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LaValva SM, LeBrun DG, Canoles HG, Ren R, Padgett DE, Su EP. Clinical outcomes and return to dance after total hip arthroplasty or hip resurfacing in professional dancers. Bone Joint J 2024; 106-B:17-23. [PMID: 38425296 DOI: 10.1302/0301-620x.106b3.bjj-2023-0854.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Aims Professional dancers represent a unique patient population in the setting of hip arthroplasty, given the high degree of hip strength and mobility required by their profession. We sought to determine the clinical outcomes and ability to return to professional dance after total hip arthroplasty (THA) or hip resurfacing arthroplasty (HRA). Methods Active professional dancers who underwent primary THA or HRA at a single institution with minimum one-year follow-up were included in the study. Primary outcomes included the rate of return to professional dance, three patient-reported outcome measures (PROMs) (modified Harris Hip Score (mHHS), Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR), and Lower Extremity Activity Scale (LEAS)), and postoperative complications. Results A total of 49 hips in 39 patients (mean age 56 years (SD 13); 80% female (n = 39)) were included. Mean follow-up was 4.9 years (SD 5.1). Of these 49 hips, 37 THAs and 12 HRAs were performed. In all, 96% of hips returned to professional dance activities postoperatively. With regard to PROMs, there were statistically significant improvements in mHHS, HOOS-JR, and LEAS from baseline to ≥ one year postoperatively. There were complications in 7/49 hips postoperatively (14%), five of which required revision surgery (10%). There were no revisions for instability after the index procedure. Two complications (5.4%) occurred in hips that underwent THA compared with five (42%) after HRA (p = 0.007), though the difference by procedure was not significantly different when including only contemporary implant designs (p = 0.334). Conclusion Active professional dancers experienced significant improvements in functional outcome scores after THA or HRA, with a 96% rate of return to professional dance. However, the revision rate at short- to mid-term follow-up highlights the challenges of performing hip arthroplasty in this demanding patient population. Further investigation is required to determine the results of THA versus HRA using contemporary implant designs in these patients.
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Affiliation(s)
- Scott M LaValva
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | - Drake G LeBrun
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | - Haley G Canoles
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | - Renee Ren
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | - Douglas E Padgett
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | - Edwin P Su
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
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Mercer RW, Peter CA, Habib U, Xie J, Graeber A, Simeone FJ, Chang CY. Anterior and posterior hip osteoarthritis: prevalence and potential value of CT compared to radiographs. Skeletal Radiol 2024; 53:473-479. [PMID: 37632549 DOI: 10.1007/s00256-023-04434-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/14/2023] [Accepted: 08/14/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE To determine the added value of computed tomography (CT) to identify severe hip osteoarthritis (OA). MATERIALS AND METHODS A retrospective query of all cases of hip or knee arthroplasty planning CTs between January 2018 and March 2022 was performed. Age, sex, and symptoms were collected from the medical record. CTs were evaluated for the degree of osteoarthritis and classified using an adapted Kellgren-Lawrence (KL) grading system in the anterior, posterior, superior, and superomedial hip. Frontal hip or pelvis radiographs within 1 year of the CT were also graded. RESULTS There were 265 eligible hips in 178 subjects, age 66 ± 11 (range 31-93) years, with 85/178 (48%) males and 93/178 (52%) females, and 127/265 (48%) right and 138/265 (52%) left hips. The posterior hip joint was the most common location for grade 2/3 OA (20%), followed by superior hip joint (14%). Anterior or posterior grade 2/3 OA occurred concurrently with superior or superomedial grade 2/3 OA in 32/68 (47%) of hips. Grade 2/3 OA was detected on CT more commonly than on XR both in the superior (14 vs 8.6%, P = 0.0016) and superomedial (8.7 vs 4.8%, P = 0.016) hip joint. Of the 71 symptomatic hips, 22 (31%) hips demonstrated either anterior and/or posterior grade 2/3 OA on CT, and 9 (9/22, 41%) of these hips had superior or superomedial grade 0/1 OA. CONCLUSION CT may be warranted when the patient has pain suggestive of osteoarthritis not detected on radiographs.
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Affiliation(s)
- Ronald W Mercer
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Cynthia Assimta Peter
- Department of Radiology, Sengkang General Hospital, East Way, Sengkang, 110, Singapore
| | - Ukasha Habib
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Juliana Xie
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Adam Graeber
- Department of Radiology, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX, 78234, USA
| | - F Joseph Simeone
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Connie Y Chang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA.
