Taiki Kanno

Spinopelvic alignment in patients with osteoarthrosis of the hip: a radiographic comparison to patients with low back pain.

Study Design. A retrospective, age- and sex-matched radiographic study. Objectives. To investigate the spinopelvic alignment in patients with osteoarthosis of the hip (HOA) and those with low back pain (LBP) and to determine the characteristics and differences in both groups. Summary of Background Data. Hip-spine syndrome, first described by Offierski and MacNab, is quite an important pathology when treating patients with pain in their low back and lower extremities. However, despite it being a well-known entity, few papers have adequately investigated and assessed the spinopelvic alignment in patients with hip-spine syndrome. Methods. Sagittal and coronal spinopelvic alignments were investigated in 150 patients with HOA and 150 with LBP using radiographs of the whole spine in both anteroposterior and lateral views. Parameters measured in this study were lumbar lordosis (LL), sacral slope (SS), the shift of the sagittal C7 plumb line, pelvic incidence (PI), and pelvic tilt (PT) on the lateral radiographs. On the anteroposterior (AP) films, lumbar scoliosis, pelvic obliquity, leg length discrepancy, the shift of the coronal C7 plumb line, and Sharp angle were measured. These parameters were compared between the two groups. In patients with HOA, the relationships between Sharp angle and other parameters were also analyzed to clarify the possible influence of sagittal and coronal spinopelvic alignments on HOA without acetabular dysplasia. Results. LL, SS, PI, and PO were found to be less in patients with LBP compared with those with HOA, and there was no significant difference in LS between the two groups. PI was significantly greater in HOA patients and strongly correlated to PT, SS, and LL (i.e., as the PI increased so did the PT, SS, and LL). Sharp angles were also significantly greater in HOA patients and strongly correlated to age, LL and SS (i.e., as Sharp angles increased so did LL and SS); however, age decreased in the hip patients. Conclusions. These findings suggest that higher PI in the younger individual may contribute to the development of HOA in later life without both lumbar kyphosis and acetabular dysplasia because of the anterior uncovering of the acetabulum. More investigation will be expected to analyze the spinopelvic alignment in patients with hip spine syndrome.

Results of transtrochanteric rotational osteotomy for nontraumatic osteonecrosis of the femoral head

From 1976 to 1985, transtrochanteric rotational osteotomy was applied to 58 hips of nontraumatic necrosis of the femoral head. Of these, 52 hips were available for the present study. The follow-up periods ranged from one to ten years (average, 5.1 years). Satisfactory results were obtained in 69%, as there was no evidence of progressive collapse of the head. Hips that had had no collapse or slight collapse before osteotomy had a significantly better prognosis, compared with those that had marked collapse of the head. The extent of the lesion as depicted on the preoperative lateral roentgenogram also influenced the eventual function. Patient satisfaction was significantly greater when these lesions were less than 70% (31/37), compared with greater than 70% (5/15).

Leg Length Change in Total Hip Arthroplasty With Subtrochanteric Femoral Shortening Osteotomy for Crowe Type IV Developmental Hip Dysplasia

Primary total hip arthroplasties were performed in 70 hips for the treatment of Crowe type IV developmental dysplasia of the hip. The patients were subdivided into 2 groups with or without iliofemoral osteoarthritis. Leg length change was measured radiographically. Preoperative hip motion was reviewed from medical records and defined as either higher or lower motion groups. The leg length change in patients without iliofemoral osteoarthritis was significantly greater than that in patients with iliofemoral osteoarthritis, and the higher hip motion group had greater leg length change in total hip arthroplasty than the lower motion group. The current study identifies several features that might help predict leg length change during the preoperative planning of total hip arthroplasty for Crowe type IV developmental hip dysplasia.

Computed tomographic measurement of acetabular and femoral component version in total hip arthroplasty

PurposeThe purposes of the present study were (1) to investigate the variation and accuracy of both acetabular and femoral component version on the axial computed tomographic (CT) images, and (2) to better define the associations between the components version and clinical factors.MethodsWe investigated acetabular and femoral component orientation in 1,411 primary total hip arthroplasties that had been performed without computer-assisted navigation. Version of the acetabular and femoral components was measured on the axial CT images.ResultsThe component version was significantly greater than the native version in both acetabular and femoral version. There was a significant correlation between the stem and native femoral versions, but not between the acetabular component and native acetabular versions.ConclusionThis study identifies several features that might help analyse the effect of pre-operative native acetabular and femoral version on the variation of component alignment.

Anterior knee pain after total hip arthroplasty in developmental dysplasia.

