Taisuke Seki

Influence of spinal sagittal alignment, body balance, muscle strength, and physical ability on falling of middle-aged and elderly males

ObjectiveRisk factors for falling in elderly people remain uncertain, and the effects of spinal factors and physical ability on body balance and falling have not been examined. The objective of this study was to investigate how factors such as spinal sagittal alignment, spinal range of motion, body balance, muscle strength, and gait speed influence falling in the prospective cohort study.MethodsThe subjects were 100 males who underwent a basic health checkup. Balance, SpinalMouse® data, grip strength, back muscle strength, 10-m gait time, lumbar lateral standing radiographs, body mass index, and fall history over the previous year were examined. Platform measurements of balance included the distance of movement of the center of pressure (COP) per second (LNG/TIME), the envelopment area traced by movement of the COP (E AREA), and the LNG/E AREA ratio. The thoracic/lumbar angle ratio (T/L ratio) and sagittal vertical axis (SVA) were used as an index of sagittal balance.ResultsLNG/TIME and E AREA showed significant positive correlations with age, T/L ratio, SVA, and 10-m gait time; and significant negative correlations with lumbar lordosis angle, sacral inclination angle, grip strength and back muscle strength. Multiple regression analysis showed significant differences for LNG/TIME and E AREA with T/L ratio, SVA, lumbar lordosis angle and sacral inclination angle (R2xa0=xa00.399). Twelve subjects (12xa0%) had experienced a fall over the past year. Age, T/L ratio, SVA, lumbar lordosis angle, sacral inclination angle, grip strength, back muscle strength, 10-m gait time, height of the intervertebral disc, osteophyte formation in radiographs and LNG/E AREA differed significantly between fallers and non-fallers. The group with SVAxa0>xa040xa0mm (nxa0=xa018) had a significant higher number of subjects with a single fall (6 single fallers/18: pxa0=xa00.0075) and with multiple falls (4 multiple fallers/18: pxa0=xa00.0095).ConclusionGood spinal sagittal alignment, muscle strength and 10-m gait speed improve body balance and reduce the risk of fall. Muscle strength and physical ability are also important for spinal sagittal alignment. Body balance training, improvement of physical abilities including muscle training, and maintenance of spinal sagittal alignment can lead to prevention of fall.

Total hip arthroplasty for Crowe type IV developmental dysplasia.

The purposes of this study were to evaluate the midterm clinical and radiographic results of total hip arthroplasty (THA) in patients with Crowe type IV developmental dysplasia and to evaluate whether low back pain would improve after THA. Eighteen consecutive patients (20 hips) were included in this study. The average age at the time of surgery was 58.5 years. The average follow-up was 10.2 years. The socket was placed at the level of the true acetabulum, and a femoral shortening osteotomy was performed. The average Harris hip score before surgery was improved from 56 to 85 points at the final follow-up. Revision was performed in 4 hips due to loosening of the femoral component in 1 hip and osteolysis in 3 hips. The midterm outcomes of THA in patients with Crowe type IV developmental dysplasia were satisfactory. The severity of low back pain was significantly reduced after THA.

Joint space wider than 2 mm is essential for an eccentric rotational acetabular osteotomy for adult hip dysplasia

BackgroundSatisfactory intermediate-term results after an eccentric rotational acetabular osteotomy (ERAO) for the treatment of early osteoarthritis secondary to developmental dysplasia of the hip (DDH) have been reported. The purpose of this study was to investigate whether a minimum joint space width (JSW) in patients with advanced osteoarthritis secondary to DDH influences intermediate-term clinical and radiographic outcomes after performing an ERAO.MethodsA total of 113 patients (116 hips) with a JSW of ≤3 mm were consecutively treated by ERAO for advanced osteoarthritis of the hip and then were followed for more than 5 years. Based on the preoperative JSW, the patients were divided into three groups: minimum JSW of ≤1 mm (JS1 group); JSW >1 mm but ≤2 mm (JS2 group); JSW > 2 mm but ≤3 mm (JS3 group). The average ages of the JS1, JS2, and JS3 patients were 40, 44, and 43 years, respectively. The average follow-up period was 10.6 years.ResultsOverall conversion to total hip arthroplasty (THA) was performed in 14 joints. According to a Kaplan-Meier survivorship analysis at 15 years after the index operation, 96% of the patients with a JSW of >2 mm (JS3 group) did not require conversion to THA.ConclusionsA JSW of >2 mm before surgery is considered essential to obtain an excellent intermediate-term result following performance of an ERAO.

