Clinical Outcomes of Total Hip Arthroplasty With the Anterolateral Modified Watson-Jones Approach for Displaced Femoral Neck Fractures.

Objective: In recent years, many studies have reported good results with total hip arthroplasty (THA) for displaced femoral neck fractures (FNFs). However, no study has reported the clinical outcomes of the anterolateral modified Watson-Jones THA (MWJ-THA) for displaced FNFs. This study aimed to investigate the clinical results of THA for displaced FNFs at our hospital and to discuss the advantages of MWJ-THA over THA with other approaches for displaced FNFs. Methods: Forty-three patients who underwent MWJ-THA for displaced FNFs were included in this study. Patient characteristics, preinjury walking ability, activities of daily living, implants used, walking ability (at 1, 3, and 6 months after surgery), cup placement angle, clinical hip score, surgical complications, revision surgery, and death within 1 year after surgery were investigated. Results: The mean age of the 43 patients was 63.3 years, and the mean body mass index (kg/m2) was 21.1. Regarding the heads used, 28-mm heads were used in 4 patients, 32-mm heads were used in 32 patients, and 36-mm heads were used in 7 patients. The cups were placed in the Lewinnek safety zone (93.0%). Four patients had stem sinkage of a few millimeters. 6 months postoperatively, 38 patients walked unaided, and 4 patients walked with a cane. The Harris Hip Score averaged over 90 points at all time points. No postoperative dislocation was observed. Two patients died within 1 year postoperatively. Conclusion: In this study, MWJ-THA was performed for displaced FNFs and resulted in no postoperative dislocations. Furthermore, more than 90% of the patients regained their preinjury walking ability at 6 months postoperatively. MWJ-THA has great dislocation control and is effective in treating displaced FNFs.

Bilateral Stress Fractures of the Femoral Neck after Total Knee Arthroplasty: Importance of Early Diagnosis.

Unilateral stress fracture of the femoral neck following total knee arthroplasty (TKA) is a rare complication; only 21 cases are described in English literature so far. Bilateral stress fractures of the femoral neck occurring simultaneously following a bilateral TKA have been seen in only 2 cases till now. We report a patient suffering from rheumatoid arthritis of both knees, who was treated with bilateral TKA. She developed spontaneous fractures of the femoral neck on both sides 12 months following the TKA. She was treated with bilateral total hip arthroplasty (THA). Stress fracture of the femoral neck should be suspected in patients complaining of hip pain who have undergone TKA.

Is the alignment guide technique in total hip arthroplasty sufficient for accurate cup positioning with a modified Watson Jones approach?

PURPOSE:: Cup setting with only an alignment guide has been reported to be inaccurate in the lateral decubitus position in total hip arthroplasty (THA). We assessed the accuracy of cup positioning using only the alignment guide technique via a modified Watson Jones approach in the lateral decubitus position. METHODS:: Two hundred hips of 189 patients underwent THA from October 2014 to September 2016 via a modified Watson Jones approach. In the final sample, 181 hips of 171 patients (35 males, 136 females) were included in this investigation. The alignment of the cup was evaluated by an anteroposterior radiograph of the pelvis 1 week after surgery. Measurements were divided into safe zone determined by Callanan and Lewinnek. RESULTS:: There were 168 (92.8%) acetabular cups that were placed within the safe zone for both inclination and anteversion based on the safe zones defined by Lewinnek, and 134 (74%) acetabular cups that were placed within the safe zone defined by Callanan. Multiple logistic analysis showed that the laterality and the addition of the confirmation method were indicators for malpositioning of combined inclination and anteversion. CONCLUSION:: Our data suggested that even if special tools were not used in the lateral decubitus position, using only the alignment guide enabled cup positioning to be achieved with 92.8% accuracy in the Lewinnek safe zone and 74% accuracy in the Callanan safe zone. Multiple logistic analysis showed that the laterality and the addition of a confirmation alignment guide influenced the accuracy of cup positioning.

Iatrogenic Lumbar Vertebral Fracture during Osteosynthesis for a Trochanteric Fracture of the Femur in Diffuse Idiopathic Skeletal Hyperostosis.

Vertebral fractures occur with only slight trauma in patients with diffuse idiopathic skeletal hyperostosis (DISH). However, a lumbar vertebra fracture, due to an intraoperative body position has not been previously reported. An 87-year-old woman with kyphosis sustained a left trochanteric fracture of her femur. The patient was placed in a supine position during the operation. Postoperatively, the patient experienced severe right thigh pain. Magnetic resonance imaging revealed an L4 vertebral fracture. Computed tomography revealed ankylosis from the upper thoracic spine to the sacrum. While in a supine position under general anesthesia, the contact of the patient's lower back with operating table likely created a fulcrum at her lumbosacral spine acting as a long lever arm, bearing the mass of her upper body. We performed L1-S2 posterior stabilization. DISH patients with kyphosis placed in a supine position have an increased risk for lumbar vertebral fracture.

