Methods

Between November 2000 and December 2016, we retrospectively evaluated 144 consecutive hip procedures in 122 patients a minimum of five years after undergoing modified Spitzy shelf acetabuloplasty for acetabular dysplasia including osteoarthritis (OA). Our follow-up rate was 92%. The mean age at time of surgery was 37 years (13 to 58), with a mean follow-up of 11 years (5 to 21). Advanced OA (Tönnis grade ≥ 2) was present preoperatively in 16 hips (11%). The preoperative lateral centre-edge angle ranged from -28° to 25°. Survival was determined by Kaplan-Meier analysis, using conversions to total hip arthroplasty as the endpoint. Risk factors for joint space narrowing less than 2 mm were analyzed using a Cox proportional hazards model.

Methods

We used the mouse osteosarcoma cell line LM8, the human breast cancer cell line MDA-MB-231, and the human prostate cancer cell line PC-3. Cultured cells were exposed to AO and radiation at various concentrations followed by various doses of irradiation. The cell viability was then measured. In vivo, each cell was inoculated subcutaneously into the backs of mice. In the AO-RDT group, AO (1.0 μg) was locally administered subcutaneously around the tumour followed by 5 Gy of irradiation. In the radiation group, 5 Gy of irradiation alone was administered after macroscopic tumour formation. The mice were killed on the 14th day after treatment. The change in tumour volume by AO-RDT was primarily evaluated.

Methods

We used the 143B, HOS, and Saos-2 human OS cell lines. We first analyzed the IL-6 gene expression and IL-6Rα protein expression in OS cells using reverse transcription real time quantitative-polymerase chain reaction (RT-qPCR) analysis and western blotting, respectively. We also assessed the effect of tocilizumab on OS cells using proliferation and invasion assay.

Methods

Intraoperative pelvic radiographs of 50 patients who underwent THA were collected retrospectively. The 3D pelvic bone model and the acetabular component were image-matched to the intraoperative pelvic radiograph. The radiological anteversion (RA) and radiological inclination (RI) of the acetabular component were calculated and those measurement errors from the postoperative CT data were compared relative to those of the 2D measurements. In addition, the intra- and interobserver differences of the image-matching analysis were evaluated.

Patients and Methods

A total of 52 Crowe IV and 50 normal hips undergoing total hip arthroplasty were retrospectively identified. In this CT-based simulation study, the acetabular component was positioned at the true acetabulum with a radiographic inclination of 40° and anteversion of 20° (Figure 1). Acetabular shape and the position of the centre of the acetabular component were analyzed by morphometric geometrical analysis using the generalized Procrustes analysis (Figure 2). To describe major trends in shape variations within the sample, we performed a principal component analysis of partial warp variables (Figure 3).

Methods

Three-dimensional tibial models were created from CT scans of 22 healthy Japanese knees (M7:F15, Age 31.0±12.6 years) using Mimics (Materialise NV, Leuven, Belgium).

The mid-sagittal plane of the tibia was defined by medial margin of the tibial tuberosity, origin of the PCL and center of the foot joint. The tibial plateau (or joint line plane) was determined by following three points; a dwell point of aligned femur on lateral tibial articular surface, and two points at anterior and posterior rim of medial tibial articular surface defined within sagittal plane that coincide with dwell point of femur on medial tibia. All measurements were made with respect to the mid-sagittal plane.

The shape of the tibial growth plate (GP) was extracted using Livewire function and mask editing tools of Mimics. To determine 3D orientation of the GP, moment of inertia axes were calculated for the 3D model. The inertia axes were also determined for medial and lateral half of the GP (Figure 1).

Methods

CT scans of sixteen healthy Japanese knees (M6:F10, Age 31.9±13.9 years) were studied. Three-dimensional reconstruction models were created using Mimics 17 (Materialise, Leuven, Belgium). First, a mid-sagittal tibial reference plane, for comparing the varus/valgus orientation of the tibial plateau to that of the growth plate, was defined by the medial margin of the tibial tuberosity, origin of the PCL and center of the foot joint. The tibial plateau (or joint line plane) was determined from three points; dwell point of femur (aligned in extension) on lateral tibial articular surface, and two points at anterior and posterior rim of medial tibial articular surface sampled in the sagittal view and coinciding with dwell point of femur on medial tibia.

Then, a three-dimensional model of the tibial growth plate was extracted using the Livewire function and mask editing tools in Mimics. To determine 3D orientation of the growth plate (GP), the vertical mass moment of inertia axis was calculated for the 3D model. The inertia axes were also determined for medial and lateral half of the GP (Figure 1).

Materials and Methods

Three groups of ETO sterilized MARATHON polyethylene liners (ID/OD: 28/44, 32/48, and 36/52 mm) were paired with matching CoCrMo heads (n=6 each group). To simulate rim loading, liners were assembled in the metal shells tilted at 64° (Figure 1) with sinusoidal loading (0 to 5000N at 3Hz) in a 37°C water bath for 5-million cycles or until component failure, whichever occurred first.