Quality of life following femoral osteotomy and total hip arthroplasty for nontraumatic osteonecrosis of the femoral head

BackgroundNontraumatic osteonecrosis of the femoral head (NOFH) frequently develops in active young persons. The affected femoral head collapses owing to weight-bearing, and the individual’s quality of life (QOL) can be predicted to deteriorate greatly with time. We undertook to determine the efficacy of surgery and to clarify whether patient QOL differs according to differences in the surgical method employed.MethodsWe cross-sectionally compared QOL in NOFH patients treated with femoral osteotomy, total hip arthroplasty (THA), or nonoperatively. A total of 81 cases were available for study, comprising 41 with osteotomy, 19 with THA, and 21 in the nonoperative group. The mean age was significantly higher in the THA group than in the other two groups. The Japanese Orthopaedic Association (JOA) hip score and Visual Analogue Scale (VAS) regarding hip pain were compared among the groups. These groups were also analyzed for their health-related QOL using the Short Form Health Survey (SF-36) with analysis of variance for age adjustment.ResultsThe mean JOA score was significantly lower in the nonoperative group than in the osteotomy group. The mean VAS scores showed no significant difference between any of the three groups. Regarding the subscales of SF-36, the physical functioning subscale in the nonoperative group showed a significantly lower value than was seen in the osteotomy group (P = 0.003). The physical component summary (PCS) scores were 39.4 (osteotomy group), 39.1 (THA group), and 27.8 (nonoperative group), with a significant difference between the osteotomy and nonoperative groups (P = 0.027). There was also a trend for a better PCS scores in the THA group than in the nonoperative group (P = 0.056). The mental component summary scores were 49.6 (osteotomy group), 50.3 (THA group), and 48.3 (nonoperative group), with no significant difference found among any of the three groups.ConclusionsAmong patients with NOFH, physical function impairment was a more potent factor than pain for decreasing QOL in the nonoperative group than in the surgical groups. Furthermore, osteotomy and THA were similar in regard to the evaluation of the postoperative QOL score if the indications for osteotomy were strictly applied.

Similar survival of eccentric rotational acetabular osteotomy in patients younger and older than 50 years.

Pelvic osteotomy for middle-aged patients with hip dysplasia remains controversial. We asked whether pelvic osteotomy would yield lower Harris hip scores and survivorship in older patients than in younger patients. We compared patients younger than 50xa0years (nxa0=xa0123) with patients 50xa0years or older (nxa0=xa041). At last followup, the mean Harris hip scores improved similarly in both groups: from 60 to 89 points in the older group and from 63 to 92 points in the younger group. However, in patients with bilateral surgery, the older group tended to have lower mean scores than the younger group (86 versus 93 points, respectively). Fifteen-year survivorship with a Harris hip score less than 80 points as the end point was similar in the two groups (71% in older patients and 81% in younger patients). In patients with bilateral surgery, the 15-year survivorship was lower in the older group (66% in older patients and 83% in younger patients). The data suggest eccentric rotational osteotomy for older patients can provide lasting function in most patients. However, prudent selection of patients is required for older patients with bilateral osteoarthritis.Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Reliability and validity of the Japanese Orthopaedic Association hip disease evaluation questionnaire (JHEQ) for patients with hip disease