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Steingrebe H, Spancken S, Sell S, Stein T. Effects of hip osteoarthritis on lower body joint kinematics during locomotion tasks: a systematic review and meta-analysis. Front Sports Act Living 2023; 5:1197883. [PMID: 38046934 PMCID: PMC10690786 DOI: 10.3389/fspor.2023.1197883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 10/09/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Motion analysis can be used to gain information needed for disease diagnosis as well as for the design and evaluation of intervention strategies in patients with hip osteoarthritis (HOA). Thereby, joint kinematics might be of great interest due to their discriminative capacity and accessibility, especially with regard to the growing usage of wearable sensors for motion analysis. So far, no comprehensive literature review on lower limb joint kinematics of patients with HOA exists. Thus, the aim of this systematic review and meta-analysis was to synthesise existing literature on lower body joint kinematics of persons with HOA compared to those of healthy controls during locomotion tasks. Methods Three databases were searched for studies on pelvis, hip, knee and ankle kinematics in subjects with HOA compared to healthy controls during locomotion tasks. Standardised mean differences were calculated and pooled using a random-effects model. Where possible, subgroup analyses were conducted. Risk of bias was assessed with the Downs and Black checklist. Results and Discussion A total of 47 reports from 35 individual studies were included in this review. Most studies analysed walking and only a few studies analysed stair walking or turning while walking. Most group differences were found in ipsi- and contralateral three-dimensional hip and sagittal knee angles with reduced ranges of motion in HOA subjects. Differences between subjects with mild to moderate and severe HOA were found, with larger effects in severe HOA subjects. Additionally, stair walking and turning while walking might be promising extensions in clinical gait analysis due to their elevated requirements for joint mobility. Large between-study heterogeneity was observed, and future studies have to clarify the effects of OA severity, laterality, age, gender, study design and movement execution on lower limb joint kinematics. Systematic Review Registration PROSPERO (CRD42021238237).
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Affiliation(s)
- Hannah Steingrebe
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Sports Orthopedics, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Sina Spancken
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Stefan Sell
- Sports Orthopedics, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Joint Center Black Forest, Hospital Neuenbürg, Neuenbürg, Germany
| | - Thorsten Stein
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
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Harada S, Hamai S, Ikebe S, Hara D, Higaki H, Gondo H, Kawahara S, Shiomoto K, Harada T, Nakashima Y. Elucidation of target implant orientations with the safety range of hip rotation with adduction or abduction during squatting: Simulation based on in vivo replaced hip kinematics. Front Bioeng Biotechnol 2022; 10:1023721. [DOI: 10.3389/fbioe.2022.1023721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives: The study aimed to elucidate target cup orientation and stem anteversions to avoid impingement between the liner and stem neck even at hip rotation with adduction during the deeply flexed posture.Methods: A computer simulation analysis was performed on 32 total hip arthroplasty patients applying patient-specific orientation of the components and in vivo hip kinematics obtained from three-dimensional analysis of the squatting motion. The anterior/posterior liner-to-neck distance and impingement were evaluated based on a virtual change in internal/external rotation (0°–60°) and adduction/abduction (0°–20°) at actual maximum flexion/extension during squatting. Cutoff values of cup orientations, stem anteversion, and combined anteversion to avoid liner-to-neck impingements were determined.Results: The anterior liner-to-neck distance decreased as internal rotation or adduction increased, and the posterior liner-to-neck distance decreased as external rotation or adduction increased. Negative correlations were found between anterior/posterior liner-to-neck distances at maximum flexion/extension and internal/external rotation. Anterior/posterior liner-to-neck impingements were observed in 6/18 hips (18/56%) at 45° internal/external rotation with 20° adduction. The range of target cup anteversion, stem anteversion, and combined anteversion to avoid both anterior and posterior liner-to-neck impingements during squatting were 15°–18°, 19°–34°, and 41°–56°, respectively.Conclusion: Simulated hip rotations caused prosthetic impingement during squatting. Surgeons could gain valuable insights into target cup orientations and stem anteversion based on postoperative simulations during the deeply flexed posture.
