Satoshi Iida

Osteonecrosis Of The Femoral Head: A Prospective Study With MRI

We performed a prospective study using MRI to evaluate early necrosis of the femoral head in 48 patients receiving high-dose corticosteroids for the treatment of various autoimmune-related disorders. The mean interval from the initiation of corticosteroid therapy to the first MRI examination was 2 months (0.5 to 6). MRI was repeated, and the mean period of follow-up was 31 months (24 to 69). Abnormalities were found on MRI in 31 hips (32%). The initial changes showed well-demarcated, band-like zones which were seen at a mean of 3.6 months after initiation of treatment with steroids. In 14 of these hips (45%) there was a spontaneous reduction in the size of the lesions about one year after treatment had started, but there was no further change in size with a longer follow-up.

Hip dysfunction-related urinary incontinence: a prospective analysis of 189 female patients undergoing total hip arthroplasty.

Patients reporting that their symptoms of urinary incontinence have decreased after total hip arthroplasty can be encountered in orthopedic practice. In this questionnaire‐based study, we prospectively evaluated the symptoms of urinary incontinence before and after total hip arthroplasty. The International Consultation on Incontinence Questionnaire‐Short Form was used to prospectively evaluate these symptoms in 189 consecutive female patients undergoing total hip arthroplasty. The patients were asked to fill in a questionnaire before and 3 months after surgery. A decrease in the International Consultation on Incontinence Questionnaire‐Short Form score of ≥1 point was defined as an improvement, whereas an increase of ≥1 point was defined as worsening. A total of 81 (43%) patients reported urinary incontinence before total hip arthroplasty. At 3 months after surgery, symptoms of urinary incontinence were improved in 64% of these patients, remained unchanged in 32% and worsened in 4%. Mean International Consultation on Incontinence Questionnaire‐Short Form score in patients with urinary incontinence before surgery significantly improved from 6.0 to 3.5 (P = 0.0002). These findings suggest a relationship between hip joint function and pelvic floor function, and consequently a hip dysfunction‐related urinary incontinence.

An anatomic study of the impressions on the greater trochanter: bony geometry indicates the alignment of the short external rotator muscles.

In this study, 44 hip regions from 25 embalmed cadavers were dissected to identify the bony landmarks on the greater trochanter, which indicate the individual short external rotator muscle insertions. Micro-computed tomography (micro-CT) images were obtained to identify the bony impressions on the greater trochanter. Then, the soft tissues were removed and their insertions were identified to assess correlation with micro-CT images. Bony landmarks indicating the insertions and the running course of the piriformis muscle, the obturator internus muscle, and the obturator externus muscle were identified on the greater trochanter in all specimens. These findings could be helpful for preserving muscles during capsular release in the anterior approach because the alignment of the short external rotator muscles can be estimated preoperatively using CT images.

OSTEONECROSIS OF THE FEMORAL HEAD

We performed a prospective study using MRI to evaluate early necrosis of the femoral head in 48 patients receiving high-dose corticosteroids for the treatment of various autoimmune-related disorders. The mean interval from the initiation of corticosteroid therapy to the first MRI examination was 2 months (0.5 to 6). MRI was repeated, and the mean period of follow-up was 31 months (24 to 69).Abnormalities were found on MRI in 31 hips (32%). The initial changes showed well-demarcated, band-like zones which were seen at a mean of 3.6 months after initiation of treatment with steroids. In 14 of these hips (45%) there was a spontaneous reduction in the size of the lesions about one year after treatment had started, but there was no further change in size with a longer follow-up.

