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1.
Yuta Sakemi Keisuke Komiyama Kensei Yoshimoto Kyohei Shiomoto Miho Iwamoto Yasuharu Nakashima 《Journal of orthopaedic science》2019,24(2):269-274
Background
Due to anterior bone defects, high and/or posterior placement of an acetabular cup is often required to achieve sufficient coverage in patients with hip dysplasia. We examined whether posterior cup placement affected the postoperative range of motion (ROM) in primary total hip arthroplasty (THA).Methods
Using computer software, bone coverage and ROM were examined in 32 patients with unilateral osteoarthritis of the hip with Crowe type II or III hip dysplasia. We determined the cup position to satisfy cup center-edge (Cup-CE) angle ≥0° and the required ROM. The cup was placed at the anatomic hip center and moved in 2-mm increments anteroposteriorly and 10-mm increments vertically.Results
At vertical anatomic hip center, less than 68.8% hips fulfilled Cup-CE ≥0° regardless of anteroposterior position. Significantly more hips at higher hip center with posterior cup placement achieved Cup-CE ≥0° than hips at vertical anatomic hip center, and 10 mm higher hip center was the most suitable for achieving bone coverage. However, posterior and superior cup placement significantly decreased the flexion and IR due to early bone impingement, whereas ER and extension were not affected. A smoothing spline curve demonstrated that more posterior cup placement than 4.8 mm and 3.6 mm did not satisfy the required ROM at 10 mm and 20 mm higher hip center, respectively.Conclusions
Posterosuperior cup placement gained more bone coverage but decreased the range of hip flexion and internal rotation. Consequently, posterosuperior cup placement did not satisfy the required ROM. 相似文献2.
Umito Kuwashima Ken Okazaki Kenyu Iwasaki Yukio Akasaki Hideya Kawamura Hideki Mizu-uchi Satoshi Hamai Yasuharu Nakashima 《Journal of orthopaedic science》2019,24(5):855-860
BackgroundFew studies have evaluated the impact of age on patient-reported outcomes in the long-term follow-up after high tibial valgus osteotomy (HTO). The purpose of this study is to assess the association between age at surgery and patient-reported clinical outcomes in the mid-term to long-term follow-up of HTO.Materials and methodsWe mailed the 2011 Knee Society score (KSS) questionnaires to 234 consecutive patients (295 knees) who had undergone closing-wedge HTO, and 158 patients (202 knees, 68.5%) returned a completed questionnaire. The cohort was divided into two groups depending on the age at the time of surgery, and pairs matched the follow-up period and sex was created. The mean follow-up period was approximately 12 years. KSS scores at the final follow-up were compared between two groups using the Student t test and chi-square test, and the survival rates were calculated using Kaplan–Meier survival curves.ResultsThe symptom, satisfaction, and expectation scores were not significantly different between the ≤64-year-old patients and ≥65-year-old patients. The functional activities score was significantly lower in older patients than in younger patients. The overall survival rates of HTO were 99.1 ± 0.4% at 5 years, 94.4 ± 1.2% at 10 years, and 84.6 ± 2.7% at 15 years. There was no significant difference in the survival rate after HTO between the two groups divided by the age (p = 0.602).ConclusionsPain relief and satisfaction after HTO in older patients were comparable to those in younger patients in the mid-term to long-term follow-up, although the functional activity was affected by age. 相似文献
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4.
Yusuke Kohno Yasuharu Nakashima Toshio Kitano Taichi Irie Atsushi Kita Tomoyuki Nakamura Hirosuke Endo Yosuke Fujii Takayuki Kuroda Shigeru Mitani Hiroshi Kitoh Masaki Matsushita Tadashi Hattori Koji Iwata Yukihide Iwamoto 《Journal of orthopaedic science》2017,22(1):112-115
Background
An unstable slipped capital femoral epiphysis (SCFE) is associated with a high rate of avascular necrosis (AVN). The etiology of AVN seems to be multifactorial, although it is not thoroughly known. The aims of our study were to determine the rate of AVN after an unstable SCFE and to investigate the risk factors for AVN, specifically evaluating the notion of an “unsafe window”, during which medical interventions would increase the risk for AVN.Methods
This retrospective multicenter study included 60 patients with an unstable SCFE diagnosed between 1985 and 2014. Timing of surgery was evaluated for three time periods, from acute onset of symptoms to surgery: period I, <24 h; period II, between 24 h and 7 days; and period III, >7 days. Multivariate logistic regression analysis was used to identify risk factors for AVN.Results
Closed reduction and pinning was performed in 43 patients and in situ pinning in 17. Among these cases, 16 patients (27%) developed AVN. The rate of AVN was significantly higher in patients treated by closed reduction and pinning (15/43, 35%) than in those treated by in situ pinning (1/17, 5.9%) (p = 0.022). In patients treated by closed reduction and pinning, the incidence of AVN was 2/11 (18%) in period I, 10/13 (77%) in period II and 3/15 (20%) in period III, showing the significantly higher rate in period II (p = 0.002). The surgery provided in period II was identified as an independent risk factor for the development of AVN.Conclusions
Our rate of AVN was 27% using two classical treatment methods. Time-to-surgery, between 24 h and 7 days, was independently associated with AVN, supporting the possible existence of an “unsafe window” in patients with unstable SCFE treated by closed reduction and pinning. 相似文献5.
