ankle motion. Although cervical cytology tests are essential in screening for cervical cancer, transient bacteremia can be in-duced by the tests. Thus, physicians must watch out for the development of septic arthritis caused by GBS when patients present with fever or swollen joints after a recent Pap smear test. Emergent diagnosis and ap-propriate surgical intervention is also important.

DOI： 10.12659/AJCR.939719

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Scientific Reports  

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

DOI： 10.1038/s41598-023-35484-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Scientific Reports  

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

DOI： 10.1038/s41598-023-35514-9

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Orthopaedic Science  

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

DOI： 10.1016/j.jos.2022.01.011

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記述言語：日本語   出版者・発行元：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

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記述言語：日本語   出版者・発行元：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

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記述言語：日本語   出版者・発行元：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)

掲載種別：研究論文（学術雑誌）   出版者・発行元：Arthroplasty Today  

Background: Prosthetic joint infection, which is caused by implant treatment, is a severe complication. Consequently, silver-containing hydroxyapatite (Ag-HA)-coated implants have been developed to prevent prosthetic joint infection by combining Ag with HA. The Ag-HA-coated total hip prosthesis, which combines the antibacterial activity of Ag and the osteoconductivity of HA, is the first antibacterial cementless total hip prosthesis worldwide. This study aimed to evaluate the short-term outcomes of total hip arthroplasty (THA) with Ag-HA-coated implants. Methods: Overall, 50 hips with various disabling hip diseases and postoperative infection risks that underwent a primary THA using an Ag-HA total hip prosthesis were enrolled. The patients included 37 women (41 hips) and 8 men (9 hips), and the mean age at the time of surgery was 77 years. The clinical outcomes and hip function before and at 5 years postoperatively were measured using the Japanese Orthopaedic Association hip score. Implant stability was assessed, and postoperative complications were also examined. Results: The Japanese Orthopaedic Association score increased in all cases and improved from 41 to 86 points after the THA (P < .001). Radiography revealed no implant failure. Dislocation and deep vein thrombosis also occurred in 1 case each. However, there were no adverse reactions associated with Ag, and argyria was not observed in any case. Additionally, none of the patients experienced infection following the surgery. Conclusions: Silver-containing hydroxyapatite–coated implants significantly enhanced patients’ daily activities without any adverse effects on the human body attributed to Ag, and they are expected to reduce postoperative infections.

DOI： 10.1016/J.ARTD.2022.10.017

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記述言語：日本語   出版者・発行元：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

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Bone and Joint Surgery  

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

DOI： 10.2106/JBJS.21.01547

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Scientific Reports  

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

DOI： 10.1038/s41598-022-23427-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Scientific Reports  

For accurate cup alignment without navigation in total hip arthroplasty (THA), we developed a “laser guide technique.” The major purposes of this paper are to introduce the technique and compare its accuracy with a conventional manual technique. As a clinical outcome, the dislocation rate was reviewed. Our laser guide technique, which includes preoperative postural adjustment and intraoperative angular reference, has been detailed in the manuscript. 599 hips in 523 patients who underwent primary THA with piriformis-sparing posterolateral approach in April 2010–March 2016 were reviewed. Patients were divided into three groups: conventional group (135 hips), laser guide group (80 hips), and laser + radiographic alignment guide group (384 hips). Radiographic inclination (RI) and radiographic anteversion (RA) errors were evaluated. The dislocation rate was reviewed in 540 hips in 476 patients who were followed up > 2 years postoperatively. Absolute values of the RI/RA error in the three groups were 5.3° ± 4.0°/6.5° ± 4.5°, 4.0° ± 2.8°/4.9° ± 4.4°, and 3.3° ± 2.6°/3.6° ± 2.8°, respectively, indicating substantially enhanced accuracy with laser and radiographic alignment guide. The dislocation rates were 2.5% (3/119) and 0.2% (1/421) in the conventional and laser groups, respectively. Our novel laser guide technique considerably enhanced cup alignment accuracy, suggesting its potential applicability for THA in the lateral decubitus position.