BackgroundThe Japanese Orthopaedic Association hip disease evaluation questionnaire (JHEQ) was developed to evaluate the quality of life (QOL) in patients with hip disease. This questionnaire consists of three subscales: pain; movement; and mental. The purpose of this study was to assess the reliability and validity of the JHEQ for use as a clinical evaluation tool.MethodsWe investigated patients who visited the outpatient department at our hospital and affiliated hospital between April and May 2010. The study population comprised 286 patients (239 women) with a mean age of 56.8 years. The diagnosis was osteoarthritis of the hip in 230 patients, avascular osteonecrosis of the femoral head in 49 patients, and other conditions in 7 patients. The JHEQ questionnaire, the SF-36 questionnaire as a generic QOL scale, and the Oxford hip score (OHS) as a disease-specific scale, were filled out by the patient while waiting in the outpatient department.ResultsPearson’s correlation coefficients of 0.6 were observed between JHEQ pain and SF-36 bodily pain (BP) subscales, and between JHEQ movement and SF-36 physical functioning (PF) subscales. The JHEQ mental subscale correlated with SF-36 social functioning (SF) and BP subscales. A strong negative correlation was seen between JHEQ pain and OHS pain subscales (rxa0=xa0−0.817). JHEQ movement subscale also showed a strong negative correlation with the OHS function subscale (rxa0=xa0−0.715). These results indicated the convergent validity of JHEQ. The internal consistency of pain, movement, and mental subscales of JHEQ was satisfactory, indicated by Cronbach’s α coefficients of 0.92, 0.91, and 0.94, respectively. Each subscale also showed high test–retest reliability with intra-class correlation coefficients of 0.89, 0.93, and 0.85, respectively.ConclusionsWe determined the reliability and validity of JHEQ as a self-administered questionnaire that evaluates hip disease. JHEQ is useful as a tool for evaluating patients with hip disease.

Significantly Lower Wear of Ceramic-on-Ceramic Bearings Than Metal-on-Highly Cross-Linked Polyethylene Bearings: A 10- to 14-Year Follow-Up Study

BACKGROUNDnThis study aimed to retrospectively compare clinical and radiographic results between consecutive total hip arthroplasties (THAs) using ceramic on ceramic (CoC) and metal-on-highly cross-linked polyethylene (MoP), with >10 years of follow-up.nnnMETHODSnSixty-seven patients (52 women and 15 men) underwent CoC THA, whereas 81 (67 women and 14 men) underwent MoP THA. The average patient age at the time of surgery was 54.0 years in the CoC group and 54.2 years in the MoP group.nnnRESULTSnThe mean postoperative Harris Hip Scores were 88.9 and 86.4 in the CoC and MoP groups, respectively (Pxa0= .063), and the mean annual liner rates of wear were 0.0043 and 0.0163 mm/year, respectively (P < .001). Osteolysis was observed on the femoral side of 1 joint (1.5%) in the CoC group and in 1 (1.2%) acetabular and femoral (1.2%) joint each in the MoP group. Three joints (3.7%) in the MoP group showed aseptic cup loosening, one of which (1.2%) required revision THA because of progression of the loosening. Revision THA was also required in 1 joint (1.5%) in the CoC group because of ceramic fracture. The Kaplan-Meier survival rate at 10 years with implant loosening or revision THA as the end point was 98.5% for CoC and 96.3% for MoP (Pxa0= .416).nnnCONCLUSIONnThe wear rate of CoC implants was significantly lower than that of MoP implants. Kaplan-Meier survival at 10 years with implant loosening and revision THA as end points did not differ significantly between these implants.

Association of serum carotenoids, retinol, and tocopherols with radiographic knee osteoarthritis: possible risk factors in rural Japanese inhabitants

BackgroundThe consumption of antioxidant nutrients may influence the development and progression of osteoarthritis (OA). To determine the association between serum antioxidants and radiographic knee osteoarthritis, we undertook a cross-sectional investigation in a community-based study in Japan.MethodsA total of 562 subjects (224 male, 338 female) ≥40 years of age were enrolled in the Comprehensive Health Examination Program (CHEP, Yakumo Study) from 2003 to 2005. Subjects were categorized to the OA group (n = 140) if either knee was graded as Kellgren-Lawrence (K-L) grade ≥2. The no-OA group was defined as showing radiographic findings of K-L 0 or 1 in either knee (n = 422). The serum levels of retinol, β-/γ-tocopherols, α-tocopherol, zeaxanthin/lutein, canthaxanthin, cryptoxanthin, lycopene, α-carotene, and β-carotene were measured by high-performance liquid chromatography. The values of these antioxidants were divided into tertiles, and a logistic regression analysis was performed to analyze the association between them and radiographic knee OA, adjusting for potential confounders.ResultsLogistic regression analysis showed that compared to the lowest tertile of β-/γ-tocopherols the adjusted odds ratio (OR) was 0.52 [95% confidence interval (CI) 0.29–0.93] in the highest tertile; it also indicated a linear trend across tertiles. Furthermore, the adjusted OR was significantly decreased only in the middle tertile of α-tocopherol (OR 0.51, 95% CI 0.29–0.90). We reevaluated any independent association for these tocopherols after adjustment by entering them into the model simultaneously. The significance of β-/γ-tocopherols was maintained. In contrast, no associations were found with any carotenoids or retinol.ConclusionsHigh serum values of β-/γ-tocopherols were found to be significantly associated with a low OR for radiographic knee osteoarthritis. The decreasing risk with a high serum value of β-/γ-tocopherols may support the possible protective effects against knee OA.

