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Bone & Joint Research
Vol. 6, Issue 8 | Pages 489 - 498
1 Aug 2017
Mifuji K Ishikawa M Kamei N Tanaka R Arita K Mizuno H Asahara T Adachi N Ochi M

Objectives

The objective of this study was to investigate the therapeutic effect of peripheral blood mononuclear cells (PBMNCs) treated with quality and quantity control culture (QQ-culture) to expand and fortify angiogenic cells on the acceleration of fracture healing.

Methods

Human PBMNCs were cultured for seven days with the QQ-culture method using a serum-free medium containing five specific cytokines and growth factors. The QQ-cultured PBMNCs (QQMNCs) obtained were counted and characterised by flow cytometry and real-time polymerase chain reaction (RT-PCR). Angiogenic and osteo-inductive potentials were evaluated using tube formation assays and co-culture with mesenchymal stem cells with osteo-inductive medium in vitro. In order to evaluate the therapeutic potential of QQMNCs, cells were transplanted into an immunodeficient rat femur nonunion model. The rats were randomised into three groups: control; PBMNCs; and QQMNCs. The fracture healing was evaluated radiographically and histologically.


Bone & Joint Research
Vol. 6, Issue 5 | Pages 277 - 283
1 May 2017
Yoshikawa M Nakasa T Ishikawa M Adachi N Ochi M

Objectives

Regenerative medicine is an emerging field aimed at the repair and regeneration of various tissues. To this end, cytokines (CKs), growth factors (GFs), and stem/progenitor cells have been applied in this field. However, obtaining and preparing these candidates requires invasive, costly, and time-consuming procedures. We hypothesised that skeletal muscle could be a favorable candidate tissue for the concept of a point-of-care approach. The purpose of this study was to characterize and confirm the biological potential of skeletal muscle supernatant for use in regenerative medicine.

Methods

Semitendinosus muscle was used after harvesting tendon from patients who underwent anterior cruciate ligament reconstructions. A total of 500 milligrams of stripped muscle was minced and mixed with 1 mL of saline. The collected supernatant was analysed by enzyme-linked immunosorbent assay (ELISA) and flow cytometry. The biological effects of the supernatant on cell proliferation, osteogenesis, and angiogenesis in vitro were evaluated using human mesenchymal stem cells (hMSCs) and human umbilical cord vein endothelial cells (HUVECs).


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_6 | Pages 107 - 107
1 Mar 2017
Yasunaga Y Yamasaki T Ochi M
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Background

The clinical results of total hip arthroplasty (THA) with a cementless prosthesis have been constantly improving due to progress in the area of stem design and surface finish. However, majority of stems are well-fixed with canal filling or diaphyseal fit, and cortical hypertrophy or metaphyseal bone atrophy has been often observed. Cementless Spotorno stem (CLS stem; Zimmer, Warsaw, USA) is a double-tapered rectangular straight stem. The purpose of this study is to investigate the mean 13 years' results of CLS stem and to evaluate the press-fit stability of CLS stem.

Methods

Between 1999 and 2004, we treated 134 patients (142 hips) with CLS stem. Of those patients, 86 females (92 hips) and 13 males (14 hips), in total 99 patients (106 hips) were available at minimum of 11 years after surgery. At the time of follow-up, six females and five males were dead. The follow-up rate was 82% and the mean follow-up period was 13 years (SD; 20, range; 11–16). The mean age at the time of surgery was 65 years (SD; 10, range; 38–86). The mean body mass index was 24 (SD; 1.8, range; 19 to 28). Preoperative diagnoses were osteoarthritis in 92 patients, osteonecrosis in five patients, and rheumatoid arthritis in two patients. Majority of the patients were female because 84 patients of osteoarthritis suffered from hip dysplasia. For cementless acetabular reconstruction, APR cups (Zimmer, Warsaw, USA) were implanted in 10 hips, IOP cups (Zimmer, Warsaw, USA) in 22 hips, and Converge cups (Zimmer, Warsaw, USA) in 74 hips. As the liner of acetabular component, conventional UHMWPE (Sulene: Zimmer, Warsaw, USA) was used in APR cup and highly crosslinked UHMWPE (Durasul: Zimmer, Warsaw, USA) in IOP and Converge cups. The lipped liner was chosen in all cases, and lipped lesion was placed posteriorly. The radiographic stability of the femoral stem was determined by Engh's criteria. The ascertained period of spot welds was noted by Gruen zones on the femoral side. The presence of stress shielding, and subsidence was also evaluated.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_4 | Pages 138 - 138
1 Jan 2016
Yamasaki T Yasunaga Y Ochi M
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Introduction

