The purpose of this study was to compare the outcomes of arthroscopic unilateral surgery and simultaneous bilateral surgery for posterior ankle impingement syndrome (PAIS) in athletes and to evaluate the usefulness of simultaneous bilateral surgery. A total 48 hindfeet of 41 athletes (14 hindfeet of 14 males, 34 hindfeet of 27 females) who underwent arthroscopic surgery for PAIS were studied. Japanese society for surgery of the foot (JSSF) score and visual analogue scale (VAS) were compared before and after surgery, using Wilcoxon signed-rank test. The operation time and the time to return to sports activity were compared in 10 hindfeet of 5 patients who underwent simultaneous bilateral surgery and 38 hindfeet of 36 patients who underwent unilateral surgery, using Wilcoxon rank sum test. Classic ballet was the most common type of sport that caused PAIS (59%, 24/41 athletes). Soccer (10%, 4/41 athletes), baseball (10%, 4/41 athletes), badminton (5%, 2/41 athletes), volleyball (5%, 2/41 athletes), and athletics (5%, 2/41 athletes) followed. The JSSF score improved significantly from 72.7 preoperatively to 98.9 postoperatively in unilateral surgery, and significantly improved from 75.2 preoperatively to 99.0 postoperatively in simultaneous bilateral surgery. VAS significantly decreased from 64.7 preoperatively to 4.8 postoperatively in unilateral surgery, and significantly decreased from 72.7 preoperatively to 1.0 postoperatively in simultaneous bilateral surgery. The operating time was 53.7 minutes on average for unilateral surgery and 101.0 minutes for simultaneous bilateral surgery, significantly longer in bilateral simultaneous surgery. The mean time to return to sports activity was 4.8 weeks for unilateral surgery and 9.6 weeks for simultaneous bilateral surgery, significantly longer in simultaneous bilateral surgery. Both unilateral and simultaneous bilateral surgeries for PAIS in athletes were useful. It should be noted that the operating time and the time to return to sports will be longer. However, considering the 2 times hospitalizations and 2 times surgeries, simultaneous bilateral surgery is one of the treatment options for PAIS.
The aim of this study was to investigate the effect of granulocyte-colony stimulating factor (G-CSF) on mesenchymal stem cell (MSC) proliferation MSCs from rabbits were cultured in a control medium and medium with G-CSF (low-dose: 4 μg, high-dose: 40 μg). At one, three, and five days after culturing, cells were counted. Differential potential of cultured cells were examined by stimulating them with a osteogenic, adipogenic and chondrogenic medium. A total of 30 rabbits were divided into three groups. The low-dose group (n = 10) received 10 μg/kg of G-CSF daily, the high-dose group (n = 10) received 50 μg/kg daily by subcutaneous injection for three days prior to creating cartilage defects. The control group (n = 10) was administered saline for three days. At 48 hours after the first injection, a 5.2 mm diameter cylindrical osteochondral defect was created in the femoral trochlea. At four and 12 weeks post-operatively, repaired tissue was evaluated macroscopically and microscopically.Objectives
Methods
In order to achieve good clinical results in TKA, soft tissue balance is important. Soft tissue balance is closely related to knee kinematics which affects clinical results. Modified gap balancing technique is one of the standard techniques for posterior stabilized (PS) TKA. On the other hand, appropriate load for the measurement of gap balance has not been established. The purpose of the present study is to measure the mechanical properties of soft tissue structure of knee sleeve in flexion and extension during PS TKA using newly developed balancer. The understanding of the mechanical properties is crucial. In particular if these properties are used as input for surgical procedures, standard technique for many surgeons will be established. Medial compartmental osteoarthrosis (OA) patients (13 female and 7 male) were evaluated. Average age, BMI, and Varus deformity were 72.1 years, 26.9, and 12 degrees, respectively. The newly developed center paddle balancer consists of a built-in spring (Fig. 1). Figure 2 shows the sequence of surgery and measurements. In the surgery, we measured the balance (degrees in Figure 1, A) and distance (mm in Figure 1, B) in extension with a load (Figure 1,C) at transition zone of toe region to linear region. Then, applying the load until flexion gap was the same as that in extension with a patella reduction, we measured the femoral component rotation from the balancer (degrees in Figure 1, A). The anterior and posterior femoral cuts were performed according to measured femoral component rotation which angle is parallel to tibial cut surface.Introduction