The influence of bone cement and American Society of Anesthesiologists (ASA) class on cardiovascular status during bipolar hemiarthroplasty for displaced femoral-neck fracture: A multicenter, prospective, case-control study

BACKGROUND Little is known about how bone cement and American Society of Anesthesiologists (ASA) classification influence the cardiovascular system in elderly patients with femoral-neck fractures treated with cemented hemiarthroplasty. Therefore, we performed a case-control study to investigate these questions and compared the following:≥ASA III with≤ASA II patients who underwent cemented hemiarthroplasty; and cemented with cementless hemiarthroplasty in≥ASA III patients. HYPOTHESIS ASA classification influences the cardiovascular system during cemented hemiarthroplasty and bone cement influences intraoperative blood pressure [IBP] in patients rated≥ASA III. MATERIALS AND METHODS This multicenter, prospective study included patients with acute displaced femoral-neck fractures. Baseline data, medical history, anesthesia, FiO2, vasopressor use, femoral component, IBP, SpO2, and complications were evaluated. Of 200 patients, 100 were cemented (mean age, 77±10 years), and 100 were cementless (mean age, 78±9 years). Cemented hemiarthroplasty employed a third-generation technique (plugging, irrigating, drying and filling the canal with cement under pressurization). RESULTS Systolic blood pressure (SBP) decreased significantly during cementing, versus pre-rasping in≤ASA II patients (from 117.9±24.5 [range, 65-199] to 106.9±20.3 [range, 59-172]; p=0.007), in≥ASA III patients (from 129.5±21.0 [range, 90-169] to 110.4±17.9 [range, 79-157]; p=0.006), and post-stem-insertion, versus pre-rasping in≤ASA II patients (from 117.9±24.5 [range, 65-199] to 103.9±20.7 [range, 53-178]; p=0.0004), and in≥ASA III patients (from 129.5±21.0 [range, 90-169] to 111.2±24.6 [range, 70-156]; p=0.009). In≥ASA III patients, SBP decreased significantly during cementing or rasping, versus pre-rasping in cemented patients (from 129.5±21.0 [range, 90-169] to 110.4±17.9 [range, 79-157]; p=0.006), in cementless patients (from 115.0±17.7 [range, 85-150] to 100.7±15.7 [range, 75-142]; p=0.004), and post-stem-insertion, versus pre-rasping in cemented patients (from 129.5±21.0 [range, 90-169] to 111.2±SD [range]; p=0.009), and in cementless patients (from 115.0±17.7 [range, 85-150] to 89.4±17.5 [range, 58-140]; p<0.0001). There were no lethal complications. CONCLUSIONS This study indicate a similar hemodynamic change intraoperatively between≤ASA II patients and≥ASA III patients in the cemented group, and between patients with cemented and cementless hemiarthroplasty in the≥ASA III patients. With modern hemiarthroplasty techniques, bone cement might be as safe as cementless techniques in elderly,≥ASA III patients. LEVEL OF EVIDENCE III, multicenter case-control cohort study.

Advantages and Limitations of Shelf Acetabuloplasty for Dysplastic Osteoarthritis of the Hip

We retrospectively reviewed 47 hips with symptomatic acetabular dysplasia treated with shelf acetabuloplasty. The mean follow-up period was 17 years with a minimum of 5 years. Ten hips (21%) had been converted to total hip arthroplasty (THA) at a mean of 18.2 years. Survival analysis using conversion to THA as an endpoint showed survival rate of 97.8% at 10 years and 78% at 20 years. Forty hips without preoperative joint space narrowing had a survival rate of 90% at 20 years postoperatively. This was significantly higher (p < 0.01) than that of seven hips with joint space narrowing, which was 29% at 20 years. In 27 hips from patients aged <35 years at operation, the survival rate was 95% at 20 years. This was significantly higher (p = 0.00761) than the survival rate of 55% at 20 years in 20 hips from patients aged ≥35 years.

