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. 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.Aims
Methods
To compare the effect of femoral bone tunnel configuration on tendon-bone healing in an anterior cruciate ligament (ACL) reconstruction animal model. Anterior cruciate ligament reconstruction using the plantaris tendon as graft material was performed on both knees of 24 rabbits (48 knees) to mimic ACL reconstruction by two different suspensory fixation devices for graft fixation. For the adjustable fixation device model (Socket group; group S), a 5 mm deep socket was created in the lateral femoral condyle (LFC) of the right knee. For the fixed-loop model (Tunnel group; group T), a femoral tunnel penetrating the LFC was created in the left knee. Animals were sacrificed at four and eight weeks after surgery for histological evaluation and biomechanical testing.Objectives
Methods
Most Japanese patients who receive total hip arthroplasty (THA) are osteoarthritic and 70% have development dysplasia of the hip. Their stature is shorter than average and their sizes (acetabular cup and femoral stem) are smaller. The Taperloc Microplasty (BIOMET) is a short femoral stem. It was launched on July 2012 in Japan (extended on January 2013). It is essentially a shortened version of the Taperloc stem (35mm shorter than the standard stem). We aimed to evaluate the outcomes of minimally invasive anterolateral THA using a short stem.Introduction
Objectives
Proximal tibial fracture is one of the most common postoperative complications of unilateral knee arthroplasty (UKA). The objective of the present study is to investigate the risk factors of these fractures, occurred after UKA in our facility. We performed 314 UKAs between May 2006 and December 2013. All cases were done using Oxford UKA. Proximal tibial fractures were observed in 5 cases. 4 cases were female and 1 case was male, and the age at the operation ranged from 73 to 90. All cases were osteoarthritis. 4 cases were diagnosed as stress fracture with minimum displacement, and 1 case was fracture with displacement. We investigated the risk factors of the tibial fracture among those 5 cases. Low bone mineral density(BMD), the presence of medial tibial cortex pinhole, excessive vertical cut, and adjacence of keel and posterior tibia cortex were estimated as risk factors.Objectives
Method
Unexplained pain is one of the most common complications after Oxford UKAs. We have retrospectively reviewed the patients who underwent Oxford UKAs and investigated those patients with prolonged pain and found that many of these patients had strong tenderness over the Hunter canal and they were well treated with Hunter canal block or administration of Pregabalin. We have checked the details of these prolonged pain and key to the treatment will be discussed. Between May 2006 and September 2014 we have performed 316 Oxford UKAs. There were 47 males and 269 females with average age of 70.4 years old (46–90). The patients were followed up for at least 6 months (6 months to 8.0 years, mean follow-up period of 3.1 years). The patients were examined both clinically and radiologically.Background
Methods
We have been using continuous epidural block and local infiltration cocktail for the pain management after TKA since 2005, and good pain control has been acquired with this method. During the past few years we have changed our protocol of postoperative pain management. We have stopped the administration of Loxoprofen starting next morning of the operation, instead Celecoxib was given starting before the operation. We have started mixing steroid to the intraoperative local infiltration cocktail to reduce acute pain as well as swelling. We also have stopped using suction drain, and delayed the timing of CPM start from day 2 to day 3. This is case control study, and 78 cases of unilateral TKA were investigated for the study. All cases were anesthetized with continuous epidural block with intravenous dosage of phentanyl and propofol. Compositions of local infiltration cocktail are 40ml 0.75% Ropivacaine, 60ml saline, 0.5ml epinephrin. Group1 (n=40) used this cocktail independently, and Group2 (n=38) used this cocktail with addition of 40mg of triamcinolone(Fig.1). Local infiltration cocktail was used during operation, which was injected to the whole joint capsule. In group1 Loxoprofen was given starting next morning, in group 2 Celecoxib was given starting at 7am on the day of operation. In group1 suction tube was left for 2 days, where as in group2 no suction tube was used postoperatively, and continuous epidural block catheter was removed on postoperative day 2 in both groups. CPM was started at postoperative day 2 in group 1 and postoperative day 3 in group 2. Numerical Rating Scale (NRS) was used to analyze the pain. Circumferences of knee and thigh, as well as ROM of knee joint were measured periodically.Objective
Methods
We report a case which total knee arthroplasty (TKA) was able to be performed on schedule for the patient with occult fracture of proximal tibia which seemed to have occurred three months prior to the surgery, and has healed in short period of time by the use of Teriparatide. The patient is 84-year-old female, having right knee pain for past 7 years. Her knee pain increased by passive extension maneuver that was done by a bonesetter 3 months prior to the surgery. On her initial visit, the X-ray finding was severe medial osteoarthritis, and femorotibial angle (FTA) in the upright film was 197°, but there was no other disorder including fracture. Since the bone mineral density (BMD) of affected femoral neck was 62%YAM, and affected lateral femoral condyle as well as lateral tibial condyle seemed very porotic, we started using daily 20μg Teriparatide injection from 3 months prior to the surgery. Proximal tibial fracture was presented in the X-ray taken on the day before surgery, but since adequate bone union has already been formed, surgery was performed on schedule. Tibial implant with long stem was used for just to be certain. Thanks to the Teriparatide, the condition of cancellous bone in cut surface was excellent, and reaming of the tibia through fracture area felt very solid.Introduction
Case report
In recent years, an increasing number of reports related to adverse reactions to metal debris (ARMD) following metal-on-metal (MOM) total hip arthroplasty (THA) have been published. Some patients who experience ARMD require revision surgery. In this study, we aimed to evaluate the mid-term results of MOM THA.Introduction
Objectives
We conducted an anatomical study to determine
the best technique for transfer of the anterior interosseous nerve (AIN)
for the treatment of proximal ulnar nerve injuries. The AIN, ulnar
nerve, and associated branches were dissected in 24 cadaver arms.
The number of branches of the AIN and length available for transfer
were measured. The nerve was divided just proximal to its termination
in pronator quadratus and transferred to the ulnar nerve through
the shortest available route. Separation of the deep and superficial
branches of the ulnar nerve by blunt dissection alone, was also
assessed. The mean number of AIN branches was 4.8 (3 to 8) and the
mean length of the nerve available for transfer was 72 mm (41 to
106). The transferred nerve reached the ulnar nerve most distally
when placed dorsal to flexor digitorum profundus (FDP). We therefore
conclude that the AIN should be passed dorsal to FDP, and that the
deep and superficial branches of the ulnar nerve require approximately
30 mm of blunt dissection and 20 mm of sharp dissection from the
point of bifurcation to the site of the anastomosis. The use of this technique for transfer of the AIN should improve
the outcome for patients with proximal ulnar nerve injuries. Cite this article:
