The rate of elderly people over 65 year-old increased from 18.5 % in 2004 to 26.0% in 2015 in Japan. Northern part of Japan is a head of the super-aging society, and the rate already reached 30.9% in 2015. Along with aging society, rapid increase of total hip arthroplasties (THA) has been predicted. The aim of this study is to estimate the trend of total hip arthroplasties in our super-aging area in Northern Japan. Trend on number and rate of THA in one of the local area of leading super-aging society were surveyed in the last decade using the database of diagnostic procedure and surgical records from 2004 to 2015. The cause of revision THA was analyzed in 2004–2009 versus in 2010–2015. Spearman's rank-correlation coefficient and student's t-tests were performed using the PASW 18 software (SPSS Institute Inc). Values of p < 0.05 were considered statistically significant.Background
Methods
Patients undergoing total hip arthroplasty (THA) stand in the danger, a particularly high risk for venous thromboembolism (VTE). Fondaparinux and edoxaban, which inhibit FXa, indirectly and directly, respectively, have been used for prevention of VTE after THA in Japan. The aim of this study was to compare the efficacy of fondaparinux and edoxaban for VTE after elective THA in Japanese patients. We randomly assigned 320 patients underdoing elective cemented THA to receive postoperative 2.5 mg fondaparinux once daily for first postoperative 3 days and 1.5 mg once daily for the subsequent 7 days (FPX group) [1], postoperative 15 mg edoxaban once daily for postoperative 10 days (EDO15mg group), 30 mg edoxaban once daily for postoperative 10 days (EDO30mg group), and 30 mg edoxaban once daily for first postoperative 3 days and 15 mg once daily for the subsequent 7 days (EDOmix group). Deep venous thrombosis (DVT) was diagnosed by ultrasonography at postoperative day 3 and 14. Computed tomography to detect pulmonary thromboembolism was performed to all patients who had proximal DVTs. The χ2 test with Bonferroni correction was used to compare variables of the incidence of DVT between each group. The intention-to-treat analysis was performed for statistical analysis in each group. The EDO30 mg group and EDOmix group were regarded as one group in the assessment at the postoperative day 3, and named as the EDO30mg+mix group.Introduction
Materials and methods
Acetabular reconstruction of extensive bone defect is troublesome in revision total hip arthroplasty (rTHA). Kerboull or Kerboull type reinforcement acetabular device with allobone grafting has been applied since 1996. Clinical results of the procedure were evaluated. One hundred and ninety-two consecutive revision total hip arthroplasties were performed with allograft bone supported by the Kerboull or Kerboull type reinforcement acetabular device from 1996 to 2009. There were 23 men and 169 women. Kerboull plates were applied to 18 patients, and Kerboull type plates to 174. The mean follow up of the whole series was 8 years (4–18years). The superior bone defect was reconstructed principally by a large bulky allo block with plate system. Medial bone defect was reconstructed by adequate bone chips and/or sliced bone plates. After temporally fixation of bulky bone block with two 2.0mm K-wires, it was remodeled by reaming to fit the gap between host bone and plate, followed by fixation to the iliac bone by screws. Finally, residual space of the defect between host bone and the fixed plated was filled up with morselized cancellous bones, bone chips, and/or wedged bony fragments with impaction. This method was sufficiently applicable to AAOS Typeâ�, II, and III bone defects. In case of AAOS Typeâ�£, the procedure was also available after repairing discontinuation between distal and proximal bones by reconstrusion plate or allografting with tibial bone plates or sliced femoral head.Patients
Surgical Technique
Macrophages phagocytes implant wear debris and produce various cytokines to evoke inflammation and periprosthetic osteolysis of aseptic loosening. It had been reported that expression of Toll-like receptor (TLR) 2 and other TLRs increased in periprosthetic tissues of aseptic loosening. Pathogen-associated molecular patterns (PAMPs) and damaged-associated molecular patterns (DAMPs) have been known as ligands of TLRs and considered to be involved in the osteolytic reactions TLR1, TLR2, TLR6, NLRP3, TNF-α and IL-1β of macrophages in aseptic loose periprosthetic tissues were immnohistorically evaluated and compared to osteoarthritic synovium. RAW264.7 cells, macrophagic cell line, were stimulated by titanium particles (Ti) and lipoteichoic acid (LTA)-coated Ti. The celluar reaction associated with TLR2 and NLRP3 and the correlation of them were analyzed at mRNA expression levels with small-interfering RNA of Introduction
Materials and methods
Biologic agents (BIO) drastically changed the rheumatoid arthritis (RA) therapy from starting to use biologics at 2003 in Japan. The rate of orthopaedic surgery, especially total joint arthroplasty (TJA) may reflect trends in disease severity, management and health outcomes. We surveyed the number and rate of orthopaedic surgeries and TJA in RA treatment with BIO in the last decade, so called BIO-era.Objectives
Methods
Although the treatment for infected total hip arthroplasty (THA) has been still controversial, some reports suggested two-stage revision THA seems to be more preferable rather than one-stage revision. The purpose of this study is to estimate the outcome of treatment for infected THA in our institutions. The medical records of patients who have been underwent surgical treatment for infected THA between 2006 and 2012 in two hospitals and followed more than one year after surgery were reviewed. 34 patients and 35 hips were included. Age at surgery, gender, a period until surgical treatment after diagnosis of infection, method of treatment (debridement, one-stage or two-stage revision THA) and the outcome are estimated for each hips. Remission was defined by the absence of local and systemic sign of implant related infection and the normalization of WBC and C-reactive protein value without antibiotics.Background and Purpose
Patients and methods
Venous thromboembolism (VTE), especially, deep vein thrombosis (DVT) in lower extremities, often seriously combined with pulmonary embolism (PE), is a major and critical complication after total hip arthroplasty (THA). For better disgonsis of VTEs, D-dimer test is one of the useful methods. The aim of this study was to evaluate the efficacy of D-dimer levels before THA. Medical records of patients with osteoarthritis who received THA between April 2009 and March 2010 were reviewed. Value of D-dimer at preoperative day 1, postoperative day 3 and 14 was examined in those patients. D-dimer levels were examined by Latex Immunity Nephelometry Measurement Method and the Kit (Sysmex Corporation, Kobe, Japan). A total of 327 patients with D-dimer values were examined. The values D-dimer of the available patients were under 1.0 μg/ml. Ninety-nine patients (30%) had a high D-dimer level. DVT was diagnosed by doppler ultrasonography at preoperative day 1, postoperative day 3 and 14. The sensitivity and specificity of D-dimer in different cutoffs were verified by Receiver Operating Characteristic (ROC) curve. The ROC curve was constructed to describe the relationship between the sensitivity and the false positive rate for different values of D-dimer to patients suspected of VTEs. The study protocol was approved by the institutional ethics committee.INTRODUCTION
MATERIALS AND METHODS
