1
|
Onaga M, Nakasone S, Ishihara M, Igei T, Washizaki F, Kuniyoshi S, Nishida K. Total hip arthroplasty after failed transtrochanteric rotational osteotomy for osteonecrosis of the femoral head: analysis of three-dimensional morphological features. BMC Musculoskelet Disord 2024; 25:194. [PMID: 38439044 PMCID: PMC10910828 DOI: 10.1186/s12891-024-07299-z] [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: 11/18/2023] [Accepted: 02/21/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND In total hip arthroplasty (THA) after failed transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head (ONFH), deformity of the proximal femur has been reported to affect stem placement. The aims of this study were to evaluate the morphological changes in the proximal femur, muscle atrophy, and soft tissue thickening in THA after TRO and the clinical outcomes. METHODS The TRO group included 17 patients (18 hips) who underwent THA after failed TRO. The control group included 21 patients (28 hips) who underwent primary THA for ONFH. To evaluate the deformity of the proximal femur before THA, we measured the anteroposterior and mediolateral diameters of the femur on computed tomographic slices 5 mm proximal to the lesser trochanter. To evaluate muscle atrophy and soft tissue thickening, we measured the thicknesses of the psoas major, iliac, and gluteus medius muscles and the anterior capsule of the hip joint. RESULTS The ratio of the anteroposterior to mediolateral diameters of the proximal femur was significantly greater in the TRO group (p < 0.01). The thicknesses of the muscles did not differ between the two groups, whereas the anterior capsule was significantly thicker in the TRO group (p < 0.05). Varus or valgus stem alignment (> 3°) was frequent in the TRO group (p < 0.01). CONCLUSIONS The round shape of the proximal femur was deformed after TRO compared with primary THA for ONFH, which may have caused malposition of the stem. In addition, we should pay attention to anterior protrusion of the proximal femur and thickening of the anterior capsule.
Collapse
Affiliation(s)
- Masamichi Onaga
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Aza-Uehara, Nishihara Cho, Nakagami-Gun, Okinawa, 9030215, Japan
| | - Satoshi Nakasone
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Aza-Uehara, Nishihara Cho, Nakagami-Gun, Okinawa, 9030215, Japan.
| | - Masato Ishihara
- Department of Orthopedic Surgery, Nakagami Hospital, 610 Noborikawa, Okinawa, Okinawa, 9042195, Japan
| | - Takahiro Igei
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Aza-Uehara, Nishihara Cho, Nakagami-Gun, Okinawa, 9030215, Japan
| | - Fumiyuki Washizaki
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Aza-Uehara, Nishihara Cho, Nakagami-Gun, Okinawa, 9030215, Japan
| | - Sakura Kuniyoshi
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Aza-Uehara, Nishihara Cho, Nakagami-Gun, Okinawa, 9030215, Japan
| | - Kotaro Nishida
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Aza-Uehara, Nishihara Cho, Nakagami-Gun, Okinawa, 9030215, Japan
| |
Collapse
|
2
|
Suzuki M, Kinoshita K, Sakamoto T, Seo H, Kinoshita S, Yoshimura I, Yamamoto T. Utility of anterior wall of greater trochanter in predicting femoral anteversion angle: a three-dimensional computed tomography-based simulation study. J Orthop Surg Res 2022; 17:412. [PMID: 36088332 PMCID: PMC9464406 DOI: 10.1186/s13018-022-03313-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 09/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background The femoral anteversion angle is an important factor in performing surgery in the proximal part of the femur. Predicting the femoral anteversion angle based on the morphology of the proximal femur is clinically useful. The purpose of this study was to investigate whether an anatomical landmark can be used to predict the femoral anteversion angle intraoperatively. Materials and methods We analysed CT data obtained from 100 hips in 69 patients with osteonecrosis of the femoral head with no more than 2 mm collapse and no evidence of osteoarthritic changes. The measured variables were the femoral anteversion angle, the femoral neck-shaft angle, and the AW angle (defined as the angle between the femoral shaft axis and the tangential line of the anterior wall of the greater trochanter). The correlations between variables were also investigated. Multiple regression analysis by the forced input method was performed for the degree of femoral anteversion angle, using sex and the AW angle as explanatory variables. Results On CT, the mean femoral anteversion angle was 14.8° ± 10.8°, the mean AW angle was 17.5° ± 8.0°, and the mean femoral neck-shaft angle was 127.3° ± 5.4°. There was a positive correlation between the femoral anteversion angle and the AW angle. The approximation equations based on the multiple regression analysis were as follows: male femoral anteversion angle = AW angle × 0.7 − 0.7 and female femoral anteversion angle = AW angle × 0.7 + 4.3. Conclusions Femoral anteversion angle can be predicted based on the AW angle of the greater trochanter.
