Three-year follow-up study of health related QOL and lifestyle indicators for Japanese patients after total hip arthroplasty

Psychometric properties of Japanese version15D and cultural characteristics of quality of life undergoing patients with hip and knee arthroplasty

BACKGROUND

Health-related quality of life (HRQoL) following total hip and knee arthroplasty (THA/TKA) may decline more in Asian countries due to lifestyle and housing factors compared with patients in Western countries.

AIMS

To evaluate the psychometric properties of the Japanese version of 15D and clarify the characteristics of HRQoL in Japanese patients who underwent THA/TKA compared with Finnish patients.

METHODS

This longitudinal study included 182 patients between 2019 and 2021. Patients' HRQoL was measured using the 15D preoperatively and 3 months postoperatively. Student's t-tests were used to compare lifestyles between Japan and Finland.

RESULTS

The Japanese version of the 15D showed good internal consistency, reliability, construct validity, and responsiveness. Patients with many steps inside their house had worse HRQoL in the dimensions of mobility, distress, and vitality in Japan. There were significant differences in mobility, distress, vitality, and sexual activity dimensions between Japan and Finland 3 months postoperatively.

CONCLUSIONS

The lower HRQoL in Japan in the dimensions of mobility, distress, and vitality is likely due to Japan's traditional housing structure with many steps. Identifying differences in cultural and psychological characteristics, as well as by residential setting, will enable health care providers to help patients improve their HRQoL.

Association Between Anterior Hip Capsule Thickening and Sagittal Pelvic Alignment Among Patients With Developmental Dysplasia of the Hip

INTRODUCTION

The pathogenesis and pathology of secondary osteoarthritis (OA) of the hip, which is mainly due to developmental dysplasia of the hip (DDH), in Japan are obscure. There are some reports on the thickening of the hip capsule, but the relationship between the thickness of the hip capsule and the pelvic alignment due to hip deformity is not well known. This research investigated whether the capsular thickness of female DDH patients was related to pelvic alignment.

METHODS

This single-center cross-sectional study included female patients aged 50-79 years (n=13) who had undergone primary total hip arthroplasty (THA) due to secondary hip OA with a background of DDH. The part of the hip capsule including the iliofemoral ligament was resected and measured directly with a digital caliper. The Sharp angle, center-edge (CE) angle, sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), and lumbar lordosis angle (LLA) were measured with an X-ray image to investigate the relationship between the capsular thickness and the pelvic posture.

RESULTS

Pearson's correlation coefficient showed a negative correlation between hip capsular thickness and Sharp angle (r=-0.57, p>0.05). No significant correlation was found between the thickness of the hip capsule and the sagittal X-ray parameters including SS, PT, PI, LLA, and CE angle in the coronal plane.

CONCLUSION

The thickness of the hip capsule is moderately associated with the Sharp angle on the coronal plane. The results of this study suggest that the thickness of the joint capsule does not necessarily relate to the degenerative process among patients with DDH and the process can be complex to apply two-dimensional postural indices for the explanation.

Oxford Hip Scores, Floor-Sitting Score Trajectories, and Postoperative Satisfaction Rates at 10 Years After Primary Total Hip Arthroplasty

BACKGROUND

Available evidence on outcomes at 5 years and beyond for total hip arthroplasty (THA) is mainly limited to patient-reported outcome measures (PROMs). This study documented the trajectory of functional measurement using the Oxford hip score (OHS) and floor-sitting posture in Japan for up to 10 years post-THA and investigated predictors of dissatisfaction at 10 years with THA.

METHODS

Patients scheduled for primary THA at a university hospital in Japan between 2003 and 2006 were enrolled in this prospective study. Overall, 826 preoperative participants were eligible for follow-up, with response rates ranging from 93.6% to 69.4% at each postoperative survey point. The OHS and floor-sitting scores were calculated using a self-administered questionnaire 6 times up to 10 years postoperatively. Patient satisfaction, including general surgery, walking ability, and activities of daily living (ADL), was assessed in the 10-year survey.