Masanori Fujii Tetsuro Nakamura Toshihiko Hara Yasuharu Nakashima 《Journal of orthopaedic science》2017,22(6):1089-1095
Background
We aimed to determine correlations between the hip joint center position and pelvic dimensions and whether the three-dimensional position of the original hip joint center could be estimated from pelvic landmarks in dysplastic and normal hips.Methods
We reviewed the pelvic CT scans of 70 patients (70 hips) with hip dysplasia. Seventy-seven normal hips were used as controls. The hip joint center coordinates (Cx, Cy, and Cz) and pelvic dimensions were measured with reference to the anterior pelvic plane coordinate system. Multiple regression formulas were used to estimate the original hip joint center.Results
The hip center for both dysplastic and normal hip was highly correlated with the distance between the anterior superior iliac spine (ASIS) in the coronal plane (r = 0.76 and 0.84), the distance from the ASIS to the pubic tubercle in the sagittal plane (r = 0.81 and 0.76), and distance from the pubic tubercle to the most posterior point of the ischium on the transverse plane (r = 0.76 and 0.78). The hip joint center could be estimated within a 5-mm error for more than 80% of hips on their respective axes in both dysplastic and normal hips.Conclusions
The three-dimensional position of the original hip joint center was correlated with pelvic dimensions, and can be estimated with substantial accuracy using pelvic landmarks as references. Although these results are preliminary, this estimation method may be useful for surgeons planning total hip arthroplasties. 相似文献6.
Dongmin Xu Hiroshi Koyama Hiroki Furuhashi Shoichi Nishikino Hironobu Hoshino Yukihiro Matsuyama 《Journal of orthopaedic science》2017,22(6):1102-1106
Background
In total hip arthroplasty (THA) surgery, hip muscle preservation is important in strengthening the stability of the hip and improving the activities of the patient. However, whether the type of femoral stem affects the recovery of the hip muscles remains unknown. The aim of this study was to compare the postoperative hip muscle recovery among femoral stem varieties after THA.Methods
The computed tomography (CT) images of 44 patients (44 hips) who underwent THA using an anterolateral approach were reviewed. Twenty-two patients received a fit-and-fill (FF) stem and 22 received the tapered-wedge (TW) stem. The volumes of the gluteus maximus (GMA), gluteus medius (GME), and obturator internus (OI) were measured on three-dimensional models reconstructed using preoperative and 6-month postoperative CT images. Relationships between muscle volume changes and factors including the femoral stem length were evaluated.Results
The GMA and GME volumes increased postoperatively by 8.2% and 8.3%, respectively, in the FF stem group and 7% and 6%, respectively, in the TW stem group, with no group differences. In contrast, the OI volume decreased postoperatively by 17.8% in the FF group and was preserved in TW group (p < 0.001). Moreover, OI volume was decreased in 19 patients (86%) in the FF group and in 11 patients (50%) in the TW group (p = 0.01). The normalized stem length was significantly associated with the postoperative change in OI volume (r = ?0.45, p = 0.002).Conclusions
The TW stem showed a significant advantage over the FF stem in terms of OI preservation. Surgeons should pay close attention during surgery to avoid OI injury when using different femoral stem types. We suggest that a short and reduced lateral shoulder femoral stem is a better choice for the preservation of external rotation muscles. 相似文献7.
