We compared the clinical outcomes of curved intertrochanteric varus osteotomy (CVO) with bone impaction grafting (BIG) with CVO alone for the treatment of osteonecrosis of the femoral head (ONFH). This retrospective comparative study included 81 patients with ONFH; 37 patients (40 hips) underwent CVO with BIG (BIG group) and 44 patients (47 hips) underwent CVO alone (CVO group). Patients in the BIG group were followed-up for a mean of 12.2 years (10.0 to 16.5). Patients in the CVO group were followed-up for a mean of 14.5 years (10.0 to 21.0). Assessment parameters included the Harris Hip Score (HHS), Oxford Hip Score (OHS), Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ), complication rates, and survival rates, with conversion to total hip arthroplasty (THA) and radiological failure as the endpoints.Aims
Methods
Modulation of signaling pathways, which involves tendon development, regeneration, or homeostasis, is one of the potential modalities to facilitate proper regeneration of the injured tendon. Authors have previously reported that activation of Wnt/beta-catenin signaling suppressed the expression of tenogenic genes (i.e. Scleraxis (Introduction
Materials and Methods
Transtrochanteric rotational osteotomy (TRO) is performed for
young patients with non-traumatic osteonecrosis of the femoral head
(ONFH) to preserve the hip. We aimed to investigate the long-term
outcomes and the risk factors for failure 15 years after this procedure. This study included 95 patients (111 hips) with a mean age of
40 years (21 to 64) who underwent TRO for ONFH. The mean follow-up
was 18.2 years (3 to 26). Kaplan–Meier survivorship analyses were
performed with conversion to total hip arthroplasty (THA) and radiological
failure due to secondary collapse of the femoral head or osteoarthritic changes
as the endpoint. Multivariate analyses were performed to assess
risk factors for each outcome.Aims
Patients and Methods
The influence of identifiable pre-operative factors on the outcome
of eccentric rotational acetabular osteotomy (ERAO) is unknown.
We aimed to determine the factors that might influence the outcome,
in order to develop a scoring system for predicting the prognosis
for patients undergoing this procedure. We reviewed 700 consecutive ERAOs in 54 men and 646 women with
symptomatic acetabular dysplasia or early onset osteoarthritis (OA)
of the hip, which were undertaken between September 1989 and March
2013. The patients’ pre-operative background, clinical and radiological
findings were examined retrospectively. Multivariate Cox regression
analysis was performed using the time from the day of surgery to
a conversion to total hip arthroplasty (THA) as an endpoint. A risk
score was calculated to predict the prognosis for conversion to
THA, and its predictive capacity was investigated.Aims
Patients and Methods
Salter innominate osteotomy is an effective reconstructive
procedure for the treatment of developmental dysplasia of the hip
(DDH), but some children have a poor outcome at skeletal maturity.
In order to investigate factors associated with an unfavourable
outcome, we assessed the development of the contralateral hip. We retrospectively
reviewed 46 patients who underwent a unilateral Salter osteotomy
at between five and seven years of age, with a mean follow-up of
10.3 years (7 to 20). The patients were divided into three groups
according to the centre–edge angle (CEA) of the contralateral hip
at skeletal maturity: normal (>
25°, 22 patients), borderline (20°
to 25°, 17 patients) and dysplastic (<
20°, 7 patients). The
CEA of the affected hip was measured pre-operatively, at eight to
nine years of age, at 11 to 12 years of age and at skeletal maturity.