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Harada S, Hamai S, Gondo H, Higaki H, Ikebe S, Nakashima Y. Squatting After Total Hip Arthroplasty: Patient-Reported Outcomes and In Vivo Three-Dimensional Kinematic Study. J Arthroplasty 2022; 37:734-741. [PMID: 34968648 DOI: 10.1016/j.arth.2021.12.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/12/2021] [Accepted: 12/20/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Squatting is an important function for many daily activities, but has not been well documented after total hip arthroplasty (THA). This study investigated the participation rate of squatting and in vivo kinematics during squatting. METHODS A survey questionnaire about squatting was mailed to patients who underwent primary THA and 328 patients returned acceptable responses. Additionally, 32 hips were evaluated for dynamic 3-dimensional kinematics of squatting using density-based image-matching techniques. Multivariate analyses were applied to determine which factors were associated with anterior liner-to-neck distance at maximum hip flexion. RESULTS Patients who could easily squat significantly increased this ability postoperatively (23.5% vs 46%, P < .01). In 29.5% of the patients there was still no ability to squat after THA; the main reason was anxiety of dislocation (34.2%). Kinematic analysis revealed that maximum hip flexion averaged 80.7° ± 12.3° with 12.8° ± 10.7° of posterior pelvic tilt and 9.7 ± 3.0 mm of anterior liner-to-neck distance. Neither liner-to-neck, bone-to-bone, nor bone-to-implant contact was observed in any of the hips. Larger hip flexion and smaller cup anteversion were negatively associated with the anterior liner-to-neck distance at maximum hip flexion (P < .05). CONCLUSION Postoperatively, approximately 70% of patients squatted easily or with support. Anxiety of dislocation made patients avoid squatting after THA. In vivo squatting kinematics suggest no danger of impingement or subsequent dislocation, but excessively large hip flexion and small cup anteversion remain as risks.
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Affiliation(s)
- Satoru Harada
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Medical-Engineering Collaboration for Healthy Longevity, Kyushu University, Fukuoka, Japan
| | - Hirotaka Gondo
- Department of Biorobotics, Faculty of Engineering, Kyushu Sangyo University, Fukuoka, Japan
| | - Hidehiko Higaki
- Department of Biorobotics, Faculty of Engineering, Kyushu Sangyo University, Fukuoka, Japan
| | - Satoru Ikebe
- Department of Creative Engineering, National Institute of Technology, Kitakyushu College, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
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Marin L, Vandoni M, Zaza G, Febbi M, Pedrotti L, Chiodaroli M, Lovecchio N, Manzoni F. The Effects of Insole-Based Visual Feedback on Weight-Bearing in Patients Undergoing Total Hip Replacement. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3346. [PMID: 33804915 PMCID: PMC8037670 DOI: 10.3390/ijerph18073346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/10/2021] [Accepted: 03/20/2021] [Indexed: 01/10/2023]
Abstract
This study aimed to investigate the visual biofeedback effect of a sensorized system for plantar pressure dynamic evaluation of in patients with a total hip replacement. Experimental group followed the rehabilitation training wearing sensorized insoles that provided images on three monitors. The control group followed the verbal instructions of physiotherapists during training. Weight bearing percentage healthy limb (WBPH), weight bearing percentage surgical limb (WBPS), swing healthy limb (SWH) and swing surgical limb (SWS) improved significantly more in the experimental group. The results underline the effectiveness of visual biofeedback based on sensorized system with dynamic evaluation of the plantar pressure.
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Affiliation(s)
- Luca Marin
- Department of Rehabilitation, Faculty of Medicine, University of Ostrava, 70103 Ostrava, Czech Republic; (L.M.); (M.F.)
- Laboratory for Rehabilitation, Medicine and Sport (LARMS), 00100 Rome, Italy;
- Department of Rehabilitation, Città di Pavia Hospital, 27100 Pavia, Italy;
| | - Matteo Vandoni
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Giancarlo Zaza
- Laboratory for Rehabilitation, Medicine and Sport (LARMS), 00100 Rome, Italy;
| | - Massimiliano Febbi
- Department of Rehabilitation, Faculty of Medicine, University of Ostrava, 70103 Ostrava, Czech Republic; (L.M.); (M.F.)