For neck-liner impingement testing, metal shells were potted at 54º (in the abduction/adduction plane with a ±10° of motion per ISO 14242–1 [8]) on a hip simulator (n=4 each group) using a physiological loading (max 3000N at 1Hz) for 3-million cycles (Figure 2). The impingement occurred at 64º during the simulated gait cycle (Figure 3).

The liners were inspected every million cycles, using a high intensity light to search for signs of crack initiation and/or fractures. Both test methods were validated to be able to replicate liner fractures.

Methods

A dynamic three-dimensional finite element model of the lower limb of a TKA patient was developed. Detailed description of the model has been previously published [4]. The model included femur, tibia and patella bones, TF ligaments, patellar tendon, quadriceps and hamstrings, and was virtually implanted with contemporary cruciate-retaining fixed-bearing TKA components. The model was initially aligned in ideal mechanical alignment with neutral HKA limb alignment. A design-of-experiments (DOE) study was performed whereby component placement was altered from neutral to 3° and 7° varus alignment, and HKA angle was altered from neutral to ±3° and ±7° (valgus and varus) (Figure 1).

Materials and Methods

A prospective cohort study performed on 93 patients (113 hips) who had undergone primary cemented THAs at our hospital between January 2001 and December 2003. The subject population included 85 females and 8 males with a mean age of 58.0 years (22 to 78) at the time of surgery. The mean follow-up period was 10.2 years (9 to 12). We randomly used two types of implants: the HXLPE cup with a 22.225 mm diameter zirconia head (Kyocera Medical, Osaka, Japan) in 60 hips (HXLPE group), and the CPE cup with a 22.225 mm diameter ortron head (DePuy International, Leeds, UK) in 53 hips (CPE group). Linear wear (penatration) by computer-assisted method with PolyWare software (Draftware Inc, Indiana, USA) was measured at 10 years. Anteroposterior radiographs were evaluated for osteolysis or component loosening defined by the criteria of Hodgkinson et al. Analysis of covariance using the general linear models procedure was carried out to determine the linear wear rate difference between the groups after adjusting for variables (age at surgery, sex, body mass index, vertical distance, horizontal distance, cup inclination, and cup anteversion) as covariates. The differences were considered significant when the p value was <0.05.

Methods

Between December 2013 and February 2014, 16 hips (16 patients) underwent application of the ALAC including VCM at our institution. Two hips were used for the treatment of infection, in the first stage of two-staged revision THAs (i.e., cement beads). Two hips were used for the both treatment and prevention of infection, in one-staged revision THAs. Twelve hips were used for the prevention of infection, in aseptic revision THAs or primary THAs with high risks. Patients were classified into two groups depending on the VCM concentration of ALAC, as follows: high-dose group (2 hips), average 4.4% (3.8–5.0%); low-dose group (14 hips), average 1.6% (1.3–2.5%). The amount of VCM placed as ALAC into the hip was calculated by using the remaining ALAC. The serum concentration of VCM was evaluated at 1 day, 4 days, 7 days, and 28 days after surgery. Statistical analysis was performed by using the t-test, and the differences were considered significant when the p value was <0.05.

Methods

A dynamic three-dimensional finite element model of the knee joint was developed and used to simulate a deep knee bend in a patient with excessive external tibial torsion (Figure 1). Detailed description of the model has been previously published [1]. The model included femur, tibia and patellar bones, TKA components, patellar ligament, quadriceps muscles, PF ligaments, and nine primary ligaments spanning the TF joint. The model was virtually implanted with two contemporary TKA designs; a FB design with domed patella, and a RP design with anatomic patella. The FB design was implanted in two different alignment conditions; alignment to the tibial A-P axis, and optimal alignment for bone coverage. Four different loading conditions (varying internal-external (I-E) torque and A-P force) were applied to the model to simulate physiological loads during a deep knee bend. Quadriceps muscle force, patellar tendon force, and PF and TF joint forces were compared between designs.

METHODS

We analyzed a total of 28 knees implanted with PS TKAs: Fourteen knees with the new PS prosthesis (group A), and the other fourteen knees with a popular PS prosthesis as a control group (group B). Preoperative data of both groups were not significantly difference. Flat-panel radiographic knee images were recorded during five static knee postures including full extension standing, lunge at 90° and maximum flexion, and kneeling at 90° and maximum flexion. The three-dimensional position and orientation of the implant components were determined using model-based shape matching techniques. The results of this shape-matching process have standard errors of approximately 0.5° to 1.0° for rotations and 0.5 to 1.0 mm for translations in the sagittal plane. Unpaired t-tests were used for statistical analysis and probability values less than 0.05 were considered significant.