Tetsuro Ishimatsu Masatoshi Naito Koichi Kinoshita Satohiro Ishii Takuaki Yamamoto 《Journal of orthopaedic science》2017,22(3):531-535
Background
Curved periacetabular osteotomy (CPO) is one of the joint preserving procedures for developmental dysplasia of the hip. CPO requires osteotomy of the medial wall of the acetabulum, which may cause narrowing of the bony birth canal and this step may result in increased risk of cesarean delivery. We analyzed the narrowest part of the bony birth canal using three-dimensional computed tomography (3D-CT) before and after bilateral CPO.Methods
Between February 2007 and March 2014, there were 29 cases of bilateral CPO in which both pre- and post-operative 3D-CT were available. Transverse diameters of the pelvic inlet, contraction, outlet, expansion, and teardrop were analyzed. Among them, the narrowest part of the bony birth canal was investigated, which being smaller than the normal lower threshold value for vaginal delivery (95 mm) was considered as a risk for cesarean delivery.Results
The transverse diameters of both pelvic expansion and teardrop significantly decreased after CPO (both p < 0.01), while other diameters showed no significant changes. Among these two diameters, the narrowest diameter of the bony birth canal was the pelvic teardrop in all 29 cases. That in 24 patients (82.8%) was greater than 95 mm, while that in five patients (17.2%) showed less than 95 mm.Conclusions
Based on 3D-CT analysis, the narrowest part of the bony birth canal after bilateral CPO was the pelvic teardrop. In this study, 82.8% of the patients showed pelvic teardrop diameter greater than 95 mm, while that of the other patients (17.2%) were less than 95 mm. 相似文献8.
Norio Imai Ryota Takubo Hayato Suzuki Hayato Shimada Dai Miyasaka Kazuki Tsuchiya Naoto Endo 《Journal of orthopaedic science》2019,24(3):482-487
BackgroundIn obese patients, malpositioning of the acetabular cup increases the risk of dislocation in total hip arthroplasty (THA). The aim of this study was to determine whether obesity affects the accuracy of acetabular cup positioning using a computed tomography (CT)-based navigation system.MethodsWe retrospectively evaluated 226 consecutive patients who underwent cementless primary THAs assisted by the CT-based hip navigation system. We divided the patients into three groups according to body mass index (BMI) and examined the difference between preoperative planning and postoperative implantation angles from CT data.ResultsThere was no significant correlation between BMI and both inclination and anteversion differences (R = 0.028 and R = 0.045, respectively). There were no significant differences among the BMI < 25, 25 ≦ BMI < 30, and BMI ≧ 30 groups (p value: 0.725, 0.934, respectively); between the BMI < 25 and BMI ≧ 25 groups (p value: 0.542, 0.697, respectively); and between the BMI < 30 and BMI ≧ 30 groups with regard to inclination and anteversion (p value: 0.859, 0.456, respectively). Moreover, similar findings were observed with regard to the distance between the preoperative planning and postoperative cup positioning for the transverse, anteroposterior, and craniocaudal axes of the pelvis.ConclusionWe found that the accuracy of acetabular cup placement using CT based-navigation in THA was not affected in obese patients. Therefore, THAs with a CT-based navigation system are considered useful in obese patients. 相似文献
9.
Takayuki Nakajima Seiji Ohtori Junichi Nakamura Takane Suzuki Yasuchika Aoki Atsuya Watanabe Makoto Takazawa Kazuhisa Takahashi 《Journal of orthopaedic science》2017,22(2):325-329
Background
Hip pain is transmitted to the dorsal horn of the spinal cord via the dorsal root ganglion (DRG), which contains two types of neurons with differential sensitivity to neurotrophic factors. If either type predominantly innervates the hip joint, it may represent a good target for hip joint pain treatment.Methods
Inflammation was induced in the left hip joint of rats (n = 10) by using complete Freund's adjuvant. Fluoro-Gold (FG) was applied to the hip joint after 7 days, and T12–L6 DRGs were double-stained for calcitonin gene-related peptide (CGRP) and isolection-IB4 1 week later.Results
FG-labeled neurons in the control group were distributed throughout the left DRG from T13 to L5, primarily in L2 to L4, and CGRP-positive neurons were significantly more frequent than IB4-binding neurons. In the inflammatory group, FG-labeled neurons were similarly distributed, primarily at L3 and L4, and CGRP-positive neurons were significantly more frequent than IB4-binding neurons. The percentage of CGRP-positive neurons was significantly greater in the inflammatory group (P < 0.05).Conclusions
Most small neurons innervating the hip joint express CGRP. Furthermore, hip joint inflammation caused an increase in CGRP-positive neurons, but not in IB4-binding neurons. Our results suggest that CGRP-expressing nerve growth factor-dependent neurons are primarily responsible for hip joint pain and may represent therapeutic targets. 相似文献10.
