Patients who were just operated on for artificial carpal bone replacement or total artificial hip joint replacement are at high risk of luxation. They are recommended to use pillow-like cushions for propping up their hips or legs for a couple of weeks postoperatively. Even after the removal of the props, there remains a chance of dislocation. Some patients, lying upon their back and spreading their legs apart day and night, complain of pain. With a view to allaying the patients' pain, we attempted to develop a cushion such that patients could toss and turn in bed easily. A questionnaire survey was carried out on all the nurses who had learnt a lot from experience in using pillows commercially available. Based on the findings of the survey, we trial manufactured cushions and used them in one capitate bone replacement patient and three hip joint replacement patients. The cushions were well received by the patients and rated high by a orthopedic surgeon who checked X-rays of the patients.
Prevention ; Dislocation, complete, NOS ; Skeletal bone ; Replacement of joint, NOS ; Surveys

Enrolled in our study were 16 seriously handicapped persons (9 males and 7 females) institutionalized in our medical center. They were 20 to 58 years of age (mean 35 yrs). In the previous study, we found they had no evidence, serological or clinical, of osteomalacia but were verified as having significantly low bone mineral density (BMD) at the calcaneus and lumbar vertebrae. Serum levels of 25-OH-vitamin D were low and positively correlated with the lumbar vertebral BMD. Thus we postulated that low BMD was at least partly due to the lack of ultraviolet exposure. In the present study, the lumbar vertebral BMD of the above subjects were measured before and after increasing their exposure to sunlight. We found that mean lumbar BMD increased signigicantly from 770 mg/cm² to 786 mg/cm² (P<0.05, Wilcoxon, paired test). The Z-score also increased significantlyfrom 78 ± 13% to 80 ± 12%(P<0.05, Wilcoxon, paired test).
These findings suggest low BMD could be corrected to some extent by increasing sunlight exposure of institutionalized persons. Former members of farming communities who are retired, handicapped, or otherwise limited to indoor activity, can also recover their BMD and prevent osteoporosis by an increased daily exposure to sunlight.