| 1. |
Satoru Harada, Satoshi Hamai, Kyohei Shiomoto, Shinya Kawahara, Daisuke Hara, Tetsunari Harada, Yasuharu Nakashima, Predictors of physical activity recovery after total hip arthroplasty: a prospective observational study., International orthopaedics, 10.1007/s00264-023-06022-2, 48, 3, 753-760, 2023.11, PURPOSE: Little is known about the changes and the factors in physical activity as following total hip arthroplasty (THA). There are potential discrepancies between subjective and objective measurements of physical activity. Thus, our porpose is to compare objective and subjective measurements of activity levels in patients undergoing THA preoperatively, three months and one year following surgery, and investigated the factors that predicts the objective activity level after THA. METHODS: This prospective observational study included 42 patients with unilateral symptomatic hip osteoarthritis who underwent THA. The objective activity level (step counts, sit-to-stands, and upright time) by using a tri-axial accelerometer, PRO (Oxford hip score; OHS and University of California, Los Angeles activity score; UCLA score), and muscle volume around the hip joint by using preoperative computed tomography were measured. RESULTS: The number of steps, OHS, and UCLA score before, at three months, and one year after THA averaged 5092, 6532, and 6545 steps, 30.3, 43.0, and 44.2 points, and 3.4, 4.8, and 4.6 points, respectively, with significant postoperative increases (P |
| 2. |
Kazuhiro Kai, Hisakata Yamada, Ryosuke Tsurui, Koji Sakuraba, Kenjiro Fujimura, Shinya Kawahara, Yukio Akasaki, Hidetoshi Tsushima, Toshifumi Fujiwara, Daisuke Hara, Jun-Ichi Fukushi, Shinichiro Sawa, Yasuharu Nakashima, Synovial-tissue resident macrophages play proinflammatory functions in the pathogenesis of RA while maintaining the phenotypes in the steady state., Immunological medicine, 10.1080/25785826.2023.2300853, 1-10, 2024.01, Synovial tissue-resident macrophages (STRMs) maintain normal joint homeostasis in a steady state. However, it is unclear whether STRMs still play homeostatic roles or change the functions in the joint of rheumatoid arthritis (RA), where infiltrating peripheral blood monocyte-derived macrophages (PBMoMs) play proinflammatory roles. In the present study, we examined changes in the phenotypes and functions of STRMs in response to RA-related stimuli in vitro. STRMs were prepared from non-inflammatory osteoarthritis (OA) joint synovium, which is histologically indistinguishable from normal joint synovium. PBMoMs were prepared and used for comparison. After stimulation with plate-bound IgG, which mimics anti-citrullinated protein antibody immunocomplex formed in RA joints, or with combinations of RA-related inflammatory mediators, namely tumor necrosis factor-α (TNF-α) and prostaglandin E2 or interferon-γ, PBMoMs downregulated surface markers and genes associated with anti-inflammatory macrophages, and upregulated cytokine and marker genes of proinflammatory macrophages in RA. On the other hand, STRMs hardly changed the expression of surface molecules and marker genes but altered the pattern of cytokine gene expression after stimulation like PBMoMs. Furthermore, in vitro stimulated STRMs promote proinflammatory functions of cocultured synovial fibroblasts. Thus, STRMs might play proinflammatory roles in RA joints, while maintaining their phenotypes in the steady state.. |
| 3. |
Kenji Kitamura, Masanori Fujii, Goro Motomura, Satoshi Hamai, Shinya Kawahara, Taishi Sato, Ryosuke Yamaguchi, Daisuke Hara, Takeshi Utsunomiya, Yasuhiko Kokubu, Yasuharu Nakashima, The sourcil roundness index is a useful measure for quantifying acetabular concavity asphericity., Scientific reports, 10.1038/s41598-023-42630-z, 13, 1, 15851-15851, 2023.09, 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 |
| 4. |
Tetsunari Harada, Satoshi Hamai, Daisuke Hara, Tsutomu Fujita, Daisuke Fujiyoshi, Shinya Kawahara, Ryosuke Yamaguchi, Kenichi Kawaguchi, Yasuharu Nakashima, Contralateral Hip Abductor Muscle Strength Associated with Comfort of Getting into and out of the Car after Total Hip Arthroplasty., Journal of clinical medicine, 10.3390/jcm12175515, 12, 17, 2023.08, There are no studies that have investigated the characteristics of car use across THA patients, including those who do not drive. This study aimed to evaluate, in THA patients, (1) postoperative car usage, (2) comfort while entering and exiting a car, and (3) whether lower limb muscle strength affects action comfort. One hundred seventy-two post-THA patients completed the questionnaire in 2020, along with assessments of hip abductor and knee extensor muscle strength before surgery and at discharge. Patients whose overall comfort level was judged as comfortable were defined as the comfort group; others were placed in the discomfort group. Of the 172 patients, 161 reported car usage at a mean of 5.6 years after THA. Of these, 114 and 47 patients were placed in the comfort and discomfort groups, respectively. Patients in the discomfort group were three times more likely to experience discomfort using the contralateral side door than the surgical side door, and about twice as many patients experienced discomfort when entering as when exiting. Lower preoperative contralateral hip abductor muscle strength was the only independent predictor for discomfort. The take-home messages were that prevention of contralateral-side weakness may improve comfort during the action after THA.. |
| 5. |
Tetsunari Harada, Satoshi Hamai, Daisuke Hara, Shinya Kawahara, Masanori Fujii, Satoshi Ikemura, Goro Motomura, Yasuharu Nakashima, Three-dimensional kinematics and kinetics of getting into and out of a car in patients after total hip arthroplasty., Gait & posture, 10.1016/j.gaitpost.2022.10.003, 98, 305-312, 2022.10, 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.. |
| 6. |
Satoshi Ikemura, Goro Motomura, Ryosuke Yamaguchi, Takeshi Utsunomiya, Satoshi Hamai, Masanori Fujii, Shinya Kawahara, Taishi Sato, Daisuke Hara, Kyohei Shiomoto, Takuaki Yamamoto, Yasuharu Nakashima, The influence of bone marrow edema for the assessment of the boundaries of necrotic lesions in patients with osteonecrosis of the femoral head., Scientific reports, 10.1038/s41598-022-23427-y, 12, 1, 18649-18649, 2022.11, 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.. |
| 7. |
Kyohei Shiomoto, Satoshi Hamai, Daisuke Hara, Satoru Harada, Goro Motomura, Yasuharu Nakashima, Objective activity levels and patient-reported outcomes after total hip arthroplasty and periacetabular osteotomy: Retrospective matched cohort study at mean 12-year follow-up., The Journal of arthroplasty, 10.1016/j.arth.2022.08.034, 38, 2, 323-328, 2022.08, BACKGROUND: There is increasing interest in improving activity after total hip arthroplasty (THA) and periacetabular osteotomy (PAO). The present study evaluated whether there were differences in the subjective and objective activity levels of THA and PAO patients at mean 12-year follow-up (range 4-20) and what factors influence the objective activity levels. METHODS: THA and PAO patients (30 patients each; mean age: 66 and 63 years, respectively), who had undergone surgery for osteoarthritis due to acetabular dysplasia were included. Patients were retrospectively matched based on age, sex, body mass index (BMI), follow-up duration, and preoperative University of California Los Angeles activity score (UCLA score). Patients were surveyed for the subjective activity levels using the Oxford Hip Score (OHS) and UCLA score. Objective activity levels (the number of steps, upright time, and the number of sit-to-stand transitions) was made using an accelerometer. RESULTS: There was no significant difference in subjective activity level between THA and PAO patients. The number of steps was significantly higher in PAO than in THA patients. Multivariable analyses revealed that THA and low OHS_ADL were negatively associated with the number of steps, that men and high UCLA score were negatively associated with upright time, and that high BMI was negatively associated with sit-to-stand transitions in THA and PAO patients. CONCLUSION: This study suggested that although there was no difference in postoperative subjective activity level between THA and PAO patients, there was a difference in objective activity level. Providing guidance to these patients based on objective activity may lead to higher activity levels.. |
| 8. |
Satoshi Yamate, Satoshi Hamai, Shinya Kawahara, Daisuke Hara, Goro Motomura, Satoshi Ikemura, Masanori Fujii, Taishi Sato, Satoru Harada, Tetsunari Harada, Yasuhiko Kokubu, Yasuharu Nakashima, Multiple Imputation to Salvage Partial Respondents: Analysis of the Forgotten Joint Score-12 After Total Hip Arthroplasty., The Journal of bone and joint surgery. American volume, 10.2106/JBJS.21.01547, 104, 24, 2195-2203, 2022.10, 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 |
| 9. |