Materials and Methods
Some patients complain ingrown pain or discomfort after implanting Co-Cr conventional endprosthesis of the hip. Some of this complaint may be attributable for effect on cartilage metabolism. It have been reported that ceramic is bioinert for biological tissue. On the other hand, metal including cobalt-chrome (Co-Cr) have some detrimental effect on biological tissue. However, there is no report concerning acetabular cartilage metabolism after hip endprosthesis implantation. In the present study, we hypothesized that ceramic head have small detrimental effect on cartilage cell metabolism. Specific aim of the study is to compare the protein level of inflammation related cytokines, amount of hyaluronic acid (HA) in culture media, and cartilage mRNA expression in organ culture model of hip end prosthesis implanted using ceramic head and Co-Cr head. Six acetabulum of 3 matured crossbred pig (average weight: 36 +/− 3.6kg) was retrieved. Animal experiment was performed under the rules of ethical committee of animal experiment. Average diameter of pig acetabulum was 26.3 +/− 0.6 mm. Just after sacrifice, mechanical loading using Instron testing machine with 26mm diameter of Co-Cr in right hip and Ceramic heads in left hip was performed in culture media. Ten thousand cycles of cyclic compression and rotation load (1.5kN to 0.15kN of compression and 12 degrees of rotation) to cartilage was applied at 1Hz (Figure 1). Culture media was analyzed for protein levels of inflammation related cytokines and amount of HA. Relative quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) from acetabular cartilage was performed as previously reported using specific primer sets for type II collagen, aggrecan, TNF-alpha, Interleukine-1 and 6, and MMP-1, 3, 13.Introduction
Materials and Methods
In total knee arthroplalsties, there are risks of revision surgeries because of aseptic loosening, polyethylene wear, and metal component breakage. The data such as model, type, size, and manufacturing companies are required at the time of revision surgeries. However, it is sometimes difficult to acquire such data due to patient's change of address and the elimination and consolidation of hospitals in the long-term. Therefore, we try to use the Radio Frequency IDentification (RFID) in the total knee joint system. The FerVID family (Fujitsu Co. Ltd., Tokyo, Japan) was prepared as the RFID tag. It was radio-resistant below the dose of 50kGy, which allowed gamma sterilization. The RFID tags were embedded into the anterior side of GUR 1050 UHMWPE inserts and 0.3wt% vitamin E blended UHMWPE. The UHMWPE inserts were manufactured by thecompression molding method at the maximum temperature of 220°C and the maximum compressive force of 245kgf/cm2. The manufactured inserts were implanted in fresh cadaveric knees. The tibial base plate was made of Ti6Al4V. The femoral components were made of Co-Cr-Mo or Ti-6Al-4V. Communication Performance was measured with the interrogator (DOTR-920 MHz-band, Tohoku Systems Support Co. Ltd., Miyagi, Japan). The transmission output was up to 1W. Received Signal Strength Indicator (RSSI) was measured 500 times at 15 mm away from the surface of skin in the extension and 90° flexion of the knee (Fig1).Introduction
Materials and methods
In 1970's, condylar type knee prosthese with anatomic design appeared, however, joint flexion was not satisfactory. Y/S II total knee arthroplasty (TKA) was developed to obtain deep flexion together with bilateral ligament balance in 1980. The articular surface of the tibial component was flattened to permit femoral shift posteriorily during knee flexion. Medial and lateral soft tissue release was determined by a unique ligament tensor both at flexion and extension. A metal tray was embedded in polyethylene, which had a shape of glasses frame. Though the usage of Y/SII TKA was finished in 1984, we here studied its long term surgical results using the Kaplan-Meyer method. From 1988 to 1991, 122 knees were replaced by Y/SII TKA in 81 patients with rheumatoid arthritis (RA). Among them, 24 joints in 12 patients were examined directly. The average age of follow-up was 19.5 years. The survival rate was investigated according to medical records.Back ground
Study design