RESULTS

The linear mixed-effects model demonstrated a postoperative improvement, peaking at 7 years for OHS and 5 years earlier for the floor-sitting score. The postoperative overall surgical dissatisfaction at 10 years with THA was very low (3.2%). No predictors of surgical dissatisfaction were identified in the logistic regression analyses. Predictors of walking ability dissatisfaction were older age, men, and worse OHS at 1 year postoperatively. Predictors of ADL dissatisfaction were poorer preoperative and 1-year postoperative floor-sitting scores and 1-year postoperative OHS.

CONCLUSION

The floor-sitting score is a simple PROM suitable for the Japanese population; other populations would require a scale suitable for their lifestyles.

Relationship between Perceived Leg Length Discrepancy at One Month and Preoperative Hip Abductor Muscle Elasticity in Patients after Total Hip Arthroplasty

OBJECTIVE

Preoperative factors related to perceived leg length discrepancy (PLLD) after total hip arthroplasty (THA) are not well studied. This study aimed to examine the preoperative factors, including hip abductor modulus, related to PLLD one month after THA.

METHODS

The study included 73 patients diagnosed with osteoarthritis secondary to developmental dysplasia of the hip and a posterior approach to surgery. Multiple logistic regression analysis was performed using the presence or absence of PLLD as the dependent variable and preoperative hip abductor's modulus of elasticity, pain, hip abduction range of motion, hip abductor muscle strength and pelvic obliquity as the independent variable. Additionally, receiver operating characteristic curves were used for the extracted variables for calculating the cutoffs, sensitivity, specificity and area under the curve (AUC) to determine the presence or absence of PLLD. The significance level was set at p<0.05.

RESULTS

The hip abductor modulus (odds ratio=1.13; 95% confidence interval=1.06-1.21; p<0.001) was selected as a preoperative factor. The cutoff value to determine the presence or absence of a PLLD was 16.32 kPa. The sensitivity and specificity were 81.8% and 72.5%, respectively, and the AUC was 0.8137.

CONCLUSION

The hip abductor muscle elastic modulus affected PLLD one month after THA. If the preoperative hip abductor elastic modulus is higher than the cutoff value, it may affect the appearance of PLLD at one month postoperatively.

Differences among the observers in the assessments of Japanese orthopedic association hip scores between surgeons and physical therapists and the correlations to patients' reported outcomes after total hip arthroplasty

BACKGROUND

We aimed to assess the utility of a clinician-reported outcome (the Japanese Orthopedic Association [JOA] hip score) as evaluated by clinicians and physiotherapists. This assessment was made by comparing these scores to those of the JOA hip disease evaluation questionnaire (JHEQ), which is a measurement of patient-reported outcomes after total hip arthroplasty.

METHODS

In this retrospective case-control study, 52 hips that underwent primary total hip arthroplasty were included in the analyses. The mean age of the participants was 66.8 years (sex, seven male and 45 female participants). The JOA hip score included four categories: pain, range of motion, ability to walk, and active daily living. The JHEQ included three categories: pain, movement, and mental health. These scores were evaluated preoperatively and postoperatively by clinicians or physiotherapists. Pearson's correlation coefficients were utilized to analyze the association of the JOA hip scores to those of the JHEQ.

RESULTS

The JOA hip scores were determined by clinicians and physiotherapists (scores of 46.8 and 57.3, respectively) preoperatively and at 24 months (scores of 94.4 and 91.7, respectively) postoperatively. The JHEQ points were 28.8 and 66.2 preoperatively and at 24 months postoperatively, respectively. The correlation coefficients between the JOA hip and JHEQ scores were .66 and .69 preoperatively and .57 and .76 at 24 months postoperatively, as evaluated by clinicians and physiotherapists, respectively.

CONCLUSIONS

Although the JHEQ scores were positively correlated to the JOA hip scores by clinicians and physiotherapists preoperatively and postoperatively, this study implies that clinicians may interpret the results in a way that might have been beneficial to them. To comprehend a patients' health status, we should inclusively understand the varying range of information among different evaluators.

Minimum 10 years clinical results of an anatomical short stem with a proximal hydroxyapatite coating

OBJECTIVES

The CentPillar stem (Stryker Orthopaedics), an anatomical short stem, was designed to match the proximal femoral canal shape in both patients with normal hips and those with developmental dysplasia of the hip (DDH). The long-term outcomes of the CentPillar stem was examined herein.