Clione Anchored Replacement Prosthesis (CARP-H system) is a novel femoral implant for cementless fixation at the metaphysis of the proximal femur and preservation of cancellous bone of the femoral diaphysis is expected (Fig.1). We developed CARP-H system and started to use the prosthesis after the approval by Pharmaceuticals and Medical Devices Agency in 2012. This study examines the efficacy and short-term outcome of CARP-H system in a series of patients undergoing total hip arthroplasty (THA) or bipolar hemi-arthroplasty (BHA).

Patients and Methods

Seventeen patients (17 hips) of osteonecrosis of the femoral head (ON) or osteoarthritis of the hip (OA) were included. The diagnoses were OA in 10 patients, and ON in 7 patients. The mean age at surgery was 55 years (35–62 years). The mean follow-up was 12 months (6–19 months). THA using CARP-H system was performed in 11 hips and BHA in 6 hips.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_11 | Pages 126 - 126
1 Jul 2014
Eguchi A Ochi M Adachi N Deie M Nakamae A Nakasa T
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Summary Statement

We evaluated the mechanical strength of two cortical suspension devices by reproducing clinical situation for ACL reconstruction. A most important factor affecting the displacement during cyclic load was the length of the tendon rather than the length of the device.

Introduction

A definite consensus for the optimal graft fixation technique to the femur in an anterior cruciate ligament (ACL) reconstruction has not been reached, although there have been several fixation techniques such as cortical suspension devices, transfixation devices, and interference screws. The purpose of this study was to evaluate the mechanical strength of two cortical suspension devices by reproducing actual clinical situation for ACL reconstruction in order to compare the TightRopeTM as a new adjustable-length loop device and the EndoButtonTM as a well-known fixed-length loop device under the consistent conditions.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_VIII | Pages 22 - 22
1 Mar 2012
Yamasaki T Yasunaga Y Hamaki T Yoshida T Oshima S Hori J Yamasaki K Ochi M
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Introduction

Since 2005, we have performed implantation of bone marrow-derived mononuclear cells for osteonecrosis of the femoral head in order to improve vascularization and bone repair. This study focused on early bone repair of osteonecrosis of the femoral head after transplantation of bone marrow-derived mononuclear cells (BMMNC).

Patients and Methods

Twenty-two patients (30 joints) who had bilateral osteonecrosis followed for more than 2 years after BMMNC implantation were evaluated. Eight women and 14 men were included. Their mean age at surgery was 41 years (range, 18 to 64 years) and the mean follow-up period was 31 months. Pre-operative stage according to the ARCO classification was Stage 2 in 25 joints and Stage 3 in 5 joints. The mean volume ratio of osteonecrosis was 21%. For preparing BMMNC, about 700ml of bone marrow was aspirated from the ilium and centrifuged using a Spectra cell separator (Gambro). The BMMNC were seeded to interconnected porous calcium hydroxyapatite (IP-CHA) and implanted to the osteonecrotic lesion. As a control, cell-free IP-CHA was implanted for 8 patients (9 joints). A woman and 7 men were included. The mean age at surgery was 49 years (range, 28 to 73 years) and the mean follow-up period was 37 months. Preoperative stage was stage 2 in all patients. The mean volume ratio of osteonecrosis was 22%. At post-operative evaluations; progression of collapse, consolidation at reactive zone, post-operative course of volume rate of osteonecrosis, and bone absorption at osteonecrosis was assessed.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 149 - 150
1 May 2011
Yasunaga Y Yamasaki T Hamaki T Yoshida T Oshima S Hori J Yamasaki K Ochi M
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Background: A retroverted acetabulum has been hypothesized as a cause of osteoarthritis. This study was performed to evaluate whether radiographical cross-over sign influence the painful femoro-acetabular impingement or the radiographical progression of osteoarhritis after rotational acetabular osteotomy (RAO) for dysplastic hip.

Methods: Between 1987 and 1999, 104 patients (115 hips) who had pre- or early stage osteoarthritis of the hip due to dysplasia underwent a RAO. There were 99 women and five men; their mean age at the time of surgery was 34.7 years. The mean follow-up period was 13 years. Clinical follow-up was performed with use of the system of Merle d’Aubigne and the impingement sign was evaluated. Radiographical analyses included measurements of the center-edge angle, acetabular roof angle, head lateralization index, joint congruency, cross-over sign, posterior wall sign, acetabular index of depth to width, pistol grip deformity and femoral head-femoral neck ratio.

