[Show abstract][Hide abstract] ABSTRACT: Objective. To clarify the sensory innervation and inflammatory cytokines in hypertrophic synovia associated with pain transmission in OA of the hip. Methods. A piece of the synovium was extracted during reconstruction surgery in 50 patients with OA of the hip as an inflammatory synovium and in 12 patients with femoral neck fracture as a normal synovium. Each sample was immersed in fixative solution, sectioned on a cryostat, and then processed for immunohistochemistry using antibodies as follows: neuron-specific class III β-tubulin (TuJ-1) as a general marker for nerve fibres, calcitonin gene-related peptide (CGRP) for sensory nerve fibres, nuclear factor κB (NF-κB) for the protein complex controlling the transcription of DNA in cellular responses to painful stimuli, and TNF-α for cytokines involved in acute inflammation. The number of immunopositive cells and fibres were counted using a fluorescence microscope. Results. In the inflammatory synovium of OA of the hip, TuJ-1 was positive in 46% (23 hips). Of those positive for TuJ-1, 78% (18 hips) were also positive for CGRP, but 22% (5 hips) were negative for CGRP. NF-κB was positive in 68% (34 hips). Of those positive for NF-κB, 76% (26 hips) were also positive for TNF-α, but 24% (8 hips) were negative for TNF-α. In normal synovia, all four substances were negative. Conclusion. We suggest sensory innervation and inflammatory cytokines in hypertrophic synovia are associated with nociception in OA of the hip. Trial registration: University Hospital Medical Information Network, www.umin.ac.jp, UMIN000001335.
[Show abstract][Hide abstract] ABSTRACT: Study Design. Case series.Objective. To present the difficulty of diagnosing the origin of lower leg pain in patients with lumbar spinal stenosis and hip joint arthritis.Summary of Background Data. Pain arising from a degenerated hip joint is sometimes localized to the lower leg. Patients with lumbar spinal disease may also show radicular pain corresponding to the lower leg area. If patients present with both conditions and only pain at the lower leg, it is difficult to determine the origin of the pain.Methods. We reviewed 420 patients who had leg pain with lumbar spinal stenosis diagnosed by myelography, computed tomography after myelography, or magnetic resonance imaging. Only pain at the ipsilateral lateral aspect of the lower leg, but slight low back pain or pain around the hip joint was shown in 4 patients who had lumbar spinal stenosis and hip osteoarthritis. Their symptoms disappeared after L5 spinal nerve block, but remained after lidocaine infiltration into the hip joint. We performed decompression and posterolateral fusion surgery for these 4 patients.Results. Leg pain did not disappear after lumbar surgery in all patients. Conservative treatment was not effective from 6 to 12 months, so ultimately we performed ipsilateral total hip replacement for all patients and they became symptom-free.Conclusions. It is difficult to determine the origin of lower leg pain by spinal nerve block and hip joint block in patients with lumbar spinal stenosis and hip osteoarthritis. We take this into consideration before surgery.
[Show abstract][Hide abstract] ABSTRACT: Total hip arthroplasty (THA) is recognized as a successful treatment for degenerative hip joint disease. An epidemiological study using the National Hospital Discharge Survey in the United States reported that the number of primary THAs increased from 119,000 in 1990 to 193,000 in 2002. According to nationwide inpatient sample data, the demand for primary THA was estimated to increase from 208,600 in 2005 to 572,000 (174%) in 2030 in the United States. The number of revision THAs in the United States has subsequently increased and is projected to increase from 40,800 in 2005 to 96,700 in 2030. Because revision THAs have a higher incidence of dislocation than primary THAs, preserving the soft tissue, including the gluteus medius muscle, is more necessary at revision THA. However, to our knowledge, few studies have reported soft tissue damage at revision THA. An anterolateral modified Watson-Jones approach, which is between the hip abductor and the tensor fascia lata, preserves the abductor muscles.This article describes 2 cases in which acetabular liner revision was performed through an anterolateral modified Watson-Jones approach. The anterolateral approach provided an excellent surgical field at acetabular liner revision, with no major complications, and has the possibility of being a useful for acetabular liner revision.
[Show abstract][Hide abstract] ABSTRACT: The purpose of the study was to clarify the incidence of alcohol-associated osteonecrosis of the knee using MRI.
A total of 131 patients (56 women and 75 men) with osteonecrosis of the femoral head were enrolled; 60 patients had a history of alcohol abuse and 71 had previously received steroids. All patients underwent MRI of the knee. The incidence of alcohol-associated osteonecrosis of the knee was compared with that of steroid-associated osteonecrosis of the knee. Predictive factors of alcohol- and steroid-associated osteonecrosis of the knee were also evaluated.
The incidence of alcohol-associated osteonecrosis of the knee was lower than that of steroid-associated osteonecrosis of the knee (18.3 vs 54.9%; P < 0.001, Fisher's exact probability test). No significant difference in weekly alcohol consumption was observed between patients with osteonecrosis of the knee and those without osteonecrosis of the knee. No significant difference in daily maximum steroid doses was observed between patients with osteonecrosis of the knee and those without osteonecrosis of the knee.
The present study revealed that the incidence of alcohol-associated osteonecrosis of the knee is lower than that of steroid-associated osteonecrosis of the knee.
[Show abstract][Hide abstract] ABSTRACT: ObjectivesThe aim of the present study was to evaluate the relationship between neuropathic pain and pain deriving from osteoarthritis
of the hip joint, using painDETECT, a self-report questionnaire.
MethodsPatients with osteoarthritis of the hip joint referred to the Department of Orthopaedic Surgery at Chiba University Hospital
were eligible for participation in the study. All the patients completed painDETECT and visual analogue scales and underwent radiological examination. We classified the patients into three groups: likely neuropathic
pain, possible neuropathic pain and unlikely neuropathic pain by painDETECT score. And we evaluated the relationships between painDETECT score and radiological findings, visual analogue scales score and age.
ResultsOne hundred thirty-five patients participated in this study. In all, 8 (5.9%) were classified as likely neuropathic pain,
17 (12.6%) as possible neuropathic pain, and 110 (81.5%) as unlikely neuropathic pain. Visual analogue scales scores were
significantly higher in likely neuropathic pain and possible neuropathic pain patients than in unlikely neuropathic pain patients.
painDETECT score did not significantly correlate with radiological findings or age but did positively correlate with visual analogue
scales score (rs = 0.53, p < 0.001).
DiscussionOur study results suggest that in a certain percentage of patients, the mechanism of pain in osteoarthritis of the hip joint
is predominantly neuropathic in origin.