DOI： 10.1038/s41598-022-21975-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Gait and Posture  

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

DOI： 10.1016/j.gaitpost.2022.10.003

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Orthopedics  

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

DOI： 10.3928/01477447-20220425-02

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記述言語：日本語   出版者・発行元：日本股関節学会  

当科でセメントレス人工股関節全置換術を行った96例112関節(男性17例20関節、女性79例92関節、手術時平均年齢54.8歳)を対象に、手術後20年の成績を検討した。その結果、aseptic looseningによる再置換術をend pointとした20年生存率は100%、全ての再置換術とした20年生存率は97.1%であった。X線学的評価ではインプラントの固定性は良好であったが、Grade 3以上のstress shieldingの出現は42.3%に認められた。

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Bone and Joint Journal  

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

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

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：International Journal of Computer Assisted Radiology and Surgery  

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

DOI： 10.1007/s11548-022-02592-5

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記述言語：英語   出版者・発行元：Journal of Artificial Organs  

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

DOI： 10.1007/s10047-021-01297-x

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記述言語：英語   出版者・発行元：シュプリンガー・ジャパン(株)  

高架橋ポリエチレン(XLPE)寛骨臼ライナーを組込んだ人工股関節全置換術(THA)を受け、10年間の追跡検査後にスポーツ活動に関する質問票に回答した215名(236肢)を対象として、第一世代XLPEの摩耗性能とスポーツ活動がXLPE摩耗率に及ぼす影響を調査した。THAカップへの大腿骨頭のpenetrationはXLPEによるTHAを受けた腰のX線写真でデジタル測定した。年齢、性別、BMI、経過観察期間、術前診断、XLPEの種類、ボール直径、ヘッド材質、カップ傾き、身体機能スコア、スポーツ参加などのデータを後ろ向きに検討した。その結果、クリープと定常摩耗率(SWR)はそれぞれ0.18mm/年と0.00mm/年で、スポーツ参加はSWRに有意な影響を及ぼさなかった。重回帰分析では、スポーツ参加はSWRを増加させなかった。以上より、スポーツ参加はTHAライナーの摩耗に大きな影響を与えず、第1世代XLPEはTHA後に最低10年間の優れた摩耗性能を持つと考えられた。

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Orthopaedic Surgery and Research  

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

DOI： 10.1186/s13018-022-03111-7

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その他リンク： https://link.springer.com/article/10.1186/s13018-022-03111-7/fulltext.html

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Bone and Joint Surgery  

Background: Little is known concerning differences in assessment of anteroposterior osteonecrotic lesion of the femoral head (ONFH) between the axial plane parallel to the body axis (axial) and the axial plane parallel to the femoral neck axis (oblique axial) using magnetic resonance imaging (MRI). This study aimed to compare the posterior boundary of necrotic lesions between the axial and oblique axial planes on MRI. Methods: This study retrospectively reviewed 120 consecutive hips in 71 patients (47 males and 24 females; mean age, 42 years) with ONFH, for which both axial and oblique axial MRI slices were available. The posterior boundaries of the necrotic lesions were calculated as the ratio of posterior intact circumference to anteroposterior circumference of the femoral head using mid-axial and mid-oblique axial MRI slices. The necrotic angles, calculated using the modified Kerboul method, were compared between cases with progression and nonprogression of collapse. Results: The mean posterior intact ratio in the axial slice was 49.2% (range, 8.6 to 85.1%), while that in the oblique axial slice was 33.5% (7.5 to 79.2%). The posterior intact ratio in the oblique axial slice significantly decreased compared to that in the axial slice (p < 0.0001). In cases with progression of collapse, the mean necrotic angle was significantly larger in the oblique axial slice than in the axial slice (p < 0.0001). The sensitivity and specificity of the necrotic angle with regard to the prognosis of the femoral head were both higher when using the oblique axial slice (sensitivity: 88.4%, specificity: 82.3%) than when using the axial slice (sensitivity: 85.1%, specificity: 62.0%). The posterior intact ratio at a mean of 6.8 mm superior to the mid-axial slice corresponded to that of the mid-oblique axial slice. Conclusion: Our findings suggest that the posterior boundaries of necrotic lesions differ between axial and oblique axial slices, and examination of the oblique axial MRI slice might be more suitable for predicting the prognosis of the femoral head.