The CEA of the affected hip was significantly smaller in the borderline
and dysplastic groups at 11 and 12 years of age (p = 0.012) and
at skeletal maturity (p = 0.017) than in the normal group. Severin
group III was seen in two (11.8%) and four hips (57.1%) of the borderline
and dysplastic groups, respectively (p <
0.001). Limited individual development of the acetabulum was associated
with an unfavourable outcome following Salter osteotomy. Cite this article:
Two types of fracture, early and late, have been
reported following limb lengthening in patients with achondroplasia (ACH)
and hypochondroplasia (HCH). We reviewed 25 patients with these conditions who underwent 72
segmental limb lengthening procedures involving the femur and/or
tibia, between 2003 and 2011. Gender, age at surgery, lengthened
segment, body mass index, the shape of the callus, the amount and
percentage of lengthening and the healing index were evaluated to determine
predictive factors for the occurrence of early (within three weeks
after removal of the fixation pins) and late fracture (>
three weeks
after removal of the pins). The Mann‑Whitney U test and Pearson’s
chi-squared test for univariate analysis and stepwise regression
model for multivariate analysis were used to identify the predictive factor
for each fracture. Only one patient (two tibiae) was excluded from
the analysis due to excessively slow formation of the regenerate,
which required supplementary measures. A total of 24 patients with
70 limbs were included in the study. There were 11 early fractures in eight patients. The shape of
the callus (lateral or central callus) was the only statistical
variable related to the occurrence of early fracture in univariate
and multivariate analyses. Late fracture was observed in six limbs
and the mean time between removal of the fixation pins and fracture
was 18.3 weeks (3.3 to 38.4). Lengthening of the tibia, larger healing
index, and lateral or central callus were related to the occurrence
of a late fracture in univariate analysis. A multivariate analysis
demonstrated that the shape of the callus was the strongest predictor
for late fracture (odds ratio: 19.3, 95% confidence interval: 2.91
to 128). Lateral or central callus had a significantly larger risk
of fracture than fusiform, cylindrical, or concave callus. Radiological monitoring of the shape of the callus during distraction
is important to prevent early and late fracture of lengthened limbs
in patients with ACH or HCH. In patients with thin callus formation,
some measures to stimulate bone formation should be considered as
early as possible. Cite this article:
In order to ensure safety of the cell-based therapy for bone
regeneration, we examined BM cells obtained from a total of 13 Sprague-Dawley (SD) green
fluorescent protein transgenic (GFP-Tg) rats were culture-expanded
in an osteogenic differentiation medium for three weeks. Osteoblast-like
cells were then locally transplanted with collagen scaffolds to
the rat model of segmental bone defect. Donor cells were also intravenously infused
to the normal Sprague-Dawley (SD) rats for systemic biodistribution.
The flow cytometric and histological analyses were performed for
cellular tracking after transplantation.Objectives
Methods
The main form of treatment of a chordoma of the
mobile spine is total We report two patients who underwent TES after CIRT for treating
a chordoma in the lumbar spine with good medium-term outcomes. At
operation, there remained histological evidence of viable tumour
cells in both cases. After the combination use of TES following
CIRT, neither patient showed signs of recurrence at the follow-up examination.
These two cases suggest that CIRT should be combined with total
spondylectomy in the treatment of chordoma of the mobile spine. Cite this article:
One-stage bilateral total hip arthroplasty (THA) is twice as invasive as unilateral THA. Therefore, increases in bleeding, postoperative anemia, and complications are a concern. The purpose of this study was to investigate hemoglobin values and the use of autologous and allogenic blood transfusion after one-stage bilateral THA. Twenty-nine patients (7 men and 22 women; 58 hips) were treated with one-stage bilateral THA. The mean age of subjects at the time of surgery was 60.6 years. The average body mass index for patients was 21.7 kg/m2. The diagnoses were secondary osteoarthritis due to developmental dysplasia of the hip (n=25) and avascular necrosis (n=4). All patients had donated 800 ml of autologous blood in 2 stages preoperatively (1 to 4 weeks apart). All patients took iron supplements starting from 5 weeks preoperatively. For all patients, the procedure was performed under general anesthesia in the lateral decubitus position via a posterolateral approach. Intra-operative blood salvage was not used. Suction drains were inserted subfascially. As a general rule, pre-donated autologous blood was transfused back to the patients intra- or post-operatively. Allogenic blood transfusion was performed when clinical symptoms of anemia occurred (hypotension, low urinary output, tachycardia, etc.) rather than using a preset blood threshold (hemoglobin level <8 g/dl). To determine changes in blood pressure following surgery until the next morning, systolic and diastolic blood pressure were measured at 3-hr intervals.Background
Methods
We reviewed seven children with torticollis due to refractory atlanto-axial rotatory fixation who were treated in a halo vest. Pre-operative three-dimensional CT and sagittal CT imaging showed deformity of the superior articular process of C2 in all patients. The mean duration of halo vest treatment was 67 days (46 to 91). The mean follow-up was 34 months (8 to 73); at the latest review six patients demonstrated remodelling of the deformed articular process. The other child, who had a more severe deformity, required C1-2 fusion. We suggest that patients with atlanto-axial rotatory fixation who do not respond to conservative treatment and who have deformity of the superior articular process of C2 should undergo manipulative reduction and halo-vest fixation for two to three months to induce remodelling of the deformed superior articular process before C1-2 fusion is considered.
