Ultraviolet (UV) light-mediated photofunctionalisation is known to improve osseointegration of pure titanium (Ti). However, histological examination of titanium alloy (Ti6Al4V), which is frequently applied in orthopaedic and dental surgery, has not yet been performed. This study examined the osseointegration of photofunctionalised Ti6Al4V implants. Ti and Ti6Al4V implants were treated with UV light, and the chemical composition and contact angle on the surfaces were evaluated to confirm photofunctionalisation. The implants were inserted into femurs in rats, and the rats were killed two or four weeks after the surgery. For histomorphometric analysis, both the bone–implant contact (BIC) ratio and the bone volume (BV) ratio were calculated from histological analysis and microcomputed tomography data.Objectives
Methods
The surface of pure titanium (Ti) shows decreased histocompatibility over time; this phenomenon is known as biological ageing. UV irradiation enables the reversal of biological ageing through photofunctionalisation, a physicochemical alteration of the titanium surface. Ti implants are sterilised by UV irradiation in dental surgery. However, orthopaedic biomaterials are usually composed of the alloy Ti6Al4V, for which the antibacterial effects of UV irradiation are unconfirmed. Here we evaluated the bactericidal and antimicrobial effects of treating Ti and Ti6Al4V with UV irradiation of a lower and briefer dose than previously reported, for applications in implant surgery. Ti and Ti6Al4V disks were prepared. To evaluate the bactericidal effect of UV irradiation, Objectives
Materials and Methods
Proper acetabular cup placement is very important factor for successful clinical results in total hip arthroplasty (THA). Malposition of acetabular cup has been linked to increased rates of dislocation, impingement, pelvic osteolysis, cup migration, leg length discrepancy and polyethylene wear. Recently, some authors reported usefulness of navigation systems to set the acetabular cups with correct position. The purpose of this study is to evaluate the accuracy of acetabular cup placement in THA using computed tomography (CT)-based navigation system. Subjects were 235 hip joints we performed primary THA using CT based navigation system (Stryker® Navigation System, Stryker Corporation, Kalamazoo, MI, USA) from 2008 to 2014 and could assess the implant position by postoperative CT images. Their average age was 65.1 years (range 35–88). In all cases, non-cemented acetabular cups were implanted. TriAD cups (Stryker®) were used in 31 hips, and Tritanium cups (Stryker®) were used in 15 hips, and Trident cups (Stryker®) were used in 189 hips. Registration in this navigation system used surface matching system. We designed cup implantation using preoperative CT images and 3-dimensional (3-D) templates. The planned position of acetabular cup was in principle 40 degrees of inclination and 20 degrees of anteversion. However, we adjusted the better position of the cups according to pelvic tilt and femoral neck anteversion. When we placed acetabular cups, the position, inclination and anteversion, were measured by navigation system. After surgery, the positions of the cups were measured using postoperative CT images, navigation software and 3-D templates. Postoperative position using CT images were adjusted according to preoperative pelvic plane. The discrepancies between intraoperative navigation data and postoperative CT images data were analyzed as accuracy of navigation system in cup placement.Introduction
Material and Methods
Acetabular reconstruction of a total hip arthroplasty (THA) for a case with severe bone loss is most challenging for surgeon. Relatively high rate of failure after the reconstruction surgery have been reported. We have used Kerboull-type acetabular reinforcement devices with morsellised or bulk bone allografts for these cases. The purpose of this study was to examine the midterm results of revision THA using Kerboull-type acetabular reinforcement devices. We retrospectively reviewed 20 hips of revision THA (20 patients) between February 2002 and August 2010. The mean age of the patients at the time of surgery was 67.4 years (range 45–78). All of the cases were female. The mean duration of follow-up was 6.5 years (range 2.1–10.4). The reasons of revision surgeries were aseptic loosening in 10 hips, migration of bipolar hemiarthroplasty in 8 hips, and rheumatoid arthritis in 2 hips. We classified acetabular bone defects according to the American Academy of Orthopaedic Surgeons (AAOS) classification; we found two cases of Type II and eighteen cases of Type III. In terms of bone graft, we performed both bulk and morsellised bone grafts in 6 hips and morsellised bone grafts only in 14 hips. We assessed cup alignment using postoperative computed tomography (CT) and The post-operative and final follow-up radiographs were compared to assess migration of the implant. We measured the following three parameters: the angle of inclination of the acetabular device (Fig. 1); the horizontal migration (Fig. 2a); and vertical migration (Fig. 2b). Substantial migration was defined as a change in the angle of inclination of more than 3 degrees or migration of more than 3 mm. The pre- and postoperative hip functions were evaluated using the Japanese Orthopaedic Association (JOA) hip score.Introduction
