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In contrast, three other Japanese lifestyle-related items showed much less improvement. Even though Japanese patients with THAs are quite satisfied with their dramatic improvements in pain, they reportedly experience anxiety about possible dislocation and durability of their prostheses (Fujita et?al., 2006). These attitudes are not covered by the HRQOL scales. [https://en.wikipedia.org/wiki/Dabigatran Dabigatran] In terms of activities requiring deep flexion of the hip joint, the Chinese lifestyle is considered closer to a Western one than is the Japanese lifestyle. Although the number of THAs in China is expected to outnumber that of any nation in coming years, there is little research from this country regarding the impact of non-Western lifestyles on THA patients. The purposes of this study were 1) to explore the impact of non-Western lifestyles on HRQOL in pre- and post-THA patients and 2) to examine the association between HRQOL and attitudes toward THA in Japan and China. In China, a cross-sectional survey of pre-THA patients and those who had undergone THA 1 or 3 years prior to the study was conducted. In Japan, patients were retrospectively selected from a patient research database that had been established between [http://www.selleckchem.com/products/Bortezomib.html Bortezomib datasheet] 2008 and 2011 by the Department of Orthopedic Surgery of Saga University Hospital. Based on previous studies (Fujita et?al., 2009), a sample size of 120 per country was set to obtain statistically significant differences in HRQOL scores between pre- and post-THA patients. One-third of the study group comprised pre-THA patients, one-third one-year post-THA patients, and the remaining one-third three-year post-THA patients. The postoperative period of three [http://www.selleckchem.com/products/AZD6244.html Selumetinib manufacturer] years was chosen because the Chinese hospitals participating in the study had few patients who were more than three years post-THA. Eligibility criteria in both countries were: (i) community-dwelling patients who were scheduled to undergo THA or who had undergone THA one or three years prior to the survey; and (ii) patients who could comprehend the questionnaire. The exclusion criterion was a comorbidity or disability that affected ambulation, such as stroke. Japanese patients had been recruited from the university hospital in the Kyushu region in Japan between December 2008 and July 2011. Chinese patients were recruited from two hospitals in Guangzhou, China between March and June 2011. Both generic and disease-specific HRQOL scales were used. The EuroQol, a generic instrument used to assess quality of life, comprises five questions about mobility, self-care, usual activity, pain/discomfort, and anxiety/depression (Wolfe & Hawley, 1997). There are three possible response levels for each item. A single weighted utility score, the EuroQol utility, is calculated from the scores on each of these five categories. The utility score for perfect health is 1 and for death 0; states worse than death (