Total knee arthroplasty (TKA) is one of the most successful surgeries to relieve pain and dysfunction caused by severe arthritis. However, it is a still big problem that there is a possibility of death in pulmonary embolism (PE) after TKA. We previously reported that there was more incidence of asymptomatic PE than estimated in general by detail examinations. But it was difficult to whom we decided to perform additional examinations except the patients with some doubtful symptoms. Therefore, we investigated detail of PE patients after primary TKA to find out anything key point in PE. Consecutive ninety-nine patients who underwent primary TKA from January 2015 to March 2018 were applied. There were 23 male and 76 females included, and the mean age was 73.7 years old. There were 96 cases of osteoarthritis, 2 cases of osteonecrosis and one of rheumatoid arthritis. A single knee surgery team performed all operations with cemented type prostheses and air tourniquet during operation. There were 35 cases of one-staged bilateral TKA and 64 of unilateral TKA. Detail examinations with contrast enhanced CT (CE-CT) and venous ultrasonography (US) were performed at the 3rd day after surgery. Next, we applied ultra sound cardiogram (UCG) to the patients diagnosed as PE by CE-CT, we checked right ventricular overload (RVO) to treat PE. These images were read by a single senior radiologist team.Introduction
Methods
Leg length discrepancy after total hip arthroplasty (THA) sometimes causes significant patient dissatisfaction. In consideration of the leg length after THA, leg length discrepancy is often measured using anteroposterior (AP) pelvic radiography. However, some cases have discrepancies in femoral and tibial lengths, and we believe that in some cases, true leg length differences should be taken into consideration in total leg length measurement. We report the lengths of the lower limb, femur, and tibia measured using the preoperative standing AP full-leg radiographs of the patients who underwent THA. From August 2013 to February 2017, 282 patients underwent standing AP full-leg radiography before THA. Of the patients, 33 were male and 249 were female. The mean age of the patients was 65.7±9.4 years. We measured the distances between the center of the tibial plafond and lesser trochanter apex (A-L), between the femoral intercondylar notch and lesser trochanter (K-L), and between the centers of the tibial plafond and intercondylar spine of the tibia (A-K) on standing AP full-leg radiographs before THA operation. We examined the differences in leg length and the causes of these discrepancies after guiding the difference between them.Purpose
Materials and methods
Pedicle screw (PS) insertion has been critised for its risk of serious injury to neurovascular structures. Although computed tomography (CT)-based navigation has been developed to avoid such complications, perforation remains an issue, even with the aid of additional guidance. We clarify screw perforation rate and direction in 359 consecutive patients treated using CT-based PS insertion and present important considerations for more accurate screw placement. The medical records of 359 consecutive patients who underwent PS insertion involving C2-L5 using a CT-based navigation system were reviewed. Postoperative CT images were analysed to evaluate the accuracy of screw placement. We investigated both rate and direction of screw perforation according to vertebral level. Of the 3413 PS that were inserted, 3.0% (104/3413) were judged as Grade 3 (more than 4mm) perforations. Allover perforation rates by vertebral level were shown in Table 1. The rate of these perforations was 5.0% for C2, 7.8% for C3–5, 3.9% for C6–7, 3.4% for T1–4, 3.5% for T5–8, 1.4% for T9–12, and 1.7% for L1–5. We also analysed the odds ratio (OR) for screw perforation in vertebrae accounting for the effects of age and disease. Multivariate analysis identified that PS insertions at C3–5 (OR 4.9, 95% CI 2.2–10.9; p<0.001) were significantly associated with Grade 3 screw perforation as compared with that of L1–5. Even with CT-based navigation, careful insertion of PS is needed in the middle cervical spine because of a significantly higher perforation rate as compared with the lumbar region. For figures and tables, please contact authors directly.