Patients and methods
While research has been carried out widely for sagital pelvic tilt, research reports for coronal pelvic obliquity are few. The aim of this study is to evaluate changes of the pelvic obliquity before and after total hip arthroplasty. This retrospective study includes 146 cases of hips that were received total hip arthroplasty. There were 20 cases of revision, and 2 cases of re-revision. 17 cases were received bilateral total hip arthroplasty. The standing plain X-ray was used for evaluation of the pelvic obliquity in both before and 1-year after surgery. The correlation of pelvic obliquity was assessed between before and after surgery. 146 cases were classified into 3 groups (A, B, and C) according to the severity of the pelvic obliquity (0º−3º, 3º−6º, and >6º). Among the groups, statistical analysis was evaluated in the leg length discrepancy and the range of motion of the hip (flexion, extension, abduction, adduction, internal and external rotation) before and after surgery with 95% confidence intervals.Introduction
Material 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
Rotational malalignment of the femoral component still causes patellofemoral complications that result in failures in total knee arthroplasty (TKA). To achieve correct rotational alignment, a couple of anatomical landmarks have been proposed. Theoretically, transepicondylar axis has been demonstrated as a reliable rotational reference line, however, intraoperative identification of the transepicondylar axis is challenging in some cases. Therefore, surgeons usually estimate the transepicondylar axis from posterior condylar axis (PCA) using twist angle determined by the preoperative X-rays and CT. While PCA is the most apparent landmark, radiographs are not able to detect posterior condylar cartilage. In most osteoarthritic knees, the cartilage thickness of the posterior condyle is different between medial and lateral condyles. The purpose of this study is to evaluate the effect of the posterior condylar cartilage on rotational alignment of the femoral component in large number of arthritic patients. Furthermore, we investigated whether the effect of posterior condylar cartilage is different between osteoarthritis (OA) and rheumatoid arthritis (RA). Ninety-nine OA knees and 36 RA knees were included. Detailed information is summarized in Table 1. All cases underwent TKA using navigation system. The institutional review board approved the study protocol and informed consent was obtained from each participants. To evaluate the effect of posterior condylar cartilage, we measured two different condylar twist angle (CTA) using navigation system and intraoperative fluoroscopy-based multi-planner reconstruction (MPR) images obtained by a mobile C-arm. To uniform the SEA in two different measuring systems, we temporary inserted a suture anchors in medial and lateral prominence. The CTA that does not include the posterior condylar cartilage (MPR CTA) is evaluated on MPR images and the CTA that does include the posterior condylar cartilage (Navi. CTA) is calculated by navigation system. The difference between these two angles corresponds to the effect of posterior condylar cartilage on the rotation of the femoral component (Fig. 1). The paired or unpaired t test was used to compare the obtained data. The statistics were performed using GraphPad Prism 6. A P value of 0.05 or less is considered as a significant difference.Objective
Methods
Recently, there are increasing literatures of the in vivo kinematics of total knee arthroplasty (TKA). Those previous studies have been reported in regard of either intra-operative kinematics or post-operative kinematics. However, the direct correlation between intra- and post-operative kinematics of TKA has not been revealed. There are no evidences that intra-operative kinematics can lead to post-operative kinematics. The purpose of this study is to verify the direct correlation between intra- and post-operative kinematics of TKA.Introduction
Purpose
The aim of this study is to verify the intra-rater and inter-rater reliability of intra-operative kinematics by hand in TKA using a computer assisted image-free navigation system. Total knee arthroplasty (TKA) was performed on the knees of twelve (12) patients with knee navigation by one surgeon. Patients were divided into two groups: Group A included six knees that were operated on with assistant A (senior joint surgeon); and Group B included the other six knees that were operated on with assistant B (resident). For each knee, axial rotation was evaluated three times by the operator and the assistant using a navigation system at 30°, 60°, 90°, 120° passive flexions by hand. Intra-class correlation coefficients (ICC) were calculated for each evaluation to examine intra-rater and inter-rater reliability.Introduction
Material and Methods