Clinical outocome of revision total elbow arthroplasty(TEA) in rheumatoid arthritis(RA) patients were evaluated. Clinical outocome of revision TEA that underwent between 2005 and 2013 were evaluated. Causes of revision, implanted revised prosthesis, a clinical score (the Japanese Orthopaedic Association (JOA) elbow assessment score), the arc of motion and complications were investigated. Totally, 6 patients underwent revision TEA. The patients were females with a mean age of 60.4 years (range, 32 to 72).Purpose
Methods
The bioactive polyetheretherketone (PEEK) was fabricated by the combination of PEEK and CaO-SiO2 particles, which formed hydroxyapatite on its surfaces in simulated body fluid and showed good mechanical propeties. The study revealed osteoblast-like cell proliferation and gene expression on the bioactive PEEK. Peek and bioactive PEEK discs (24 mm in diameter and 2 mm in thickness) were prepared. Bioactive PEEk was produced by the combination of 80 vol% Peek powder and 20 vol% CaO-SiO2 particles (30CaO · 70SiO2). Discs were sterilized with ethylene oxide gas. The study was approved by the ethics committee in Chiba University. Human osteoblast-like cells were used in the study. The cells at passage 3–5 were used in the experiments. 2 × 105cells /disc were culture at 37°C in a humidified atmosphere with 5% CO2, and the media was replaced every 3 days. At days 3, 7, 21, the culture media, cells and discs were collected respectively. Cell attachment assay was performed. Cells were seeded at a density of 4 × 105 cells /well and incubated for 2 hours at 37 C in a humidified atmosphere with 5% CO2. The cells on the discs were evaluated by DNA content. The real-time PCR was performed with regard to type I collagen (COLI), osteocalcin (OC), osteonectin (ON), osteopontin (OPN), and GAPDH. The alkaline phosphatase activity (ALP) was measeured at 3, 7, and 21 days, which samples as used in the DNA-content assay. Alizalin Red Staining was performed at day 21 to quantify calcification deposits in discs. Results were analyzed using Student's The content of DNA showed similar increases on PEEK and bioactive PEEK in the course of day 3, 7, 21. The cell attachment of bioactive PEEK was two times larger than that of PEEK. Real-time PCR results of human osteoblast-like cells cultured on PEEK and bioactive PEEK discs were shown in Fig. 1. There were no significant differences between cells on PEEK and bioactive PEEK with respect to COL I and ON mRNA expression. However, human osteoblast-like cells on bioactive PEEK presented higher expression of OPN and OCN mRNA at day 21. No significant differences were found in ALP activity of both discs. Calcification deposits were observed only on bioactive PEEK at day 21Materials and Methods
Results
Nociceptive and neuropathic components both contribute to chronic pain. Since these components require different pain management strategies, correct pain diagnosis before and during treatment is important. Freynhagen et al. (2006) reported that they had developed and validated the pain-DETECT questionnaire (PD-Q) to detect neuropathic components in chronic low back pain patients. They also reported that 37% of unselected cohort of chronic LBP patients had predominantly neuropathic pain. However, the extent to which neuropathic components relate to the pathomechanism of pain deriving from osteoarthritis of hip joint remains unknown. The purpose of this study was to utilize PD-Q to investigate the relationship between neuropathic components and pain deriving from osteoarthritis of the hip joint. Between March and August 2010, 125 patients with osteoarthritis of hip joint completed PD-Qs about their pain. From this data set, we investigated whether or not the patients’ pain contained neuropathic components.Introduction
Methods
Several reports suggest that low-intensity pulsed ultrasound stimulation (LIPUS) facilitates chondrogenesis1). Recently it has been suggested that LIPUS may be transmitted via Integrin: a protein which mediates cellular attachment between cells and extracellular matrix2). In this study, the Arg-Gly-Asp (RGD) amino acid sequence, which is a ligand of Integrin, was induced to the fibroin substrates by either gene transfer or physical mixing, and the variation of chndrocyte response to LIPUS was evaluated. Three kinds of culture dishes coated with three diffrent fibroin aqueous solutions were prepared: 1 wild-type, 2 transgenic and 3 mixed. The wild-type aqueous solution was prepared from INTRODUCTION
EXPERIMENTAL METHODS