We occasionally come across cortical atrophy of the femur with cemented collarless polished triple-taper stem, a short time after the operation. This study aimed to estimate the radiographs of cemented collarless polished triple-taper stem taken at three, six, twelve, and twenty-four months after the initial operation. Between May 2009 and April 2011, 97 consecutive patients underwent primary total hip arthroplasty and hemiarthroplasty using a SC-stem or C-stem implant. During the 24 month follow-up, radiographic examination was performed on a total of 95 patients (98 hips). Out of those 95 patients, 52 hips had total hip arthroplasty, 45 had osteoarthritis, 5 had idiopathic osteonecrosis, there were two 2 other cases and 46 hips had hemiarthroplasty for femoral neck fractures. The cementing grade was estimated on the postoperative radiographs. The 24 month postoperative radiographs were analyzed for changes in stem subsidence, cortical atrophy and cortical hypertrophy. According to the Gruen zone, cortical atrophy and cortical hypertrophy were classified on the femoral side. We defined no cortical atrophy as grade 0, cortical atrophy less than 1 mm as grade 1, more than 1 mm and less than 2 mm as grade 2, and more than 2 mm as grade 3. We defined Grade 1 as 1 point, Grade 2 as 2 points, and Grade 3 as 3 points. The points in every zone were calculated, and the average per zone was determined.Background
Methods
Hip-Spine syndrome has various clinical aspects. For example, schoolchild with severe congenital dislocation of the hip have unfavorable standing posture and disadvantageous motions in ADL. Hip-Spine syndrome is closely related closely as the adjacent lumbar vertebrae and the hip joint. Furthermore, not only the pelvis and the lumbar spine, but also the neck position might influence on the maximum hip flexion angle. In this study, we examined the maximum hip flexion angle and pelvic movement angle by observing the lumbar spine, the pelvis and the neck in three different positions. The participants were five healthy volunteers (three males and two females) and ranged in age from 16 to 49 years. We measured the hip flexion angle (=∠X) and the pelvic tilt angle (=∠Y), using Zebris WinData and putting the six markers on skin. The positions of the marker are Femur lateral condyle (M1), Greater trochanter (M2), Lateral margin of 10th rib (M3), Anterior superior iliac spine (M4), Superior lateral margin of Iliac (M5), and Acromion (M6). We performed maximum hip flexion three times in three positions and measured ∠X (=∠M1,2,3) and ∠Y (=∠M4,5,6) and calculated the mean and SD of each position. The first position (P1) that we investigated is the regular position specified by the Japanese Orthopedics Association and Rehabilitation Medical Association. The second position (P2) is performed in the limited position of the posterior pelvic tilt and lumbar movement, by placing the tube under the subject's lower back. The third position (P3) is the altered limited position of P2 added by placing the 500ml PET bottle filled water under the back of the subject's neck.Introduction
Subjects and Methods
Our objective was to predict the knee extension strength and post-operative function in quadriceps resection for soft-tissue sarcoma of the thigh. A total of 18 patients (14 men, four women) underwent total or partial quadriceps resection for soft-tissue sarcoma of the thigh between 2002 and 2014. The number of resected quadriceps was surveyed, knee extension strength was measured with the Biodex isokinetic dynamometer system (affected side/unaffected side) and relationships between these were examined. The Musculoskeletal Tumor Society (MSTS) score, Toronto Extremity Salvage Score (TESS), European Quality of Life-5 Dimensions (EQ-5D) score and the Short Form 8 were used to evaluate post-operative function and examine correlations with extension strength. The cutoff value for extension strength to expect good post-operative function was also calculated using a receiver operating characteristic (ROC) curve and Fisher’s exact test.Objectives
Methods
The aim of this study is to evaluate the effect of three-dimensional (3D) simulation with 3D planning software ZedKnee® (ZK) in total knee arthroplasty (TKA). The participants in this study were all TKA patients whose operations were simulated by using ZK. The alignment of all components was evaluated with the ZK valuation software in postoperative computer tomography. Thirty patients (43 knees) met the inclusion criteria. 6 patients were male and 24 patients were female. The mean age of the 30 patients was 72 years old. Diagnoses for surgery were: osteoarthritis- 40 knees, rheumatoid arthritis- 2 knees and osteonecrosis- 1 knee. TKA was performed using the measured resection technique. The distal femur axis where the intramedullary rod would be inserted was drawn manually on the 3D image. Then, the angle between the distal femoral axis and the mechanical axis was measured. The rotational angles of the femoral components were determined from the automatically calculated angle between the posterior condylar axis and the surgical epicondylar axis (SEA) by using ZK. The ZK data used during the operation was the posterior condylar angle, the angle between the distal femoral axis and the mechanical axis and implant size.Aim