Little has been reported on knee pain after total hip arthroplasty (THA). The purpose of this study was to investigate the incidence and mechanism of knee pain after THA. Two hundred fifty-two patients with hip dysplasia were clinically and radiographically assessed for knee pain before and after THA. Incidences of knee pain and patellofemoral alignment were analyzed with reference to postoperative change in leg length, femoral anteversion, and the femoral offset. Anterior knee pain was present in 16 patients (7.3%). Lateral patellar tilt was increased in all patients with knee pain and significantly larger compared to that seen in patients without knee pain. The increased patellar tilt disappeared within 3 months, but symptoms in 4 patients persisted for more than 3 months. The patellar tilt was significantly related to the amount of leg lengthening. This study demonstrates that THA influences the patellofemoral joint via leg lengthening and causes anterior knee pain.

Reliability of measurements of hip abduction strength obtained with a hand-held dynamometer

Abstract This study aimed to evaluate intrarater and interrater reliability when measuring hip abductor strength in the supine position using a hand-held dynamometer (HHD) (Study 1), and to elucidate the relationships between measured values and examiners’ physical characteristics (Study 2). Three healthy examiners (1 female, 24 y.o. and 2 males 23 and 27 y.o) and 12 subjects (6 females, 24.5 ± 2.8 years and 6 males, 27.7 ± 3.5 years) participated in Study 1, and 20 healthy examiners (7 females, 22.3 ± 1.3 years and 13 males, 29.4 ± 8.2 years) and 2 subjects (1 female, 24 y.o. and 1 male 27 y.o) participated in Study 2. All healthy examiners were hospital employees. Hip abductor strength was measured by HHD with hand fixation and with belt fixation, and examiner age, sex, height, weight, BMI, and dominant hand grip strength were evaluated. The intraclass correlation coefficient (ICC) (1,1), a measure of intrarater reliability, was 0.89–0.95 with hand fixation and 0.96–0.97 with belt fixation. ICC (2,1), a measure of interrater reliability, was 0.76–0.79 and 0.90–0.93, respectively. In subjects with high muscle strength (the examiner’s hand was moved), the examiner’s dominant hand grip strength affected muscle strength values with hand fixation (standardized partial regression coefficient = 0.78, determination coefficient R2 = 0.61, p < 0.01). In subjects with low muscle strength (the examiner’s hand was not moved), no variables had effect. When the muscle strength of the subject is weak, both methods can be used. When the muscle strength of the subject is strong, it is necessary to adjust the value obtained by the examiner’s dominant hand grip strength in the hand fixation method.

Using the transverse acetabular ligament as a landmark for acetabular anteversion: an intra-operative measurement.

Purpose. To measure the transverse acetabular ligament (TAL) anteversion in hips with severe deformity, using fluoroscopy–computed tomographic navigation. Methods. 31 hips in 10 men and 19 women aged 40 to 78 (mean, 58.7) years who underwent total hip arthroplasty for primary osteoarthritis (n=6) or osteoarthritis secondary to developmental hip dysplasia (n=19) or congenital hip dislocation (n=6) were included. The severity of hip dislocation was classified according to the Crowe classification; 15 hips were grade 1, 7 were grade 2, 3 were grade 3, and 6 were grade 4. The TAL anteversion was measured using fluoroscopy–computed tomographic navigation. The difference in TAL anteversion between non-dislocated hips (Crowe grade 1, n=15) and dislocated hips (Crowe grades 2–4, n=16) was compared. Results. In all 31 hips, the TAL could be visualised intra-operatively. No patient reported severe pain, early wear, loosening, or dislocation after 2 years. The mean TAL anteversion and inclination angles measured by the navigation system were 26.5° (SD, 8.9°; range, 8°–42°) and 41.5° (SD, 4.6°; range, 32°–49°), respectively. 22 of the 31 hips were in the safe zone. TAL anteversion in non-dislocated and dislocated hips was not significantly different. Inter- and intra-observer mean absolute differences in TAL anteversion were 0.3° and 0.4°, respectively. Conclusion. The TAL is a useful anatomic landmark for total hip arthroplasty in dislocated hips.