The purpose of this study was to clarify the incidence of steroid-induced osteonecrosis among different collagen diseases and to evaluate the predictive factors for steroid-induced osteonecrosis in a prospective MRI study. We prospectively used MRI to study 337 eligible collagen disease patients requiring corticosteroid therapy and succeeded in examining 1199 joints (hips and knees) in 302 patients with MRI for at least one year starting immediately after the onset of corticosteroid therapy, a one-year follow-up rate of approximately 90%. The underlying collagen diseases included systemic lupus erythematosus (SLE) in 687 joints and a variety of other collagen diseases in 512 joints.Introduction
Methods
The purpose of this study was to assess N-acetyl aspartate changes
in the thalamus in patients with osteoarthritis of the hip using
proton magnetic resonance spectroscopy. Nine patients with osteoarthritis of the hip (symptomatic group,
nine women; mean age 61.4 years (48 to 78)) and nine healthy volunteers
(control group, six men, three women; mean age 30.0 years (26 to
38)) underwent proton magnetic resonance spectroscopy to assess
the changes of N-acetyl aspartate in the thalamus. Objectives
Methods
The aim of this study was to report a 3 year follow up of vitamin E add polyethylene in total knee arthroplasty. UHMWPE powder (GUR1050) was mixed with 0.3% of vitamin E before consolidation by direct compression molding. The vitamin E added UHMWPE was applied to the articular surface and patella in 65 patients (mean age, 69.6 years). Joint fluid concentrations of tocopherol and matrix metalloproteinase 9 were measured in vitamin E added UHMWPE cases one year after surgery, and were compared to those of conventional UHMWPE cases and osteoarthritis patients. Concentrations of α-tocopherol and γ-tocopherol were measured by using HPLC with ultraviolet-visible wavelength detection. Concentrations of matrix metalloproteinase 9 were detected by using enzyme immunoassay. The Average Knee Society score were 91.7(clinical) and 76.7(functional). There were three failures (1 supracondylar fracture, and 2 skin necrosis). The average concentrations of α-tocopherol were 281.8μg/dL (10 cases) in the vitamin E group, 371.8μg/dL (15 cases) in the conventional group, and 317.8μg/dL (46 cases) in the osteoarthritis group. There were no significant differences among three groups. The average concentrations of γ-tocopherol were 43.4μg/dL in the vitamin E group, 52.3μg/dL in the conventional group, and 49.8μg/dL in the osteoarthritis group. There were no significant differences among three groups. The average concentrations of matrix metalloproteinase 9 were 83.2 ng/mL in the vitamin E group, 78.4 ng/mL in the conventional group, and 17.4 ng/mL in the osteoarthritis group. There was no significant difference between the vitamin E group and the conventional group. However, The matrix metalloproteinase 9 concentrations of the osteoarthritis group were significantly lower than others. No cases exhibited measurable polyethylene wear or osteolysis and also no abnormal values relating to vitamin E on joint fluid examinations. At three year follow-up, vitamin E added polyethylene demonstrated the safe use for the human body.
All types of cervical laminoplasties for cervical spondylotic myelopathy (CSM) gave the same degree of postoperative neurological recoveries. However, postoperative neck functions differed according to degrees of intervention with posterior supporting elements of the neck (spinoligamentous complex, SLC). To obtain optimal postoperative neck function, SLC should be preserved. Laminar enlargement destroying SLC resulted in anterior tilt of neck, loss of cervical lordosis and loss of cervical range of motion (ROM) by 40–60% of preoperative ROM, whereas, tension-band laminoplasty ( To obtain optimal postoperative neurological recovery, the timing of decompression was a key issue. Japanese Orthopaedic Association (JOA) score for cervical myelopathy (normal = 17 points) was used for neurological evaluation. One hundred and nine patients who underwent tension-band laminoplasty, were grouped into 3 groups according to preoperative JOA scores: group A with JOA score above 14 (10 patients), group B with JOA score between 11 and 13 (48 patients), and group C with JOA score below 10 (51 patients). Mean pre-/post- JOA scores and ratios of patients with postoperative JOA score above 16 for each group were as follows: 1 0.4/14.1, 34% for total patients, 14.6/16.5, 80% for group A, 11.9/14.8, 40% for group B, and 8.2/12.9, 20% for group C. There was a statistical difference among three groups. It was concluded that decompression at the early stage with JOA score above 14 using tension-band laminoplasty might provide the best outcome to CSM-patients regarding neurological improvement and postoperative neck function.