We undertook a study of the anti-tumour effects of hyperthermia, delivered via magnetite cationic liposomes (MCLs), on local tumours and lung metastases in a mouse model of osteosarcoma. MCLs were injected into subcutaneous osteosarcomas (LM8) and subjected to an alternating magnetic field which induced a heating effect in MCLs. A control group of mice with tumours received MCLs but were not exposed to an AMF. A further group of mice with tumours were exposed to an AMF but had not been treated with MCLs. The distribution of MCLs and local and lung metastases was evaluated histologically. The weight and volume of local tumours and the number of lung metastases were determined. Expression of heat shock protein 70 was evaluated immunohistologically. Hyperthermia using MCLs effectively heated the targeted tumour to 45°C. The mean weight of the local tumour was significantly suppressed in the hyperthermia group (p = 0.013). The mice subjected to hyperthermia had significantly fewer lung metastases than the control mice (p = 0.005). Heat shock protein 70 was expressed in tumours treated with hyperthermia, but was not found in those tumours not exposed to hyperthermia. The results demonstrate a significant effect of hyperthermia on local tumours and reduces their potential to metastasise to the lung.
We have reviewed 1858 patients who had undergone a cervical laminoplasty and identified 43 (2.3%) who had developed a C5 palsy with a MMT (MRC) grade of 0 to 2 in the deltoid, with or without involvement of the biceps, but with no loss of muscular strength in any other muscles. The clinical features and radiological findings of patients with (group P; 43 patients) and without (group C; 100 patients) C5 palsy were compared. CT scanning of group P revealed a significant narrowing of the intervertebral foramen of C5 (p <
0.005) and a larger superior articular process (p <
0.05). On MRI, the posterior shift of the spinal cord at C4–5 was significantly greater in group P, than in group C (p <
0.01). This study is the first to correlate impairment of the C5 nerve root with a C5 palsy. It may be that early foraminotomy in susceptible individuals and the avoidance of tethering of the cord by excessive laminoplasty may prevent a post-operative palsy of the C5 nerve root.
It is accepted that the development of scoliosis has a close relationship with physical growth, but the aetiology and mechanism of the disease remain unknown. Few studies have assessed the bone microarchitecture and histomorphological findings in vertebrae. After the occurrence of scoliosis, those include secondary changes caused by mechanical compression. It is important to investigate those data in the period prior to the occurrence of scoliosis.
Study Two: Sixty female Broiler chickens were divided into three groups: the control group (group C, n=20), the sham operation group (group S, n=20), and the pinealectomy group (group P, n=20). Each group was then subdivided into two groups according to the time of sacrificing: 3 days after the operation (group 3-C, 3-S, 3-P, n=10), and six days after the operation (group 6-C, 6-S, 6-P, n=10). Decalcified thin sagittal sections were made using a tartrate-resistant acid phosphatase (TRAP) stain. Histological examinations of the growth plate, trabecular structure and osteoclast number were performed.
Study Two: Nine out of ten chickens in group 6-P showed scoliosis deformity, while the presence of scoliosis was unclear in any of chickens in group 3-P. The osteoclast number increased significantly in group 3-P, compared to groups 3-C and 3-S, and the trabecular thickness was greater in group 3-P than in groups 3-C and 3-S. There was no significant change in the growth plate or in other aspects of the trabecular structure, except for trabecular thickness, in any of the groups. The results of study one showed that the change of microarchitecture might be caused by Wolff’s law and was the secondary response to the scoliotic deformity. Therefore, it was difficult to clarify the cause of scoliosis using micro CT. In study 2 we found that the number of osteoclast increased in pinealectomised chickens after 3 days postoperatively, just before scoliosis began to develop. We also found there was no change in the growth plate. These outcomes suggest that there are no relationships between changes in the growth plate and the development of scoliosis. However, the change in osteoclast number may have a relationship with the development of scoliosis through changes in bone modelling.