METHODS

In total, 222 hips that underwent total hip arthroplasty using the CentPillar stem were analyzed. DDH was the main reason for surgery (79.3%). Implant survivorship was assessed using Kaplan-Meier analysis. For radiographic evaluation, stress shielding was assessed using the Engh classification. For functional evaluation, patients' ability to perform deep hip bending activities (sit on the floor, squat, and sit straight) was assessed.

RESULTS

During a median follow-up of 13.1 years, 2 stem revisions were performed (aseptic loosening and late hematogenous periprosthetic infection), and the overall cumulative implant survival rate was 99.0% at 15 years. In the radiographic evaluation, grade >3 stress shielding was found in only one hip. More than 80% of the patients were able to perform each of the three deep hip bending activities.

CONCLUSIONS

Good fixation at the proximal part of the femur was obtained, and the implant survival rate of the CentPillar stem was excellent during a long-term follow-up.

Case Report: Culture-Dependent Postures in Japanese Patients With Schizophrenia

Cross-cultural understanding of psychiatric symptoms is important in the current globalised society. Lack of knowledge regarding culture-dependent manifestations of psychiatric illnesses may lead to misjudgement by clinicians, resulting in inappropriate treatment. We present the cases of two patients with schizophrenia who showed Japanese-culture-dependent postures (seiza and dogeza). Seiza is a Japanese style of formal floor sitting. Dogeza includes bowing and touching the forehead to the floor while sitting in a kneeling position. When patients with schizophrenia perform these postures in a clinical setting, clinicians receive plenty of information regarding the patients' clinical states, including schizophrenia-related fear/tension, accusatory auditory verbal hallucinations, and pathological guilt.

Cross-cultural adaptation, reliability and validity of the Japanese version of the Hospital for Special Surgery Hip Replacement Expectations Survey

BACKGROUND

The Hospital for Special Surgery Hip Replacement Expectations Survey (HSS-THRES) is used in many countries to determine patient expectations before surgery. This study aimed to assess the reliability and validity of the Japanese version of HSS-THRES.

METHODS

A total of 134 patients scheduled for total hip arthroplasty (THA) underwent a self-administered preoperative survey questionnaire. Patient's expectation and quality of life (QOL) were measured using the Japanese version of HSS-THRES, overall expectations for THA, Oxford hip score (OHS), and EuroQol-5D (EQ-5D). Some patients completed the Japanese version of HSS-THRES and the overall expectations for THA after a ten-day interval. Cross-cultural adaptation was validated by an expert committee comprising health professionals, a methodologist, language experts, and orthopedic specialists. The internal consistency was evaluated by the Cronbach α coefficient. The test-retest reliability was examined using the intraclass coefficient correlation (ICC) and the Bland and Altman analysis. To test the construct validity, nine priori hypotheses were tested by correlation analysis between the Japanese version of HSS-THRES and two QOL scales, and by examining the association with demographic variables.

RESULTS

A total of 116 patients completed four scales. Patients were predominantly female (75.9%), with an average age of 62.2 ± 11.7. In the cross-cultural adaptation, all patients responded to the questionnaire without problems. The Japanese version of HSS-THRES showed good internal consistency (Cronbach α: 0.9). ICC was 0.94 and Bland-Altman analysis indicated no bias. The correlation between Japanese HSS-THRES and overall expectations for THA was high (r = 0.67). Similarly, the correlation with the OHS was higher than that with EQ-5D. A total of 77.8% of the hypotheses were confirmed.

CONCLUSIONS

The Japanese version of HSS-THRES showed good cultural acceptability, high reliability, and validity to evaluate preoperative expectations for THA patients.

Predictors of Health-Related Quality of Life After Revision Total Hip Arthroplasty for Aseptic Loosening

BACKGROUND

Few studies have investigated the relationships between preoperative or intraoperative patient factors and postoperative quality of life (QOL) after revision total hip arthroplasty (THA). The aim of our study was to identify the predictors of QOL after revision THA for aseptic loosening.