Materials and methods
Continuous epidural anesthesia or femoral nerve block has decreased postoperative pain after total knee arthroplasty to some extent. Although the established efficacy of these pain relief method, some adverse events such as hematoma or muscle weakness are still problematic. Intraoperative local infiltration of analgesia (LIA) has accepted as a promising pain control method after total knee arthroplasty. The safety and efficacy of LIA has been reported, although there are still limited evidence about the effect of LIA on quadriceps function and recovery of range of motion in early post-operative phase. The purpose of this study is to compare the quadriceps function and range of motion after TKA between the LIA with continuous epidural anesthesia and continuous epidural anesthesia alone. Thirty patients with knee osteoarthritis who underwent primary TKA were included in this study. Patients who took anticoagulants were treated continuous epidural anesthesia alone (n=11) and the other patients were treated with LIA with continuous epidural anesthesia (n=19). A single surgeon at our department performed all surgeries. Surgical procedure and rehabilitation process was identical between two groups. Before the implantation, analgesic drugs consisting of 20 ml of 0.75 % ropivacaine and 6.6 mg of dexamethasone were injected into the peri-articular tissues. In each group, fentanyl continuous epidural patient-controlled analgesia (PCA) was also used during 48-h post-operative period. Knee flexion and extension angle were evaluated before surgery, post-op day 3, 7, 10 and 14. The quadriceps function was evaluated by quadriceps peak torque at 30° and 60° flexion using VIODEX. The peak torque was recorded preoperatively, day 14 and 3 month after surgery. The difference between two groups was analyzed by Mann Whitney U-test using Prism 6, a statistical software.Background
Methods
In the previous study regarding the relationship among maximum hip flexion, the pelvis, and the lumbar vertebrae on the sagittal plane, we have found in X-rays that the lumbo lordotic angle (LLA) and the sacral slope angle (SSA) have a large impact on hip flexion angle. We examined hip flexion angles to the various height of the objects (half round plastic tube) placed under the subject's lower back and compared the passive hip flexion angles in the supine position between younger and middle age groups. The participants were 14 healthy volunteers: 7 females with an average age of 17 years (Group 1: G-1), 7 females with an average age of 45 years (Group 2: G-2). The average BMI (Body Mass Index) of volunteers was less than 25, and their Tomas Tests were negative.Introduction
Participants
Posterior pelvis tilt (PPT) would affect lumbar lordosis and lead to hip flexion, which causes difficulties walking and standing in patients with hip disorders. Hip flexion movement associated with PPT is well known. We investigated the effect of the angle of hip flexion without the movement of PPT in the supine position. The study enrolled 24 healthy males with an average age of 20.5 ± 2.3 years. Two pelvic positions in the supine position were investigated: (1) the limited position of the PPT by 500ml PET bottle with water placed under their low back, and (2) the position without placing a PET bottle. We assessed unilateral hip flexion angle with photos taken with a digital camera. For reference, we took an X-ray of a healthy female and observed the lumbo-sacral from the sagittal plane in the supine position.Purpose
Methods
Direct anterior approach (DAA) is one of the best way to the hip joint for prevention of post-operative dislocation. We have applied this method as minimum invasive surgery (MIS) to more than two hundred developmental dysplastic hip of Japanese patients in total hip arthroplasty (THA) and there is no post-operative dislocation within three years of last observation carried forward (LOCF). The reason of this benefit is derived from the accuracy of cup positioning and keeping good muscle balance. But the learning curve is very important and some technical pitfalls are there in this approach. We have chosen thirty four patients that the duration of operating time more than one and half hours and loss of blood more than five hundred gram in hour series. The most important factors of the difficulties are the combinations of shortening of femoral neck, especially Perthes like deformity of developmental deformities of the hip joint (DDH) and widening of pelvic bone for the reason of insufficiency working spaces and the difficulties of broaching insertion (8/34). The second factor is the contracture of hip and knee joints combinations for the difficulties of lift up the proximal femur as broaching stem (3/34). The obesity, Body Mass Index (BMI) above thirty is not the reason of difficulties of women in our series. DAA can be extended to Smith-Petersen approach and very useful technique for primary THA in Japanese dysplastic hip patients.