Results: The mean clinical score improved significantly from 14.6 preoperatively to 17.0 at follow-up. The impingement sign at the follow-up was observed in 14 hips (12.2%). The center-edge angle improved significantly from mean −0.6 degrees to a postoperative mean of 34 degrees. The acetabular roof angle improved from 30 degrees to 2.2 degrees, and head lateralization index from 0.64 to 0.60. The cross-over sign was observed in 8 hips (7.0%) preoperatively and in 49 hips (42.6%) postoperatively. The posterior wall sign was observed in 70 hips (60.9%) preoperatively and observed in 73 hips (63.5%) postoperatively. The mean preoperative acetabular index of depth to width was 35.5% and the mean preoperative femoral head to femoral neck ratio was 1.49. The pistol grip deformity was observed in only 4 hips (3.5%) preoperatively. The impingement sign after the RAO was positive significantly in the postoperative cross-over sign positive hips (p=0.0074). Radiographical progression of osteoarthritis was observed in 11 hips (cross over sign positive; 7 hips, cross over sign negative; 4 hips). The Kaplan-Meier survivorship analysis predicted a survival rate of 84.6 % at 15 years. The only factors significantly associated with radiographic signs of progression of osteoarthritis after RAO were fair (rather than excellent and good) postoperative joint congruency (p< 0.0001) and age at surgery (p=0.0042). Presence of postoperative cross-over sign had no effect on the outcome (p=0.2073).

Conclusions: Although there was no significant radiographical progression of osteoarthritis despite a significant retroversion in most cases, the goal of RAO should be a correct alignment of the acetabulum including a correct version with a negative cross-over sign.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 135 - 135
1 Mar 2010
Takada T Soda Y Shoji T Nishikawa K Ishida O Ochi M
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The purpose of this study was to elucidate the hemostatic effects of tranexamic acid (TA) in patients undergoing total knee arthroplasty (TKA) performed with different three methods.

The subjects were 89 patients (10 males, 79 females; mean age at surgery 74 years old) who underwent TKA for osteoarthritic knees in our department between April 2006 and October 2007. A cemented prosthesis (NexGen LPS flex, Zimmer) was used in all cases. The subjects were divided into three groups; Group A (n=39), in whom intravenous administration of TA (1 000 mg) 15 minutes before tourniquet release and a drain-clamping method [DC; joint filled with 50 ml of fluid that contained TA (1 000 mg, 10 ml) and 40 ml of physiological saline just after surgery] were performed, as reported by Prof. Otani (Keio Univ., Tokyo, Japan) in 2005; Group B (n=20), who had the same protocol as Group A, except that the DC Joint was filled with a total of 50 ml physiological saline alone; and group C (n=30), who received DC alone with 50 ml of physiological saline and no intravenous administration of TA. The parameters evaluated were the amounts of intra-operative bleeding, bleeding after 24 hours, total bleeding (intra- and post-operative), and changes in Hb levels between before surgery and 1 week after surgery. Statistical analyses were performed using a Mann-Whitney U-test, with P-values greater than 0.05 considered to be significant.

No differences were observed in the amount of bleeding during the TKA among the groups. In contrast, bleeding at 24 hours after surgery and total amounts of bleeding were significantly lower in Group A (281 and 695ml, respectively) as compared to Group B (337 and 868 ml, respectively) and Group C (650 and 1043 ml, respectively) (p< 0.01). In addition, Hb levels at 1 week after surgery were reduced by 1.8 g/dl in Group A, as compared to 2.3 and 3.0 g/dl in Groups B and C, respectively, demonstrating a significantly lower amount of reduction in Group A (p< 0.01).

The effect of TA for reducing blood loss in TKA is widely recognized. In the present study, concomitant use of an intravenous administration and infiltration into the joint (via DC) significantly reduced blood loss during and after TKA. Furthermore, allogenic blood transfusion could be avoided in all patients (Group A) who underwent that protocol. In our study, even when given intra-operatively, such as intravenous administration and infiltration, there were no complications. Nevertheless, when used during the post-operative course, careful attention should be paid to prevent such problems. In order to reduce blood loss during and after TKA, it is important to elucidate the optimal conditions, volume, and timing of administration of TA in future studies.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 161 - 161
1 Mar 2010
Soda Y Takada T Shoji T Nishikawa K Ishida O Ochi M
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This study was conducted to investigate the cases which were obliged to receive revision surgery within the first 5 years after primary Total Knee Arthroplasty (TKA).