DOI： 10.2106/JBJS.20.00493

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記述言語：日本語   出版者・発行元：(株)南江堂  

＜文献概要＞はじめに　整形外科分野において,人工関節や内固定材料などのインプラントを用いた治療は日常的に行われる標準的な手法であり,今後さらに高齢化が進行していくわが国においてはインプラントを用いた手術件数がより増加していくと予測される.インプラントを使用するにあたり合併症の発生は深刻な問題であり,特に人工股関節全置換術(THA)の主な合併症として脱臼,弛み,破損および術後感染があげられる.近年では人工関節の材質やデザインおよび手術手技の改良による脱臼や弛み・破損の抑制,手術環境整備など合併症への対策がすすんでいる.しかし完全に克服したとはいえず,特に感染は一度発生すると,その治療には多大な困難が伴う.加えて昨今,糖尿病や肝疾患,透析患者などの感染リスクの高い症例に対する人工関節置換術や人工関節再置換も増加しており,感染症対策の必要性が増している.日本整形外科学会の学術プロジェクト研究である「人工関節置換術および脊椎instrumentation術後感染症例の実態調査」によると,術後感染発生率は人工関節置換術で134/9,882例(1.36%)と報告されている.また,初回THAよりも再置換術のほうが有意に感染率は高かったという報告もある.近年では人工関節周囲感染(periprosthetic joint infection:PJI)の予防対策の一つとして,人工関節表面の細菌付着やバイオフィルム形成を阻害することを目的に抗菌性素材を表面に付与してインプラント自体に抗菌性をもたせる抗菌人工関節研究・開発が盛んに行われている.銀は太古よりその抗菌性能が知られており,ヒポクラテスも創傷の治療として用いていたともいわれている.銀は無機系抗菌薬のなかでも広い抗菌スペクトルと優れた抗菌性能を有しながらも比較的安全性が高く,なおかつ耐性菌を生じにくいとされる.また,ハイドロキシアパタイト(HA)は脊椎動物の骨の主成分であり,良好な生体親和性と優れた骨伝導性を有する.佐賀大学では2005年より,京セラ社(京都)と抗菌性インプラント開発の共同研究を行い,銀とHAを複合化して金属表面にコーティングする技術を開発した.そして銀HAコーティングを行った人工股関節インプラントを,当大学で行った臨床治験の後に,2015年9月にAG-PROTEX HIPシステムとして製造販売承認を取得した.

掲載種別：研究論文（学術雑誌）   出版者・発行元：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

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Clinical Biomechanics  

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

DOI： 10.1016/j.clinbiomech.2021.105555

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記述言語：英語   出版者・発行元：International Orthopaedics  

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

DOI： 10.1007/s00264-021-05196-x

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記述言語：英語   出版者・発行元：Clinical Orthopaedics and Related Research  

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

DOI： 10.1097/CORR.0000000000001893

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Ovid Technologies (Wolters Kluwer Health)  

DOI： 10.2106/JBJS.ST.21.00048

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：理学療法科学学会  

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

DOI： 10.1589/jpts.34.76

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： Risk factors for radiological changes after bipolar hemiarthroplasty for osteonecrosis of the femoral head

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jos.2019.07.006

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Little information has been available regarding the usefulness of Ranawat triangle method in estimating anatomical hip joint center in the Japanese population. In this study, we aimed to determine the accuracy of the method in estimating hip joint center. Methods: Using digitally reconstructed radiographs of 123 normal hips (123 patients), we measured the hip joint center coordinates (Cx, Cy) with reference to the ipsilateral lowest point of the teardrop, the pelvic width, and the pelvic height. Using these measurement values, we performed the following analyses: (1) the relationship of hip joint center location with pelvic dimensions; (2) accuracy of Ranawat method in estimating hip joint center; (3) alternative methods to estimate hip joint center using pelvic height. Results: The mean Cx and Cy were 32 ± 3.0 mm and 13 ± 2.1 mm, respectively. Pelvic height was positively correlated with Cx (r = 0.51, p < 0.001) and Cy (r = 0.69, p < 0.001), but the correlations of pelvic width with Cx and Cy were negligible. The mean estimation error of the Ranawat method was −6.7 ± 2.6 mm in x-axis and 6.6 ± 1.9 mm in y-axis, respectively. The hip joint center was estimated within a 5 mm error in both axes in only 8 hips (6.5%). Thus, we developed two estimating methods using pelvic height, modified Ranawat method and pelvic height ratio method, and the estimation errors of these methods were within 5 mm in both axes in 118 hips (96%) and 116 hips (94%), respectively. Conclusions: Ranawat method showed poor accuracy in estimating anatomical hip joint center and is not recommended for clinical use. Our alternative methods may be useful for surgeons planning the position of the acetabular component in total hip arthroplasty.