Establishment of an animal model for delayed-onset muscle soreness after high-intensity eccentric exercise and its application for investigating the efficacy of low-load eccentric training.

BACKGROUND: Delayed-onset muscle soreness (DOMS) occurs after unaccustomed exercise and is particularly associated with eccentric exercise. Previous studies have proposed the use of a single bout of eccentric exercise to prevent the muscle damage subsequent to a bout of eccentric exercise. This study aimed to establish a suitable animal model to evaluate the pain in DOMS and to assess whether low-load eccentric training confers a protective effect against a subsequent high-intensity eccentric exercise bout. METHODS: Thirty-six female Wistar rats were divided into five groups: rats that received muscular compression only (Comp); those that received high-intensity eccentric exercise only (HE); those that received muscular compression at 3, 24, 48, and 96 h after high-intensity eccentric exercise (HE + Comp/3, 24, 48, and 96 h); those that received muscular compression 48 h after a single low-load eccentric exercise (LE); and those that received a week of low-load eccentric training before high-intensity eccentric exercise, which was followed by muscular compression 48 h later (LET). Immunohistochemistry was used to investigate c-fos expression in the dorsal horn of the spinal cord. RESULTS: For the HE + Comp/48 h rats, the total number of c-fos-positive neurons at the L2-3 segments was significantly greater than that in the Comp and HE rats in the same segments. A week of low-load eccentric training resulted in a decreased number of c-fos-ir neurons relative to that in the HE + Comp/48 h rats. CONCLUSIONS: Muscle tenderness after high-intensity eccentric exercise was evaluated by c-fos expression in the dorsal horn of the rat spinal cord. Using this rat model, the present study clarified that the muscle tenderness following high-intensity eccentric exercise is inhibited by prior low-load eccentric training.

Effect of heat shock preconditioning on ROS scavenging activity in rat skeletal muscle after downhill running.

The mechanisms of the protective effect conferred by heat shock preconditioning (HS) are currently unknown. The purpose of this study was to determine the effect of HS on muscle injury after downhill running and to address the mechanism of the effect. Female Wistar rats were assigned to three groups: HS, downhill running (E), and downhill running after heat shock preconditioning (HS + E). The HS and HS + E rats were placed in a heat chamber for 60 min (ambient temperature 42 +/- 1.0 degrees C) 48 h before downhill running. Reactive oxygen species (ROS) scavenging activity was determined by electron spin resonance (ESR), and heat shock protein 72 (HSP72) mRNA expression was measured in rat quadriceps femoris. Leukocyte infiltration and degenerated muscle fibers were determined histopathologically. ROS scavenging activity significantly increased at 3 days after HS (151 +/- 18%) and HSP72 mRNA expression increased immediately after HS (1750 +/- 1914%). No decrease in ROS scavenging activity was observed in the HS + E rats at 2 days after exercise compared with the E rats (102 +/- 9% vs. 79 +/- 5%). Degenerated muscle fibers in HS + E rats were significantly less than in E rats at 2, 3, and 7 days after exercise (0.8 +/- 1.0 vs. 2.8 +/- 1.6, 0.8 +/- 1.0 vs. 1.8 +/- 1.6, 0 vs. 0.3 +/- 0.6, respectively). These data demonstrated that HS can reduce muscle injury after downhill running, and this effect may be mediated by increased ROS scavenging activity. Furthermore, HS may protect the antioxidant defense system in skeletal muscle by enhancing the adaptive HSP72 mRNA response.

ROS scavenging activity and muscle damage prevention in eccentric exercise in rats.

Depending on intensity, eccentric exercise is experimentally and clinically documented to have opposing dual effects on skeletal muscle; intense eccentric exercise damages muscle, but daily low-load eccentric exercise prevents damage. To clarify the mechanisms of this dual effect, microscopic damage and oxidative stress were studied in rat quadriceps muscle. Oxidative stress was estimated from an immunostaining of advanced glycation end-products (AGE) and a measurement of muscle tissue preparations, the ability to scavenge reactive oxygen species (ROS). Intense eccentric downhill running (IEE) induced muscle damage that was, microscopically apparent 3 days later. Since AGE-positive cells and decreased ROS scavenging activity were observed earlier (on the day after IEE), cellular damage may be related to ROS production. Intense concentric uphill running (ICE) induced an immediate but transient decrease in ROS scavenging activity, which recovered within a day. Neither AGE-positive cells nor microscopic damage was observed after ICE. Since each contracting muscle fiber develops greater tension during eccentric rather than concentric exercise, the initial trigger of IEE-induced muscle damage may be damage to muscle fibers and connective tissues at the subcellular level. Daily low-load training of eccentric downhill running (LET), but not concentric uphill running, efficiently prevented muscle damage after subsequent IEE. No evident elevation of ROS scavenging activity was evident after LET. We concluded that LET prevents IEE-induced muscle damage not through elevated ROS scavenging activity, but through a suppression of initial subcellular damage that triggers subsequent ROS-producing processes, resulting in cellular delayed damage.