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Bone & Joint Research
Vol. 13, Issue 3 | Pages 91 - 100
1 Mar 2024
Yamamoto Y Fukui T Sawauchi K Yoshikawa R Takase K Kumabe Y Maruo A Niikura T Kuroda R Oe K

Aims

Continuous local antibiotic perfusion (CLAP) has recently attracted attention as a new drug delivery system for orthopaedic infections. CLAP is a direct continuous infusion of high-concentration gentamicin (1,200 μg/ml) into the bone marrow. As it is a new system, its influence on the bone marrow is unknown. This study aimed to examine the effects of high-concentration antibiotics on human bone tissue-derived cells.

Methods

Cells were isolated from the bone tissue grafts collected from six patients using the Reamer-Irrigator-Aspirator system, and exposed to different gentamicin concentrations. Live cells rate, apoptosis rate, alkaline phosphatase (ALP) activity, expression of osteoblast-related genes, mineralization potential, and restoration of cell viability and ALP activity were examined by in vitro studies.


The Bone & Joint Journal
Vol. 104-B, Issue 1 | Pages 97 - 102
1 Jan 2022
Hijikata Y Kamitani T Nakahara M Kumamoto S Sakai T Itaya T Yamazaki H Ogawa Y Kusumegi A Inoue T Yoshida T Furue N Fukuhara S Yamamoto Y

Aims

To develop and internally validate a preoperative clinical prediction model for acute adjacent vertebral fracture (AVF) after vertebral augmentation to support preoperative decision-making, named the after vertebral augmentation (AVA) score.

Methods

In this prognostic study, a multicentre, retrospective single-level vertebral augmentation cohort of 377 patients from six Japanese hospitals was used to derive an AVF prediction model. Backward stepwise selection (p < 0.05) was used to select preoperative clinical and imaging predictors for acute AVF after vertebral augmentation for up to one month, from 14 predictors. We assigned a score to each selected variable based on the regression coefficient and developed the AVA scoring system. We evaluated sensitivity and specificity for each cut-off, area under the curve (AUC), and calibration as diagnostic performance. Internal validation was conducted using bootstrapping to correct the optimism.


Bone & Joint Research
Vol. 6, Issue 3 | Pages 123 - 131
1 Mar 2017
Sasaki T Akagi R Akatsu Y Fukawa T Hoshi H Yamamoto Y Enomoto T Sato Y Nakagawa R Takahashi K Yamaguchi S Sasho T

Objectives

The aim of this study was to investigate the effect of granulocyte-colony stimulating factor (G-CSF) on mesenchymal stem cell (MSC) proliferation in vitro and to determine whether pre-microfracture systemic administration of G-CSF (a bone marrow stimulant) could improve the quality of repaired tissue of a full-thickness cartilage defect in a rabbit model.

Methods

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.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_2 | Pages 61 - 61
1 Jan 2016
Inoue T Yokokura T Yamamoto Y Nagamura K Nakanishi Y
Full Access

Cases of intertrochanteric hip fractures as a result of osteoporosis have been increasing in recent years. Treatment of these types of fractures is often performed with intramedullary (IM) nails or compression hip screws (CHS) [1]. IM nails are composed of a stem, which is inserted into the medullary canal of the femur, and a lag screw that is placed inside the head of the femur. One problem with this type of device is that both the left and right femurs are fixed with IM nails that have right-hand threaded lag screws. Therefore, on left femurs, the right-handed threads may not provide satisfactory fixation in the bone. This insufficient fixation could cause rotary motion and slippage in the femoral head, which would inhibit fracture healing. This study used three-dimensional finite element analysis (FEA) to examine the fixation and rotational characteristics in reference to the thread direction of the lag screw and the relative angle between the stem and lag screw.

In this study, a 3D CAD model of a left femur and four proximal femoral IM nail designs were analyzed in FEA for stress and displacement. An intertrochanteric femoral fracture was created so that the femoral head and diaphysis were separated. The four IM nails were designed to with either left or right-handed lag screw threads (figure .1) and with relative stem-lag screw angles of 125 or 135 degrees. (Traditional IM nails use a right-handed screw and a relative angle of 125 degrees.)

The results showed the femoral head displacement was smaller when using the left-handed lag screw. It is thought that this difference between the left and right-handed screws is caused by the direction of rotation, which would cause the left-handed screw to tighten and the right-handed screw to loosen within the femoral head. The femoral head displacement also decreased with a screw-stem angle of 135 degrees in comparison to the standard 125 degree angle. The standard right-handed screw with 125 degree relative angle was shown to have the largest displacement of all four types of tested IM nails, whereas the left-handed, 135 relative degree design produced the smallest displacement of all four implants.

These results show how using a left-handed lag screw with proper relative angles in the left femur, effectively reduces femoral head displacement when compared to traditional right-handed lag screw IM implants. This is important for the promotion of intertrochanteric fracture healing.


Bone & Joint Research
Vol. 1, Issue 10 | Pages 238 - 244
1 Oct 2012
Naraoka T Ishibashi Y Tsuda E Yamamoto Y Kusumi T Kakizaki I Toh S

Objectives

This study aimed to investigate time-dependent gene expression of injured human anterior cruciate ligament (ACL), and to evaluate the histological changes of the ACL remnant in terms of cellular characterisation.