Spinopelvic Alignment and Low Back Pain after Total Hip Replacement Arthroplasty in Patients with Severe Hip Osteoarthritis

Study Design Retrospective observational study. Purpose We examined change in lumbrosacral spine alignment and low back pain (LBP) following total hip arthroplasty (THA) in patients with severe hip osteoarthritis (OA). Overview of Literature Severe hip osteoarthritis has been reported to cause spine alignment abnormalities and low back pain, and it has been reported that low back pain is improved following THA. Methods Our target population included 30 patients (29 female, mean age 63.5 years) with hip OA who underwent direct anterior approach THA. There were 12 cases with bilateral hip disease and 18 cases with unilateral osteoarthritis. Visual analogue scale (VAS) scores for LBP and coxalgia, the Roland-Morris Disability Questionnaire (RDQ), and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were assessed before and after surgery. Spinal alignment metrics were measured before and after surgery. Results VAS for LBP change from preoperative to final postoperative observation was significantly improved (p <0.05), as was VAS for hip pain (p<0.001). RDQ improved significantly (p<0.01). All five domains of JOABPEQ were significantly improved (p<0.05). In terms of coronal alignment, lumbar scoliosis change from preoperative to last observation was significantly reduced (p<0.05). There were no significant changes in the sagittal alignment metrics. In addition, there was a correlation between before and after RDQ difference and before and after lumbar scoliosis difference (p<0.05). VAS for LBP (p<0.05) as well as RDQ (p<0.05) were significantly improved only in unilateral OA. Lumbar scoliosis was significantly improved in cases of unilateral OA (p<0.05), but alignment did not improve in cases of bilateral OA (p=0.29). Conclusions The present study demonstrates improvements in VAS for LBP, RDQ, and all domains of JOABPEQ. There were also significant reductions in lumbar scoliosis and an observed correlation of RDQ improvement with lumbar scoliosis improvement. We were able to observe improvements in lumbar scoliosis and low back pain only in cases of unilateral OA. It has been suggested that the mechanism of low back pain improvement following THA is related to compensatory lumbar scoliosis improvement.

Femoral Varus Osteotomy for Hip Instability after Traumatic Fracture Dislocations of the Hip Associated with Femoral Head Fractures: A Report of Two Cases.

Fracture of the femoral head and the acetabulum with traumatic dislocation of the hip is a severe injury representing various types and unfavorable outcome. We showed a 45-year-old man with Pipkin type-IV fracture and coxa valga. An immediate closed reduction was achieved followed by open reduction and internal fixation via a posterior approach 6 days later. However, dislocation occurred three times without traumatic events after three weeks. CT demonstrated no displacement of posterior fragments or implant failure. Femoral intertrochanteric varus osteotomy was performed to gain concentric stability and successfully resolved recurrent dislocation. Another 45-year-old woman with Pipkin type-IV fracture and coxa valga also underwent closed reduction initially and then continued conservative treatment. After eight weeks, when she started gait training, progressive pain became symptomatic. Persistent hip pain at weight bearing was not improved in spite of arthroscopic synovectomy and osteochondroplasty. Two years after injury, femoral intertrochanteric varus osteotomy was indicated and her refractory pain was resolved gradually. We suggest that femoral varus osteotomy should be considered for superolateral subluxation associated fracture dislocation of the hip in Pipkin type-IV and coxa valga.

In Situ Pinning for Slipped Capital Femoral Epiphysis

We reviewed retrospectively 28 hips of 25 patients (22 boys and 3 girls) after in situ pinning for slipped capital femoral epiphysis. The mean follow-up period was 5 years (range, 1.5–17). The mean age at surgery was 12.1 years (range, 10–14). Twenty-four hips were stable slips and 4 hips were unstable. Fourteen hips were mild slips (lateral head-shaft angle less than 30°), 10 hips were moderate (30°–59°), and 4 hips were severe (60° or greater). All patients had no hip pain at the latest follow-up; however, the range of internal rotation was mildly limited in 11 hips. Osteonecrosis and chondrolysis were not detected radiographically. Remodeling occurred in 21 of 23 hips (91%) and was not dependent on the degree of slip. The mean period from surgery to physeal closure was 16.1 months (range, 3–57). Progressive slippage occurred in 1 patient after pinning with a single screw. The patient (an 11-year-old boy with a mild chronic slip) started to do hard activities before the physeal closure, and an additional surgery was performed 29 months after the initial pinning. Moderate and severe slips can be treated by in situ pinning; however, careful postoperative management will be required.