The Dall approach is a modified anterolateral approach with osteotomy of the anterior part of the greater trochanter. This approach relatively preserves the soft tissue tension during total hip arthroplasty (THA). We insert the stem and select a ball neck size so as to have a stable hip which will not dislocate easily during the trial reduction. The aim of this study is to evaluate the adequacy of this method, to measure leg length discrepancy and offset discrepancy at postoperative radiographs. We selected patients for inclusion in this study from those who have more than a 120 degree of affected hip flection angle, the opposite hip is almost normal with a low leg length discrepancy (primary OA, osteonecrosis, Crowe 1 secondary OA, femoral neck fracture). All THA were performed with cement fixation using an alignment guide to ensure accurate acetabular positioning. The ball head's diameter used were all 26mm. From September 2011 to October 2013, 22 patients met inclusion criteria among 103 THA. The mean age for 22 subjects was 66.6±12 years. The mean flexion angle of preoperative hip joints was 127.2±6.1 degrees. The cup inclination was 43.8° ± 3.5°. Anteversion was 11.8°±6°. The mean preoperative leg length discrepancy was 5.8mm±6.3mm. The mean postoperative leg length discrepancy was 0.7±3.5mm. The mean postoperative offset discrepancy was 0.7±6.6mm. There were no dislocations in this series of 103 cases. Discussion. Dislocation and leg length discrepancies are major complications following a total hip arthroplasty. A good range of motion of the preoperative hip joint is considered a high risk dislocation factor. The Dall approach with minimal release of soft tissue related to a tension of hip joint offers maximal stability and the ability to accurately restore leg length.
In order to ensure safety of the cell-based therapy for bone
regeneration, we examined BM cells obtained from a total of 13 Sprague-Dawley (SD) green
fluorescent protein transgenic (GFP-Tg) rats were culture-expanded
in an osteogenic differentiation medium for three weeks. Osteoblast-like
cells were then locally transplanted with collagen scaffolds to
the rat model of segmental bone defect. Donor cells were also intravenously infused
to the normal Sprague-Dawley (SD) rats for systemic biodistribution.
The flow cytometric and histological analyses were performed for
cellular tracking after transplantation.Objectives
Methods
Total knee arthroplasty (TKA) provides good results even for severe knee osteoarthritis (OA) patients. However, patients often suffer from post-operative pain and have long rehabilitation periods. In recent years, utilization of unicompartmental knee arthroplasty (UKA) has increased in an effort to decrease pain and shorten recovery compared to TKA. Moreover, the long-term results of the UKA have improved. Many surgeons now wonder whether TKA or UKA is better for patients with isolated medial knee OA. In Japan, the government has public insurance system and patients are able to receive the joint replacement surgery inexpensively. This study was conducted to compare the cost the public insurance and the patients co-payment for TKA and UKA. We investigated a series of thirty TKAs and fifteen UKAs performed in Fussa Hospital (Tokyo, Japan) from July 2012 to April 2013. Data from two TKAs' were excluded since the patients had comorbidities (asthma and severe DM) that extended their hospitalizations. Patients were discharged from the hospital if they were able to go up and down the stairs or were able to conduct routine activities of daily living. Total payments the hospital received averaged $19600 (S.D. $1600) for a TKA and $15200 (S.D. $1300) for a UKA. Patients paied averaged of $690 (S.D. $370) for a TKA and $470 (S.D. $170) for a UKA (Figure 1). The surgical fee was $3769 for both TKA and UKA, and was uniform thoughout Japan. The implant price averaged $6200 (S.D. $300) for TKA and $3900 (S.D. $200) for UKA, where prices were also determined by the government. Hospitalization averaged 28 days (S.D. 7 days) for TKA and 21 days (S.D. 6 days) for UKA. For both TKA and UKA, the total cost and the number of days in hospital were highly correlated (R = 0.92 and R = 0.96, respectively). A linear cost model suggests the TKA cost was $210 times days of hospitalization plus $13100 and the UKA cost was $220 times days of hospitalization plus $10000. Patients' payments were not correlated to the days of hospitalization (R = 0.22 and R = 0.45, respectively). TKA and UKA are performed all over the world now and the number of the surgeries increases each year. Althouth each country has a different insurance system, many countries face an increasing and problematic economic burden for both patients and insurance organization (either public or private company). This study showed UKA is less expensive than TKA by $4400, an advantage that might complement the traditional view that UKA is less invasive and often has fewer complications for treating isolating medical compartment OA. For Japanese system, patients pay relatively little out-of pocket despite long hospitalization, and length of stay has a direct and significant effect on total cost for TKA and UKA
The ratio of the incidence of trochanteric to cervical fractures increased with age in the elderly female population, but the reason for this fact remain unclear. The purposes of this study were to investigate whether or not there are specificities of the local distribution of mechanical properties at the trochanteric region of the elderly female using a scanning acoustic microscope (SAM). Human proximal femurs were harvested from seven female cadavers (67–88 years) and proximal femur was coronally sectioned into halves across the center of neck. The surface of the coronal section was polished in order to achieve flat surfaces of smoothness well below the surface resolution in scanning with SAM. Bone tissue density and elastic modulus were calculated from the acquired SAM data. Mechanical properties were measured at the lateral and medial trochanter. Cortical bone tissue of the lateral trochanter had significantly lower elastic modulus than that of the medial trochanter in the all specimen over 70s(p<0.05). Trabecular bone tissue of proximal region of the lateral trochanter had significantly lower elastic modulus than that of distal region in all 80s specimens (p<0.05). Decrease of the elastic modulus of cortical bone in the lateral trochanter and low value of the elastic modulus of trabecular bone in the proximal region of the lateral trochanter may be related to the increase of the ratio of trochanteric to cervical fractures with age in the elderly female population.