Methods

Injured human ACL tissues were harvested from 105 patients undergoing primary ACL reconstruction and divided into four phases based on the period from injury to surgery. Phase I was < three weeks, phase II was three to eight weeks, phase III was eight to 20 weeks, and phase IV was ≥ 21 weeks. Gene expressions of these tissues were analysed in each phase by quantitative real-time polymerase chain reaction using selected markers (collagen types 1 and 3, biglycan, decorin, α-smooth muscle actin, IL-6, TGF-β1, MMP-1, MMP-2 and TIMP-1). Immunohistochemical staining was also performed using primary antibodies against CD68, CD55, Stat3 and phosphorylated-Stat3 (P-Stat3).


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_IV | Pages 533 - 534
1 Oct 2010
Yamamoto Y
Full Access

Objectives: During the past decade, acetabular labrum injury has been increasingly recognized as a cause of hip joint pain. Currently, T1-weited MR arthrography (MRa) with gadolinium is the most popular diagnostic imaging technique used for direct detection of acetabular labrum injury. However, the intra-articular injection of gadolinium is not a procedure approved in Japan. We have conducted radial MRa using T2*-weighted images with saline instead. The purpose of this report was to evaluate the sensitivity, specificity, and accuracy of T2*-weighted MRa with saline for the diagnosis of acetabular labrum injury.

Methods: Between November 2005 and March 2007, thirty-two hip joints of 30 patients (8 joints of 7 males and 24 joints of 23 females) aged between 13 and 81 (mean; 58) years at the time of study, who underwent MR arthrogram and hip arthroscopy were studied.

Prior to performing T2*-weighted MRa, a mixture of 5ml of 2% lidocaine chloride, 5ml of 64% iotrolan, and 15ml of saline was injected under fluoroscopy guidance injected into the hip joint. T2*-weighted MRa was conducted using a 1.5-tesla magnet and local surface coil in radial slices perpendicular to the labral rim, at 15-degree intervals. Radial sequences were operated at T2*-weighted images, Gradient echo method, TR of500ms, TE of 20ms, flip angle of 30 degrees, slice thickness of 5 mm, and FOV of 180 mm.

On the MRa, acetabular labrum tear was diagnosed when inflow of contrast medium (high intensity) was observed continuous with the joint space at the base of acetabular labrum.

Hip arthroscopy was conducted in the supine position by the standard three portal methods. The results of T2*-weighted MRa were compared with arthroscopic findings to calculate the sensitivity, specificity and accuracy of T2*-weighted MRa.

Results: On T2*-weighted MRa, acetabular labrum tear was observed in 17 joints, and no abnormalities in 15 joints. From arthroscopic findings, acetabular labrum tear was observed in 20 joints, and no acetabular labrum abnormalities in 12 joints. Comparing the two methods, the T2*-weighted MRa results were true positive in 17 joints, true negative in 12 joints, and false negative in 3 joints. Therefore, MRa had a sensitivity of 85%, specificity of 100%, and accuracy of 90.6%.

Discussion: MRa has become the standard imaging technique for the diagnosis of acetabular labrum tear. The sensitivity was reported to range from 63 to 100%, specificity from 44 to 75%, and precision from 63 to 94%.

Our results showed that this method provides sensitivity, specificity and accuracy that approach conventional MRa, demonstrating that radial T2* weighted MRa is a useful imaging technique for the diagnosis of acetabular labrum pathology.

Conclusions: We recommend T2*-weighted MRa with saline for the diagnosis of acetabular labrum injury.


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_I | Pages 22 - 22
1 Jan 2003
Yamamoto Y Ide T
Full Access

We perform arthroscopy of the hip in cases like osteoarthritis, aseptic necrosis of the femoral head, rapidly destructive coxarthrosis to exactly locate the site and extent of the lesion of articular cartilage, acetabulare labrum, and synovial membrane. 381 hips in 279 patients were examined by an arthroscopic technique during the last 16 years. Our technique consists of a three directional approach to the hip joint which facilitates a global view of the joint. This three directional anterior, lateral, and antero-lateral approach means the advantage of the swift replacement of the optical instruments and the easy insertion of arthroscopic tools.

Arthroscopic observation is also very useful for academic purposes. Pathological change of cartilage in osteoarthritis of the hip were classified into 4 grades according to the arthroscopic findings. In 113 joints only biopsies for synovial tissue, cartilage or acetabular limbus were performed. Arthroscopic surgical procedures such as joint debridement for osteoarthritis, synovectomy for rheumatoid arthritis, extraction of loose bodies, release of adhesions between the joint capsule and femoral head, and partial resection of the limbus were also carried out in 60 joints with a mean follow-up of 48 months. Average hip score according to Japanese Orthopedic Association achieved in pain point from 6 points to 24 points. With new improved instruments and three-directional technique, hip arthroscopy is rather easy to perform and less traumatic to the patient therefore we believe that it is suitable procedure for the relief from the coxalgia caused by osteoarthritis, rheumatoid arthritis, and torn limbus.