Collapse
|
3
|
Ikemura S, Motomura G, Kawano K, Hamai S, Fujii M, Nakashima Y. The Discrepancy in the Posterior Boundary of Necrotic Lesion Between Axial and Oblique Axial Slices of MRI in Patients with Osteonecrosis of the Femoral Head. J Bone Joint Surg Am 2022; 104:33-39. [PMID: 35108239 DOI: 10.2106/jbjs.20.00493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Little is known concerning differences in assessment of anteroposterior osteonecrotic lesion of the femoral head (ONFH) between the axial plane parallel to the body axis (axial) and the axial plane parallel to the femoral neck axis (oblique axial) using magnetic resonance imaging (MRI). This study aimed to compare the posterior boundary of necrotic lesions between the axial and oblique axial planes on MRI. METHODS This study retrospectively reviewed 120 consecutive hips in 71 patients (47 males and 24 females; mean age, 42 years) with ONFH, for which both axial and oblique axial MRI slices were available. The posterior boundaries of the necrotic lesions were calculated as the ratio of posterior intact circumference to anteroposterior circumference of the femoral head using mid-axial and mid-oblique axial MRI slices. The necrotic angles, calculated using the modified Kerboul method, were compared between cases with progression and nonprogression of collapse. RESULTS The mean posterior intact ratio in the axial slice was 49.2% (range, 8.6 to 85.1%), while that in the oblique axial slice was 33.5% (7.5 to 79.2%). The posterior intact ratio in the oblique axial slice significantly decreased compared to that in the axial slice (p < 0.0001). In cases with progression of collapse, the mean necrotic angle was significantly larger in the oblique axial slice than in the axial slice (p < 0.0001). The sensitivity and specificity of the necrotic angle with regard to the prognosis of the femoral head were both higher when using the oblique axial slice (sensitivity: 88.4%, specificity: 82.3%) than when using the axial slice (sensitivity: 85.1%, specificity: 62.0%). The posterior intact ratio at a mean of 6.8 mm superior to the mid-axial slice corresponded to that of the mid-oblique axial slice. CONCLUSION Our findings suggest that the posterior boundaries of necrotic lesions differ between axial and oblique axial slices, and examination of the oblique axial MRI slice might be more suitable for predicting the prognosis of the femoral head. LEVEL OF EVIDENCE Diagnostic-Investigating a diagnostic test. Level IV (Case series).
Collapse
Affiliation(s)
- Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | | | | | | | | | | |
Collapse
|
4
|
Qiu S, Lin H, Xu M, Liu C, Wang H, Cao Q, Liu J. Effect of acetabular morphological parameters applied in proximal femoral varus osteotomy on the treatment of developmental dysplasia of the hip in children. Transl Pediatr 2021; 10:1361-1368. [PMID: 34189095 PMCID: PMC8193007 DOI: 10.21037/tp-21-200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The study was carried out based on the background that though proximal femoral varus osteotomy is one of the most effective methods in treating developmental dysplasia of the hip (DDH), its surgical efficiency and effect need to be improved. METHODS The neck shaft angle and acetabular morphological parameters were measured before and after operation and during clinical follow-up. The Severin criteria and McKay criteria were both adopted to score the measurements. The distance from the center of the femoral head to the medial cutting bone (expressed as C value) and the shortened lengths of the proximal femur (expressed as Δ S) calculated by formula and obtained by actual measurement were compared. RESULTS The neck shaft angle and acetabular morphological parameters after operation and during clinical follow-up were significantly lower than those before operation (P<0.05). The proportion of children with McKay scores of I, II, III, and IV after operation was 50.00%, 41.67%, 8.33%, and 0.00%, respectively; while the proportion of children with Severin scores of I, II, III, and IV was 55.00%, 38.33%, 6.67%, and 0.00%, respectively. There were no significant differences in the C value and Δ S obtained after formula calculation and actual measurement (P>0.05). CONCLUSIONS The acetabular morphological parameters applied in proximal femoral varus osteotomy are of great value for the treatment of DDH in children.