We occasionally came across cortical atrophy of femurs with cemented collarless polished triple-taper stem in a short term period. This study aimed to estimate radiographs of cemented collarless polished triple-taper stem taken 6 months after the initial operation. Between May 2009 and April 2011, 97 consecutive patients underwent primary total hip arthroplasty and hemiarthroplasty using SC-stem or C-stem implants. At the 6 month follow-up, a radiographic examination was performed on 70 patients (71 hips). 44 hips had Total Hip Arthoplasty, 35 had osteoarthritis, 5 had idiopathic osteonecrosis, 2 had other diseases and 27 hips had hemiarthroplasty for femoral neck fractures. The postoperative radiographs were used to estimate the cementing grade. Then the 6 month postoperative radiographs were analyzed for changes in stem subsidence, cortical atrophy and cortical hypertrophy. According to the system of Gruen- cortical atrophy and cortical hypertrophy were classified on the femoral side. We defined no cortical atrophy as grade 0, cortical atrophy less than 1 mm as grade 1, more than 1 mm and less than 2 mm as grade 2, more than 2 mm as grade 3.Background
Methods
Surgical site infection (SSI) is an infrequent but serious complication of total joint arthroplasty (TJA). Orthopaedic SSI causes substantial morbidity, prolonging the hospital stay by a median of 2 weeks, doubling the rates of rehospitalization, and more than tripling overall healthcare costs. Colonization with methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) is known to be associated with an increased risk of subsequent SSI. Carriers are two to nine times more likely to acquire S. aureus SSIs than non-carriers. Screening of the nose and throat for MRSA colonization and preoperative patient decolonization have been shown to decrease the incidence of subsequent MRSA infection. The aim of this study was to investigate the association between the results of MRSA colonization screening and the incidence of SSI in our hospital. Between June 2007 and June 2010, 238 patients were admitted for TJA, among whom 235 underwent preoperative assessment that included screening of the nose and throat for MRSA colonization. Fifty-nine of these patients underwent total hip arthroplasty (THA), 69 underwent total knee arthroplasty (TKA), 6 underwent unilateral knee arthroplasty (UKA), and 101 underwent bipolar hip prosthesis arthroplasty (BPH). The mean age of the patients was 72.7 (49–95) years and the male to female ratio was 1:3.8. We analyzed these patients retrospectively, and determined the site of colonization, eradication prior to surgery, and subsequent development of SSI in the year after surgery. SSI was defined according to the criteria established by the Centers for Disease Control and Prevention.Purpose
Materials and Methods
Correction and arthrodesis for cervical kyphosis associated with atetoid cerebral palsy has been considered to be difficult because of their involuntary neck movements and severe deformity. The aim of this study is to evaluate the surgical outcome of midline T-saw laminoplasty and posterior arthrodesis using pedicle screws. 15 patients were retrospectively reviewed. There were 6 women and 9 men, with a mean age 52.9 years (range 31–71 years). Mean follow-up period was 43 months (range 24–84 months). For clinical evaluation, the Japanese Orthopaedic Association (JOA) score and Barthel index (BI) which shows independence in ADL were used. For radiographic evaluation, change of C2–C7 Cobb angle of sagittal alignment, adjacent segment instability after the surgery were evaluated.Introduction
Methods
Total elbow arthroplasty (TEA) has been shown to be a treatment option for elderly patients with complex distal humeral fractures and osteoporotic bone. The published results have often included rheumatoid patients who traditionally would be expected to do well from elbow arthroplasty. Only short-term results have been published using this technique in non-rheumatoid patients. The current study contains the largest number and longest follow-up of non-rheumatoid patients whose fractures have been treated with a non-custom TEA. In total there were 26 patients, mean age 72 years, 22 female and 4 male, 25% dominant arm. The mean follow-up was of 5 years. There was 1 case of loosening, 1 radial nerve palsy and 2 cases of heterotrophic ossification. At final review the mean range of flexion/extension was 97.5 degrees and the mean range of pronation/supination was 151.75 degrees. The mean Mayo Elbow Performance score was 92. We would suggest that TEA provides a very satisfactory outcome in elderly patients with complex distal humeral fractures, the benefit of which can be observed at a mean of 5 years.