Yasuharu Nakashima, Daisuke Hara, Masanobu Ohishi, Goro Motomura, Ichiro Kawano, Satoshi Hamai, Shinya Kawahara, Taishi Sato, Ryosuke Yamaguchi, Takeshi Utsunomiya, Kenji Kitamura, Abductor recovery after muscle-sparing periacetabular osteotomy using a lateral approach., Journal of hip preservation surgery, 10.1093/jhps/hnac047, 9, 4, 259-264, 2022.12, To decrease hip abductor dysfunction after periacetabular osteotomy using a lateral/trochanteric approach, we aimed to modify transposition osteotomy of the acetabulum (TOA) to not cut the greater trochanter and abductor-iliac crest detachment. We subsequently compared abductor muscle strength recovery between TOAs with [conventional TOA (C-TOA)] and without [modified TOA (M-TOA)] trochanteric osteotomy. C-TOA and M-TOA were performed in 27 and 34 hips, respectively. Hip abduction, flexion and knee extension muscle strength were measured preoperatively and at 3, 5, 10, 24 and 52 weeks postoperatively. The muscle strength ratio of the affected and contralateral lower limbs was compared between the C-TOA and M-TOA groups. Neither the mean Merle d'Aubigné-Postel score at the final follow-up nor the postoperative center-edge angle showed significant differences between the M-TOA and C-TOA groups (15.7 versus 16.4 points; P = 0.25 and 38.5° versus P = 0.62 and 39.8°, respectively). The mean muscle strength ratios of hip abduction at 5, 12 and 24 weeks postoperatively were significantly higher in the M-TOA group than in the C-TOA group (0.62 versus 0.39, 0.76 versus 0.59 and 0.94 versus 0.70; P = 0.03, 0.04 and 0.01, respectively). There were no significant differences between groups at Postoperative Week 52 (P = 0.36). Discomfort at the greater trochanter was observed in 18 hips (66.7%) in the C-TOA group but only in 4 hips (11.2%) in the M-TOA group. In conclusion, M-TOA is less invasive than C-TOA and allows an earlier recovery of abductor muscle strength without significant correction loss.. |
| 10. |
Tetsunari Harada, Satoshi Hamai, Kyohei Shiomoto, Daisuke Hara, Goro Motomura, Yasuharu Nakashima, A propensity score-matched comparison of patient satisfaction following periacetabular osteotomy or total hip arthroplasty for developmental dysplasia of the hip in an Asian cohort., Hip international : the journal of clinical and experimental research on hip pathology and therapy, 10.1177/11207000221114272, 33, 4, 11207000221114272-11207000221114272, 2022.07, BACKGROUND: No studies have compared patient satisfaction between periacetabular osteotomy (PAO) and total hip arthroplasty (THA) for osteoarthritis (OA) secondary to developmental dysplasia of the hip (DDH) in Asian cohorts. METHODS: Multivariate analyses were applied to determine whether patient demographics and postoperative patient-reported outcomes were correlated with postoperative patient satisfaction in 737 DDH patients (251 PAO and 486 THA patients). Additionally, postoperative patient satisfaction, Oxford Hip Score (OHS), University of California-Los Angeles (UCLA) activity score, and sports participation were compared between propensity-matched PAO and THA patients for OA secondary to DDH (Kellgren-Lawrence grade II: 32 PAO and 16 THA patients, grade III: 20 PAO and 40 THA patients). RESULTS: Of the 737 patients, 663 patients (90%) were postoperatively satisfied. Multivariate analysis demonstrated that THA was positively correlated with patient satisfaction. Furthermore, high postoperative OHS-pain, OHS-ADL, and UCLA scores were positively correlated with satisfaction. In propensity-matched PAO and THA patients, PAO elicited greater patient satisfaction than THA for KL grade II OA secondary to DDH, with comparable postoperative OHS (including the pain and ADL subscale), UCLA score, and sports participation rate. In contrast, THA resulted in better satisfaction and OHS-pain for KL grade III OA secondary to DDH, with comparable postoperative OHS-ADL, UCLA score, and sports participation rate in the 2 surgeries. CONCLUSIONS: Both PAO and THA procedures offer distinct patient satisfaction advantages based on preoperative OA severity. These findings can assist in the clinical decision-making process for the surgical treatment of middle-aged patients with symptomatic DDH.. |
| 11. |
Tetsunari Harada, Satoshi Hamai, Daisuke Hara, Tsutomu Fujita, Kazuya Okazawa, Naoya Kozono, Shinya Kawahara, Ryosuke Yamaguchi, Masanori Fujii, Satoshi Ikemura, Goro Motomura, Yasuharu Nakashima, Reverse dynamics analysis of contact force and muscle activities during the golf swing after total hip arthroplasty., Scientific reports, 10.1038/s41598-023-35484-y, 13, 1, 8688-8688, 2023.05, 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.. |
| 12. |
Hidetoshi Tsushima, Sakuragi Takahide, Yukio Akasaki, Toshifumi Fujiwara, Daisuke Hara, Satoshi Ikemura, Kouji Sakuraba, Satoshi Kamura, Hisaaki Miyahara, Hisakata Yamada, Jun-Ichi Fukushi, Yasuharu Nakashima, Is there a reduction in hip destruction under a treat-to-target strategy in patients with rheumatoid arthritis?, Modern rheumatology, 10.1093/mr/road021, 34, 2, 334-339, 2023.02, OBJECTIVES: The treatments for rheumatoid arthritis (RA) have been greatly improved, and the tight control of disease activity yields superior clinical outcomes. This study aimed to elucidate the accompanying changes in hip destruction following the implementation of a treat-to-target strategy for patients with RA. METHODS: We extracted 190 hips over two periods, i.e., the early period (1998-2003) and late period (2013-2019), with 103 and 87 hips, respectively. The observed rheumatic changes, such as inward migration, upward migration, and femoral head collapse, were quantitatively evaluated, while osteoarthritic changes, such as the formation of a capital drop, were investigated from radiographs before primary total hip arthroplasty. RESULTS: Comparison of the two periods' data showed that the degree of inward migration (-3.44 mm vs. -7.45 mm; P |
| 13. |
Yasuhiko Kokubu, Shinya Kawahara, Kenji Kitamura, Satoshi Hamai, Goro Motomura, Satoshi Ikemura, Taishi Sato, Ryosuke Yamaguchi, Daisuke Hara, Masanori Fujii, Yasuharu Nakashima, Evaluation of the anterior acetabular coverage with a false profile radiograph considering appropriate range of positioning., Scientific reports, 10.1038/s41598-023-35514-9, 13, 1, 8288-8288, 2023.05, 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 |
| 14. |
Takeshi Utsunomiya, Goro Motomura, Ryosuke Yamaguchi, Satoshi Hamai, Taishi Sato, Shinya Kawahara, Daisuke Hara, Kenji Kitamura, Yasuharu Nakashima, Effects of the location of both anterior and lateral boundaries of the necrotic lesion on collapse progression in osteonecrosis of the femoral head., Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 10.1016/j.jos.2023.01.011, 29, 2, 552-558, 2023.02, BACKGROUND: The location of the lateral boundary of the necrotic lesion to the weight-bearing portion of the acetabulum (Type classification) is an important factor for collapse in osteonecrosis of the femoral head (ONFH). Recent studies also reported the significance of the location of the anterior boundary of the necrotic lesion on the occurrence of collapse. We aimed to assess the effects of the location of both anterior and lateral boundaries of the necrotic lesion on collapse progression in ONFH. METHODS: We recruited 55 hips with post-collapse ONFH from 48 consecutive patients, who were conservatively followed for more than one year. Using a plain lateral radiograph (Sugioka's lateral view), the location of the anterior boundary of the necrotic lesion to the weight-bearing portion of the acetabulum was classified as follows: Anterior-area I (two hips) occupying the medial one-third or less; Anterior-area II (17 hips) occupying the medial two-thirds or less; and Anterior-area III (36 hips) occupying greater than the medial two-thirds. The amount of femoral head collapse was measured by biplane radiographs at the onset of hip pain and each follow-up period, and Kaplan-Meier survival curves with collapse progression (≥1 mm) as the endpoint were produced. The probability of collapse progression was also assessed by the combination of Anterior-area and Type classifications. RESULTS: Collapse progression was observed in 38 of the 55 hips (69.0%). The survival rate of hips with Anterior-area III/Type C2 was significantly lower. Among hips with Type B/C1, collapse progression occurred more frequently in hips with Anterior-area III (21 of 24 hips) than in hips with Anterior-area I/II (3 of 17 hips, P |
| 15. |
Satoshi Ikemura, Goro Motomura, Satoshi Hamai, Masanori Fujii, Shinya Kawahara, Taishi Sato, Daisuke Hara, Kyohei Shiomoto, Yasuharu Nakashima, Tapered wedge stems decrease early postoperative subsidence following cementless total hip arthroplasty in Dorr type C femurs compared to fit-and-fill stems., Journal of orthopaedic surgery and research, 10.1186/s13018-022-03111-7, 17, 1, 223-223, 2022.04, 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 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.. |
| 16. |
Shinya Kawahara, Daisuke Hara, Koji Murakami, Satoshi Hamai, Yukio Akasaki, Hidetoshi Tsushima, Scott A Banks, Yasuharu Nakashima, Smaller femoral neck anteversion in varus knees than in healthy and valgus knees., Clinical anatomy (New York, N.Y.), 10.1002/ca.23862, 35, 8, 1044-1050, 2022.03, It is important to investigate anatomical differences of the femur and tibia three-dimensionally between varus and valgus knees to enhance surgical approaches and better understand structural factors related to specific patterns of osteoarthritis progression. Three-dimensional femoral and tibial bone models were reconstructed from transverse computed-tomography scans in varus osteoarthritis (43 knees), valgus osteoarthritis (40 knees), and healthy (32 knees) groups. Different coordinate systems were defined in each femoral bone model ("Knee" and "Hip" Coordinate System). Femoral neck inclination, lateral bowing, anterior bowing, and neck anteversion were measured and compared between knee and hip coordinate systems. Those parameters were also compared between varus, valgus, and healthy groups. The tibial anterior and lateral bowing, external torsion and the fibular axis relative to the tibial mechanical axis were measured and compared between varus and valgus groups. Femoral neck anteversion was significantly 1-2° greater in the hip coordinate system compared to the knee coordinate system. Femoral neck anteversion was significantly smaller in varus knees than in healthy or valgus knees, with average difference of approximately 5°. The knee and hip joint are often rotated externally relative to the trunk axis in patients with varus osteoarthritis, perhaps maintaining the geometric relations between pelvis and proximal femur (including peripheral hip muscles) regardless of knee deformities. The fibular axis was inclined slightly valgus and posteriorly in two groups. The results may inform hypotheses on, and future studies of, skeletal morphologic development and factors contributing to the progression of knee osteoarthritis.. |