MATERIALS AND METHODS

Fifty-one patients who underwent revision THA for aseptic loosening were included in the present study. Preoperative hip function was evaluated using the Japanese Orthopaedic Association (JOA) score. The patients' QOL after surgery was evaluated with EuroQol 5D (EQ-5D) assessment at the end of the 2-year follow-up. The patients were then divided into two groups: good QOL (score ≥ 0.6) and poor QOL (score < 0.6). Predictive factors (i.e., age, BMI, preoperative JOA score, and the degree of acetabular bone defect according to the Paprosky classification) were compared between both QOL groups. Furthermore, multiple linear regression was performed to assess independent factors affecting the QOL.

RESULTS

Significant differences between the good and poor QOL groups were identified for BMI, walking ability, and severity of acetabular bone defect (BMI: 21.5 ± 2.9 vs. 24.1 ± 4.3, P = 0.0331; walking ability: 11.5 ± 5.0 vs. 5.5 ± 4.9, P = 0.0058; acetabular bone defect: 44.4% vs. 81.0%, P = 0.0103). The walking ability independently affected the EQ-5D utility score.

CONCLUSIONS

The present study indicates that a higher BMI, lower walking ability, and more severe acetabular bone defect are predictors of lower QOL after revision THA for aseptic loosening. In particular, the walking ability was the only independent factor. Thus, surgeons should pay attention to the postoperative management of patients with these risk factors.

Expectations and depression in patients who have undergone total hip arthroplasty in Japan: A prospective cohort study

BACKGROUND

Patients with hip osteoarthritis may be severely depressed preoperatively due to pain and limited daily-living activities. Hence, evaluating their expectations preoperatively might underestimate their true hopes regarding the upcoming total hip arthroplasty (THA).

AIM

We aimed to assess changes in patients' level of depression, understand their expectations and fulfillment, and identify factors affecting fulfillment.

METHOD

We performed a longitudinal study of 366 Japanese patients who had undergone THA during 2005-2006. Those with THA of the contralateral hip were excluded. Patients' expectations, fulfillment, depression, and physical function were assessed perperative and at 6 weeks and one year postoperatively using our own questionnaire, the Arthritis Impact Measurement Scale 2, and by the Oxford Hip Score . Logistic regression analysis was applied to identify independent predictors of expectation fulfillment.

RESULTS

At 6 weeks, 78.1% expressed expectation fulfillment and drastic alleviation of depression. Preoperative depression and fulfillment of patient expectations at 6 weeks were significant predictors of expectation fulfillment at 1 year (95% confidence intervals: 1.01-2.48 and 2.30-9.92, respectively.

CONCLUSIONS

It is worthwhile for health providers to investigate patients' expectations early in the postoperative period by considering their preoperative depression to confirm fulfillment of expectations.

Patients 10 years after total hip arthroplasty have the deficits in functional performance, physical activity, and high fall rate compared to healthy adults

Background Long-term results in muscle strength, physical activity (PA), and functional improvement after total hip arthroplasty (THA) have not been studied. The purpose of this study was to evaluate the deficits in functional performance, PA, and high fall rate in patient 10 years after THA compared to healthy adults. Methods The subjects were 58 patients who underwent primary THA for unilateral hip osteoarthritis 10 years, and 46 healthy adults. Hip abductor strength, balance function (single-leg stance time), Maximal Walking Speed (MWS), fall rate, and PA (IPAQ short ver.) were evaluated. The unpaired t-test and χ² test were used to assess differences between the groups. Statistical significance was set at p value <0.05. Results Compared to healthy adults, THA patients had 9.5% less hip abductor muscle strength on the operated side, 42.1% shorter single-leg stance time on the operated side, 14.8% slower MWS, 2.0 times less High-PA group, and 2.8 times higher fall rate (p<0.05). Conclusion This study showed that hip abductor muscle strength, gait speed, balance function, and PA were significantly lower in patients 10 years after THA than in healthy adults. Additionally, the fall rate was significantly higher in patients 10 years post-THA than in healthy adults.

Quality of life, effects on Asian Lifestyle, and perceived satisfaction after total hip arthroplasty in Japan and Korea

BACKGROUND

The Asian lifestyle requires deep hip flexion, which increases the risk of dislocation. Hence, Asian total hip arthroplasty (THA) patients may have problems postoperatively. This study aimed to 1) document quality of life (QoL), Asian lifestyle-related items (five postures that require deep hip flexion), and perceived satisfaction in patients who underwent THA in Japan versus Korea, 2) assess the differences in QoL and Asian lifestyle-related items by patient lifestyle, and 3) identify the factors predicting QoL.