Intra-articular distal humeral fractures in the elderly are difficult to treat. There is evidence in the literature to support the use of both Open Reduction and Internal Fixation (ORIF) and Total Elbow Arthroplasty (TEA) as primary procedures, although we have been unable to find any direct comparisons of outcome. This study reports the results of ORIF in 12 elderly patients with distal humeral fractures and compares the outcome with 12 matched patients who had undergone TEA. All procedures were performed by two experienced Consultant Surgeons. The Coonrad-Morrey TEA was used in all cases of TEA and a double-plating technique was used in all ORIFs. Both groups of patients were similar with respect to fracture configuration, age, sex, co-morbidity and hand dominance. The mean follow-up in both groups of patients was over 30 months. At final review, patients who had had a TEA had a mean Mayo score of 91 and a range of flexion/extension of 90 degrees. There was 1 superficial wound infection that resolved with antibiotics, 1 temporary radial nerve palsy, and 1 case of heterotrophic ossification The ORIF group had a mean Mayo score of 89 (p>
0.05) and a range of flexion/extension of 112 degrees (P=0.03). There was 1 case of heterotrophic ossification, 2 cases of ulnar nerve compression that needed decompression and 1 superficial wound infection that resolved with antibiotics. All the fractures united.
A special surgical technique and consideration is necessary in the total hip arthroplasty for dysplastic osteoarthritis after Kalamchi and MacEwen Type III or IV deformity (so called “Perthes-like-deformity”). There have been few reports concerning the total hip arthroplasty for “Perthes-like-deformity”. We evaluated the clinical and radiological outcome of 52 uncemented hip arthroplasties for the lesion. We have performed 106 hips of uncemented total hip arthroplasty for dysplastic osteoarthritis after Kalamchi and MacEwen Type III or IV deformity. Among them, 52 hips of 47 patients (11 males and 41 females) were evaluated with minimum of three years follow-up. The average age at the surgery was 52 (28 to 65). The average follow-up period was 4.8 (3 to 8.1) years. Against the developmental dysplasia or dislocation, 29 hips of 26 patients had been treated by casting or surgery in infancy. Thirteen hips of 11 patients had no previous treatment before the arthroplasty. Spongiosa metal cup (GHE: ESKA implants, Lübeck, Germany) was used for 33 hips of 28 patients and Zweymüller type cup (Allo-classic cup: Zimmer Inc., Warsaw, IN, Bicon cup: Smith &
Nephew Orthopedics AG, Rotkreuz, Switzerland) for 19 hips of 19 patients. Spongiosa Metal stem (GHE: ESKA implants) was used for 23 hips of 19 patients and Zweymüller type stem (Alloclassic stem: Zimmer Inc., SL stem: Smith &
Nephew Orthopedics AG) for 29 hips of 28 patients. The average operative time was 108 (53 to 233) minutes. The average blood loss during the surgery was 731(150 to 1749) milliliters. The adductor tendon release was added in 28 hips of 26 patients against the severe contracture. The patients were evaluated clinically (pre-surgical history, hip score, leg length discrepancy, Trendelenburg sign, and gait function) and radiologically (ATD before the surgery, alignment, and stability of implants). Average ATD before the surgery was −2.2 (−28 to 17) millimeters. The average leg length discrepancy was 1.9 (0 to 7) centimeters before the surgery and was improved to 0.1 (0 to 1) centimeters after the surgery. The average hip score was 54 (23 to 80) before the surgery and was improved to 90 (69 to 100) after the surgery. At the final follow-up, Trendelenburg sign was positive in 14 hips of 14 patients (26.9%) and the limping was not obvious in 38 hips of 33 patients (73.1%). All implants were stable at the final follow-up. “Perthes-like-deformity” often has the severe deformity. It has a shortening or an absence of the neck and an excessive antetorsion of the femur. When it has the coxa magna, the acetabulum is shallow, has the narrow anteroposterior diameter, and has the thin wall like the osteophyte. It is frequently accompanied by shortening of leg and contracture, as the lesion arises from the development disorders. Thus, the total hip arthroplasty, especially uncemented one, is complicated. However, the satisfactory result can be obtained by careful consideration and surgical procedure such as a provision against the bleeding and the soft tissue release.