DOI： 10.1016/j.jos.2020.03.007

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Perceiving replaced joints as natural is one of the best scenario after total hip arthroplasty (THA). We investigated the distribution of and influencing factors for patient's joint perception after THA in Asian cohort, which is not well known. Methods: We mailed a questionnaire to Asian patients who had undergone THA in our institution between 2012 and 2016, and this study included 318 Asian patients. The questionnaire assessed patient's joint perception, Oxford Hip Score (OHS), Short Form-12 Health Survey (SF-12) physical, mental, and role component summaries, and satisfaction score. Leg length discrepancy and global femoral offset before and after THA were measured using radiographs. The patients were divided into 2 groups with patient's joint perception: natural and artificial perception groups. OHS, SF-12, satisfaction, leg length discrepancy, and global femoral offset were compared between natural and artificial perception groups, and which factors significantly influenced joint perception were determined. Results: Of the 318 patients, 165 patients (51.8%) perceived their replaced joint as a natural joint. OHS, SF-12 physical and role component summaries, and satisfaction score in natural perception group were significantly higher than those in artificial perception group, without significant difference in SF-12 mental component summary. Multivariate analysis showed that less of usual pain, easier to get in or out of a car, and osteoarthritis in the contralateral hip were positively associated with natural joint perception after THA. Conclusion: This study indicated to surgeons that pain relief and improvement in getting in or out of a car after THA could lead to even better patient's joint perception.

DOI： 10.1016/j.arth.2019.12.039

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objectives: This retrospective study aimed to assess long-term hip survival after transtrochanteric anterior rotational osteotomy (ARO) for osteonecrosis of the femoral head (ONFH) and identify factors influencing patient-reported outcome measures (PROMs) in patients with preserved joints. Methods: Altogether, 95 consecutive hips in 85 ONFH patients who underwent ARO during 2000–2007 (86.7% follow-up) were studied. Controls were 35 patients with 41 hips with ONFH managed conservatively for >1 year after collapse. We analyzed hip survival using the Kaplan–Meier method, with the endpoint defined as any therapeutic surgery related to ONFH. We also evaluated PROMs for both groups in patients with surviving hips and available radiographs at the final follow-up. Results: The 10-year hip survival rate after ARO was 85.4%, which was significantly higher than the 5-year rate in the control group (50.4%). Multiple regression analyses showed that the presence of osteoarthritic change after ARO was significantly associated with poor scores for both the Oxford Hip Score and the Short Form-12 Health Survey Physical Component Summary. Conclusions: ARO could effectively preserve hip joints with post-collapse ONFH, although the presence of osteoarthritic change could lead to lower satisfaction even among patients with long-term hip survival after ARO.