Collapse
Affiliation(s)
- Shenghua Qiu
- Department of Pediatric Surgery, Linyi Central Hospital, Linyi, China
| | - Haiwei Lin
- Department of Pediatric Surgery, Linyi Central Hospital, Linyi, China
| | - Meng Xu
- Department of Pediatric Surgery, Linyi Central Hospital, Linyi, China
| | - Chengliang Liu
- Department of Pediatric Surgery, Linyi Central Hospital, Linyi, China
| | - Haifeng Wang
- Department of Pediatric Surgery, Linyi Central Hospital, Linyi, China
| | - Qingwei Cao
- Department of Pediatric Surgery, Linyi Central Hospital, Linyi, China
| | - Jinxiang Liu
- Department of Pediatric Surgery, Linyi Central Hospital, Linyi, China
| |
Collapse
|
5
|
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.
Collapse
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.
| |
Collapse
|
6
|
Mayr HO, Schmidt JP, Haasters F, Bernstein A, Schmal H, Prall WC. Anteversion Angle Measurement in Suspected Torsional Malalignment of the Femur in 3-Dimensional EOS vs Computed Tomography-A Validation Study. J Arthroplasty 2021; 36:379-386. [PMID: 32826141 DOI: 10.1016/j.arth.2020.07.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/19/2020] [Accepted: 07/22/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Computed tomography (CT) scan is the standard for assessment of femoral torsion. This observational study was conducted to evaluate the comparability of the EOS radiation dose scanning system (EOS imaging, Paris, France) and the CT scan in patients with suspected torsional malalignment of the femur. METHODS Patients with suspected torsional malalignment of the femur were included in a study for surgical planning. The primary endpoint was to compare the 3-dimensional radiological (EOS) imaging system with the CT scan to determine femoral anteversion (AV) angle. Three independent raters performed measurements. Comparability of CT scan and EOS values was assessed by Pearson correlation, t test, interobserver reliability, and intraobserver reliability (Cronbach alpha). RESULTS About 34 femora were examined. Interobserver reliability/intraobserver reliability was 0.911 of 0.955 for EOS and 0.934 of 0.934 for CT scan. EOS system revealed an AV angle of 12.2° ± 10.0° (-15.0° to 32.0°). CT examinations showed an AV angle of 12.6° ± 9.2° (-3.2° to 35.6°). About 11 hips featured physiological AV, 14 hips showed decreased AV (<10°) or retroversion (<0°), and 9 hips showed increased AV (>20°). Overall, a strong Pearson correlation of τ = 0.855 and a highly significant correlation in the t test for both methods was seen. In patients with decreased AV, retroversion, or increased AV, Pearson correlation only resulted in a moderate/low correlation of τ = 0.495 and τ = 0.292. The t test showed no significant correlation at malrotation. CONCLUSION In torsional malalignment, EOS does not have correlation with CT measurements. In contrast to CT scan, EOS allows femoral torsion measurement independent of legs' positioning.