Satoshi Ikebe Motoki Sonohata Masaru Kitajima Shunsuke Kawano Masaaki Mawatari 《Journal of orthopaedic science》2018,23(3):532-537
Background
Complications associated with re-implantation of total hip arthroplasty (THA) after resection arthroplasty for the treatment of primary septic hip arthritis or infected THA and bipolar hemiarthroplasty (BHA) are not well-documented. Furthermore, no comparison has been made between septic arthritis (SA) and infected THA and BHA. We divided subjects into two groups for evaluation: a SA group and an infected THA or BHA group.Methods
Nineteen hips in 19 patients (12 in the SA group, 7 in the infected THA or BHA group) with an average of 77 months of follow-up from the time of re-implantation THA were retrospectively evaluated.Results
The average Japanese Orthopaedic Association hip score improved from 50 points (range, 30 to 73 points) preoperatively to 80 points (range: 64 to 96 points) at the time of the final follow-up (p < 0.01). Intra- and postoperative complications occurred in 11 cases, including intraoperative fracture in 1 hip, deep infection in 6 hips, dislocation in 7 hips, and septic loosening of acetabular component in 2 hips. Following re-implantation, further surgical revision was required in four cases. Two revisions were performed for recurrent infection: one patient had recurrent dislocation of one hip, and one patient had recurrent infection and dislocation. The number of hips with relapsed infection in the infected THA or BHA group (5 hips) was significantly higher than that in the SA group (1 hip) (p < 0.05).Conclusions
Re-implantation after septic hip arthritis or infected THA or BHA was an effective treatment for improving the activity of daily life, especially the gait function. Furthermore, 94.7% of patients were free of infection at the latest follow-up. However, the rate of recurrence of infection was 31.6%, and re-implantation after resection arthroplasty following infected THA or BHA led to a lower rate of infection control than that after primary SA. 相似文献11.
Masayuki Miyagi Hisako Fujimaki Kouji Naruse Kaori Suto Gen Inoue Toshiyuki Nakazawa Takayuki Imura Wataru Saito Kentaro Uchida Eiki Shirasawa Naonobu Takahira Masashi Takaso 《Journal of orthopaedic science》2019,24(1):153-158
Background
It has been reported that switching from daily (d) teriparatide (TPTD) to denosumab (DMAb) is effective for severe osteoporosis patients. However, there have been no reports about switching from weekly (w) TPTD to DMAb in patients with osteoporosis. Once-weekly 56.5-μg TPTD treatment increases bone mineral density (BMD) and reduces fracture events. The objective of the current retrospective study was to elucidate the impact of switching w-TPTD to DMAb in patients with osteoporosis.Methods
In this study, 40 patients were treated with w-TPTD for 18 months and then switched to DMAb for 18 months. The sample included 2 men and 38 women with a mean age of 74.5 (60–85) years. Twenty-five subjects had primary osteoporosis, and 15 had secondary osteoporosis. The mean number of osteoporotic vertebral fractures was 4.1. Serum bone turnover markers and BMD were evaluated every 6 months.Results
Bone alkaline phosphatase (BAP) and tartrate resistant acid phosphatase 5b (TRACP5b), markers of bone formation and resorption respectively, were not significantly different in w-TPTD subjects at 18 months compared with those at baseline (p > 0.05), but BAP and TRACP5b in subjects treated with DMAb were significantly lower at 36 months compared with those at baseline (p < 0.05). BMD of the lumbar spine (LS), femoral neck (FN), and total hip (TH) increased by 12.3%, 2.5%, and 2.2% by 36 months with DMAb treatment, significantly higher than at baseline (p < 0.05). Changes in BMD of FN and TH in primary osteoporosis patients were significantly higher than in secondary osteoporosis patients at 18 months (w-TPTD) and 36 months (DMAb, p < 0.05).Conclusion
BMD significantly increased in osteoporosis patients switched from w-TPTD to DMAb. However, the impact of switching from w-TPTD to DMAb in secondary osteoporosis patients was not as great as in primary osteoporosis patients at the view points of changes in BMD of FN and TH. 相似文献12.