| 17. |
Toshifumi Fujiwara, Masakazu Kondo, Hisakata Yamada, Akihisa Haraguchi, Kenjiro Fujimura, Koji Sakuraba, Satoshi Kamura, Jun-Ichi Fukushi, Hisaaki Miyahara, Yasushi Inoue, Tomomi Tsuru, Toshihide Shuto, Seiji Yoshizawa, Eiichi Suematsu, Tomoya Miyamura, Masahiro Ayano, Hiroki Mitoma, Yojiro Arinobu, Hiroaki Niiro, Masanobu Ohishi, Akie Hirata, Shoji Tokunaga, Atsushi Takada, Daisuke Hara, Hidetoshi Tsushima, Yukio Akasaki, Satoshi Ikemura, Takuya Sueishi, Masakazu Toya, Takahide Sakuragi, Tomoko Tsutsui, Kazuhiro Kai, Shinkichi Arisumi, Yasuharu Nakashima, Factors affecting patient satisfaction related to cost and treatment effectiveness in rheumatoid arthritis: results from the multicenter observational cohort study, FRANK Registry., Arthritis research & therapy, 10.1186/s13075-022-02746-5, 24, 1, 53-53, 2022.02, BACKGROUND: To further improve rheumatoid arthritis (RA) treatment, it is necessary to understand each RA patient's satisfaction and to identify the factors affecting their satisfaction. Despite the rise in medical costs for RA, little is known about the factors that influence patient satisfaction with the cost of treatment in RA patients. METHODS: This is a multicenter observational study of Japanese RA patients from the FRANK Registry with data analyzed from March 2017 to August 2020. We collected data on demographic characteristics, clinical data, quality of life which was evaluated using the EuroQol 5-dimensional questionnaire (EQ5D), and patient satisfaction. The four categories of patient satisfaction were evaluated individually (i.e., cost, treatment efficacy, activities of daily living [ADL], and global treatment satisfaction). We analyzed the factors that affected each patient's satisfaction, such as age, sex, EQ5D, disease duration, disease activity, and treatment. RESULTS: This study included 2235 RA outpatients (406 males, 1829 females). In RA patients, "very satisfied" and "satisfied" were given for nearly half of each satisfaction aspect (cost 49%; efficacy 72%; ADL 58%; global treatment 66%) at the time of the initial registration. To investigate the factors influencing each satisfaction, multivariate analysis has revealed that the use of b/tsDMARDs increased satisfaction of treatment effect (odds ratio [OR] 0.66) and ADL (OR 0.78) but decreased cost satisfaction (OR 2.21). Age (50-64 years; OR 0.91; 65-74 years, 0.55: ≥ 75 years, 0.35), female (OR 0.81), and history of musculoskeletal surgery (OR 0.60) all increased cost satisfaction. Patients with lower disease activity and higher EQ5D scores had higher levels of satisfaction in all areas. CONCLUSIONS: In this study, patient satisfaction in terms of cost, treatment effect, ADL, and overall treatment was generally higher, but some patients were dissatisfied. The cost of satisfaction increased with age and a history of musculoskeletal surgery, while it decreased with a lower EQ5D score and the use of b/tsDMARDs.. |
| 18. |
Satoru Harada, Satoshi Hamai, Goro Motomura, Satoshi Ikemura, Masanori Fujii, Shinya Kawahara, Taishi Sato, Daisuke Hara, Yasuharu Nakashima, Evaluation of optimal implant alignment in total hip arthroplasty based on postoperative range of motion simulation., Clinical biomechanics (Bristol, Avon), 10.1016/j.clinbiomech.2021.105555, 92, 105555-105555, 2022.02, 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.. |
| 19. |
Kyohei Shiomoto, Satoshi Hamai, Satoru Ikebe, Hidehiko Higaki, Daisuke Hara, Hirotaka Gondo, Keisuke Komiyama, Kensei Yoshimoto, Satoru Harada, Yasuharu Nakashima, Computer simulation based on in vivo kinematics of a replaced hip during chair-rising for elucidating target cup and stem positioning with a safety range of hip rotation., Clinical biomechanics (Bristol, Avon), 10.1016/j.clinbiomech.2021.105537, 91, 105537-105537, 2022.01, Background After total hip arthroplasty, dislocation can occur when a patient unexpectedly assumes internal/external limb positions, even during chair-rising, which is a frequently activity of daily life. Therefore, determining the target cup position to avoid impingement in unexpected limb positions using in vivo data of daily life activities is critical. Methods A computer simulation was performed on 21 total hip arthroplasty patients using patient-specific component placements and hip kinematics obtained during chair-rising analysis using image-matching techniques. The liner-to-neck distance and impingement were evaluated by simulating the change in internal/external rotation angle at maximum hip flexion/extension from 0 to 90°. The cutoff values of cup anteversion and combined anteversion at 60° of internal/external rotation were determined. Findings The anterior/posterior liner-to-neck distances were negatively correlated with internal/external rotation angles (r = -0.82 and -0.78, respectively) and decreased by 1.7 and 1.8 mm for every 15° increase, respectively. Three cases (14%) of anterior/posterior impingement were observed at 60° of internal/external rotation angle, respectively. The cutoff values for cup anteversion and combined anteversion to avoid impingement at 60° of internal/external rotation angle were 12°-25°/38°-62°, respectively. The stem anteversion, adjustable by cup anteversion to meet both the target cup anteversion and combined anteversion, was 13°-50°. Interpretation Simulated unintentional internal or external hip rotation, even during chair-rising, caused impingement and posed a dislocation risk. If the stem anteversion is excessively small or large in meeting the target combined anteversion, adjustments to stem anteversion could be recommended in addition to adjustments in cup anteversion.. |
| 20. |
Tsutomu Fujita, Satoshi Hamai, Kyohei Shiomoto, Kazuya Okazawa, Yu-Ki Nasu, Daisuke Hara, Satoru Harada, Goro Motomura, Satoshi Ikemura, Masanori Fujii, Shinya Kawahara, Ken-Ichi Kawaguchi, Yasuharu Nakashima, Analysis of factors influencing patient satisfaction after total hip arthroplasty in a Japanese cohort: the significant effect of postoperative physical activity., Journal of physical therapy science, 10.1589/jpts.34.76, 34, 2, 76-84, 2022.02, [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.. |
| 21. |
Tetsunari Harada, Satoshi Hamai, Kyohei Shiomoto, Daisuke Hara, Shinya Kawahara, Masanori Fujii, Goro Motomura, Yasuharu Nakashima, Analysis of Factors That Influence Patient Satisfaction After Periacetabular Osteotomy: An Asian Cohort Study., Orthopedics, 10.3928/01477447-20220425-02, 45, 5, 1-7, 2022.04, 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. [Orthopedics. 20XX;4X(X):xx-xx.].. |
| 22. |
Satoru Harada, Satoshi Hamai, Kyohei Shiomoto, Daisuke Hara, Goro Motomura, Satoshi Ikemura, Masanori Fujii, Yasuharu Nakashima, Wear analysis of the first-generation cross-linked polyethylene at minimum 10 years follow-up after THA: no significant effect of sports participation., Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs, 10.1007/s10047-021-01297-x, 25, 2, 140-147, 2021.10, 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.. |
| 23. |
Satoru Harada, Satoshi Hamai, Kyohei Shiomoto, Daisuke Hara, Masanori Fujii, Satoshi Ikemura, Goro Motomura, Yasuharu Nakashima, Patient-reported outcomes after primary or revision total hip arthroplasty: A propensity score-matched Asian cohort study, PLOS ONE, 10.1371/journal.pone.0252112, 16, 5, e0252112-e0252112, 2021.05,
Background
Few studies have compared patient-reported outcome measures (PROMs) between primary and revision total hip arthroplasty (THA). We investigated and compared PROMs between propensity score-matched primary and revision THA in an Asian cohort.
Methods
The Oxford Hip Score (OHS) and University of California-Los Angeles (UCLA) activity score, satisfaction score, and Short Form-12 Health Survey (SF-12) were compared between 110 primary and 110 revision THAs after propensity score matching. Multivariate analyses were performed to determine which factors, including patients’ demographics, indication for revision, and pre-operative PROMs, were associated with post-operative PROMs in the revision THA cohort.
Results
The revision THA cohort demonstrated significantly lower post-operative OHS, UCLA activity score, and satisfaction score (10% decrease on average) than those in the primary THA cohort (P < .05). The difference in SF-12 mental component summary measure (MCS) between the two cohorts was statistically insignificant (P = .24). In multivariate analysis for the revision THA cohort, lower post-operative UCLA activity score was significantly associated with higher BMI and lower pre-operative UCLA activity score (P < .05).
Conclusion
Revision THA was associated with a modest but significant decrease in physical PROMs as compared with primary THA. Pre-operative UCLA activity score significantly affected the post-operative physical outcome measures in the revision THA cohort. However, post-operative SF-12 MCS was comparable between the primary and revision THA cohorts.