DOI： 10.1080/14397595.2018.1558917

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Anterior localization of the necrotic lesion was recently proposed as an important factor for the occurrence of collapse even in medially located osteonecrosis of the femoral head (ONFH). We examined the effects of the anterior boundary of the necrotic lesion on progressive collapse after varus osteotomy for ONFH. Methods: We reviewed the outcomes of 31 hips in 27 patients with ONFH treated by transtrochanteric curved varus osteotomy (CVO) from 2000 to 2012 with a mean follow-up of 10.5 years. The occurrence of progressive collapse of the anterior necrotic lesion was defined as the presence of ≥2 mm collapse using follow-up lateral radiographs. Postoperative osteoarthritic change was defined as ≥1 mm progression of joint space narrowing on follow-up radiographs. The location of the anterior boundary of the necrotic lesion was assessed using the anterior necrotic angle (the angle between the midline of the femoral neck shaft and the line passing from the femoral head center to the anterior boundary of the necrotic lesion on a mid-slice oblique magnetic resonance image). Results: All hips had a postoperative intact ratio of ≥34% (percentage of the transposed intact articular surface of the femoral head to the weight-bearing area of the acetabulum after femoral osteotomy). Progressive collapse of the anterior necrotic lesion was seen in five hips (16%) during a mean of 2.2 years after CVO. Of these, four hips (80%) proceeded to develop osteoarthritic change at an average of 4.3 years after the collapse. Multivariate analysis revealed that the anterior necrotic angle was independently associated with progressive collapse of the anterior necrotic lesion as well as the postoperative intact ratio. Conclusions: This study suggests that hips with anterior localization of the necrotic lesion have a possible risk of progressive collapse of the anterior necrotic lesion after CVO, which can frequently lead to subsequent osteoarthritic change.

DOI： 10.1016/j.jos.2019.02.014

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: To achieve sufficient socket coverage by the native bone, high placement of cementless acetabular cup is often required. We previously reported, using computer simulation, that higher hip centre improved the bone coverage but decreased the range of motion in total hip arthroplasty (THA) for patients with hip dysplasia. However, in a clinical setting, the correlation between the hip centre height and dislocation after primary THA is still unclear. We examined whether a high hip centre affects dislocation after THA. Methods: A total of 910 patients, with 1079 dysplastic hips, who underwent primary THA were retrospectively reviewed. The age at THA averaged 63.0 years and mean follow-up was 74.3 months. Vertical centre of rotation (V-COR) was defined as the distance from the head centre to the interteardrop line. Uni- and multivariate logistic regression models were applied to identify significant factors affecting dislocation. Results: Ten hips in nine patients (0.9%) had dislocation after THA. In univariate analysis, age at surgery and V-COR were significant risk factors for dislocation. Multivariate analysis identified advanced age at operation (odds ratio [OR] 1.8/5 years), Crowe classification (OR 15.6), V-COR (OR 3.1/5 mm), and femoral head size (OR 11.6) as independent risk factors for dislocation. Receiver operating characteristic curve analysis revealed the cutoff value of the V-COR for dislocation as 23.9 mm. Conclusions: A higher hip centre with the V-COR > 23.9 mm affected dislocation after THA for DDH. Our results would be useful for reconstruction of the hip centre, particularly with cementless acetabular cups.

DOI： 10.1007/s00264-018-4154-x

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Introduction: The clinical significance of acetabular retroversion in non-dysplastic hips can be explained as pincer-type femoroacetabular impingement (FAI), whereas that in dysplastic hips is not clarified because FAI normally poses little problems for dysplastic hips. We aimed to evaluate three-dimensional (3D) femoral head coverage in dysplastic hips with and without acetabular retroversion and to elucidate the role of acetabular retroversion on the 3D femoral head coverage. Materials and methods: We retrospectively investigated 93 hips in 93 patients (9 males and 84 females) that underwent periacetabular osteotomy for hip dysplasia. Dysplastic hips were divided into anteversion and retroversion groups according to their cranial anteversion, which was measured on the axial section 5 mm caudal to the acetabular roof. The 3D femoral head coverage was provided as a percentage of the acetabulum-covered surface area of the upper femoral hemisphere using a 3D preoperative planning software for total hip arthroplasty. Results: Of the 93 dysplastic hips, 15 hips (16%) were assigned to the retroversion group, which had significantly younger age at surgery (31.9 years versus 39.2 years; p = 0.033). The lateral center-edge angles were comparable between the groups (13.8° versus 12.9°; p = 0.68); however, the hips in the retroversion group had a trend of smaller 3D femoral head coverage than those in the anteversion group (59% versus 63%; p = 0.058). Multivariate analysis using two-way analysis of covariance showed that lateral center-edge angle (partial regression coefficient = 0.83; t value = 17.3; p < 0.001) and acetabular retroversion (partial regression coefficient = − 2.3; t value = − 4.9; p < 0.001) were independent factors that contributed to the 3D femoral head coverage. Conclusions: Acetabular retroversion in dysplastic hips was associated with decreased 3D femoral head coverage independently from lateral center-edge angle. The age at surgery in the retroversion group was significantly younger, suggesting a relationship between decreased 3D coverage and potentially earlier symptom onset.