- Laboratory for Rehabilitation, Medicine and Sport (LARMS), 00100 Rome, Italy;
| | - Luisella Pedrotti
- Department of Pediatric Diagnostic Surgical Clinical Science, Section of Pathologies of the Musculoskeleta System, Orthopedics Unit, University of Pavia, 27100 Pavia, Italy;
| | - Matteo Chiodaroli
- Department of Rehabilitation, Città di Pavia Hospital, 27100 Pavia, Italy;
| | - Nicola Lovecchio
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Federica Manzoni
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
- Health Promotion—Environmental Epidemiology Unit, Hygiene and Health Prevention Department, Health Protection Agency, 27100 Pavia, Italy
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Hara D, Hamai S, Miller KR, Motomura G, Yoshimoto K, Komiyama K, Shiomoto K, Ikemura S, Nakashima Y, Banks SA. How does transtrochanteric anterior rotational osteotomy change the dynamic three-dimensional intact ratio in hips with osteonecrosis of the femoral head? Clin Biomech (Bristol, Avon) 2021; 82:105284. [PMID: 33529867 DOI: 10.1016/j.clinbiomech.2021.105284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/30/2020] [Accepted: 01/22/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The intact ratio (the ratio of the intact area of the femoral head) on a two-dimensional anteroposterior radiograph is associated with the prognosis of hips with osteonecrosis of the femoral head after transtrochanteric anterior rotational osteotomy. However, changes of the three-dimensional intact ratio during dynamic weight-bearing activity and correlation of the three-dimensional intact ratio with clinical scores are still unknown. METHODS Kinematics of eight hips with osteonecrosis of the femoral head that underwent anterior rotational osteotomy were analyzed using image-matching techniques during chair-rising and squatting preoperatively and postoperatively. Two types of dynamic three-dimensional intact ratios were examined, including the lunate covered area (IRLC) and in vivo peak contact force vector intersected area (IRFV). The static three-dimensional intact ratio in each octant of the femoral head was also examined. FINDINGS The mean Harris hip score significantly improved from 67 preoperatively to 90 postoperatively. During chair-rising rising/squatting, the mean IRLC and IRFV significantly increased from 42%/41% and 7%/4% preoperatively, to 66%/65% and 79%/77% postoperatively, respectively. IRLC significantly changed during the motion whereas substantial postoperative IRFV was maintained throughout the motion. Additionally, Harris hip score and the static three-dimensional intact ratio in the superolateral regions had significant positive correlations with both IRLC and IRFV. INTERPRETATION Hip kinematics affected IRLC but not IRFV, which suggests that substantial intact bone occupies the region in which peak contact forces are applied during deep hip flexion. Additionally, improving intact ratio in the superolateral region led to improvements in both IRLC and IRFV with favorable clinical scores.
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Affiliation(s)
- Daisuke Hara
- Department of Mechanical and Aerospace Engineering, University of Florida, 330 MAE-A, P.O. Box 116250, Gainesville, FL 32611-6250, USA; Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; Department of Orthopaedic Surgery, Kyushu Rosai Hospital, 1-1 Sonekitamachi, Kokuraminami-ku, Kitakyushu, Fukuoka 800-0296, Japan.
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Kyle R Miller
- Department of Mechanical and Aerospace Engineering, University of Florida, 330 MAE-A, P.O. Box 116250, Gainesville, FL 32611-6250, USA.
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Kensei Yoshimoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Keisuke Komiyama
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Kyohei Shiomoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Scott A Banks
- Department of Mechanical and Aerospace Engineering, University of Florida, 330 MAE-A, P.O. Box 116250, Gainesville, FL 32611-6250, USA.