METHODS

This cross-sectional study included 222 THA patients. Korean patients completed the questionnaires. Japanese patients were then matched with Korean patients by age, sex, and post-THA period. Assessed parameters included QoL measured by the EuroQoL, Oxford hip score (OHS), Asian lifestyle (measured by the Asian lifestyle-related items), and perceived satisfaction (measured by the five items of postoperative satisfaction). Multiple regression analysis was used to determine the predictors of QoL.

RESULTS

Compared with Korean patients, Japanese patients had better QoL, but more difficulty performing postures requiring deep hip flexion. Greater QoL was associated with greater satisfaction. The predictors of decreased QoL after THA were lower OHS in both countries, worse squatting ability in Japan, and worse leg-crossing ability in Korea.

CONCLUSIONS

In Japan and Korea, the OHS is an important predictor of QoL after THA.

Increased Serum Ion Levels After Ceramic-on-Metal Bearing Total Hip Arthroplasty: Influence of an Asian Lifestyle

BACKGROUND

Recent clinical studies have suggested that systemic metal ion levels are significantly elevated at midterm follow-up in patients with ceramic-on-metal (COM) bearing. However, it is not clear whether there is a correlation between patient-related factors including the lifestyle and elevated levels of serum metal ions following COM total hip arthroplasty (THA).

METHODS

Serum metal levels were measured in 201 patients (234 hips) including 121 COM patients (140 hips) and 80 non-COM patients (94 hips). The Harris Hip Score, University of California, Los Angeles activity scale score, and Western Ontario and McMaster Universities Osteoarthritis Index score were measured and radiographs were obtained for the analysis.

RESULTS

Significantly higher levels of cobalt (Co) and chromium (Cr) were detected in the serum of the COM THA group (Co: 1.86 ± 4.0 μg/L; Cr: 1.81 ± 2.87 μg/L) than those of the non-COM THA group (Co: 0.27 ± 0.14 μg/L; Cr: 0.19 ± 0.25 μg/L; P < .001). The serum metal levels of patients who achieved the squatting position and the kneeling position were significantly higher than those of patients who could not squat (Co: P = .033; Cr: P = .074) and kneel (Co: P = .049; Cr: P = .031). The metal ion levels of the COM THA group correlated with the total range of motion (Co: P = .0293; Cr: P = .0399).

CONCLUSION

Patients who underwent a 36-mm COM THA showed high serum metal levels although good clinical outcomes at the midterm follow-up. We found that COM THA patients who were capable of greater range of motion, squatting, and kneeling are at risk of metal ion-related problems.

Patient-reported outcomes in patients who undergo total hip arthroplasty after periacetabular osteotomy

BACKGROUND

There has been constant discussion about whether the clinical outcome of THA after periacetabular osteotomy (PAO) is equivalent to that after primary total hip arthroplasty (THA). However, there have been few reports about patient-reported outcomes (PRO) for those who undergo THA after PAO. We compared the pre- and postoperative PRO of patients who underwent THA after PAO and those who underwent primary THA alone.

METHODS

We performed a case-control study. Twenty-seven patients (29 hips) underwent THA after PAO (osteotomy group); their mean age at surgery was 57.2 years, and they underwent postoperative follow-up for a mean period of 3.0 years. For the control group, after matching age, sex, and Crowe classification, we included 54 patients (58 joints) who underwent primary THA for hip dysplasia. Assessment performed preoperatively and at the last follow-up included the Harris hip score, the Short Form 36 (SF-36) for the Physical Component Summary (PCS), Mental Component Summary (MCS), and Role/Social Component Summary (RCS) domains, Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ) for pain, movement, and mental health, and the visual analog scale (VAS) score of hip pain and satisfaction.

RESULTS

The two groups demonstrated no significant difference in the preoperative Harris hip score, each domain of the SF-36, JHEQ, and the VAS score of hip pain and satisfaction. The osteotomy group demonstrated significantly poor Harris hip scores for gait and activity, and JHEQ for movement at the last follow-up. There was no significant difference in each domain of the SF-36 and the VAS score of hip pain and satisfaction at the last follow-up.