The aim of our study was to investigate the effect of platelet-rich plasma on the proliferation and differentiation of rat bone-marrow cells and to determine an optimal platelet concentration in plasma for osseous tissue engineering. Rat bone-marrow cells embedded in different concentrations of platelet-rich plasma gel were cultured for six days. Their potential for proliferation and osteogenic differentiation was analysed. Using a rat limb-lengthening model, the cultured rat bone-marrow cells with platelet-rich plasma of variable concentrations were transplanted into the distraction gap and the quality of the regenerate bone was evaluated radiologically. Cellular proliferation was enhanced in all the platelet-rich plasma groups in a dose-dependent manner. Although no significant differences in the production and mRNA expression of alkaline phosphatase were detected among these groups, mature bone regenerates were more prevalent in the group with the highest concentration of platelets. Our results indicate that a high platelet concentration in the platelet-rich plasma in combination with osteoblastic cells could accelerate the formation of new bone during limb-lengthening procedures.
Hydroxyapatite (HA) is a bioactive material with a high affinity for bone. Ti-6Al-4V is lightweight and less biotoxic. Using these materials, a cementless hip prosthesis has been clinically used, consisting mainly of a Ti femoral stem coated with plasma-sprayed biocompatible HA. However, this type of stem entails several disadvantages: HA is likely to decompose at the coating; long term HA coating layer bonding to Ti is unstable and optimal HA thickness is unfeasible. In many actual cases, debonding of HA coating layer from the Ti surface was found upon removal of stems. To resolve these concerns, we started developing a new hip prosthesis using composite materials comprised of Ti-6Al-4V and HA containing bioinactive and highly stable glass in 1985. The cementless hip prosthesis, named HAPG-Profile, unites the bioactive stem surface with the surrounding bone via adhesive glass. In basic experiments, the glass-coated HAPG-Profile has been demonstrated to possess much higher bonding stability than the plasma-sprayed HA, with bone affinity and safety not compromised. On the basis of these results, we manufactured the HAPG-Profile jointly with DePuy International, UK, and initiated a clinical trial in January 1997 in the teaching Hospital, Nagoya University School of Medicine, and Tokyo Kosei Nenkin Hospital. A total of 63 patients were followed up for more than two year and evaluated according to the Japanese Orthopedic Association Score and Harris Hip Score (HHS) clinically, functionally and radiographically. The results of the two-year follow-up study indicated success of early fixation associated with favorable outcomes.
We reviewed the outcome of curved intertrochanteric varus osteotomy in the treatment of osteonecrosis of the femoral head in 20 hips. A mean varus angulation of 31° was obtained by the osteotomy. The ratio of intact area on the weight-bearing portion increased from 19% to 61%. The mean elevation and lateral displacement of the greater trochanter were 1.2 cm and 0.5 cm, respectively. These changes in the position of the greater trochanter were very small when compared with those after conventional varus wedge osteotomy. Nonunion or delayed union was not observed. Quantitative analyses showed aggressive bone remodelling in the medial intertrochanteric region. Eighteen hips survived without collapse after a mean follow-up of 48 months. We conclude that curved varus osteotomy can be used to preserve the hip joint in patients with osteonecrosis of the femoral head.
We have measured the concentration of cartilage-derived retinoic-acid-sensitive protein (CD-RAP) in synovial fluid (SF) from the knees of 49 patients with osteoarthritis (OA) and 79 with rheumatoid arthritis (RA) in order to investigate the correlation between the type of joint disease and level of CD-RAP. The mean concentration of CD-RAP in synovial fluid was significantly higher in OA than in RA. The level of CD-RAP in the group of patients with mild OA was significantly higher than in the moderate or severe groups and that in the group with mild RA was also significantly higher than in the other RA groups and decreased with progression of the disease. Immunohistochemical studies showed expression of CD-RAP in the cytoplasm of chondrocytes in newly-formed fibrocartilage. Since CD-RAP is mainly produced in young and proliferating chondrocytes, our results suggest that the level of CD-RAP in synovial fluid reflects remodelling of articular cartilage and may be used as a marker to estimate objectively the restorative reaction of chondrocytes.