Toru Yoshioka Nobukazu Okimoto Yoshifumi Fuse Makoto Kawasaki Toshiharu Mori Akinori Sakai Tokifumi Majima 《Journal of orthopaedic science》2018,23(2):371-376
Background
We hypothesized that ceramic bipolar shows less impingement between stem neck and outer head compared to metal bipolar, because of its low coefficient of friction with the acetabulum cartilage. In this paper, a three dimensional (3D) postoperative motion analysis has been used to assess the different motion characteristics of metal and ceramic bipolar hip hemiarthroplasty systems.Methods
This study was conducted on 40 patients divided in two matched cohorts: 20 patients with metal bipolar and 20 patients with the ceramic bipolar. We obtained motion pictures from standing position to maximum abduction in flexion by fluoroscopy then analyzed by 2D-3D image matching method. The motion range of the “Outer head angle”, “Stem neck angle” and the “Stem neck and outer head angle” was compared between the metal bipolar group and the ceramic bipolar group.Results
The metal bipolar group's inner head's range of movement was greater than the ceramic bipolar group. Impingement between stem neck and outer head occurred in 30% of metal group patients. There were no impingement cases for the ceramic bipolar group.Conclusions
The ceramic bipolar shows less impingement between stem neck and outer head compared to the metal bipolar. Ceramic bipolar may reduce the typical bipolar related complication and exert less effect on the acetabular cartilage due to less surface coefficient of friction. 相似文献13.
Tadashi Hattori Yutaka Inaba Sadafumi Ichinohe Toshio Kitano Daisuke Kobayashi Takashi Saisu Toshifumi Ozaki 《Journal of orthopaedic science》2017,22(1):121-126
Background
It has been reported that the national incidence of developmental dysplasia of the hip (DDH) has decreased in Japan. This is because of prevention activities after birth since around 1970. However, cases of late-diagnosed DDH have still been noted in some children's hospitals. There has been no recent survey of DDH in Japan. The purpose of this study was to investigate the current epidemiology of DDH using a comprehensive nationwide survey.Methods
A questionnaire was sent to orthopedic surgeons in 1987 facilities nationwide, who were asked to complete and return a survey card on each DDH patient treated between April 2011 and March 2013.Results
A total of 783 (39%) facilities completed and returned the card. Of these, 79% reported no cases of DDH-related dislocation over the 2-year period, while the remaining facilities reported 1295 cases. The characteristics of children diagnosed with DDH-related dislocation were as follows: girls (89%), left side involvement (69%), bilateral involvement (4%), positive family history (27%), first-born (56%), and pelvic position at birth (15%). Seasonal variation showed an increase in DDH incidence among those born in the winter. Overall, 199 cases (15%) were diagnosed at >1 year of age, and these included 36 cases diagnosed very late, at >3 years of age. The majority of the 199 cases of late diagnosis had received earlier routine screening at <1 year of age.Conclusion
The characteristics of the children diagnosed with DDH nationwide were similar to past data from local regions. However, many children were diagnosed late (>1 year of age), particularly in the more populous regions. The findings identify a need for improved early routine screening for DDH in Japan. 相似文献14.