Total elbow arthroplasty (TEA), as a primary procedure and open reduction and internal fixation (ORIF) have been used to treat complex intra-articular distal humeral fractures in elderly patients. The failure rate after ORIF is high and TEA has often been used as a salvage procedure. Although satisfactory results have been reported after TEA as a primary procedure, there are no publications reporting the results of TEA after failed internal fixation (FIF). In this study we compared the results of patients that had TEA after FIF with those that had had primary arthroplasty (PA). We reviewed the results of 9 consecutive patients who had FIF with 12 patients who had PA. All the operations were performed by one surgeon using the same technique and same prosthesis. Both groups of patients were similar with respect to ages, sex, co-morbidity and hand dominance. The mean follow-up for both groups of patients was 5 years. At final review, patients who had had FIF had a mean Mayo score of 68 and a range of flexion/extension of 90 degrees, there was 1 infection and 1 case of loosening. The PA group had a mean Mayo score of 88 and a range of flexion/extension of 96 degrees, there were no cases of infection or loosening. This study shows the results of TEA are satisfactory either as a PA or after FIF, however the results after PA are significantly better than after FIF.
Total elbow arthroplasty (TEA) has been shown to be a treatment option for elderly patients with complex distal humeral fractures and osteoporotic bone. The published results have often included rheumatoid patients who traditionally would be expected to do well from elbow arthroplasty. Only short-term results have been published using this technique in non-rheumatoid patients The current study contains the largest number and longest follow-up of non-rheumatoid patients whose fractures have been treated with a non-custom TEA. In total there were 26 patients, mean age 72 years, 22 female and 4 male, 25% dominant arm. All had a minimum of 5 years follow-up. There was 1 case of loosening, 1 radial nerve palsy and 2 cases of heterotrophic ossification. At final review the mean range of flexion/extension was 97.5 degrees and the mean range of pronation/supination was 151.75 degrees. The mean Mayo Elbow Performance score was 92. We would suggest that TEA provides a very satisfactory outcome in elderly patients with complex distal humeral fractures, the benefit of which can be observed for at least 5 years.
Assess the outcome of plating of lateral end clavicle fractures. Lateral end clavicle fractures can be treated both conservatively and surgically. Different surgical methods are available to stabilize lateral end clavicle fractures. We treated 15 lateral end clavicle fractures with plate fixations (4 AO ‘T’ plate and 11 ACUMED lateral clavicle plate) from September 2002 to December 2005. There were 12 males and 3 females and the mean age was 33.12 year (range 23–61). 3 were done for non-union and 13 for acute fractures. 2 non-unions were treated with AO ‘T’ plate and 1 with ACUMED lateral clavicle plate. 1 patient with non-union had bone grafting at the time of the procedure. Acute fractures were stabilized with in 3 weeks from the time of the injury. All fractures were Type 2 according to Neer classification of lateral end clavicle fractures. The cause of the injury was, simple fall (3), fall from pushbike (3), assault (3), sports/skate-board (3), and RTA (3). The senior author operated on all patients. The arm was immobilized in a sling for six weeks post operatively. The follow up ranged between 5 months to 36 months All but one fracture healed. 1 ‘T’ and 1 ACUMED plate was removed 7 months after the index procedure after fracture consolidation. There was no superficial or deep infection. Patients were assessed clinically with Constant and DASH scores; patient satisfaction with the procedure was also recorded and union assessed radiologically.. Lateral end clavicle fractures pose a challenge due to the small size of the distal fragment. In our experience plating of these fractures give satisfactory results. Oblique fracture patterns result in better fixation and union rates. The plate design and advantages of the ACUMED contoured distal clavicle plates are further discussed in the paper.
