Total hip arthroplasty was performed in 19 patients using the lateral approach. Laser Doppler flowmetry was used to measure the blood flow in the anterior and posterior parts of the gluteus medius. The anterior part was split and detached. The posterior part was left intact. The blood flow in the gluteus medius of the anterior part was decreased by 15.4%, while that of the posterior part remained constant during surgery. Postoperatively, the Trendelenburg sign remained positive in 3 of 16 patients. No correlations were observed between a positive Trendelenburg sign and reduction in blood flow of the gluteus medius.
The existing methods of assessing limb lengthening during total hip arthroplasty (THA) are prone to error because the measurements are not parallel to the limb lengthening axis. In order to address this, we designed a caliper to estimate limb lengthening during THA and evaluated its accuracy compared with our previous device, the straight caliper. Limb lengths were measured in 100 patients. The L-shaped caliper was used in 50 cases and the straight caliper in 50. The correlation between intra-operative and post-operative radiographic measurements was significantly improved using the L-shaped device (p < 0.0001, r = 0.934). This method was extremely accurate in predicting changes in limb length due to surgery.
The aim of this study was to compare the radiographic and clinical results after Mayo -stem and conventional femoral component replacements. Seventy-nine total hip arthroplasties were performed in young patients, utilizing conservative hip prostheses developed at the Mayo clinic. We compared the anteroposterior radiographs of 74 control hips who underwent conventional femoral replacement, with 79 hips who had Mayo-stem replacement. We measured the femoral offset, %FO, and valgus angle of the component. In comparison to the conventional femoral component, the Mayo-stem had decrease in femoral offset, %FO and an increase in the valgus angle after implantation. In conclusion, the Mayo-stem is considered to be a suitable femoral component for young patients because the proximal femoral bone can be conserved and the incidence of thigh pain is low, but a weakening of the abductor muscle may ensue after the implantation of this type of femoral prosthesis. It is therefore necessary to pay attention to the stem position during implantation.
Pulmonary embolism (PE) due to deep vein thrombosis (DVT) remains the most serious complication in acute spinal cord injury (SCI). The incidence of PE has been reported as relatively low in Japan, however it can be lethal if it occurs. We experienced two similar cases of fatal PE after SCI. Case 1 was a 44-year-old male with BMI of 29.4. He was treated for schizophrenia on an out-patient basis. He attempted suicide by leaping from a height and suffered polytrauma including bursting fracture of the third lumbar vertebra, for which posterior lateral fixation of the spine was performed. Seventeen days after surgery, he fell into cardiopulmonary arrest due to suspected PE and died in spite of aggressive cardiopulmonary resuscitation. Case 2 was a 34-year-old male with BMI of 35.5. He had a very similar history of mental disorder, mechanisms of injury and surgical procedures as case 1. He suddenly collapsed on the 27th postoperative day and was diagnosed as massive PE by arteriography. Thrombolytic therapy and catheter-tip embolectomy were immediately performed without success. For these two ceses, anticoagulation was not instituted. There are several factors that predisposed these patients to PE; trauma, obesity and postsurgical status for spine fracture. Prevention of DVT is the key strategy against PE. Therefore, Preventive measures including routine use of anticoagulants or placement of filter devices for these high-risk group patients should be considered.
Alcaptonuria is rare metabolic disorder caused by deficiency of homogentisic acid enzyme. Ochronotic arthropathy is one of its late complications accompanied by pain and motion restriction of the spine, hips, knees, and shoulders.We report a case of a 61-year-old man with ochronotic hip arthropathy. The patient's radiograph showed rapid collapse of the femoral head. Total hip arthroplasty was carried out and short-term results were good.
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