Results

PCR Array: The expression of MCP-1 and MCP-3 had increased on day 2 than 0 or 7 in the rib fracture healing. Immunohistochemistry Staining: To verify the localization of MCP-1 expression, we examined the Wild type (WT)-mouse rib fracture healing. We observed high expression of MCP-1 and MCP-3 at the periosteum and the endosteum on post-fracture day 3. In vivo Antagonist Study: To elucidate whether MCP-1/CCR2 axis is involved during the early phase of fracture healing, we continuously administered RS102895, CCR2 antagonist, before or after rib fracture. Micro-CT analysis showed delayed fracture healing in the before-group compared with both the control and after-group. On day 21, the hard callus volume in the before-group was significantly smaller than that in the control-group. Histological analysis showed that fractures in both the control and the after-groups were healed by day 21. In contrast, less of cartilage in the callus was observed in the before-group on day 7. Gain of Function: To examine the roles of MCP-1 at the periosteum and the endosteum during the fracture healing, we created a segmental bone graft exchanging model. The bone grafts were transplanted from MCP-1^−/− mice to another MCP-1^−/− mice (KO-to-KO). Micro-CT analysis showed that KO-to-KO transplantation led to the delay of fracture healing on day 21. Next, we created exchanging-bone graft models between MCP-1^−/− and WT mice, in which a segmental bone derived from a WT mouse was transplanted into a host MCP-1^−/− mouse (WT-to-KO). In contrast to KO-to-KO bone graft transplantation, the transplantation of WT-derived graft into host KO mouse resulted in a significant increase of new bone formation on day 21. Histological analysis revealed that marked and localised induction of MCP-1 expression in the periosteum and the endosteum around the WT-derived graft was observed in the host MCP-1^−/− mouse. Loss of Function: To validate whether MCP-1 is a crucial chemokine for fracture healing, we created WT-to-WT and KO-to-WT bone graft models. When WT-donor graft was transplanted into WT-host, abundant new bone formation was observed around a WT-derived graft on day 21. In contrast, transplantation of KO-derived graft into WT-host resulted in a marked reduction of periosteal bone formation on a donor graft.

Introduction

Scapular dyskinesis has been observed in various shoulder disorders such as impingement syndrome or rotator cuff tears. However, the relationship between scapular kinematics and humeral positions remains unclear. We hypothesised that humeral rotation would influence scapular motions during humeral abduction and measured scapular motion relative to the thorax in the healthy subjects and whole cadavers.

Materials and Methods:

Between January 2013 and April 2013, a total of 19 consecutive patients underwent the removal of implants at our institution. There were 15 women and 4 men with a mean age of 71 years (32 to 90) at the time of the operation. Implants were removed because of aseptic loosening in 9 patients, infection in 6 patients, necrosis in 2 patients, dislocation in 1 patient and implant fracture in 1 patient. Removed implants, including 17 joint prostheses and 2 fracture fixation devices, were subjected to sonication in a BactoSonic (BANDELIN, Germany). Preoperative bacterial culture, intraoperative conventional culture of periprosthetic tissue, intraoperative culture of sonicate-fluid, and pathological examination were assessed.

Materials and Methods:

Four groups of polyethylene inserts (Table 1) were paired with matching femoral heads that were manufactured from CoCrMo (ASTM F1537) with diameters of 28, 32, and 36 mm. The inserts were chosen to have similar thickness at the dome for MARATHON, while for GVF it was the largest head size available.

Wear testing was performed on an AMTI Hip Simulator per the ISO 14242-1 standard [3] at 1 Hz using the described inputs (Table 2), which provide a larger range of motion than the ISO standard. The cups were mounted in accordance with ISO 14242-1 using custom fixturing and secured with cement while the femoral heads were mounted on a vertical taper support. Testing was performed in 25% bovine calf serum at 37 ± 2°C. Wear of the inserts was determined gravimetrically. Finally, wear rates were calculated by linear regression and then compared between the groups using ANOVA analysis (α = 0.05).

Materials & Methods

Three-dimensional models of 32 tibiae (23 females, 9 males, 71.2 ± 7.8 y/o) were reconstructed from CT data of the patients undergoing CT-based navigation assisted TKA. Clinically relevant mid-sagittal plane is defined by proximal tibial antero-posterior axis and an apex of the tibial plafond. After the cross-sectional contours of the tibial canal were extracted, least-square lines were fitted to define the proximal diaphyseal and the metaphyseal anatomical axis. The proximal tibia vara was firstly investigated in terms of distribution of proximal anatomical axis exits at the joint surface. TVA1 and TVA2 were defined to be a project angle on the coronal plane between the metaphyseal tibial anatomical axis and the proximal diaphyseal anatomical axis, and that between the metaphyseal tibial anatomical axis and the tibial functional axis, respectively. The correlations of each angle with age and femoro-tibial angle (FTA) were also examined.

Results

The proximal anatomical axis exits distributed 4.3 ± 1.7 mm medially and 17.1 ± 3.4 mm anteriorly. TVA1 and TVA2 were 12.5 ± 4.5°(4.4?23.0°) and 11.8 ± 4.4° (4.4?22.0°), respectively. The correlations of FTA with TVA1 (r=0.374, p<0.05) and TVA2 (r=0.439, p<0.05) were statistically significant.

Materials & Methods

We experienced four atypical femoral fractures. One was subtrochanteric and three were shaft fracture. Two cases received bisphosphonate therapy for 3–5 years. BMD, bone metabolic markers, and bone quality markers were evaluated. Histomorphometry and collagen cross-link analysis were performed. Curvature of femoral shaft and 3-D finite element analysis in one incomplete fracture case were assessed.