The subjects of this study were 15 patients (5 males & 10 females, mean age at revision 72 years) who had undertaken revision surgery within 5 years since 1996. Intervals between primary and revision TKA averaged 29.8 months. Prosthesis used for primary TKA was as follows; 11 Zimmer NexGen LPS-flex fixed bearing, 2 mobile bearing, 2 CR type.

Revised components, cause of revision, JOA score as clinical results and FTA as radiographic evaluation were examined.

Revised parts were as follows;

All components: 2,

Both Femoral and Tibial components: 4,

only Femoral component: 2,

only Tibial component: 5,

only patella component: 1,

only articular surface: 1.

Stemmed Femoral components were used in 6 out of 8 knees, stemmed Tibial components in 9 out of 11 knees.

The causes of revision were as follows;

infection: 1,

loosening: 7,

inadequate component position: 4,

instability: 2,

pain: 1.

JOA scores improved from 45 points to 78 points, and FTA proved to be 176 deg., postoperatively.

Primary TKA remains one of the most successful orthopedic procedures. Survivorship was generally reported over 15 years in the previous article. However, there are some cases in which revision TKA is necessary by some causes. There seems to be various types of causes for revisions, such as loosening, inadequate position, abrasion of components and others. Though loosening of components due to traumatic cause was inevitable, other causes, such as inadequate position of component, imbalanced soft tissues and infection, which depend on our technique, should be cared during and after surgery. From our study, except for 7 (2 trauma, 5 unknown) out of 15 knees, almost half of revision TKA (8 knees) might be due to technical demand. As for surgical techniques, in the case of poor bony quality, we routinely use stemmed components and should try not to impact strongly on setting component to prevent from sinking. In the case of non-traumatic cause, 3 out of 12, though the position of tibial component was acceptable, tibial component sunk because of bony weakness and/or imbalanced soft tissues resulting pain.

Adequate position and balance of components should be achieved during primary TKA. In our department, we are trying to revise and routinely use stemmed components as soon as possible, when loosening of component is confirmed. Metal augmentation, if necessary, is mainly used for bone defect to do early rehabilitation.

We concluded that adequate position of components and soft tissue balance was very important at the time of primary TKA. Clinical results of revision TKA were almost equal to those of primary TKA, however, long term follow-up will be needed.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 160 - 160
1 Mar 2010
Soda Y Takada T Shoji T Nishikawa K Ishida O Ochi M
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This study was conducted to investigate the correlation between intra-operative Flexion Balance (IFB) and post-operative Flexion instability in Posterior-Stabilized Total Knee Arthroplasty (TKA).

Eighty-three knees (4 males and 79 females, average 74 y/o) with primary TKA (Zimmer NexGen LPS flex fixed-bearing) for varus osteoarthritis in our hospital between January 2006 and December 2007, were included in this study. After bone-cutting independently and balancing manually, Extension Balance (EB) and IFB were measured with seesaw type tensor. Post-operative Flexion Balance (PFB) was evaluated as post-operative instability with Kanekasu’s Epicondylar view at the least more than 6 months postoperatively. Varus inclination (lateral joint opening) was indicated as plus. In addition, pre-operative standing FTA (femorotibial angle), the change of FB (CFB=PFB-IFB) and True Correction Angle (TCA=FTA-174-EB), we had defined, were calculated. The TCA was hypothesized to mean the extent of medial soft tissue release. With these data, the correlation between IFB and PFB, CFB and TCA were analyzed. Of these, furthermore, in the well-balanced knees (IFB ≥ ±2°), same analyses were done. Statistical analysis was performed with StatView software.

Each data (n=83) in all subjects was as follows (Mean ± SD, degrees.); EB: 2.74 ±2.74, IFB: 1.61 ±3.67, PFB: 1.73 ±2.66, CFB: 0.01 ±4.25, FTA: 185.3 ±6.7, TCA: 8.65 ±6.52, respectively. Though there was no correlation between IFB and PFB (r=−0.09, p=0.57), CFB was correlated with TCA (r=0.40, p< 0.01).

Each data in the well-balanced knees (n=43) was as follows, EB: 3.09 ±2.71, IFB: 0.70 ±1.30, PFB: 1.22 ±2.52, CFB: 0.57 ±2.3, FTA: 185.5 ±6.5, TCA: 8.42 ±6.09, respectively. There was a correlation between IFB and PFB (r=0.41, p< 0.01), however, FBC was not correlated with TCA (r=−0.26, p=0.10).