CONCLUSION

Previous PAO affects the quality of physical function in patients who undergo subsequent THA.

[Comparison of early effectiveness between different approaches in primary total hip arthroplasty]

Objective

To compare the early effectiveness between by anterior approach via Bikini incision and by OCM approach in the primary total hip arthroplasty (THA).

Methods

Between June 2015 and March 2016, 60 patients with ischemic necrosis of the femoral head who accorded with the inclusion criteria were chosen in the study, who were divided into 2 groups according to different surgical approaches. THA was performed on 30 patients by anterior approach via Bikini incision (group A), and on 30 patients by OCM approach (group B). There was no significant difference in age, gender, body mass index, side of affected hip, Steinberg stage of ischemic necrosis of femoral head, preoperative hemoglobin, preoperative Harris score, and preoperative visual analogue scale (VAS) between 2 groups ( P>0.05). The operation time, length of incision, intraoperative blood loss, transfusion rate, starting time of straight leg raising exercise, starting time of active abduction of hip, hospitalization time, the incidence of limb length discrepancy, postoperative Harris score and VAS score were recorded and compared between 2 groups. Anteroposterior pelvic X-ray films were taken to measure acetabular abduction and acetabular anteversion.

Results

Primary healing of incision was obtained in all patients of 2 groups, and there was no significant difference in complication between 2 groups ( χ2=0.144， P=0.704). All the patients of 2 groups were followed up 3 to 12 months, averaged 6 months. There was no significant difference in operation time, length of incision, intraoperative blood loss, transfusion rate, hospitalization time, and starting time of straight leg raising exercise between 2 groups ( P>0.05). Group A was significantly shorter than group B in starting time of active abduction of hip ( t=-4.591, P=0.000), and was significantly lower than group B in the incidence of limb length discrepancy ( χ2=5.455, P=0.020). After operation, neither Harris score at 2 weeks, 6 weeks, 3 months, and 6 months nor VSA score at 24 hours and 6 weeks showed significant difference between 2 groups ( P>0.05). The anteroposterior pelvic X-ray films showed that all the prostheses were in good position, and there was no femoral prosthesis subsidence, acetabular cup displacement or dislocation. No significant difference was found in acetabular abduction and acetabular anteversion at 2 days after operation between 2 groups ( t=0.887, P=0.379; t=0.652, P=0.517).

Conclusion

Both of two approaches in THA can avoid muscle damage and achieve favorable short-term effectiveness. But, anterior approach via Bikini incision is superior to OCM approach in starting time of active abduction of hip and the incidence of limb length discrepancy.

Total Hip Arthroplasty After Periacetabular and Intertrochanteric Valgus Osteotomy

BACKGROUND

We performed periacetabular osteotomy (PAO) combined with intertrochanteric valgus osteotomy (TVO) to obtain better congruity for patients with acetabular dysplasia and nonspherical femoral head. These patients with PAO-combined TVO demonstrate long-term progression of osteoarthritis, thereby, needing conversion to total hip arthroplasty (THA) and is difficult due to morphological changes. The objective of the present study was to investigate outcomes of patients who underwent THA after PAO-combined TVO.

METHODS

We performed 3 groups' case-control study. The participants were 20 patients (20 hips) who underwent THA after PAO-combined TVO (PAO-TVO group); these patients had a mean age at surgery of 56.3 years and underwent postoperative follow-up for a mean period of 6.8 years. For the control group, we included 53 patients (57 joints) who underwent THA after PAO and 76 patients (80 joints) who underwent primary THA for hip dysplasia matching age, sex, and time of surgery.

RESULTS

Harris hip score at the last follow-up was significantly poorer in PAO-TVO group compare with PAO group and primary group. Short Form-36 of Physical Component Summary was significantly poorer in PAO-TVO group compared with primary group. The socket position in the PAO-TVO group was significantly superior and lateral compared with that in the primary THA group. Considering socket placement in Lewinnek's safe zone and stem malalignment, there were no significant differences in the 3 groups.

CONCLUSION

Harris hip score and Short Form-36-Physical Component Summary for THA after PAO-combined TVO were significantly poorer compared to those of primary THA.