Significantly Poor Outcomes of Total Hip Arthroplasty After Failed Periacetabular Osteotomy

BACKGROUNDnPeriacetabular osteotomy (PAO) is an effective treatment for preosteoarthritis and early osteoarthritis in young and active patients with hip dysplasia. However, conversion to total hip arthroplasty (THA) for failed PAO is difficult owing to morphologic changes. The objective of the present study was to investigate outcomes of patients who underwent THA for failed PAO.nnnMETHODSnWe performed a case-control study. The participants were 48 patients (52 hips) who underwent THA after PAO (the osteotomy group); type of PAO was eccentric rotational acetabular osteotomy in 36 hips and rotational acetabular osteotomy in 16 hips. These patients had a mean age at surgery of 56.5 years and underwent postoperative follow-up for a mean period of 5.4 years. For the control group, after matching age, gender, and time of surgery, we included 96 patients (104 joints) who underwent primary THA for hip dysplasia.nnnRESULTSnThe 2 groups demonstrated no significant difference in the preoperative Harris Hip Score. However, the osteotomy group demonstrated a significantly poor Harris Hip Score at the last follow-up, with particularly low scores for gait and activity. The osteotomy group demonstrated significantly poor range of motion at the last follow-up. Although neither group had any cases of revision surgery, both groups had 1 case of postoperative dislocation. Considering socket placement in Lewinneks safe zone, the osteotomy group had significantly poorer results compared to that obtained after primary THA.nnnCONCLUSIONnThe therapeutic outcomes and socket positioning for THA after PAO were poorer compared to those of primary THA.

The effect of β-carotene on lumbar osteophyte formation.

Study Design. Cross-sectional cohort study of elderly people. Objective. The relationships of osteophyte formation on plain lumbar radiographs with serum levels of antioxidants (carotenoids, vitamin A, vitamin E) and other factors were investigated to examine whether antioxidants are involved in lumbar spine degeneration. Summary of Background Data. Antioxidants have inhibitory effects on the onset of many diseases. However, the association of lumbar osteophyte formation with antioxidant levels in the general population has not been investigated. Methods. The subjects were 286 people (103 men and 183 women; mean age = 68 years) who underwent resident health screening. Osteophyte formation on lumbar lateral radiographs (Nathan classification), lumbar lordosis angles, sacral inclination angles, serum levels of antioxidants, triglyceride levels, body mass index, osteoporosis, back muscle strength, history of alcohol intake, and smoking history were studied in these subjects. Results. Lumbar osteophyte formation was detected in 48 subjects (17%). Osteophyte formation was significantly more common in elderly persons, men, and subjects with a history of alcohol intake; and had a significant correlation with sacral inclination angle. The levels of &agr;-tocopherol, &bgr;-tocopherol, zeaxanthin/lutein, cryptoxanthin, lycopene, &agr;-carotene, and &bgr;-carotene were significantly lower in subjects with osteophytes. Logistic regression analysis adjusted for all factors showed that a higher age (odds ratio [OR] = 1.1, 95% confidence interval [CI] = 1.02–1.16; P = 0.02) and a low &bgr;-carotene level (OR = 6.7, 95% CI = 1.39–32.6; P = 0.02) were risk factors for osteophyte formation. Conclusion. The serum levels of carotenoids and vitamin E were significantly lower in subjects with lumbar osteophyte formation, and a low &bgr;-carotene level was the strongest risk factor for lumbar osteophytes. This is the first evidence of an association between carotenoids and lumbar osteophyte formation. This finding suggests that appropriate dietary intake of antioxidants is important for inhibition of lumbar spine degeneration in a rapidly aging society.