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| 24. |
Daisuke Hara, Satoshi Hamai, Kyle R Miller, Goro Motomura, Kensei Yoshimoto, Keisuke Komiyama, Kyohei Shiomoto, Satoshi Ikemura, Yasuharu Nakashima, Scott A Banks, How does transtrochanteric anterior rotational osteotomy change the dynamic three-dimensional intact ratio in hips with osteonecrosis of the femoral head?, Clinical biomechanics (Bristol, Avon), 10.1016/j.clinbiomech.2021.105284, 82, 105284-105284, 2021.02, BACKGROUND: The intact ratio (the ratio of the intact area of the femoral head) on a two-dimensional anteroposterior radiograph is associated with the prognosis of hips with osteonecrosis of the femoral head after transtrochanteric anterior rotational osteotomy. However, changes of the three-dimensional intact ratio during dynamic weight-bearing activity and correlation of the three-dimensional intact ratio with clinical scores are still unknown. METHODS: Kinematics of eight hips with osteonecrosis of the femoral head that underwent anterior rotational osteotomy were analyzed using image-matching techniques during chair-rising and squatting preoperatively and postoperatively. Two types of dynamic three-dimensional intact ratios were examined, including the lunate covered area (IRLC) and in vivo peak contact force vector intersected area (IRFV). The static three-dimensional intact ratio in each octant of the femoral head was also examined. FINDINGS: The mean Harris hip score significantly improved from 67 preoperatively to 90 postoperatively. During chair-rising rising/squatting, the mean IRLC and IRFV significantly increased from 42%/41% and 7%/4% preoperatively, to 66%/65% and 79%/77% postoperatively, respectively. IRLC significantly changed during the motion whereas substantial postoperative IRFV was maintained throughout the motion. Additionally, Harris hip score and the static three-dimensional intact ratio in the superolateral regions had significant positive correlations with both IRLC and IRFV. INTERPRETATION: Hip kinematics affected IRLC but not IRFV, which suggests that substantial intact bone occupies the region in which peak contact forces are applied during deep hip flexion. Additionally, improving intact ratio in the superolateral region led to improvements in both IRLC and IRFV with favorable clinical scores.. |
| 25. |
Kyohei Shiomoto, Satoshi Hamai, Daisuke Hara, Hidehiko Higaki, Hirotaka Gondo, Yifeng Wang, Satoru Ikebe, Kensei Yoshimoto, Keisuke Komiyama, Satoru Harada, Yasuharu Nakashima, In vivo kinematics, component alignment and hardware variables influence on the liner-to-neck clearance during chair-rising after total hip arthroplasty., Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 10.1016/j.jos.2019.05.012, 25, 3, 452-459, 2020.05, BACKGROUND: There is an interest in quantifying dynamic hip kinematics before and after total hip arthroplasty (THA) during chair-rising: one of daily life activities. METHODS: The study consisted of 21 patients who underwent unilateral total hip arthroplasty for symptomatic osteoarthritis. We obtained continuous radiographs using a flat-panel X-ray detector while the participants rose from chair. We assessed the pre and postoperative hip joint's movements using three-dimensional-to-two-dimensional model-to-image registration techniques. We also measured minimum liner-to-neck distances at maximum hip flexion and extension as anterior and posterior liner-to-neck distances, respectively. Multivariate analyses were applied to determine which factors were associated with liner-to-neck distances. RESULTS: The cup inclination, cup anteversion, and stem anteversion averaged 37.4°, 23.1°, and 30.1°, respectively. Significantly larger maximum hip flexion angle (72°) was found during chair-rising after THA compared to that before THA (63°, P |
| 26. |
Kensei Yoshimoto, Satoshi Hamai, Hidehiko Higaki, Hirotaka Gondoh, Kyohei Shiomoto, Satoru Ikebe, Daisuke Hara, Keisuke Komiyama, Yasuharu Nakashima, Dynamic hip kinematics before and after periacetabular osteotomy in patients with dysplasia., Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 10.1016/j.jos.2019.03.019, 25, 2, 247-254, 2020.03, BACKGROUND: We prospectively analyzed the hip kinematics in patients with developmental dysplasia of the hip (DDH) before and after periacetabular osteotomy (PAO) and in healthy subjects while squatting to determine the influence of coverage of the femoral head on hip kinematics. METHODS: 14 hips in 14 patients with DDH and 10 hips in 10 volunteers were included. Continuous radiographs while squatting and computed tomography images were obtained to assess the in vivo kinematics of the hip and the rim-neck distance using density-based 3D-to-2D model-to-image registration techniques. RESULTS: The maximum hip flexion angles were 100.4° and 94.9° before and after PAO (p = 0.0863), respectively. The maximum hip flexion angles after PAO did not significantly differ from those of normal hips (102.2°; p = 0.2552). The hip abduction angles at maximum hip flexion were 31.7° and 26.2° before and after PAO (p = 0.1256), respectively. The rim-neck distance decreased from averaged 12.2 mm-8.9 mm (p = 0.0044) after PAO. The lateral center edge angle (LCEA) and anterior center edge angle (ACEA) significantly improved 14.7°-42.4° and 50.4°-54.0° after PAO (p |
| 27. |
Masato Kiyohara, Satoshi Hamai, Daisuke Hara, Daisuke Fujiyoshi, Satoru Harada, Kenichi Kawaguchi, Yasuharu Nakashima, Do component position and muscle strength affect the cup-head translation during gait after total hip arthroplasty?, European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 10.1007/s00590-019-02443-1, 29, 6, 1263-1269, 2019.08, INTRODUCTION: This study examined whether the component position or muscle strength affects the cup-head translation under in vivo weight-bearing conditions after total hip arthroplasty (THA). We hypothesized that there was a correlation between the hip offset or abductor strength and cup-head translation during gait. MATERIALS AND METHODS: We prospectively evaluated 31 patients undergoing unilateral cementless primary THA. The cup height, cup/stem offset, and limb length discrepancy were measured on anterior-posterior bilateral hip radiographic images. The isometric muscle strength of the lower limbs was quantified using a handheld dynamometer. Continuous radiographic images were recorded during gait, and cup-head translation was analysed using a computer-assisted method. RESULTS: The average cup height, cup/stem offset, and limb length discrepancy were - 3.8 ± 5.1 mm, 1.2 ± 5.2 mm/- 0.7 ± 7.7 mm, and - 2.1 ± 5.2 mm, respectively. The average hip abductor/flexor and knee extensor strength were 86% ± 18%/85% ± 17% and 88% ± 17% of the contralateral healthy hip, respectively. The average cup-head translation during swing phase of gait was - 0.003 ± 0.31 mm. Multiple regression analyses found no significant independent predictors of cup-head translation (p > 0.05). CONCLUSIONS: The component position or muscle strength did not significantly influence cup-head translation during gait after well-positioned primary THA.. |
| 28. |
Keisuke Komiyama, Satoshi Hamai, Satoru Ikebe, Kensei Yoshimoto, Hidehiko Higaki, Kyohei Shiomoto, Hirotaka Gondo, Daisuke Hara, Yifeng Wang, Yasuharu Nakashima, In vivo kinematic analysis of replaced hip during stationary cycling and computer simulation of optimal cup positioning against prosthetic impingement., Clinical biomechanics (Bristol, Avon), 10.1016/j.clinbiomech.2019.05.035, 68, 175-181, 2019.08, BACKGROUND: Dynamic hip kinematics during stationary cycling after total hip arthroplasty (THA) have been unclear. Furthermore, no computer simulation of optimal cup position based on in vivo kinematics has yet been assessed. METHODS: This study consisted of 7 patients who underwent unilateral primary THA for symptomatic osteoarthritis. Using a flat-panel X-ray detector, continuous radiographs were obtained during stationary cycling. We analyzed the three-dimensional replaced hip kinematics from the top to the bottom position of the crank using image-matching techniques and quantified minimum liner-to-stem neck distance. Simulation analyses with in vivo kinematics were performed to examine patient-specific optimal cup placement against prosthetic impingement. FINDINGS: During stationary cycling, pelvis showed 27.1° of posterior tilt on average without significant change. Hip flexed by 59.4° and 19.3° on average at the top and bottom positions, respectively. Minimum liner-to-neck distance was 8.8 mm on average at the bottom position. Liner-to-neck, bone-to-bone, or bone-to-component impingement was not observed at any positions in any hips. Simulation analysis of cup placement showed that larger cup anteversion, inclination, and use of elevated liner significantly decreased the minimum distance between posterior liner and stem neck. Cup anteversion of more than 30° with elevated liner could cause posterior liner-to-neck impingement at bottom position. INTERPRETATION: Stationary cycling after THA provides no excessive hip range of motion or liner-to-neck contact. Cup placement and use of elevated liner significantly influence the minimum liner-to-neck distance, in some cases simulating posterior prosthetic impingement.. |
| 29. |
Keisuke Komiyama, Satoshi Hamai, Daisuke Hara, Satoru Ikebe, Yifeng Wang, Hirotaka Gondo, Hidehiko Higaki, Yasuharu Nakashima, Dynamic hip kinematics during recreational classical ballet and hula dance after total hip arthroplasty: two case reports., Journal of medical case reports, 10.1186/s13256-018-1942-2, 13, 1, 11-11, 2019.01, BACKGROUND: The in vivo assessment of the three-dimensional kinematics of the hip during dance activities in patients after total hip arthroplasty has not been previously reported. We evaluated the replaced hip kinematics during recreational classical ballet and hula dance using radiographic-based image-matching techniques. CASE PRESENTATION: A 58-year-old Japanese woman (patient 1; height, 157 cm; weight, 74.5 kg) and a 73-year-old Japanese woman (patient 2; height, 153 cm; weight, 48 kg) were still doing classical ballet and hula dance, respectively, after primary total hip arthroplasty. For ballet, there were gradual three-dimensional hip movements with 48° flexion, 36° abduction, and 49° external rotation in développé and 34° flexion, 29° abduction, and 43° external rotation in plié. For hula, there were small three-dimensional hip movements with 31° flexion, 15° adduction, and 11° external rotation in kao and 17° flexion, 11° adduction, and 11° external rotation in kaholo. No liner-to-neck contact was found in any dance activities. CONCLUSION: Both classical ballet and hula dance produced complex ranges of hip movements and activity-dependent kinematics. These kinematic data could be useful for recommending each patient with total hip arthroplasty to continue recreational dance activities.. |