So Minokawa Ichiro Yoshimura Kazuki Kanazawa Tomonobu Hagio Takuaki Yamamoto 《Journal of orthopaedic science》2019,24(4):693-696
BackgroundDistal first metatarsal osteotomy is an option for operative treatment of mild to severe hallux valgus (HV) deformities. Minimally invasive distal linear metatarsal osteotomy (DLMO) provides good outcomes without avascular necrosis (AVN) of the metatarsal head. However, no reports have described the in vivo blood flow changes in the metatarsal head after osteotomy. This study was performed to evaluate the in vivo blood flow of the pre- and post-osteotomy metatarsal head in patients with HV using laser Doppler flowmetry and thus clarify the effect of minimally invasive distal first metatarsal osteotomy on the change in blood flow.MethodsFrom April 2015 to October 2016, DLMO was performed on 13 feet with HV in 10 patients (2 men, 8 women). Blood flow measurements of the pre- and post-osteotomy first metatarsal head in all feet were performed by laser Doppler flowmetry. AVN was evaluated using plain radiographs at the final postoperative follow-up.ResultsThe median pre- and post-osteotomy blood flow was 1.5 (0.97–1.95) and 1.46 (0.98–1.77) ml/min/100 g, respectively (median change in blood flow, 0.00; 95% CI, ?0.23–0.13; P = 0.72). The rate of change in the blood flow was 0.0% (95% CI, ?11.9%–8.7%; range, ?28.6%–64.7%), and only three patients (23.1%) showed a decrease of ≥10%. The median pre- and post-osteotomy systolic blood pressure was 90 (84.5–97) and 93 (84.5–95) mmHg, respectively (median change in blood pressure, 0.00; 95% CI, ?3.0–2.0; P = 0.82). The rate of change in the systolic blood pressure was 0.0% (95% CI, ?3.1%–2.2%; range, ?9.1%–24.0%). No radiographic evidence of AVN was present at the final follow-up.ConclusionsNo significant difference was found in the rate of change in blood flow pre- and post-osteotomy, suggesting that minimally invasive distal first metatarsal osteotomy does not influence blood flow of the metatarsal head. 相似文献
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Kenichi Oe Hirokazu Iida Fumito Kobayashi Narumi Ueda Tomohisa Nakamura Naofumi Okamoto Takanori Saito 《Journal of orthopaedic science》2018,23(6):992-999
Background
The optimum approach in total hip arthroplasty (THA) should reduce the risk of postoperative dislocation or limping, be applicable in every case, and be reusable in the future. The purpose of this study was to introduce our transgluteal approach for THA and to evaluate the type and frequency of complications around the greater trochanter.Methods
This study retrospectively evaluated 892 THA cases between January 2010 and March 2015 performed using our transgluteal approach that osteotomized only the lateral anteroinferior greater trochanter. The trochanteric fragment was reattached using one of three different protocols: Group A, three non-absorbable polyester sutures; Group B, two non-absorbable polyester sutures and one ultra-high molecular weight polyethylene (UHMWPE) fiber cable; or Group C, two UHMWPE fiber cables. Postoperative complications were assessed and recorded, and univariate logistic regression analyses were performed to determine whether risk factors and radiological complications around the greater trochanter were correlated.Results
None of the hips required revision for infection, dislocation, or limping. The rate of radiological complications around the greater trochanter at 1 year was 19.2% in Group A, 16.3% in Group B, and 7.9% in Group C (p < 0.001). Risk factors for radiological complications included the patient's disease or the surgeon's experience in Group A and the patient's age or the surgeon's experience in Group C. In the relationship between postoperative pain around the greater trochanter and radiological complications, there were no significant differences in all groups; no group interaction was observed (p= 0.3875).Conclusion
The UHMWPE fiber cable was effective to reduce complications of the reattached osteotomized greater trochanter in THA. 相似文献17.
Takaaki Ohmori Tamon Kabata Yoshitomo Kajino Daisuke Inoue Tadashi Taga Takashi Yamamoto Tomoharu Takagi Junya Yoshitani Takuro Ueno Ken Ueoka Hiroyuki Tsuchiya 《Journal of orthopaedic science》2019,24(3):474-481
BackgroundThere have been no studies on the differences in impingement-free angle that result from different combined anteversion (CA) patterns. The aim of this study was to find the optimal CA pattern for achieving a favorable impingement-free angle, including bony and prosthetic impingement, in total hip arthroplasty.MethodsWe evaluated 100 patients with no hip arthritis. We investigated the impingement-free angle (flexion, internal rotation with 90° flexion, extension, and external rotation) after changing the stem and cup anteversions to satisfy several CA patterns [cup anteversion + stem anteversion = 30°, 40°, 50°, and 60°; cup anteversion + 0.7 × stem anteversion = 37.3° (:Widmer's theory); and cup anteversion + 0.77 × stem anteversion = 43.3° (:Yoshimine's theory)] using 3-dimensional templating software.ResultsThe impingement-free angle changed dramatically among the various CA patterns. The optimal CA was changed by various stem anteversion. Only CA: Widmer with stem anteversion of 20° satisfied daily-life range of motion (ROM) requirements (flexion ≥130°, internal rotation with 90° flexion ≥ 45°, extension ≥ 40°, external rotation ≥ 40°).ConclusionGood impingement-free angle cannot be obtained with single fixed CA. Different CA patterns should be used, depending on the differences in the stem anteversion. A CA of 30° with 0° ≤ stem anteversion ≤10°; a CA:Widmer with 20° of stem anteversion; a CA of 40° or Widmer with 30° of stem anteversion. When stem anteversion is ≥40°, CA should be decided by each patient's state. Among them, a stem anteversion of 20° with cup anteversion of 23.3° was found to be the best CA pattern. 相似文献
18.
