Although periacetabular osteotomies are widely used for the treatment of symptomatic dysplastic hips, long-term surgical outcomes and patient-reported outcome measures (PROMs) are still unclear. Accordingly, we assessed hip survival and PROMs at 20 years after transpositional osteotomy of the acetabulum (TOA). A total of 172 hips in 159 patients who underwent TOA were followed up at a mean of 21.02 years (16.6 to 24.6) postoperatively. Kaplan-Meier analysis was used to assess survivorship with an endpoint of total hip arthroplasty (THA). PROMs included the visual analogue scale (VAS) Satisfaction, VAS Pain, Oxford Hip Score (OHS), and Forgotten Joint Score-12 (FJS-12). Thresholds for favourable outcomes for OHS (≥ 42) and FJS-12 (≥ 51) were obtained using the receiver operating characteristic curve with VAS Satisfaction ≥ 50 and VAS Pain < 20 as anchors.Aims
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Although periacetabular osteotomies are widely used for the treatment of symptomatic acetabular dysplasia, the surgical outcomes after long term follow-up are still limited. Thus, we assessed hip survival and patient-reported outcomes (PROMs) at 20 years after the transposition osteotomy of acetabulum (TOA). Among 260 hips in 238 patients treated with TOA, 172 hips in 160 patients were evaluated at average 20.8 years, excluding patients who died or lost to follow-up. Kaplan-Meier analysis was used to assess survivorship with an end-point of THA. PROMs were evaluated using the VAS satisfaction, VAS pain, Oxford hip score (OHS), and Forgotten joint score (FJS). The thresholds of favorable outcomes of FJS and OHS were obtained using the receiver-operating characteristic curve with VAS satisfaction ≥ 50 and VAS pain < 20 as anchors. Thirty-three hips (19.2%) underwent THA at average 13.3 years after TOA. Kaplan-Meier analysis revealed hip survival rate at 20 years was 79.7%. Multivariate analysis showed the preoperative Tönnis grade significantly influenced hip survival. Survival rates with Tönnis grade 0, grade 1, and grade 2 were 93.3%, 86.7%, and 54.8% at 20 years, respectively. More than 60% of the patients showed favorable PROMs (VAS satisfaction ≥ 50, VAS pain < 20, OHS ≥ 42, FJS ≥ 51). Advanced Tönnis grade at the latest follow-up and higher BMI were significantly associated with unfavorable OHS, but not with other PROMs. This study demonstrated the durability of TOA for hips with Tönnis grade 0–1 and favorable satisfaction in majority of the patients at 20 years after surgery. Current presence of advanced osteoarthritis is associated with the lower hip function (OHS), but not necessarily associated with subjective pain and satisfaction. Higher BMI also showed a negative impact on postoperative function.
The objective of this study was to identify fat emboli in the arterioles of the femoral bone marrow by Scanning Electron Microscopy (SEM) after glucocorticoid administration. Female adult rabbits weighing 3.5 to 4.0 kg received a single injection of prednisolone at a dose of 4 mg/kg body weight. The day after injection was designated as day 1. Control rabbits were injected with only physiological saline and euthanized on day 14. The femoral bone marrow was obtained on days 5, 8, and 14, and processed for SEM. Aortic blood serum was passed through a filter, and the filter was processed for SEM. Some SEM specimens were embedded in a plastic resin and sectioned for correspondence of SEM-photomicroscopy or SEM-TEM.Introduction
Methods
The mechanism for development of corticosteroid-induced osteonecrosis of the femoral head remains to be understood. Elucidation of the mechanism and the establishment of preventive methods have been critical issues. To establish a clinical method for prevention of corticosteroid-induced osteonecrosis, we have examined the suppressive effect of reduced glutathione (GSH) in a corticosteroid-induced rabbit model. Female Japanese white rabbits were separated into five groups: Group S4, a single intramuscular 4 mg/kg methyl prednisolone acetate (MPSL) administration in the gluteus; Group G4, administration of a 5 mg/kg regular dose GSH for 5 consecutive days starting on the day of a single 4 mg/kg MPSL administration; Group S20, a single intramuscular administration of 20 mg/kg MPSL in the gluteus; Group G20, administrations of 5 mg/kg GSH for 5 consecutive days starting on the day of a single 20 mg/kg MPSL administration; and Group N, control group with no treatment. All rabbits were sacrificed 14 days after MPSL administration. Histopathological analyses were performed by hematoxylin-eosin staining. Immunohistological analyses were performed using anti-lectinlike oxidized LDL reseptor-1 antibody (anti-LOX-1 antibody).Introduction
Methods
Recently, oxidative stress has been implicated in the development of osteonecrosis. Here we focused on vitamins with marked antioxidant potency to see whether their use might prevent the development of osteonecrosis associated with corticosteroid administration. Fifteen male Japanese white rabbits weighing about 3.5 kg were injected once into the right gluteal muscle with methylprednisolone (MPSL) 40 mg/kg (S Group). Ten other rabbits, in addition, received consecutive daily intravenous injections of vitamin E 50 mg/kg starting from the day of MPSL administration (E Group), and 10 other animals similarly received consecutive daily intravenous injections of vitamin C 30 mg/kg (C Group). All animals were euthanized 2 weeks after MPSL administration, and femurs were extracted, and stained with hematoxylin-eosin. Blood levels of glutathione (GSH) were also measured.Introduction
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