| 30. |
Satoshi Hamai, Yusuke Kohno, Daisuke Hara, Kyohei Shiomoto, Mio Akiyama, Jun-Ichi Fukushi, Goro Motomura, Satoshi Ikemura, Masanori Fujii, Yasuharu Nakashima, Minimum 10-Year Clinical Outcomes After Periacetabular Osteotomy for Advanced Osteoarthritis Due to Hip Dysplasia., Orthopedics, 10.3928/01477447-20180806-04, 41, 5, 300-305, 2018.09, 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. [Orthopedics. 2018; 41(5):300-305.].. |
| 31. |
Keisuke Komiyama, Satoshi Hamai, Daisuke Hara, Satoru Ikebe, Hidehiko Higaki, Kensei Yoshimoto, Kyohei Shiomoto, Hirotaka Gondo, Yifeng Wang, Yasuharu Nakashima, Dynamic hip kinematics during squatting before and after total hip arthroplasty., Journal of orthopaedic surgery and research, 10.1186/s13018-018-0873-3, 13, 1, 162-162, 2018.07, BACKGROUND: The difference in in vivo kinematics before and after total hip arthroplasty (THA) for the same subjects and the clearance between the liner and neck during squatting have been unclear. The purpose of the present study was to clarify (1) the changes in the in vivo kinematics between prosthetic hips and osteoarthritis hips of the same subjects and (2) the extent of the liner-to-neck clearance during squatting under weight-bearing conditions. METHODS: This study consisted of 10 patients who underwent unilateral THA for symptomatic osteoarthritis. Using a flat-panel X-ray detector, we obtained continuous radiographs during squatting. We analyzed the hip joint's movements using three-dimensional-to-two-dimensional model-to-image registration techniques. We also quantified the minimum distance at maximum flexion and extension, and the minimum angle at maximum flexion between the liner and stem neck. RESULTS: The maximum hip flexion angles post-THA (80.7° [range, 69.4-98.6°]) changed significantly compared with the pre-THA values (71.7° [range, 55.2°-91.2°]). The pelvic tilt angle (posterior +, anterior-) at the maximum hip flexion post-THA (10.4° [range, - 6.7° to 26.9°]) was significantly smaller than that at pre-THA (16.6° [range, - 3° to 40.3°]). The minimum anterior and posterior liner-to-neck distances averaged 10.9 and 8.0 mm, respectively, which was a significant difference. The minimum liner-to-neck angle at maximum flexion averaged 34.7° (range, 20.7°-46.3°). No liner-to-neck contact occurred in any of the hips. CONCLUSION: THA increased the range of hip joint motion and the pelvis tilted anteriorly more after than before THA, with sufficient liner-to-neck clearance during squatting. These data may be beneficial for advising patients after THA regarding postoperative activity restrictions in daily life.. |
| 32. |
Kensei Yoshimoto, Yasuharu Nakashima, Miyo Wakiyama, Daisuke Hara, Akihiro Nakamura, Mikio Iwamoto, Initial stability of a highly porous titanium cup in an acetabular bone defect model., Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 10.1016/j.jos.2018.03.007, 23, 4, 665-670, 2018.07, BACKGROUNDS: The purpose of this study was to quantify the initial stability of a highly porous titanium cup using an acetabular bone defect model. METHODS: The maximum torque of a highly porous titanium cup, with a pore size of 640 μm and porosity of 60%, was measured using rotational and lever-out torque testing and compared to that of a titanium-sprayed cup. The bone models were prepared using a polyurethane foam block and had three levels of bone coverage: 100, 70, and 50%. RESULTS: The highly porous titanium cup demonstrated significantly higher maximum torque than the titanium-sprayed cups in the three levels of bone defects. On rotational torque testing, it was found to be 1.5, 1.3, and 1.3 times stronger than the titanium-sprayed cups with 100, 70 and 50% bone coverage, respectively. Furthermore, it was found to be 2.2, 2.3, and 1.5 times stronger on lever-out testing than the titanium-sprayed cup. No breakage in the porous layers was noted during the testing. CONCLUSION: This study provides additional evidence of the initial stability of highly porous titanium cup, even in the presence of acetabular bone defects.. |
| 33. |
Daisuke Hara, Satoshi Hamai, Keisuke Komiyama, Goro Motomura, Kyohei Shiomoto, Yasuharu Nakashima, Sports Participation in Patients After Total Hip Arthroplasty vs Periacetabular Osteotomy: A Propensity Score-Matched Asian Cohort Study., The Journal of arthroplasty, 10.1016/j.arth.2017.08.035, 33, 2, 423-430, 2018.02, BACKGROUND: No studies have compared sports participation between total hip arthroplasty (THA) and periacetabular osteotomy (PAO) in matched Asian cohorts. We investigated sports participation and activity levels in Asian THA cohort, and compared them between THA and PAO cohorts. METHODS: Multivariate analyses were applied to determine which factors were associated with postoperative sports participation and University of California-Los Angeles (UCLA) activity score in (1) 524 THA patients and (2) 487 acetabular dysplasia patients (295 THA patients and 192 PAO patients). In addition, postoperative sports participation and UCLA score were compared between 62 THA and 62 PAO patients after adjusting for baseline characteristics with propensity score matching. RESULTS: Sports participation and UCLA score significantly increased after THA (P |
| 34. |
Daisuke Hara, Satoshi Hamai, Jun-Ichi Fukushi, Ken-Ichi Kawaguchi, Goro Motomura, Satoshi Ikemura, Keisuke Komiyama, Yasuharu Nakashima, Does Participation in Sports Affect Osteoarthritic Progression After Periacetabular Osteotomy?, The American journal of sports medicine, 10.1177/0363546517707942, 45, 11, 2468-2475, 2017.09, BACKGROUND: Periacetabular osteotomy (PAO) is an effective treatment for symptomatic acetabular dysplasia. However, whether postoperative participation in sports leads to progression of the Kellgren-Lawrence (KL) grade of osteoarthritis (OA) in these patients is unclear. PURPOSE: To investigate (1) participation in sports before and after PAO and (2) whether postoperative participation in sports leads to progression of the KL grade. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: The authors retrospectively reviewed data on 161 patients (183 hips) who underwent PAO for symptomatic acetabular dysplasia with preoperative KL grade 1 or 2 between 1998 and 2011. The mean age at the time of surgery was 42.0 ± 10.9 years (range, 12-64 years), and the mean follow-up duration was 100 months (range, 13-180 months). Data included participation in sports, the University of California, Los Angeles (UCLA) activity scale score, age at the time of surgery, body mass index, follow-up duration, history of treatment for developmental hip dislocations, Merle d'Aubigné-Postel score, Oxford Hip Score, center-edge angle, and KL grade. Univariate and multivariate analyses were applied to determine which factors were associated with progression to KL grade 3 or 4 after PAO. RESULTS: The number of patients who participated in sports significantly increased from 50 (31.1%) preoperatively to 89 (55.3%) postoperatively. The mean UCLA score significantly increased from 4.7 ± 2.1 preoperatively to 5.5 ± 2.0 postoperatively. The KL grade progressed to grade 3 or 4 in 16 hips, including 4 hips that underwent conversion to total hip arthroplasty. No significant differences were found in postoperative participation in sports (89 hips [53.3%] vs 11 hips [68.8%], respectively; P = .24) and the UCLA score (5.6 ± 2.0 vs 5.1 ± 2.0, respectively; P = .30) between hips with KL grade 1 or 2 and KL grade 3 or 4. A multivariate analysis revealed that no factors, including postoperative participation in sports, were significantly associated with progression to KL grade 3 or 4. CONCLUSION: Postoperative participation in sports after PAO did not significantly and negatively influence progression of the KL grade at midterm follow-up.. |
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Yasuharu Nakashima, Masanori Fujii, Yasuo Noguchi, Kenya Suenaga, Takuaki Yamamoto, Jun-Ichi Fukushi, Goro Motomura, Satoshi Hamai, Daisuke Hara, Yukihide Iwamoto, Arthroscopic validation of radiographic minimum joint space width associated with the subchondral bone exposure in symptomatic hip dysplasia., Modern rheumatology, 10.1080/14397595.2016.1222663, 27, 3, 524-528, 2017.05, 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 |
| 36. |
Keisuke Komiyama, Yasuharu Nakashima, Masanobu Hirata, Daisuke Hara, Yusuke Kohno, Yukihide Iwamoto, Does High Hip Center Decrease Range of Motion in Total Hip Arthroplasty? A Computer Simulation Study., The Journal of arthroplasty, 10.1016/j.arth.2016.03.014, 31, 10, 2342-7, 2016.10, BACKGROUND: High placement of a cementless acetabular cup is often required to have sufficient bone coverage in hip dysplasia. We examined whether a high hip center decreases the postoperative range of motion (ROM) in total hip arthroplasty. METHODS: Using a computer software, ROM and bone coverage were examined in 32 patients with unilateral osteoarthritis of the hip with Crowe type II or III hip dysplasia. The cup was placed at the anatomic hip center and moved vertically in 5-mm increments. Vertical center of rotation (V-COR) was defined as the distance from the head center to the interteardrop line. The required ROM was defined as flexion ≥110°, internal rotation (IR) at 90° flexion ≥30°, extension ≥30°, and external rotation ≥30°. We determined the V-COR to satisfy the required ROM and cup center-edge angle (Cup-CE) ≥0°. RESULTS: Only 40.6% of the patients satisfied Cup-CE ≥0° at the anatomic hip center. Bone coverage increased with the peak at 30, 35 mm of V-COR (90.6% satisfied Cup-CE ≥0°) and decreased at ≥40 mm. Higher V-COR resulted in lower range of flexion and IR, but increased the range of extension and external rotation. The cutoff value from the receiver-operating characteristic curve for both flexion and IR was a V-COR of 35 mm. CONCLUSION: The higher hip center gained more bone coverage but decreased the range of hip flexion and IR. Acceptable V-COR in hip dysplasia was around 35 mm, about 20 mm above the true hip center, in terms of ROM.. |
| 37. |