Taiki Murakami Makoto Enokida Kei Kawaguchi Ryoji Otsuki Hideki Nagashima 《Journal of orthopaedic science》2017,22(2):318-324
Objective
Medial radial displacement (MRD) of the medial meniscus is a feature proving a dysfunction in the medial meniscus in osteoarthritis (OA) of the knee. MRD was measured in radiographic pre-OA knee and early osteoarthritis of the knee (early-OA) longitudinally using ultrasound (US) to investigate the characteristics involved in the onset and progression of OA.Methods
Fifty-five patients with pain on the medial side of the knee participated in the present study. It was possible to follow-up 46 patients for 5 years, and, thus, they were divided into 32 pre-OA patients (female: 59%, mean age: 69.0 years) and 14 early-OA patients (female: 78%, mean age: 74.4 years) based on radiography at the baseline time-point. MRD was measured in standing and supine positions at baseline and after 1 and 5 years using US. MRD corrected with the skeletal size, i.e., the medial displacement index (MDI), was analyzed. The pre- and early-OA groups were divided into subgroups at 5 years: stable and OA progression groups, following the Kellgren/Lawrence classification, and ⊿MDI (gap of the MDI between the standing and supine positions) were retrospectively compared between the subgroups at baseline, 1 and 5 years.Results
In the overall pre-OA group, MDI increased by 7% and 10% at 5 years in the supine and standing position, showing a significant increase (P = 0.044, 0.0147). ⊿MDI was significantly greater in the subgroup with OA progression in the pre- and early-OA groups (P = 0.02 and 0.03, respectively), and was continuously 6–7% in the pre-OA progression group, showing that the displacement rate was 2-fold or higher than in the stable group.Conclusion
An increase in ⊿MDI on US may be an important risk factor for the disease stage progression of OA and useful as a feature predicting the onset of radiographic knee OA. 相似文献19.
Shunsuke Fujibayashi Bungo Otsuki Hiroaki Kimura Shimei Tanida Kazutaka Masamoto Shuichi Matsuda 《Journal of orthopaedic science》2017,22(3):420-424
Background
Performing the minimally invasive lateral lumbar interbody fusion (LIF), such as the extreme lateral interbody fusion (XLIF) and oblique lateral interbody fusion (OLIF), through a retroperitoneal approach has become increasingly popular. Although urological injury is a major complication of LIF, the anatomical location of the ureter and its risk of injury have not been assessed. The purpose of this study was to evaluate the efficacy of dual-phase contrast-enhanced computed tomography for assessing the location of the ureter and risk of its injury in consecutive LIF cases.Methods
27 cases (12 men and 15 women) were enrolled in the study. Dual-phase contrast-enhanced CT was performed preoperatively, and the risk of ureteral injury was assessed. The location of the ureter was classified using the psoas muscle and vertebral body as reference structures for OLIF and XLIF procedures, respectively. During the OLIF procedures, the location of the ureter was additionally assessed with direct vision and manual palpation in all cases. Simultaneously, potential vascular anomalies were assessed with both 3D and axial images of CT.Results
A total of 125 among 162 ureters, excluding 13 with insufficient enhancement and 24 (44.4%) within the kidney at the L2–L3 level, were assessed preoperatively; 113 ureters (90.4%) were classified as anatomically close to the surgical corridor for OLIF, and 20 ureters (16.0%) as having a potential risk of injury during XLIF. In one case, OLIF was converted to a conventional posterior procedure because of a vascular anomaly. Intraoperative findings showed that ureters moved anteriorly with the peritoneum in all cases, as assessed by manual palpation under direct vision.Conclusions
Dual-phase contrast-enhanced CT is useful in assessing the location of the ureter, kidney, and vascular structures simultaneously. Both OLIF and XLIF have a potential risk of urological injury. 相似文献20.
Atsunori Murase Masahiro Nozaki Masaaki Kobayashi Hideyuki Goto Masahito Yoshida Sanshiro Yasuma Tetsuya Takenaga Yuko Nagaya Jun Mizutani Hideki Okamoto Hirotaka Iguchi Takanobu Otsuka 《Journal of orthopaedic science》2017,22(5):874-879