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Shiomoto K, Hamai S, Hara D, Higaki H, Gondo H, Wang Y, Ikebe S, Yoshimoto K, Komiyama K, Harada S, Nakashima Y. In vivo kinematics, component alignment and hardware variables influence on the liner-to-neck clearance during chair-rising after total hip arthroplasty. J Orthop Sci 2020; 25:452-459. [PMID: 31178276 DOI: 10.1016/j.jos.2019.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/10/2019] [Accepted: 05/14/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND There is an interest in quantifying dynamic hip kinematics before and after total hip arthroplasty (THA) during chair-rising: one of daily life activities. METHODS The study consisted of 21 patients who underwent unilateral total hip arthroplasty for symptomatic osteoarthritis. We obtained continuous radiographs using a flat-panel X-ray detector while the participants rose from chair. We assessed the pre and postoperative hip joint's movements using three-dimensional-to-two-dimensional model-to-image registration techniques. We also measured minimum liner-to-neck distances at maximum hip flexion and extension as anterior and posterior liner-to-neck distances, respectively. Multivariate analyses were applied to determine which factors were associated with liner-to-neck distances. RESULTS The cup inclination, cup anteversion, and stem anteversion averaged 37.4°, 23.1°, and 30.1°, respectively. Significantly larger maximum hip flexion angle (72°) was found during chair-rising after THA compared to that before THA (63°, P < 0.01). The anterior pelvic tilt at the maximum hip flexion after THA (3° of anterior tilt) was significantly (P < 0.05) anterior compared to that before THA (1° of posterior tilt). The anterior and posterior liner-to-neck distances averaged 12.3 mm and 8.1 mm, respectively, with a significant difference (P < 0.01). No liner-to-neck contact was found in any hips. In multivariate analysis, the hip flexion angle, cup inclination, stem anteversion and head diameter were significantly associated with the anterior liner-to-neck distance (P < 0.05), the hip extension angle, cup anteversion, neck length and with or without elevated rim were significantly associated with the posterior liner-to-neck distance (P < 0.05, 0.01, 0.05, 0.01, respectively). CONCLUSION This study indicates that well-positioned THA provide increased range of hip flexion with sufficient anterior liner-to-neck clearance during chair-rising. Dynamic hip kinematics, component position, and hardware variables significantly influenced on the liner-to-neck clearance under weight-bearing conditions.
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Affiliation(s)
- Kyohei Shiomoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Daisuke Hara
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hidehiko Higaki
- Department of Biorobotics, Faculty of Engineering, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-8583, Japan
| | - Hirotaka Gondo
- Department of Biorobotics, Faculty of Engineering, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-8583, Japan
| | - Yifeng Wang
- Department of Biorobotics, Faculty of Engineering, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-8583, Japan
| | - Satoru Ikebe
- Department of Creative Engineering, National Institute of Technology, Kitakyushu College, 5-20-1 Shii, Kokuraminami-ku, Kitakyushu, Fukuoka, 802-0985, Japan
| | - Kensei Yoshimoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Keisuke Komiyama
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoru Harada
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Tibiofemoral kinematics in healthy and osteoarthritic knees during twisting. J Orthop 2020; 21:213-217. [PMID: 32273659 DOI: 10.1016/j.jor.2020.03.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/26/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose The purpose of this study was to determine the in vivo kinematics of healthy knees and those with osteoarthritis (OA), during twisting using density-based image-matching techniques. Methods Five healthy subjects and 26 patients with medial knee OA performed twisting under periodic X-ray imaging. Results The tibiofemoral rotation at the ipsilateral/contralateral twist in healthy and OA knees were 11° ± 9.3° externally/9.5° ± 5.6° internally (p < 0.05) and 4.4° ± 7.2° externally/2.7° ± 8° internally (p < 0.05), respectively. Conclusions The kinematic analysis of OA knees during twisting revealed significantly smaller tibiofemoral rotation than those of healthy knees.
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Yoshimoto K, Hamai S, Higaki H, Gondoh H, Shiomoto K, Ikebe S, Hara D, Komiyama K, Nakashima Y. Dynamic hip kinematics before and after periacetabular osteotomy in patients with dysplasia. J Orthop Sci 2020; 25:247-254. [PMID: 31000375 DOI: 10.1016/j.jos.2019.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 02/16/2019] [Accepted: 03/27/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND We prospectively analyzed the hip kinematics in patients with developmental dysplasia of the hip (DDH) before and after periacetabular osteotomy (PAO) and in healthy subjects while squatting to determine the influence of coverage of the femoral head on hip kinematics. METHODS 14 hips in 14 patients with DDH and 10 hips in 10 volunteers were included. Continuous radiographs while squatting and computed tomography images were obtained to assess the in vivo kinematics of the hip and the rim-neck distance using density-based 3D-to-2D model-to-image registration techniques. RESULTS The maximum hip flexion angles were 100.4° and 94.9° before and after PAO (p = 0.0863), respectively. The maximum hip flexion angles after PAO did not significantly differ from those of normal hips (102.2°; p = 0.2552). The hip abduction angles at maximum hip flexion were 31.7° and 26.2° before and after PAO (p = 0.1256), respectively. The rim-neck distance decreased from averaged 12.2 mm-8.9 mm (p = 0.0044) after PAO. The lateral center edge angle (LCEA) and anterior center edge angle (ACEA) significantly improved 14.7°-42.4° and 50.4°-54.0° after PAO (p < 0.0001, p = 0.0347), respectively; in particular, the ACEA after PAO did not significantly differ from that in the normal hips (p = 0.1917). The ACEA was not correlated with hip flexion, or the rim-neck distance (p = 0.9601, 0.8764). The LCEA was also not correlated with hip abduction (p = 0.1683). CONCLUSION Patients after PAO showed no significant difference in maximum hip flexion while squatting compared to before PAO and normal hips. Horizontalized weight-bearing acetabulum with normalized ACEA could be adequate correction of the acetabular fragment to restore hip RoM without coxalgia that induce the inability to perform squats after PAO.