Yusuke Kohno, Yasuharu Nakashima, Takashi Hatano, Mio Akiyama, Masanori Fujii, Daisuke Hara, Masayuki Kanazawa, Akihisa Haraguchi, Yukihide Iwamoto, High prevalence of cam deformity in dysplastic hips: A three-dimensional CT study., Journal of orthopaedic research : official publication of the Orthopaedic Research Society, 10.1002/jor.23147, 34, 9, 1613-9, 2016.09, Cam deformity could lead to suboptimal articulation by causing secondary femoroacetabular impingement after periacetabular osteotomy; however, the inherent femoral head-neck morphology in dysplastic hips and the effect of an additional osteoarthritic deformity have not been well described. We compared femoral head-neck morphology using three-dimensional imaging of normal and dysplastic hips in pre/early (Tönnis grade 0 and 1) and advanced stage osteoarthritis (Tönnis grade 2). Using computed tomography, we measured the circumferential α-angle and head-neck offset ratio in 68 dysplastic hips and 24 normal hips. Locations of the head-neck junction were represented by the clock position. In the pre/early group, the α-angle was significantly larger at the anterosuperior and inferior aspects (1, 2, and 5-7 o'clock) and head-neck offset ratio was smaller at the anterosuperior aspect (2 o'clock) than in the control group. The α-angle was significantly larger at the anterior aspects (1-4 o'clock) in the advanced group than in the pre/early group. The maximum α-angle was most commonly found at 2 o'clock (60%, 41/68 hips) in dysplastic hips. The prevalence of cam deformity (maximum α-angle >55°) was 4.2% (1/24 hips) in the control group, 22% (11/50 hips) in the pre/early group, and 50% (9/18 hips) in the advanced group. Cam deformity, inherent in the pre/early group, was found with relatively high frequency. The higher prevalence in the advanced group reflected degeneration-modified changes. When performing periacetabular osteotomy, preoperative radiographic assessments should include the femoral head-neck junction to prevent secondary femoroacetabular impingement, especially in patients with advanced stage osteoarthritis. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1613-1619, 2016.. |
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Masayuki Kanazawa, Yasuharu Nakashima, Takayuki Arai, Takahiro Ushijima, Masanobu Hirata, Daisuke Hara, Yukihide Iwamoto, Quantification of pelvic tilt and rotation by width/height ratio of obturator foramina on anteroposterior radiographs., Hip international : the journal of clinical and experimental research on hip pathology and therapy, 10.5301/hipint.5000374, 26, 5, 462-467, 2016.09, OBJECTIVE: Compared to sagittal pelvic tilt, only a few studies have examined axial rotation on anteroposterior radiographs. We therefore quantified 3-D pelvic rotation using the width and height ratio of the obturator foramina under the various pelvic tilts. METHODS: Using CT reconstructions of 10 healthy pelvises, anterior pelvic planes (APPs) were rotated by 20° in 5° increments on the axial plane with various degrees of sagittal pelvic tilt. The correlation between the pelvic rotation angle and the width ratio (WR) in the axial plane and the height/width ratio (H/W) in the sagittal plane were examined. RESULTS: Axial pelvic rotation and WR showed a high linear correlation regardless of the sagittal tilt, with the correlation coefficient ranging from 0.93 to 0.98 in males and 0.87 to 0.95 in females. The angle that resulted in a WR of 1:2 was approximately 13° in males and 18° in females. H/W also showed a linear regression with sagittal tilt. Axial rotation was determined by the following equation incorporating pelvic tilts; axial rotation (male:female) = (19.9:24.2) + (2.1:3.6) × Hright/Wright + (0.9:1.5) × Hleft/Wleft - (23.2:25.1) × WR. CONCLUSIONS: Pelvic tilt and rotation could be quantified by the equation using width and height ratios of the obturator foramina on a plain anteroposterior radiograph. Width and height ratios of the obturator foramina proved to be useful parameters in clinical practice for understanding pelvic rotation.. |
| 39. |
Daisuke Hara, Yasuharu Nakashima, Satoshi Hamai, Hidehiko Higaki, Satoru Ikebe, Takeshi Shimoto, Kensei Yoshimoto, Yukihide Iwamoto, Dynamic Hip Kinematics During the Golf Swing After Total Hip Arthroplasty., The American journal of sports medicine, 10.1177/0363546516637179, 44, 7, 1801-9, 2016.07, BACKGROUND: Although most surgeons allow their patients to play golf after total hip arthroplasty (THA), the effect on the implant during the golf swing is still unclear. PURPOSE: To evaluate hip kinematics during the golf swing after THA. STUDY DESIGN: Descriptive laboratory study. METHODS: Eleven hips in 9 patients who underwent primary THA were analyzed. All patients were right-handed recreational golfers, and these 11 hips included 6 right hips and 5 left hips. Periodic radiographic images of the golf swing were taken using a flat-panel x-ray detector. Movements of the hip joint and components were assessed using 3-dimensional-to-2-dimensional model-to-image registration techniques. Liner-to-neck contact and translation of the femoral head with respect to the acetabular cup (cup-head translation) were examined. Hip kinematics, orientation of components, and maximum cup-head translation were compared between patients with and without liner-to-neck contact. RESULTS: On average, the golf swing produced approximately 50° of axial rotation in both lead and trail hips. Liner-to-neck contact was observed in 4 hips with elevated rim liners (2 lead hips and 2 trail hips) at maximum external rotation. Neither bone-to-bone nor bone-to-implant contact was observed at any phases of the golf swing in any of the hips. Four hips with liner-to-neck contact had significantly larger maximum external rotation (37.9° ± 7.0° vs 20.6° ± 9.9°, respectively; P = .01) and more cup anteversion (26.5° ± 6.1° vs 10.8° ± 8.9°, respectively; P = .01) than hips without liner-to-neck contact. No significant differences between hips with and without contact were found for cup inclination (42.0° ± 2.5° vs 38.1° ± 5.5°, respectively; P = .22), combined anteversion (45.3° ± 8.9° vs 51.4° ± 7.9°, respectively; P = .26), or maximum cup-head translation (1.3 ± 0.3 mm vs 1.5 ± 0.4 mm, respectively; P = .61). CONCLUSION: In this analysis, the golf swing did not produce excessive hip rotation or cup-head translation in any hips. However, liner-to-neck contact during the golf swing was observed in 36% of the hips, with unknown effects on the long-term results. CLINICAL RELEVANCE: Golf is an admissible sport after THA because dynamic hip stability was observed. However, the implant position, especially cup anteversion and the use of elevated rim liners, promoted liner-to-neck contact.. |
| 40. |
Koji Murakami, Satoshi Hamai, Ken Okazaki, Satoru Ikebe, Takeshi Shimoto, Daisuke Hara, Hideki Mizu-uchi, Hidehiko Higaki, Yukihide Iwamoto, In vivo kinematics of healthy male knees during squat and golf swing using image-matching techniques., The Knee, 10.1016/j.knee.2015.08.004, 23, 2, 221-6, 2016.03, PURPOSE: Participation in specific activities requires complex ranges of knee movements and activity-dependent kinematics. The purpose of this study was to investigate dynamic knee kinematics during squat and golf swing using image-matching techniques. METHODS: Five healthy males performed squats and golf swings under periodic X-ray images at 10 frames per second. We analyzed the in vivo three-dimensional kinematic parameters of subjects' knees, namely the tibiofemoral flexion angle, anteroposterior (AP) translation, and internal-external rotation, using serial X-ray images and computed tomography-derived, digitally reconstructed radiographs. RESULTS: During squat from 0° to 140° of flexion, the femur moved about 25 mm posteriorly and rotated 19° externally relative to the tibia. Screw-home movement near extension, bicondylar rollback between 20° and 120° of flexion, and medial pivot motion at further flexion were observed. During golf swing, the leading and trailing knees (the left and right knees respectively in the right-handed golfer) showed approximately five millimeters and four millimeters of AP translation with 18° and 26° of axial rotation, respectively. A central pivot motion from set-up to top of the backswing, lateral pivot motion from top to ball impact, and medial pivot motion from impact to the end of follow-through were observed. CONCLUSIONS: The medial pivot motion was not always recognized during both activities, but a large range of axial rotation with bilateral condylar AP translations occurs during golf swing. This finding has important implications regarding the amount of acceptable AP translation and axial rotation at low flexion in replaced knees. LEVEL OF EVIDENCE: IV.. |
| 41. |
Yasuharu Nakashima, Masanobu Ohishi, Ken Okazaki, Jun-Ichi Fukushi, Akiko Oyamada, Daisuke Hara, Toshio Doi, Yukio Akasaki, Hisakata Yamada, Yukihide Iwamoto, Delayed diagnosis of ankylosing spondylitis in a Japanese population., Modern rheumatology, 10.3109/14397595.2015.1088679, 26, 3, 421-5, 2016.03, OBJECTIVES: This study was conducted to evaluate the period from symptom onset to diagnosis of ankylosing spondylitis (AS) in Japanese patients and to examine possible reasons for delayed diagnosis. METHODS: Seventy-two consecutive patients with AS were studied. Diagnostic delay was defined as the gap between the first spondyloarthropathic symptom and diagnosis of AS according to the modified New York criteria. RESULTS: The mean patient ages at disease onset and diagnosis were 25.6 ± 11.3 and 33.3 ± 13.2 years old, respectively, resulting in diagnostic delay of 6.7 years. The number of medical institutions to which patients were referred before diagnosis was 2.4, and orthopedic surgeons were most commonly visited (62%). Non-specific low back pain or lumbar spondylitis (33%) and degenerative arthritis (28%) were the primary diagnoses preceding that of AS. Absence of articular symptoms significantly correlated with diagnostic delay. The patients with disease onset on year 2000 or later had significantly shorter periods until diagnosis than those before 2000 (3.6 vs. 7.5 years). CONCLUSIONS: The present study showed a marked diagnostic delay among Japanese patients with AS. Although it has been improved, continuing medical education focusing on inflammatory back pain in adolescent is required for early diagnosis of AS.. |
| 42. |