Same rectangular balance has been thought to be one the most important factors to obtain the good postoperative stability in TKA. For correcting alignment of lower extremity, medial or posteromedial release are generally needed to perform mainly in extended knee. Even if well-balanced EB was achieved, IFB does not necessarily prove to be well, rather than sparse. This might be because intra-operative balance was not measured under physiological condition, especially after wide posteromedial release. Soft tissues released for balancing would be repaired and shortened over time, so it seems to be natural that intra-operative balance would change. We have reported that EB was correlated with post-operative instability in the previous congress (ISTA 2006). However, it remains unknown as for FB. Our study demonstrated that CFB increased in accordance with the extent of soft tissue release (TCA), and that IFB was correlated with PFB only in the well balanced knees. This means that the measurement of IFB was not useful for predicting PFB in the imbalanced knees. That’s why we should achieve adequate balance & gap during operation and should recognize that FB was influenced by various factors, not only soft tissues but also rotation and inclination of components. In the future, how to measure IFB, including tensor and measurement condition, should be considered and established to predict knee balancing for good clinical results.


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_I | Pages 130 - 130
1 Mar 2006
Yasunaga Y Hisatome T Tanaka R Yamasaki T Ochi M
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Introduction. Dysplasia of the hip is the commonest cause of secondary osteoarthritis. One treatment is periacetabular osteotomy such as rotational acetabular osteotomy(RAO). These procedures have generally produced satisfactory mid- and long-term results, but unfavorable results have been reported in a few cases. We evaluated the 10-year results to determine the factors of prognostic importance.

Methods. We studied 91 patients (100 hips) at prearthritis or early stage. The mean age at surgery was 36 years (13 – 58) and mean follow-up period was 11 years (8–16). 81 were women (89 hips) and 10 were men (11 hips). Clinical follow-up was done using the system of Merle d’Aubigne. Radiologically, CE angle, AC angle and head lateralization index (HLI) were measured prior to surgery, 3 months postoperatively and at follow-up. Postoperative joint congruencies were classified into four grades.

Results. The mean clinical score significantly increased from 14 to 17 and only in 4 cases the mean score decreased. CE angle, AC angle, and HLI significantly improved after surgery. Progression of osteoarthritis was radiologically observed at follow-up in 7 hips. Kaplan-Meier survivorship analysis predicted the rate of prevention of osteoarthritic progression at 10 years as 93%. Parametric survivorship analysis using the Cox hazards model indicated that postoperative joint congruency is a risk factor for progression of osteoarthritis.

Discussion/Conclusion. Our findings have suggested that RAO is valuable in preventing osteoarthritic progression for at least 10 years. If risk factors can be reduced, a longer operative effect may be expected.


Orthopaedic Proceedings
Vol. 84-B, Issue SUPP_III | Pages 236 - 236
1 Nov 2002
Field J Hearn T Costi J McGee M Costi K Adachi N Ochi M
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Introduction: Accelerated rehabilitation programs following ACL reconstruction require adequate fixation strength. Staple fixation of grafts outside the tibial tunnel has been shown to have fixation strength comparable to interference screws. The use of bioresorbable polymer implants has potentially significant advantages especially if revision is required. The purpose of this study was to evaluate a new bioresorbable fixation staple using an ovine model.

Materials and Methods: Forty-eight mature sheep underwent unilateral cranial cruciate ligament (CrCl) reconstruction. The reconstruction comprised a loop of superficial digital flexor tendon (autograft) joined to a prosthetic ligament (LK-15). Femoral fixation was by endobutton. Tibial fixation of the LK-15 was with either a new Poly-L-lactic acid (PLLA) staple (Zimmer Japan/Gunze Ltd.) or a Cobalt-chrome (CoCr) staple. Biomechanical and histological responses were evaluated at 0, 6, 12 and 24 weeks.

Results: At all times post-reconstruction there were no significant differences between staple types for construct strength or stiffness (p> 0.05). The staple was not the site of reconstruction failure, and there were no adverse tissue reactions, for either staple type. Fibrous tissue was more often found at the interface of the CoCr staple.

Conclusions: The PLLA staple performed biomechanically as well as the metal staple for tibial fixation of cruciate ligament reconstructions. There were no significant observable adverse histological responses over the time intervals examined.