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Affiliation(s)
- Kensei Yoshimoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Hidehiko Higaki
- Department of Life Science, Faculty of Life Science, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-0004, Japan
| | - Hirotaka Gondoh
- Department of Biorobotics, Faculty of Engineering, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-0004, Japan
| | - Kyohei Shiomoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoru Ikebe
- Department of Creative Engineering, National Institute of Technology, Kitakyushu College, 5-20-1 Shii, Kokuraminami-ku, Kitakyushu, Fukuoka, 802-0985 Japan
| | - Daisuke Hara
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Keisuke Komiyama
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Kim Y, Vergari C, Girinon F, Lazennec JY, Skalli W. Stand-to-Sit Kinematics of the Pelvis Is Not Always as Expected: Hip and Spine Pathologies Can Have an Impact. J Arthroplasty 2019; 34:2118-2123. [PMID: 31138502 DOI: 10.1016/j.arth.2019.04.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/10/2019] [Accepted: 04/25/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Stand-to-sit pelvis kinematics is commonly considered as a rotation around the bicoxofemoral axis. However, abnormal kinematics could occur for patients with musculoskeletal disorders, affecting the hip-spine complex. The aim of this study is to perform a quantitative analysis of the stand-to-sit pelvis kinematics using 3D reconstruction from biplanar x-rays. METHODS Thirty volunteers as a control group (C), 30 patients with hip pathology (Hip), and 30 patients with spine pathology (Spine) were evaluated. All subjects underwent standing and sitting full-body biplanar x-rays. Three-dimensional reconstruction was performed in each configuration and then translated such as the middle of the line joining the center of each acetabulum corresponds to the origin. Rigid registration quantified the finite helical axis (FHA) describing the transition between standing and sitting with two specific parameters. The orientation angle (OA) is the signed 3D angle between FHA and bicoxofemoral axis, and the rotation angle (RA) represents the signed angle around FHA. RESULTS The mean OA was -1.8° for the C group, 0.3° for Hip group, and -2.4° for Spine group. There was no significant difference in mean OA between groups. However, variability was higher for the Spine group with a standard deviation (SD) of 15.9° compared with 10.8° in the C group and 12.3° in the Hip group. The mean RA in the C group was 18.1° (SD, 9.0°). There was significant difference in RA between the Hip and Spine groups (21.1° [SD, 8.0°] and 16.4° [SD, 10.8°], respectively) (P = .04). CONCLUSION Hip and spine pathologies affect stand-to-sit pelvic kinematics.