Kanazawa, M., Nakashima, Y., Ohishi, M., Hamai, S., Motomura, G., Yamamoto, T., Fukushi, J.-I., Ushijima, T., Hara, D., Iwamoto, Y., Pelvic tilt and movement during total hip arthroplasty in the lateral decubitus position, Modern Rheumatology, 10.3109/14397595.2015.1092914, 26, 3, 435-40, 2016.03, OBJECTIVES: Total hip arthroplasty (THA) is often performed in the lateral decubitus (lateral) position. In this position, the pelvis may have various degrees of tilt leading to implant malposition. We sought to quantify the pelvic tilt in lateral position and further pelvic movement during surgery. METHODS: In 95 cases with primary THA, three-dimensional pelvic tilts were quantified by superimposing images reconstructed from CT data onto antero-posterior radiographs taken in lateral position at set-up and after cup placement. Pelvises were fixed with a device compressing anterior superior iliac spines and sacrum. RESULTS: Various degrees of pelvic tilt occurred compared to the supine position; sagittal: -3.1° (-25.5° to 10.2°), axial: 3.9° (-8.4° to 17°), coronal: 0.9° (-11.9° to 13.2°). Absolute changes more than 5° were observed 43%, 47%, and 12% in the sagittal, axial, and coronal planes, respectively. The more preoperative posterior pelvic tilt resulted in the more change in the sagittal plane. Further pelvic movement of about 3° in three planes were observed ranging from -11° to 20° after cup placement. CONCLUSION: This study showed various pelvic tilt and movement during THA. As pelvic tilt directly alters the cup orientation, its changes should be well understood. Improved tools for positioning and holding the pelvis are required.. |
| 43. |
Daisuke Hara, Yasuharu Nakashima, Taishi Sato, Masanobu Hirata, Masayuki Kanazawa, Yusuke Kohno, Kensei Yoshimoto, Yusuke Yoshihara, Akihiro Nakamura, Yumiko Nakao, Yukihide Iwamoto, Bone bonding strength of diamond-structured porous titanium-alloy implants manufactured using the electron beam-melting technique., Materials science & engineering. C, Materials for biological applications, 10.1016/j.msec.2015.11.025, 59, 1047-1052, 2016.02, The present study examined the bone bonding strength of diamond-structured porous titanium-alloy (Porous-Ti-alloy) manufactured using the electron beam-melting technique in comparison with fiber mesh-coated or rough-surfaced implants. Cylindrical implants with four different pore sizes (500, 640, 800, and 1000μm) of Porous-Ti-alloy, titanium fiber mesh (FM), and surfaces roughened by titanium arc spray (Ti-spray) were implanted into the distal femur of rabbits. Bone bonding strength and histological bone ingrowth were evaluated at 4 and 12weeks after implantation. The bone bonding strength of Porous-Ti-alloy implants (640μm pore size) increased over time from 541.4N at 4weeks to 704.6N at 12weeks and was comparable to that of FM and Ti-spray implants at both weeks. No breakage of the porous structure after mechanical testing was found with Porous-Ti-alloy implants. Histological bone ingrowth that increased with implantation time occurred along the inner structure of Porous-Ti-alloy implants. There was no difference in bone ingrowth in Porous-Ti-alloy implants with pore sizes among 500, 640, and 800μm; however, less bone ingrowth was observed with the 1000μm pore size. These results indicated Porous-Ti-alloy implants with pore size under 800μm provided biologically active and mechanically stable surface for implant fixation to bone, and had potential advantages for weight bearing orthopedic implants such as acetabular cups.. |
| 44. |
Daisuke Hara, Yasuharu Nakashima, Satoshi Hamai, Hidehiko Higaki, Satoru Ikebe, Takeshi Shimoto, Kensei Yoshimoto, Yukihide Iwamoto, Dynamic hip kinematics in patients with hip osteoarthritis during weight-bearing activities., Clinical biomechanics (Bristol, Avon), 10.1016/j.clinbiomech.2015.11.019, 32, 150-6, 2016.02, BACKGROUND: There is an interest in quantifying the hip kinematics of patients with end-stage hip disorders before total hip arthroplasty. The purpose of the present study was to obtain dynamic hip kinematics under four different conditions, including deep flexion and rotation, in patients with osteoarthritis of the hip. METHODS: Continuous X-ray images were obtained in 14 patients during gait, chair-rising, squatting, and twisting, using a flat panel X-ray detector. These patients received computed tomography scan to generate virtual digitally reconstructed radiographs. The density-based digitally reconstructed radiographs were then compared with the serial X-ray images acquired using image correlations. These 3D-to-2D model-to-image registration techniques determined the 3D positions and orientations of the pelvis and femur during the movement cycle of each activity. FINDINGS: For gait, chair-rising, and squatting, the maximum hip flexion angles averaged 22°, 64°, and 68°, respectively. The pelvis was tilted anteriorly by an average of around 7° during the full gait cycle. For chair-rising and squatting, the maximum absolute values of anterior/posterior pelvic tilt averaged 8°/17° and 6°/18°, respectively. Hip flexion showed maximum flexion angle on the way of movement due to further anterior pelvic tilt during both chair-rising and squatting. For twisting, the maximum absolute values of internal/external hip rotation averaged 3°/13°. INTERPRETATION: Patients with hip osteoarthritis prior to total hip arthroplasty demonstrated the limited ranges of coordinated motion of the pelvis, femur, and hip joint during each activity, especially in deeply flexed and rotated postures.. |
| 45. |
Yoshimoto, K., Nakashima, Y., Nakamura, A., Mawatari, T., Todo, M., Hara, D., Iwamoto, Y., Neck fracture of femoral stems with a sharp slot at the neck: biomechanical analysis, Journal of Orthopaedic Science, 10.1007/s00776-015-0745-1, 20, 5, 881-7, 2015.05, BACKGROUND: Fracture of the femoral stem in total hip arthroplasty (THA) is a rare complication. We have encountered 2 cases of neck fractures of the femoral stem occurring 9 and 12 years after THA. Morphological and biomechanical analysis were performed to investigate the mechanism of these fractures. METHOD: A titanium alloy femoral stem having a slot with sharp corners (R = 0.2 mm) at the neck had been implanted in both cases. Fracture surfaces were examined by use of scanning electron microscopy (SEM). Stress concentration was simulated by using a finite element method (FEM) to compare slots with sharp (R = 0.2 mm) and smooth (R = 2 mm) corners. RESULTS: Study of the retrieved stems revealed that neck fractures had occurred at the distal end of the slot in both cases. SEM revealed numerous fine fissures extending from the anterolateral edge, striations on the middle of the fracture surface, and dimples on the posteromedial surface, suggesting that the fractures had occurred from the anterolateral aspect toward the posteromedial aspect because of metallic fatigue. FEM analysis showed that mechanical stress was concentrated at the distal and anterolateral corners of the slot. Under 3500-N loading force, the stress at the sharp corner was 556 MPa, which was approximately twofold that at the smooth corner and exceeded the fatigue strength of titanium alloy. CONCLUSION: These findings showed that the sharp corner of slot increased stress concentrations at the anterolateral aspect and led to the neck fractures.. |
| 46. |
Hirata, M., Nakashima, Y., Hara, D., Kanazawa, M., Kohno, Y., Yoshimoto, K., Iwamoto, Y., Optimal anterior femoral offset for functional range of motion in total hip arthroplasty—a computer simulation study, International Orthopaedics, 10.1007/s00264-014-2538-0, 39, 4, 645-51, 2015.04, PURPOSE: Compared to medial femoral offset (MFO), the role of anterior femoral offset (AFO) on range of motion (ROM) in total hip arthroplasty (THA) has not been fully examined. We therefore defined AFO as the anterior distance from the centre of the femoral head to the proximal femoral axis in the sagittal plane and determined the optimal AFO required for ROM needed for activities of daily living using a computer-simulated THA model. METHODS: Various AFOs were obtained by changing stem anteversion (stem-AV) and stem tilt in the sagittal plane (stem-tilt) using a CT-based simulation software. The required ROM was defined as: flexion ≥ 110°, internal rotation at 90° flexion (IR) ≥ 30°, external rotation (ER) ≥ 30°, and extension ≥ 30°, and we determined AFO and MFO to satisfy required ROM. RESULTS: AFO was positively correlated with stem-AV and anterior stem-tilt. MFO was negatively correlated with stem-AV and not influenced by stem-tilt. Flexion and IR increased with both increased AFO and MFO, whereas extension and ER decreased with increased AFO. A smoothing spline curve showed the optimal AFO and MFO for required ROM to be from 15 mm to 25 mm on average and more than 32.1 mm, respectively. CONCLUSIONS: This is the first study to show that AFO directly influenced ROM in THA. Optimal AFO as well as MFO should be reconstructed to achieve sufficient ROM.. |
| 47. |
Hara, D., Nakashima, Y., Hamai, S., Higaki, H., Ikebe, S., Shimoto, T., Hirata, M., Kanazawa, M., Kohno, Y., Iwamoto, Y., Kinematic analysis of healthy hips during weight-bearing activities by 3D-to-2D model-to-image registration technique, BioMed Research International, 10.1155/2014/457573, 2014, 457573-457573, 2014.11, Dynamic hip kinematics during weight-bearing activities were analyzed for six healthy subjects. Continuous X-ray images of gait, chair-rising, squatting, and twisting were taken using a flat panel X-ray detector. Digitally reconstructed radiographic images were used for 3D-to-2D model-to-image registration technique. The root-mean-square errors associated with tracking the pelvis and femur were less than 0.3 mm and 0.3° for translations and rotations. For gait, chair-rising, and squatting, the maximum hip flexion angles averaged 29.6°, 81.3°, and 102.4°, respectively. The pelvis was tilted anteriorly around 4.4° on average during full gait cycle. For chair-rising and squatting, the maximum absolute value of anterior/posterior pelvic tilt averaged 12.4°/11.7° and 10.7°/10.8°, respectively. Hip flexion peaked on the way of movement due to further anterior pelvic tilt during both chair-rising and squatting. For twisting, the maximum absolute value of hip internal/external rotation averaged 29.2°/30.7°. This study revealed activity dependent kinematics of healthy hip joints with coordinated pelvic and femoral dynamic movements. Kinematics' data during activities of daily living may provide important insight as to the evaluating kinematics of pathological and reconstructed hips.. |
| 48. |