Impact of Japanese Lifestyle on Quality of Life for Patients with Total Hip Arthroplasty

The Japanese lifestyle includes activities with a greater range of hip motion, such as squat toilet and sitting on the floor. These activities increase the risk of hip dislocation for patients with total hip arthroplasty. However, research concerning the impact of Japanese lifestyle on quality of life for patients with total hip arthroplasty is limited. This cross-sectional study investigated lifestyle differences between two regions and quality of life related to Japanese lifestyle, controlling age and other covariates. Participants comprised 392 total hip arthroplasty patients with a postoperative period of one to seven years from major hospitals in northern (192 patients) and southern (200 patients) Japan. Participants were administered by the EQ-5D (assessing generic health-related quality of life), Oxford hip score (assessing hip-specific health condition), Japanese lifestyle difficulties (squat toilet, sitting on the floor, etc.) and lifestyle at home. The southern hospital sample retained more of a Japanese lifestyle compared to the northern hospital sample. Nearly 50% of participants reported some level of difficulty related to the Japanese squat toilet, although only a low percentage had it at home. Multivariate linear regression analysis was performed to predict the quality of life, and the final model retained the pain and function of the Oxford hip scores and Japanese squat toilet difficulty. The result indicates that physical environments outside of the house have an impact on quality of life for THA patients in Japan. Some aspects of the Asian lifestyle require a greater range of motion of the hip joint. In non-Western countries, regional differences in lifestyle and physical environments outside of their home need to be taken into consideration in discharge planning and rehabilitation. Further multinational comparison of the Asian lifestyle via prospective research is necessary, controlling pre-operative conditions.

Evaluation of preoperative hip range of motion under general anaesthesia

Hip range of motion (ROM) may be an important pre-operative variable, however, measurement of hip ROM can be affected by various factors. The purposes of this study were to compare conventional pre-operative ROM measurements with those measurements obtained under general anaesthesia, and to better define the associations between pre-operative hip ROM, and demographic, functional, and diagnostic variables. Conventional pre-operative hip ROM and ROM under general anaesthesia were prospectively measured in 471 hips. Harris pain score, the Crowe classification, and the diagnosis were also investigated. The hip ROM in all directions under general anaesthesia was significantly greater than conventional pre-operative hip ROM. There were correlations between conventional pre-operative hip ROM and the Harris hip pain score. Hip ROM with Crowe type I deformity under anaesthesia was significantly greater than in hips with type II, III or IV. ROM under anaesthesia of osteonecrosis hips was significantly greater than osteoarthritis and dislocated hips. Conventional pre-operative ROM in men was greater in flexion and external rotation compared to women. Internal rotation motion in women in both conventional pre-operative ROM and ROM under anaesthesia was greater than in men. Hip pain, Crowe classification and diagnosis could influence pre-operative hip ROM. Measurement of hip ROM under general anaesthesia could better reflect true ROM compared to measurement without anaesthesia.

Predicting leg-length change after total hip arthroplasty by measuring preoperative hip flexion under general anaesthesia

Purpose. To measure preoperative hip flexion under general anaesthesia in patients with developmental dysplasia of the hip and analyse its correlation with leg-length change. Methods. 79 women and 6 men aged 27 to 82 (mean, 59) years underwent 92 total hip arthroplasties for severe developmental dysplasia of the hip of Crowe types II (n=60), III (n=17), and IV (n=15). All such patients had severe pain and/or considerable difficulty in walking and performing daily activities. 16 of the hips were treated with transverse subtrochanteric shortening osteotomy, whereas the remaining 76 had no femoral osteotomy. Preoperative passive hip flexion was measured under general anaesthesia with a goniometer by a single investigator. Its mean value in patients with Crowe type-III deformity was 60.3°. Therefore, >60° of flexion was defined as high. Postoperative leg-length change was measured radiographically. The distraction of the greater trochanter was equal to the leg-length change in patients treated without femoral osteotomy, whereas leg-length change was calculated by subtracting the amount of resection of the femur from the distraction of the greater trochanter in patients treated with femoral osteotomy. Results. Of the 16 hips treated with a transverse subtrochanteric shortening femoral osteotomy, 2, 2, and 12 were Crowe types II, III, and IV, respectively. In these 16 hips, hip flexion was high in 10 (mean, 86°) and low in 6 (mean, 36°). Leg-length change was significantly greater in the high than low flexion groups (31 vs. 13 mm, p<0.01). In the 76 hips without osteotomy, hip flexion was high in 54 (mean, 85°) and low in 22 (mean, 40°). Leg-length change was significantly greater in the high than low flexion groups (25 vs. 19 mm, p=0.016). Preoperative hip flexion under general anaesthesia correlated with leg-length change in hips with osteotomy (r=0.850, p=0.0002) and without osteotomy (r=0.267, p=0.019). Conclusion. Preoperative hip flexion measured under general anaesthesia may predict leg-length change after THA.