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Affiliation(s)
- Youngwoo Kim
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Paris Tech, Paris, France, Paris, France; Department of Orthopaedic and Trauma Surgery, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, France; Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto Prefecture, Japan
| | - Claudio Vergari
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Paris Tech, Paris, France, Paris, France
| | - François Girinon
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Paris Tech, Paris, France, Paris, France
| | - Jean Yves Lazennec
- Department of Orthopaedic and Trauma Surgery, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, France; Anatomy Department Faculté Pitié-Salpêtrière, Médecine Sorbonne Université, Paris, France, Paris, France
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Paris Tech, Paris, France, Paris, France
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Komiyama K, Hamai S, Hara D, Ikebe S, Wang Y, Gondo H, Higaki H, Nakashima Y. Dynamic hip kinematics during recreational classical ballet and hula dance after total hip arthroplasty: two case reports. J Med Case Rep 2019; 13:11. [PMID: 30635037 PMCID: PMC6330411 DOI: 10.1186/s13256-018-1942-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 12/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background The in vivo assessment of the three-dimensional kinematics of the hip during dance activities in patients after total hip arthroplasty has not been previously reported. We evaluated the replaced hip kinematics during recreational classical ballet and hula dance using radiographic-based image-matching techniques. Case presentation A 58-year-old Japanese woman (patient 1; height, 157 cm; weight, 74.5 kg) and a 73-year-old Japanese woman (patient 2; height, 153 cm; weight, 48 kg) were still doing classical ballet and hula dance, respectively, after primary total hip arthroplasty. For ballet, there were gradual three-dimensional hip movements with 48° flexion, 36° abduction, and 49° external rotation in développé and 34° flexion, 29° abduction, and 43° external rotation in plié. For hula, there were small three-dimensional hip movements with 31° flexion, 15° adduction, and 11° external rotation in kao and 17° flexion, 11° adduction, and 11° external rotation in kaholo. No liner-to-neck contact was found in any dance activities. Conclusion Both classical ballet and hula dance produced complex ranges of hip movements and activity-dependent kinematics. These kinematic data could be useful for recommending each patient with total hip arthroplasty to continue recreational dance activities.
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Affiliation(s)
- Keisuke Komiyama
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Daisuke Hara
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoru Ikebe
- Department of Creative Engineering, National Institute of Technology, Kitakyushu College, 5-20-1 Shii, Kokuraminami-ku, Kitakyushu, Fukuoka, 802-0985, Japan
| | - Yifeng Wang
- Department of Life Science, Faculty of Life Science, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-0004, Japan
| | - Hirotaka Gondo
- Department of Life Science, Faculty of Life Science, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-0004, Japan
| | - Hidehiko Higaki
- Department of Life Science, Faculty of Life Science, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-0004, Japan
| | - Yasuharu Nakashima
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Komiyama K, Hamai S, Hara D, Ikebe S, Higaki H, Yoshimoto K, Shiomoto K, Gondo H, Wang Y, Nakashima Y. Dynamic hip kinematics during squatting before and after total hip arthroplasty. J Orthop Surg Res 2018; 13:162. [PMID: 29970119 PMCID: PMC6029136 DOI: 10.1186/s13018-018-0873-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/25/2018] [Indexed: 11/22/2022] Open
Abstract
Background The difference in in vivo kinematics before and after total hip arthroplasty (THA) for the same subjects and the clearance between the liner and neck during squatting have been unclear. The purpose of the present study was to clarify (1) the changes in the in vivo kinematics between prosthetic hips and osteoarthritis hips of the same subjects and (2) the extent of the liner-to-neck clearance during squatting under weight-bearing conditions. Methods This study consisted of 10 patients who underwent unilateral THA for symptomatic osteoarthritis. Using a flat-panel X-ray detector, we obtained continuous radiographs during squatting. We analyzed the hip joint’s movements using three-dimensional-to-two-dimensional model-to-image registration techniques. We also quantified the minimum distance at maximum flexion and extension, and the minimum angle at maximum flexion between the liner and stem neck. Results The maximum hip flexion angles post-THA (80.7° [range, 69.4–98.6°]) changed significantly compared with the pre-THA values (71.7° [range, 55.2°–91.2°]). The pelvic tilt angle (posterior +, anterior−) at the maximum hip flexion post-THA (10.4° [range, − 6.7° to 26.9°]) was significantly smaller than that at pre-THA (16.6° [range, − 3° to 40.3°]). The minimum anterior and posterior liner-to-neck distances averaged 10.9 and 8.0 mm, respectively, which was a significant difference. The minimum liner-to-neck angle at maximum flexion averaged 34.7° (range, 20.7°–46.3°). No liner-to-neck contact occurred in any of the hips. Conclusion THA increased the range of hip joint motion and the pelvis tilted anteriorly more after than before THA, with sufficient liner-to-neck clearance during squatting. These data may be beneficial for advising patients after THA regarding postoperative activity restrictions in daily life.
