Predictive factors of mortality of patients with fragility hip fractures at 1 year after discharge : A multicenter, retrospective study in the northern Kyushu district of Japan

Purpose: Fragility hip fractures (FHFs) are associated with a high risk of mortality, but the relative contribution of various factors remains controversial. This study aimed to evaluate predictive factors of mortality at 1 year after discharge in Japan. Methods: A total of 497 patients aged 60 years or older who sustained FHFs during follow-up were included in this study. Expected variables were finally assessed using multivariable Cox proportional hazards models. Results: The 1-year mortality rate was 9.1% (95% confidence interval: 6.8–12.0%, n = 45). Log-rank test revealed that previous fractures (p = 0.003), Barthel index (BI) at discharge (p = 0.011), and place-to-discharge (p = 0.004) were significantly associated with mortality for male patients. Meanwhile, body mass index (BMI; p = 0.023), total Charlson comorbidity index (TCCI; p = 0.005), smoking (p = 0.007), length of hospital stay (LOS; p = 0.009), and BI (p = 0.004) were the counterparts for females. By multivariate analyses, previous vertebral fractures (hazard ratio (HR) 3.33; p = 0.044), and BI <30 (HR 5.42, p = 0.013) were the predictive variables of mortality for male patients. BMI <18.5 kg/m2 (HR 2.70, p = 0.023), TCCI ≥5 (HR 2.61, p = 0.032), smoking history (HR 3.59, p = 0.018), LOS <14 days (HR 13.9; p = 0.007), and BI <30 (HR 2.76; p = 0.049) were the counterparts for females. Conclusions: Previous vertebral fractures and BI <30 were the predictive variables of mortality for male patients, and BMI <18.5 kg/m2, TCCI ≥5, smoking history, LOS <14 days, and BI <30 were those for females. Decreased BI is one of the independent and preventable risk factors. A comprehensive therapeutic approach should be considered to prevent deterioration of activities of daily living and a higher risk of mortality

Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ): a patient-based evaluation tool for hip-joint disease. The Subcommittee on Hip Disease Evaluation of the Clinical Outcome Committee of the Japanese Orthopaedic Association

AbstractBackgroundThe Japanese Orthopaedic Association Hip Score is widely used in Japan, but this tool is designed to reflect the viewpoint of health-care providers rather than that of patients. In gauging the effect of medical therapies in addition to clinical results, it is necessary to assess quality of life (QOL) from the viewpoint of patients. However, there is no tool evaluating QOL for Japanese patients with hip-joint disease.MethodsWith the aim of more accurately classifying QOL for Japanese patients with hip-joint disease, we prepared a questionnaire with 58 items for the survey derived from 464 opinions obtained from approximately 100 Japanese patients with hip-joint disease and previously devised evaluation criteria. In the survey, we collected information on 501 cases, and 402 were subjected to factor analysis. From this, we formulated three categories—movement, mental, and pain—each comprising 7 items, for a total of 21 items to be used as evaluation criteria for hip-joint function.ResultsThe Cronbach’s α coefficients for the three categories were 0.93, 0.93, and 0.95, respectively, indicating the high reliability of the evaluation criteria. The 21 items included some related to the Asian lifestyle, such as use of a Japanese-style toilet and rising from the floor, which are not included in other evaluation tools.ConclusionsThis self-administered questionnaire may become a useful tool in the evaluation of not only Japanese patients, but also of members of other ethnic groups who engage in deep flexion of the hip joint during daily activities

Autologous Osteophyte Grafting for Open-Wedge High Tibial Osteotomy

Osteophytes are physiological bony outgrowths that develop at the margins of the articular surfaces during the progression of osteoarthritis; they are associated with active endochondral bone formation processes and expressions of various growth factors. We believe they could be a source of bone grafts as a result of a potentially strong osteoinductive effect. Moreover, osteophytes can be easily harvested by arthroscopy in patients undergoing open-wedge high tibial osteotomy (OW-HTO) for medial unicompartmental knee osteoarthritis. Therefore, we have been using osteophyte autografts for osteotomy gaps in OW-HTO with positive preliminary results indicating rapid bone healing of osteotomy sites. In this technical note, we introduce a technique for harvesting autologous osteophytes by arthroscopy and implanting them into the gap formed after OW-HTO. We expect that autologous osteophyte grafting can be a useful method for accelerating bone union and therefore enabling weight bearing from an early stage after surgery, which will lead to an early return to social activities

The morphological measurements with a micro CT and the stress analyses of the adaptive remodeling by applied mechanical stimuli in rat caudal vertebrae

To observe the remodeling process in bone adapted to mechanical stimuli, a microcomputed tomography (micro CT) system with a high spatial resolution was utilized. The rat fifth caudal vertebrae (C5) were subjected to daily axial or offset loads. Morphological alterations of C5 were measured periodically and non-invasively with the micro CT between daily mechanical stimuli for 14 days. The finite element (FE) models were built from the binary cross-sectional images of cortex and trabecular bone architecture of C5. Von Mises stresses were calculated by applying the contact pressures from the rigid-body spring model (RBSM) analyses to the FE-models as boundary conditions. The transformations of cortex and the increases of the cortical area were observed in the loaded rats. FE-analyses in the offset loaded rat indicated that von Mises stress distributed uniformly under the analytical offset loaded condition. This fact suggests that the C5 would adapt to the offset loads applied externally by morphological alterations

Influences of newly formed woven bone on tissue stresses in rat caudal vertebrae subjected to mechanical loading: A study based on morphological measurement using a micro-CT and computational stress analysis

Bone tissue stresses in mechanically loaded vertebrae were computationally investigated in order to reveal the influences of adaptive remodeling/modeling on stress distribution. Morphological alteration of the rat fifth caudal vertebrae was periodically and non-invasively measured with a microcomputed tomography (micro-CT). Von Mises stresses were calculated by using a finite element analysis (FEA) together with rigid-body spring models based on the consecutive micro-CT images. Median cross-sectional area periodically increased in the loaded rats depending on the duration of stimuli, which was caused by periosteal woven bone formation. FEA including the newly formed bone demonstrated that the loaded vertebrae showed the lower stress levels compared with non-loaded one. Averaged stress of the offset-loaded rat was markedly symmetry between ventral and dorsal sides under offset loading condition, while that of the non-loaded rat indicated asymmetry. Stress analyses suggested that the loaded vertebrae would adapt to the daily mechanical loading by depositing and calcifying woven bone over periosteum