Collapse
Affiliation(s)
- Hermann O Mayr
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Jan-Peter Schmidt
- Department of Knee, Hip and Shoulder Surgery, Schoen Clinic Munich Harlaching, Academic Teaching Hospital of the Paracelsus Medical University (PMU), Salzburg, Austria
| | - Florian Haasters
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Anke Bernstein
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Hagen Schmal
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany; Department of Orthopaedic Surgery, University Hospital Odense, Odense, Denmark
| | - Wolf C Prall
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany; Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| |
Collapse
|
7
|
Xu M, Motomura G, Ikemura S, Yamaguchi R, Utsunomiya T, Baba S, Kawano K, Nakashima Y. Proximal femoral morphology after transtrochanteric posterior rotational osteotomy for osteonecrosis of the femoral head: A three-dimensional simulation study. Orthop Traumatol Surg Res 2020; 106:1569-1574. [PMID: 33153958 DOI: 10.1016/j.otsr.2020.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/09/2020] [Accepted: 07/18/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Transtrochanteric posterior rotational osteotomy (PRO) is one of the joint-preserving surgeries for osteonecrosis of the femoral head. In general, postoperative femoral neck-shaft varus realignment is planned to obtain a sufficient intact articular surface of the femoral head in the weight-bearing portion. Unlike anterior rotational osteotomy, PRO allows for more than 90° rotation of the femoral head, resulting in more complicated morphology. However, little is known about the potential risk of postoperative femoral retroversion after PRO. This simulation study aims: 1) to assess whether postoperative femoral neck-shaft varus realignment can coexist with preserved femoral anteversion after PRO, 2) and whether postoperative proximal femoral morphology could be predicted with approximation equations. HYPOTHESIS High degree (>90°) PRO is favourable for femoral neck-shaft varus realignment, but unfavourable for maintaining postoperative femoral anteversion. MATERIALS AND METHODS PRO was simulated by using CT data from 10 hips in 10 healthy volunteers. During simulation, the intertrochanteric osteotomy plane was determined three-dimensionally based on anteroposterior-view line (the osteotomy line on anteroposterior view) and lateral-view line (the osteotomy line on lateral view). By changing either the angle of anteroposterior-view line or lateral-view line, we simulated 90°, 110°, 130° and 150° PRO. To clarify the effects of various posterior rotation angles on postoperative proximal femoral morphology, we made simplified PRO models through changing only the posterior rotation angle. RESULTS In the 90°, 110°, 130° and 150° PRO models, the vertically inclined angle of anteroposterior-view line showed a significant positive correlation with femoral neck-shaft varus realignment (90° PRO, r=0.90; 110° PRO, r=0.95; 130° PRO, r=0.97; 150° PRO, r=0.99), while a significant negative correlation with postoperative femoral anteversion angle (90° PRO, r=-0.97; 110° PRO, r=-0.95; 130° PRO, r=-0.92; 150° PRO, r=-0.7). Likewise, the posteriorly tilted angle of lateral-view line showed a significant negative correlation with both femoral neck-shaft varus realignment (90° PRO, r=-0.81; 110° PRO, r=-0.81; 130° PRO, r=-0.79; 150° PRO, r=-0.72) and postoperative femoral anteversion angle (90° PRO, r=-0.90; 110° PRO, r=-0.89; 130° PRO, r=-0.92; 150° PRO, r=-0.88). In the simplified PRO models, the posterior rotation angle showed a significant positive correlation with femoral neck-shaft varus realignment (r=0.33), while a significant negative correlation with postoperative femoral anteversion angle (r=-0.76). The approximation equations for predicting the proximal femoral morphology after PRO were validated. DISCUSSIONS It was confirmed that high-degree PRO (>90°) is favourable for femoral neck-shaft varus realignment, but works against preserving femoral anteversion. With the approximation equations developed in the current study, surgeons could examine the feasibility of PRO based on postoperative femoral anteversion. In terms of hip joint function and subsequent total hip arthroplasty, excessive deformities including femoral retroversion and severe varus deformity could be avoided. LEVEL OF EVIDENCE IV; case series without control group.
Collapse
Affiliation(s)
- Mingjian Xu
- Department of orthopaedic surgery, Graduate school of medical sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, 812-8582 Fukuoka, Japan
| | - Goro Motomura
- Department of orthopaedic surgery, Graduate school of medical sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, 812-8582 Fukuoka, Japan.
| | - Satoshi Ikemura
- Department of orthopaedic surgery, Graduate school of medical sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, 812-8582 Fukuoka, Japan
| | - Ryosuke Yamaguchi
- Department of orthopaedic surgery, Graduate school of medical sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, 812-8582 Fukuoka, Japan
| | - Takeshi Utsunomiya
- Department of orthopaedic surgery, Graduate school of medical sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, 812-8582 Fukuoka, Japan
| | - Shoji Baba
- Department of orthopaedic surgery, Graduate school of medical sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, 812-8582 Fukuoka, Japan
| | - Koichiro Kawano
- Department of orthopaedic surgery, Graduate school of medical sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, 812-8582 Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of orthopaedic surgery, Graduate school of medical sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, 812-8582 Fukuoka, Japan
| |
Collapse
|