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Affiliation(s)
- Keisuke Komiyama
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Daisuke Hara
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoru Ikebe
- Department of Creative Engineering, National Institute of Technology, Kitakyushu College, 5-20-1 Shii, Kokuraminami-ku, Kitakyushu, Fukuoka, 802-0985, Japan
| | - Hidehiko Higaki
- Department of Life Science, Faculty of Life Science, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-0004, Japan
| | - Kensei Yoshimoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kyohei Shiomoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hirotaka Gondo
- Department of Life Science, Faculty of Life Science, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-0004, Japan
| | - Yifeng Wang
- Department of Life Science, Faculty of Life Science, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-0004, Japan
| | - Yasuharu Nakashima
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Pre- and post-operative evaluation of pincer-type femoroacetabular impingement during squat using image-matching techniques: A case report. Int J Surg Case Rep 2017; 42:121-127. [PMID: 29245096 PMCID: PMC5730418 DOI: 10.1016/j.ijscr.2017.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 11/29/2017] [Accepted: 12/02/2017] [Indexed: 11/22/2022] Open
Abstract
Hip kinematics with pincer-type femoroacetabular impingement were evaluated. Rim-neck clearance was visualized based on patient’s kinematics and morphology. Image-matching techniques were used for pre-and post-operative evaluation. We could detect the precise location of the impingement during squat. Image-matching techniques were useful to assess femoroacetabular impingement.
Introduction Although combined evaluation of hip joint kinematics and bone morphology is necessary for accurate assessment of femoroacetabular impingement (FAI), there are no report which evaluated hip kinematics of pincer-type FAI. Presentation of case The pre- and postoperative hip kinematics of a 46-year-old man, with a pincer-type FAI during squat were evaluated using image-matching techniques and the rim-neck distance was measured. Preoperative simulation of squatting was also performed using patient’s bone models and healthy subject’s kinematics data to detect the overlapping lesion between the acetabulum and the femur. Post-acetabuloplasty, right coxalgia during squat disappeared, and the Harris Hip Score improved from 79 to 92 at one year after surgery. Posterior pelvic tilt, femoral and hip flexion angle changed from 24.0°, 101.1°, and 70.8° to 23.3°, 92.6°, and 63.3°, respectively. The minimum rim-neck distance at maximum hip flexion improved from 1.8 mm to 7.3 mm. Discussion We could evaluate both of hip kinematics and morphology with image-matching techniques, and could visualize the clearance between the femoral head-neck junction and the acetabular rim. Conclusion Image-matching techniques were clinically useful to assist surgeons in detecting the location of the impingement and confirming resection of the pincer lesion post-operatively.
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Yoshimoto K, Hamai S, Higaki H, Gondoh H, Nakashima Y. Visualization of a cam-type femoroacetabular impingement while squatting using image-matching techniques: a case report. Skeletal Radiol 2017; 46:1277-1282. [PMID: 28550358 DOI: 10.1007/s00256-017-2677-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/13/2017] [Accepted: 05/16/2017] [Indexed: 02/02/2023]
Abstract
The in vivo assessment of the three-dimensional (3D) kinematics of the hip in patients with femoroacetabular impingement (FAI) under weight-bearing conditions has not been previously reported. We evaluated the pre- and postoperative hip kinematics of a 34-year-old man, with a cam-type FAI while squatting, using image-matching techniques with measurement of the rim-neck distance. Post-osteochondroplasty, the α-angle improved from 51.0° to 35.5° and the head-neck offset ratio from 0.04 to 0.23. Coxalgia during squatting disappeared, and the Harris Hip Score improved from 79 to 92 at 1 year post-surgery. Postoperative hip kinematic values (3.8° of posterior pelvic tilt and 101.2° of femoral flexion at 96.8° of maximum hip flexion) were similar to the preoperative values (2.9° of posterior pelvic tilt and 102.7° of femoral flexion at 98.8° of maximum hip flexion). Meanwhile, osteochondroplasty improved the minimum rim-neck distance at maximum hip flexion from 2.0 to 10.4 mm. In vivo 3D visualization of the clearance between the femoral head-neck junction and the acetabulum could assist surgeons in adequately identifying the location of impingement and confirming sufficient resection post-operatively.
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Affiliation(s)
- Kensei Yoshimoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Hidehiko Higaki
- Department of Biorobotics, Faculty of Engineering, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-0004, Japan
| | - Hirotaka Gondoh
- Department of Biorobotics, Faculty of Engineering, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-0004, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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