About 60% of patients with hip fractures are malnourished, contributing to postoperative complications and increased mortality. Then, the relation between nutritional evaluation and activity of daily living of the hip fracture patient was verified. It was shown that the patient with the nutritional state risk tended to be inferior in muscle force and activity of daily living in comparison with the patient without the risk. The results of this study suggest that nutritional management may improve functional prognosis.
Background: This study aimed to evaluate the micromotion of the cementless short stem after total hip arthroplasty by using the finite element method and compared with postoperative X-ray images.
Patients and Methods: Ten patients who underwent total hip replacement with two types of cementless short stems in our department were included. The average age of the patients at the time of surgery was 63.4 years. Finite element models of the femur-stem complex were made by computed tomography images and were evaluated micromotion. The distributions of the micromotion were compared with postoperative X-ray images.
Results: The micromotion of 150 μm or more were concentrated proximally in nine of ten cases. These cases were observed radiolucent line with a reactive line of less than 1 mm in the postoperative X-ray image. This line was consistent with the area of the micromotion of 150 μm or more. The one of ten cases showed entirely micromotion of 150 μm or more in the stem.
Conclusion: The postoperative femoral bone reactions were consistent with the distribution of the micromotion between the cementless stem and the femur. The method of this study may be useful for predicting initial fixation of the stem.
Simultaneous bilateral total knee arthroplasty may bring many benefits including lower cost, timesaving, and better post-operative satisfaction in patients with knee osteoarthritis. However, it has the possible risks of postoperative complications. There have been few reports regarding the effectiveness of simultaneous bilateral total knee arthroplasty for very elderly patients. The purpose of this study was to investigate the safety and the efficacy of simultaneous bilateral total knee arthroplasty for elderly. In the 2 groups of 85 years and older (≥85 group; 18 cases, 36 knees) and under 85 years (<85 group; 72 cases, 144 knees), preoperative data, intraoperative factors, postoperative complications, and clinical outcomes at 1 year postoperatively were compared. Functional score and patient satisfaction before operation were significantly worse in the ≥85 group. Early postoperative complications including the incidence of pulmonary embolism, deep vein thrombosis and blood transfusion were not different between the 2 groups. Neither fatal complications nor hospital death occurred. In terms of postoperative clinical outcomes, range of motion, knee society score, and patient satisfaction were identical between the 2 groups. Although the functional score in the ≥85 group was lower than that in the <85 years group, the difference between pre and post-operation was similar between two groups. In conclusion, simultaneous bilateral total knee arthroplasty would be safe and useful even for elderly patients aged 85 years old and over.
The purpose of this study is to investigate the parameter of lower limbs related to the onset of knee osteoarthritis and reveal the longitudinal change of spinal alignment related to the progression of knee osteoarthritis during 22-years. A population register was used to recruit adult volunteers for a health screening program from 1992-1997, and the final follow-up was performed from 2015-2017. The final total of 58 volunteers were included. Current longitudinal study followed up for 22 years revealed medial proximal tibial angle was the factor related to the onset of knee osteoarthritis. Moreover, it is indicated sagittal vertical axis was related to a progression of knee osteoarthritis.
Tears of the medial meniscus posterior horn around the meniscocupsular junction (ramp lesion) are frequently found in knees with deficient anterior cruciate ligaments (ACLs). This study evaluated healing of the ramp lesion for several factors. From April 2013 to September 2016, 73 knees underwent ramp lesion repair using the arthroscopic all-inside technique with a suture hook, FAST-FIX 360®, inside-out, and rasping with concomitant ACL reconstruction. Among these patients, a second-look arthroscopy was performed at a mean of 1.4 years postoperatively in 48 patients. Among 48 patients, 31(64.5%) showed complete healing, 12(25%) had incomplete healing, and 5(10.4%) failed to heal. The high success rate for meniscal repair are the arthroscopic all-inside technique with a suture hook device. The other items that showed a significant difference were the score of telos SSD, and Lysholm score. Repaired ramp lesion with all-inside technique was related to stability of ACL-reconstructed knees.
Cup positions were reported to be significantly associated with polyethylene wear. However, other studies have failed to show this relationship. Little has been reported that both stem anteversion and combined anteversion were correlated with cross-linked polyethylene wear. The purpose was to investigate the effect of component positions on the wear of a single type of cross-linked polyethylene with one femoral head diameter, one design of acetabular cup and stem. Between 2011 and 2013, 105 hips underwent primary total hip arthroplasty. All patients were followed for a minimum 5 years. Bedding-in, steady-state wear, and volumetric wear were measured on radiographs using Hip Analysis Suite. The mean steady-state wear, and volumetric wear were 0.014 mm/y, and 25.005 mm3/y. Neither cup abduction nor cup anteversion was significantly related to the steady-state wear or volumetric wear. Stem anteversion and combined anteversion were significantly correlated to the steady-state wear or volumetric wear. Combined anteversion below 20.9° and greater than 74.5° resulted in a volume wear of more than 40 mm3/y. This range is comparable to the previously described combined anteversion of 40° to 60° for hip stability. Thus, stem anteversion and combined anteversion affect both hip stability and cross-linked polyethylene wear.