Hirata, M., Nakashima, Y., Itokawa, T., Ohishi, M., Sato, T., Akiyama, M., Hara, D., Iwamoto, Y., Influencing factors for the increased stem version compared to the native femur in cementless total hip arthroplasty, International Orthopaedics, 10.1007/s00264-014-2289-y, 38, 7, 1341-6, 2014.07, PURPOSE: Stem version is not always equivalent to femoral neck version (native version) in cementless total hip arthroplasty (THA). We therefore examined the discrepancy of version between the native femoral neck and stem using pre- and postoperative computed tomography (CT), the level of the femur where the canal version most closely fit the stem version, and the factors influencing version discrepancy between the native femoral neck and stem. METHODS: A total of 122 hips in 122 patients who underwent primary THA using a metaphyseal-fit stem through the postero-lateral approach were included. Pre- and postoperative CT images were utilized to measure native and stem version, and the version of the femoral canal at four levels relative to the lesser trochanter. RESULTS: The mean native and stem versions were 28.1 ± 11.0° and 38.0 ± 11.2°, respectively, revealing increased stem version with a mean difference of 9.8° (p |
| 49. |
Kohno, Y., Nakashima, Y., Kitano, T., Nakamura, T., Takamura, K., Akiyama, M., Hara, D., Yamamoto, T., Motomura, G., Ohishi, M., Hamai, S., Yukihide, I., Subclinical bilateral involvement of the hip in patients with slipped capital femoral epiphysis - A multicentre study, International Orthopaedics, 10.1007/s00264-013-2131-y, 38, 3, 477-82, 2014.03, PURPOSE: This study was conducted to assess the posterior inclination of the contralateral femoral epiphysis in patients with unilateral slipped capital femoral epiphysis (SCFE). METHODS: The posterior sloping angle (PSA) was measured using lateral radiographs in 67 patients with a unilateral SCFE and in 41 age-matched normal controls. A symptomatic epiphyseal slip was defined as the development of SCFE. RESULTS: The contralateral PSA in SCFE patients was more widely distributed and significantly larger compared to controls (15.0° vs. 9.0°, p 19°) are likely to become symptomatic.. |
| 50. |
Akiyama, M., Nakashima, Y., Oishi, M., Sato, T., Hirata, M., Hara, D., Iwamoto, Y., Risk factors for acetabular retroversion in developmental dysplasia of the hip: Does the Pemberton osteotomy contribute?, Journal of Orthopaedic Science, 10.1007/s00776-013-0473-3, 19, 1, 90-6, 2014.01, BACKGROUND: The purpose of this study was to investigate residual acetabular retroversion after skeletal maturity in patients with Pemberton osteotomy. PATIENTS AND METHODS: We compared 40 hips in 36 patients treated with a Pemberton osteotomy (Pemberton group) and 30 hips in 26 patients treated only with a Pavlik harness (Rb group) for developmental dysplasia of the hip. The average age at operation in the Pemberton group was 94.5 months and the follow-up duration was 151.8 months. Radiographic parameters included the acetabular index (α angle) and the center-edge angle of Wiberg, preoperatively and at skeletal maturity. We examined the crossover sign (COS) at the latest follow-up as a sign of acetabular retroversion (AR). We compared the parameters between the two groups and examined the risk factors for acetabular retroversion using a multivariate Cox model. RESULT: A COS (+) was significantly more frequent in the Pemberton group compared to the Rb group [15 hips (37.5%) vs 3 hips (10%); p = 0.0077]. In the Pemberton group, the average age at operation in COS (+) hips was significantly older than that in COS (-) hips (126.9 vs 72.8 months; p = 0.0005). The preoperative α angle did not vary between hips with and without COS; however, the postoperative α angle was significantly smaller in COS (+) hips. A multiple logistic regression analysis for prediction of COS (+) showed that the age at operation and the amount change of α angle were significant predictors for COS (+) hips. The cut-off of the age at operation was 7 years and 9 months old. CONCLUSIONS: AR was present in 37.5% of the hips in the Pemberton group after skeletal maturity. Remodeling of acetabular version was observed in younger patients; however, hips in older patients (>8 years) at the time of operation and greater degrees of correction tended to result in AR.. |
| 51. |
Nakashima, Y., Sato, T., Yamamoto, T., Motomura, G., Ohishi, M., Hamai, S., Akiyama, M., Hirata, M., Hara, D., Iwamoto, Y., Results at a minimum of 10 years of follow-up for AMS and PerFix HA-coated cementless total hip arthroplasty: Impact of cross-linked polyethylene on implant longevity, Journal of Orthopaedic Science, 10.1007/s00776-013-0456-4, 18, 6, 962-8, 2013.11, PURPOSE: The purpose of this study was to report results at a minimum of 10 years for hydroxyapatite (HA) coating on the titanium arc-sprayed cementless total hip arthroplasty (THA) and to evaluate the impact of cross-linked polyethylene (XLPE) on implant longevity. METHODS: A total of 131 consecutive primary THAs in 123 patients using an AMS acetabular cup and a PerFix HA stem were retrospectively reviewed. Conventional PE was used for 62 hips (CPE group) and cross-linked PE for 69 hips (XLPE group), with mean follow-up periods of 13 and 11.5 years, respectively. These patients were reviewed using the Japanese Orthopaedic Association (JOA) Hip Score and evaluated in terms of PE wear, osteolysis, and implant survival. RESULTS: The JOA score improved from 42.6 to 83.9 points at the final follow-up. The mean wear rate of 0.12 mm/year in the CPE group was significantly greater than that of XLPE at 0.007 mm/year. In the CPE group, ten (16.1 %) and two (3.2 %) hips, respectively, underwent PE exchange due to severe wear and acetabular revision due to loosening associated with osteolysis. Three patients had revision in the XLPE group: one cup for aseptic loosening, one PE for recurrent dislocation, and one stem for neck fracture. No evident osteolysis was seen in the XLPE group. Kaplan-Meier survivorship with any revision as the end point shows that the 12-year survival rate was 97.7 % for cups, 93.8 % for PE liners, and 99.2 % for stems. Multivariate analysis revealed that the use of XLPE significantly reduced the risk of revision, with the odds ratio (OR) of 4.3. CONCLUSIONS: AMS and PerFix HA components in this series show excellent implant fixation; however, high rates of PE wear and subsequent osteolysis were limiting factors in long-term success. Low wear rates with XLPE suggest improved implant longevity.. |
| 52. |
Hirata, M., Nakashima, Y., Ohishi, M., Hamai, S., Hara, D., Iwamoto, Y., Surgeon error in performing intraoperative estimation of stem anteversion in cementless total hip arthroplasty, Journal of Arthroplasty, 10.1016/j.arth.2013.03.006, 28, 9, 1648-53, 2013.10, To examine the accuracy of intraoperative estimation of stem anteversion in total hip arthroplasty (THA), we compared the intraoperatively estimated stem anteversion (estimated prosthetic anteversion) to stem anteversion measured by postoperative computed tomography (true anteversion) in 73 hips in 73 patients. Estimated prosthetic anteversion was significantly greater than true anteversion by 5.8°, and the mean absolute value of surgeon error was 7.3° ranging from 11° underestimation to 25° overestimation. Surgeons tended to overestimate when the true anteversion was smaller. A multivariate analysis showed that advanced knee osteoarthritis significantly increased surgeon error. These results indicated that estimated prosthetic anteversion was generally larger than true anteversion and that the grade of knee osteoarthritis affected the degree of surgeon error.. |
| 53. |
Itokawa, T., Nakashima, Y., Yamamoto, T., Motomura, G., Ohishi, M., Hamai, S., Akiyama, M., Hirata, M., Hara, D., Iwamoto, Y., Late dislocation is associated with recurrence after total hip arthroplasty, International Orthopaedics, 10.1007/s00264-013-1921-6, 37, 8, 1457-63, 2013.08, PURPOSE: This study was conducted to examine the risk factors for recurrent dislocation after total hip arthroplasty (THA) and test the hypothesis that late dislocations are associated with recurrence. METHODS: A total of 1,250 hips in 1,017 patients were retrospectively reviewed. All operations were performed through the posterolateral approach with posterior soft tissue repair. An early or late dislocation was defined as a dislocation occurring before or after one year postoperatively, respectively. RESULTS: Dislocation occurred in 36 hips (2.9 %) and 20 of them experienced recurrence. Recurrent dislocations were observed in ten out of 25 hips (40.0 %) with early dislocation; however, ten out of 11 hips (90.9 %) with late dislocation experienced recurrence (p = 0.0046). Multivariate analysis revealed that late dislocation was significantly associated with recurrence with odds ratio of 5.94 per year. Seven in 20 hips with recurrent dislocation required surgical treatment. CONCLUSION: Late dislocation significantly contributed to the development of recurrent dislocations.. |
| 54. |
Hara, D., Nakashima, Y., Yamamoto, T., Higashihara, S., Todo, M., Hirata, M., Akiyama, M., Iwamoto, Y., Late failure of annealed highly cross-linked polyethylene acetabular liner, Journal of the Mechanical Behavior of Biomedical Materials, 10.1016/j.jmbbm.2013.08.003, 28, 206-12, 2013.08, Highly cross-linked polyethylene (HXPE) in total hip arthroplasty (THA) has been shown to significantly decrease wear rates compared with conventional polyethylene (CPE). However, crosslinking, thermal treatment and oxidation can decrease the mechanical properties of PE, and several cases of fracture of remelted HXPE liners were reported. We present, for the first time, unexpected failures of THA with the use of annealed HXPE liners in two patients occurring at 7 and 8 years after operation. Operative findings revealed dislocated liners from the metal shell and a fracture of the superior rim at the rim-dome junction in both liners. Scanning electron microscopy showed that the cracks initiated at the rim and propagated toward the articular surface. Both liners showed generally a low amount of oxidation (less than 1.00) at the articular surface and low wear rates; however, oxidation at the rim was relatively higher (mean 1.55). These findings suggested that decreased mechanical properties at the rim-dome junction due to cross-linking, annealing and oxidation might have been caused breakage of the HXPE liners after a long implantation time, although the annealed HXPE achieved low degree of wear.. |
| 55. |
Neurological Complications after Cervical Spine Surgery. |
| 56. |
Translaminar Approach for Lumbar Disc Herniation : Report of Two Cases. |
| 57. |
Factors for insufficient recovery after microendoscopic lumbar decompression surgery. |
| 58. |
Radiographic Evaluation of Total Knee Arthroplasty with Kirschner Performance Knee. |