Crush injury is one of the categories of nerve injury, which is often encountered in the clinical field. There is no doubt that crushed nerves, which have anatomical continuity, regenerate spontaneously and somehow reinnervate their target tissues, such as muscle and skin. However, the longer it takes to reinnervate the target tissues, the more profoundly the atrophy of these target tissues progresses, resulting in a poor outcome. Clinically, it is therefore crucial to accelerate nerve regeneration if excellent results are to be achieved. Hepatocyte growth factor (HGF) is well known to be involved in many biological functions, such as organ regeneration and angiogenesis, and to exert neurotrophic effects on motor, sensory, and parasympathetic neurons. This raised hopes that HGF protein might be useful for the clinical treatment of nervous system disorders. However, administration of HGF as a recombinant protein is still beset by a number of problems, such as a short serum half-life and poor access to the central nervous system by the systemic route because of the presence of the blood-brain barrier. These problems can be major obstacles to the therapeutic use of such factors, and this has highlighted the need to develop innovative therapeutic strategies for more efficient delivery into the nervous system. Gene transfer into the nervous system has enormous therapeutic potential for a wide variety of disorders. It appears to have advantages over the administration of single or multiple bolus doses of a recombinant protein because gene transfer can achieve an optimally high, local concentration within the nervous system. Recently, two different strategies have been reported. Firstly gene transfer by local intraneural injection and secondly gene transfer via retrograde axonal transport. In crush injury, it is well known that some axons in the crushed nerve can remain intact. It is from this evidence that the idea of performing gene transfer via retrograde axonal transport arose. In this study, we gave repeated intramuscular injections of the human HGF gene, using nonviral HVJ (Hemagglutinating Virus of Japan) liposome method, to examine whether transfection of the rat nervous system with this gene is able to exert neurotrophic effects facilitating recovery of a crushed nerve. The expression of HGF protein and HGF mRNA indicated that gene transfer into the nervous system did occur via retrograde axonal transport. At 4 weeks after crush, electrophysiological examination of the crushed nerve showed a significantly shorter mean latency and a significantly greater mean maximum M-wave amplitude with repeated injections of HGF gene. Furthermore, histological findings showed that the mean diameter of the axons, the axon number and the axon population were significantly larger in the group with repeated injections of HGF gene. The above results show that repeated human HGF gene transfer into the rat nervous system is able to promote crushed-nerve recovery, both electrophysiologically and histologically, and suggest that HGF gene transfer has potential for the treatment of crushed nerve.
The location of the lesion shown by the band pattern low intensity was determined by Japanese investigation committee as follows. Type A lesion occupies the medial one-third or less; Type B occupies the medial two-thirds or less; Type C-1 occupies more than the medial two-thirds; and Type C-2 extends laterally to the acetabular edge at the neutral position. Types were observed on initial and final MRIs. The mean follow up was 4 years and 3 months. For the repair patterns, the direction was observed in the anterior and posterior slices of MRIs.
This study reports on postoperative changes of intra and epidural space of both degenerative lumbar spinal canal stenosis(DLSCS) and degenerative spondylolisthesis(DO)on MRI. 48cases(DLSCS:20cases, DO:28cases)were investigated in this study. All cases performed bilateral wide fenestration. The average age of these patients was 65 years and average follow-up period was 60 months. The average improvement ratio(%) of JOA score was 68% at the last follow-up. Symptomes had deteriorated in 8 cases, according to an increase in the volume of the postlaminectomy membrane, at the last follow-up. There were 8 cases(29%)in DO. showing an increase of % slip on X-ray at the last follow-up, accompanied with both a slight decreasing of the cross-sectional area(CSA)of dural sac and a slight deterioration of clinical results.
Antibiotic-impregnated polymethylmethacrylate beads, which are used to deliver antibiotic directly to infected sites in the musculoskeletal system has been evaluated most widely. The disadvantages include reduced biocompatibility with bone, short duration of drug release, very low release rate and thermal damage to the antibiotics. For solving this problem, we developed the antibiotic-impregnated calcium hydroxyapatite ceramic implant (HA) as a new drug delivery system. This study is to evaluate the clinical results of the antibiotic-impregnated HA used for the treatment of infected total hip and knee arthroplasty. Twenty-two patients with infected arthroplasty treated antibiotic-impregnated HA were evaluated. There were 5 men and 17 women with a median age of 65 (range, 54–86 years). The study included 14 hips and 8 knees. The duration from the initial arthroplasty to the detection of the infection was 16 years at the longest (median of 2 years and 2 months). The most common microorganism was Staphylococcus aureus, presented in 13 patients. Antibiotic most frequently impregnated was Vancomycin. In five patients, debridement without removal of the prosthesis was performed with antibiotic-impregnated HA implanted in surrounding bone. In another three patients, one-stage revision was performed with antibiotic-impregnated HA. In fourteen patients, antibiotic-impregnated HA was used to fill the dead space after removal of the prosthesis (two-stage revision was performed in 9 patients). No patients developed evidence of recurrent infection at an average follow-up of 18.7 months. Antibiotic-impregnated HA is an excellent drug delivery system for the infected total hip and knee arthroplasty.