DOI： 10.1007/s00402-019-03277-6

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

The purpose of this study was to examine the minimum 10-year clinical outcomes, including patient-reported and functional outcomes, of periacetabular osteotomy in patients with advanced osteoarthritis. A total of 46 hips in 44 patients with advanced osteoarthritis who underwent periacetabular osteotomy between 1992 and 2006 were retrospectively reviewed. Mean age at surgery was 47.5 years, and mean follow-up was 16.9±4.7 years. Survivorship was determined using the Kaplan-Meier method, and the associated risk factors for the endpoint-conversion to total hip arthroplasty less than 15 years after surgery-were evaluated. The Oxford Hip Score and the University of California, Los Angeles activity score were evaluated at final follow-up. The survival rates at 15 and 20 years after surgery were 80% and 59%, respectively. Multivariate analysis indicated that body mass index greater than 24 kg/m² (P=.034; odds ratio, 1.72) was significantly associated with the endpoint as an independent risk factor. For 32 hips of 31 patients with preserved native joints at final follow-up, the Oxford Hip Score and the University of California, Los Angeles score averaged 41±5 and 5.2±1.8, respectively, equivalent (P=.28 and P=.215, respectively) to the scores of 14 hips of 13 patients with conversion to total hip arthroplasty (38±8.7 and 5.8±1.4, respectively). The results of this mid-term study may be useful for surgical decision-making among patients with advanced osteoarthritis who want to preserve native hip joints.

DOI： 10.3928/01477447-20180806-04

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective: The purpose of this study was to clarify the minimum joint space width (MJSW) that leads to subchondral bone exposure (SBE) in patients with hip dysplasia. Methods: We included 82 subjects (86 hips) who had hip dysplasia with center-edge angle less than 20° and who underwent periacetabular osteotomy combined with hip arthroscopy. The acetabular and femoral cartilages were divided into three regions: anterosuperior, superior, and posterosuperior; for each region, we analyzed the correlation between the incidence of SBE and the MJSW measured on plain radiographs. The disease stage was defined according to the Kellgren and Lawrence grades (KL grade). Results: SBE was found in 51 hips (59.3%) in total, involved the acetabulum in 49 hips (57.0%), and involved the femoral head in 26 hips (30.2%). SBE was more frequent in the acetabulum, with the highest incidence in the anterosuperior region, followed by the superior region. SBE was present in six hips (22.2%), 17 hips (56.7%), and 28 hips (96.5%), at KL-1, KL-2, and KL-3, respectively. MJSW of hips with SBE was significantly smaller than those without SBE (2.3 vs 4.0 mm, p < 0.001), and the cut-off value for MJSW that led to SBE was 3.7 mm (sensitivity: 0.902, 1–specificity: 0.343). SBE was present in 23.3% in patients with MJSW ≥3.7 mm, whereas 76.7% in those <3.7 mm. Conclusions: Cartilage degeneration is more advanced than would be predicted on plain radiographs. The cut-off value of MJSW for SBE was 3.7 mm in patients with symptomatic hip dysplasia.

DOI： 10.1080/14397595.2016.1222663

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1002/jor.23147

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s11999-015-4373-z

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.clinbiomech.2012.12.011

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00256-012-1368-7

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00776-012-0213-0

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s11999-010-1385-6

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語   出版者・発行元：(株)南江堂  

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2022&ichushi_jid=J00764&link_issn=&doc_id=20220527300009&doc_link_id=10.15106%2Fj_seikei73_547&url=https%3A%2F%2Fdoi.org%2F10.15106%2Fj_seikei73_547&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：(株)南江堂  

researchmap

その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2022&ichushi_jid=J04037&link_issn=&doc_id=20220509600009&doc_link_id=10.15106%2Fj_besei81_42&url=https%3A%2F%2Fdoi.org%2F10.15106%2Fj_besei81_42&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif