| 1. |
Koji Yamada, Tomohiro Shinozaki, Junji Ito, Susumu Nakajima, Koichi Nakagawa, Takeo Furuya, Kanichiro Wada, Naomi Kobayashi, Naoto Shiba, Yoshitomo Kajino, Naohiro Kawamura, Daisuke Hamada, Yasunori Tome, Akira Nishimoto, Toshinori Sakai, Kazutoshi Hasegawa, Yuki Iijima, Katsushi Takeshita, Yasuharu Nakashima, The influence of COVID-19 epidemic on the number of orthopaedic surgeries in Japan., Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 10.1016/j.jos.2023.08.016, 2023.10, BACKGROUND: There is limited data on the impact of COVID-19 epidemic on the number of orthopaedic surgeries in Japan. METHODS: We conducted a nationwide hospital survey asking for the monthly number of orthopaedic surgeries performed at each facility from January 2019 to June 2021. Those facilities that had performed at least 100 surgeries in 2019 were included for analyses. The facilities were further grouped by prefecture and by hospital characteristics. A brief health economic evaluation was also performed. Risk ratios were compared using univariate analyses with P |
| 2. |
Keiichiro Iida, Yoshihiro Matsumoto, Akira Nabeshima, Toshifumi Fujiwara, Nokitaka Setsu, Makoto Endo, Yasuharu Nakashima, The Difference in Clinical Features between Small-Sized Soft Tissue Sarcomas and Benign Tumors., The Kurume medical journal, 10.2739/kurumemedj.MS69120015, 69, 1.2, 65-73, 2023.11, BACKGROUND: Small-sized tumors tend to be resected without thorough assessment and are often managed in a sarcoma center after a malignancy is diagnosed. The lack of knowledge about the features of smallsized sarcomas may lead to unplanned resection. The features of small-sized soft tissue sarcomas were investigated by comparing them with those of small benign soft tissue tumors. METHODS: We included 17 soft tissue sarcoma cases (7 on the hands and feet and 10 on the limbs and trunk) with a diameter of under 2 cm. The features of small-sized sarcomas were compared to those of 39 benign soft tissue tumors with a diameter of under 2 cm and non-specific imaging findings (30 on the hands and feet and 9 on the limbs and trunk). The investigated features were age, sex, presence of pain, subjective increasing tumor size, and duration of observation. RESULTS: When we compared the tumors in the hands and feet, those |
| 3. |
Satoru Harada, Satoshi Hamai, Kyohei Shiomoto, Shinya Kawahara, Daisuke Hara, Tetsunari Harada, Yasuharu Nakashima, Predictors of physical activity recovery after total hip arthroplasty: a prospective observational study., International orthopaedics, 10.1007/s00264-023-06022-2, 2023.11, PURPOSE: Little is known about the changes and the factors in physical activity as following total hip arthroplasty (THA). There are potential discrepancies between subjective and objective measurements of physical activity. Thus, our porpose is to compare objective and subjective measurements of activity levels in patients undergoing THA preoperatively, three months and one year following surgery, and investigated the factors that predicts the objective activity level after THA. METHODS: This prospective observational study included 42 patients with unilateral symptomatic hip osteoarthritis who underwent THA. The objective activity level (step counts, sit-to-stands, and upright time) by using a tri-axial accelerometer, PRO (Oxford hip score; OHS and University of California, Los Angeles activity score; UCLA score), and muscle volume around the hip joint by using preoperative computed tomography were measured. RESULTS: The number of steps, OHS, and UCLA score before, at three months, and one year after THA averaged 5092, 6532, and 6545 steps, 30.3, 43.0, and 44.2 points, and 3.4, 4.8, and 4.6 points, respectively, with significant postoperative increases (P |
| 4. |
Yasuhiko Kokubu, Toshifumi Fujiwara, Yoshihiro Matsumoto, Makoto Endo, Nokitaka Setsu, Keiichiro Iida, Akira Nabeshima, Yasuharu Nakashima, Older age at surgery and postoperative leg length discrepancy are risk factors for unfavourable patient-reported outcome measures of knee tumour endoprostheses following resection for musculoskeletal tumour of the lower limb., Bone & joint open, 10.1302/2633-1462.412.BJO-2023-0125.R1, 4, 12, 906-913, 2023.12, AIMS: To evaluate mid-to long-term patient-reported outcome measures (PROMs) of endoprosthetic reconstruction after resection of malignant tumours arising around the knee, and to investigate the risk factors for unfavourable PROMs. METHODS: The medical records of 75 patients who underwent surgery between 2000 and 2020 were retrospectively reviewed, and 44 patients who were alive and available for follow-up (at a mean of 9.7 years postoperatively) were included in the study. Leg length discrepancy was measured on whole-leg radiographs, and functional assessment was performed with PROMs (Toronto Extremity Salvage Score (TESS) and Comprehensive Outcome Measure for Musculoskeletal Oncology Lower Extremity (COMMON-LE)) with two different aspects. The thresholds for unfavourable PROMs were determined using anchor questions regarding satisfaction, and the risk factors for unfavourable PROMs were investigated. RESULTS: The thresholds for favourable TESS and COMMON were 64.8 and 70.4 points, respectively. Multivariate analysis showed that age at surgery (p = 0.004) and postoperative leg length discrepancy (p = 0.043) were significant risk factors for unfavourable TESS results, while age at surgery (p 29 years at the time of surgery require appropriate preoperative counselling and adequate postoperative physical and socioemotional support. Reconstruction equivalent to the length of the resected bone can reduce the risk of functional disabilities in daily living.. |
| 5. |
Shinkichi Arisumi, Toshifumi Fujiwara, Keitaro Yasumoto, Tomoko Tsutsui, Hirokazu Saiwai, Kazu Kobayakawa, Seiji Okada, Haibo Zhao, Yasuharu Nakashima, Metallothionein 3 promotes osteoclast differentiation and survival by regulating the intracellular Zn2+ concentration and NRF2 pathway., Cell death discovery, 10.1038/s41420-023-01729-y, 9, 1, 436-436, 2023.12, In osteoclastogenesis, the metabolism of metal ions plays an essential role in controlling reactive oxygen species (ROS) production, mitochondrial biogenesis, and survival, and differentiation. However, the mechanism regulating metal ions during osteoclast differentiation remains unclear. The metal-binding protein metallothionein (MT) detoxifies heavy metals, maintains metal ion homeostasis, especially zinc, and manages cellular redox levels. We carried out tests using murine osteoclast precursors to examine the function of MT in osteoclastogenesis and evaluated their potential as targets for future osteoporosis treatments. MT genes were significantly upregulated upon differentiation from osteoclast precursors to mature osteoclasts in response to receptor activators of nuclear factor-κB (NF-κB) ligand (RANKL) stimulation, and MT3 expression was particularly pronounced in mature osteoclasts among MT genes. The knockdown of MT3 in osteoclast precursors demonstrated a remarkable inhibition of differentiation into mature osteoclasts. In preosteoclasts, MT3 knockdown suppressed the activity of mitogen-activated protein kinase (MAPK) and NF-κB signaling pathways upon RANKL stimulation, leading to affect cell survival through elevated cleaved Caspase 3 and poly (ADP-ribose) polymerase (PARP) levels. Additionally, ROS levels were decreased, and nuclear factor erythroid 2-related factor 2 (NRF2) (a suppressor of ROS) and the downstream antioxidant proteins, such as catalase (CAT) and heme oxygenase 1 (HO-1), were more highly expressed in the MT3 preosteoclast knockdowns. mitochondrial ROS, which is involved in mitochondrial biogenesis and the production of reactive oxygen species, were similarly decreased because cAMP response element-binding (CREB) and peroxisome proliferator-activated receptor γ coactivator 1β (PGC-1β) were less activated due to MT3 depletion. Thus, by modulating ROS through the NRF2 pathway, MT3 plays a crucial role in regulating osteoclast differentiation and survival, acting as a metabolic modulator of intracellular zinc ions.. |
| 6. |
Satoshi Hamai, Satoru Harada, Hidetoshi Tsushima, Ryutaro Kozuma, Satoshi Yamate, Shinya Kawahara, Yukio Akasaki, Tetsunari Harada, Yasuhiko Kokubu, Toshiki Konishi, Yasuharu Nakashima, Interaction between functional capability and sleep quality at midterm after total knee arthroplasty: a Japanese retrospective cohort study., Scientific reports, 10.1038/s41598-023-45603-4, 13, 1, 18373-18373, 2023.10, No report has clarified the frequency and interacting factors affecting sleep disturbance among Asian patients at midterm after total knee arthroplasty (TKA). This study aimed to evaluate the frequency of sleep disturbance at midterm after TKA in a Japanese cohort and to identify intervening factors for sleep. We hypothesized that residual knee pain and decreased functional capability negatively interact with sleep quality after TKA. A total of 209 Japanese participants (average age: 77.1 ± 8.3 years; postoperative follow-up period: 4.5 ± 1.9 years) who underwent primary TKA for knee osteoarthritis were included in this study. Sleep quality, satisfaction, pain, functional capability, joint awareness, and mental condition were evaluated using the Pittsburgh Sleep Quality Index (PSQI), Knee Society Score (KSS) 2011, Forgotten Joint Score (FJS)-12, and 12-Item Short-Form Health Survey (SF-12) Mental Component Summary (MCS). Multivariable analysis was performed to determine the influencing factors on PSQI. The scores for the PSQI, satisfaction with pain level while lying in bed, pain during level walking, functional activity category in the KSS 2011, awareness of the artificial joint in bed at night in the FJS-12, and SF-12 MCS were 6.7 ± 3.0, 5.8 ± 1.8, 1.6 ± 2.3, 62 ± 22, 1.5 ± 1.4, and 56 ± 9.3 on average, respectively. Sleep disturbance (PSQI ≥ 5.5) occurred in 54% of the Japanese participants. Multivariable analysis revealed that high functional capability was a significant factor associated with sleep quality improvement (p |
| 7. |
Mingjian Xu, Goro Motomura, Takeshi Utsunomiya, Satoshi Ikemura, Ryosuke Yamaguchi, Noriko Yamamoto, Hidenao Tanaka, Yusuke Ayabe, Kousei Sakamoto, Youhua Wang, Yasuharu Nakashima, Effects of bone mineral density at the lateral sclerotic boundary on the femoral head collapse onset in osteonecrosis of the femoral head: A preliminary study., Clinical biomechanics (Bristol, Avon), 10.1016/j.clinbiomech.2023.106156, 111, 106156-106156, 2023.11, BACKGROUND: In the natural course of osteonecrosis of the femoral head, sclerotic changes at the boundary of necrotic lesion gradually occur until femoral head collapse. This study aims to examine the effects of bone mineral density at the lateral boundary of necrotic lesion on a subsequent femoral head collapse. METHODS: We developed patient-specific finite element models of 9 hips with subsequent collapse and 10 hips without subsequent collapse. Cubic regions of interest were selected at both subchondral areas of the lateral boundary and the adjacent necrotic lesion. Bone mineral density values of the regions of interest were quantitatively measured, and a ratio of bone mineral density values (lateral boundary/necrotic lesion) was calculated. Stress values at the lateral boundary were also evaluated. FINDINGS: The ratio of bone mineral density values was significantly higher in hips with subsequent collapse than that without subsequent collapse (p = 0.0016). The median equivalent stress and shear stress were significantly higher in hips with subsequent collapse than that without subsequent collapse (p = 0.0071, and p = 0.0143, respectively). The ratio of bone mineral density values showed a promising value in predicting the occurrence of subsequent femoral head collapse (AUC = 0.97). INTERPRETATION: Our results indicated that bone mineral density value at the lateral boundary of necrotic lesion may be associated with the occurrence of subsequent femoral head collapse in pre-collapse stage osteonecrosis of the femoral head.. |
| 8. |
Kenji Kitamura, Masanori Fujii, Goro Motomura, Satoshi Hamai, Shinya Kawahara, Taishi Sato, Ryosuke Yamaguchi, Daisuke Hara, Takeshi Utsunomiya, Yasuhiko Kokubu, Yasuharu Nakashima, The sourcil roundness index is a useful measure for quantifying acetabular concavity asphericity., Scientific reports, 10.1038/s41598-023-42630-z, 13, 1, 15851-15851, 2023.09, This study aimed to clarify the clinical utility of the sourcil roundness index (SRI), a novel index for quantifying the asphericity of the acetabular concavity, by determining (1) the difference in the SRI between dysplastic and normal hips and (2) the correlation between the SRI and radiographic parameters of hip dysplasia. We reviewed standing anteroposterior pelvic radiographs of 109 dysplastic and 40 normal hips. The SRI was determined as the ratio of the distance from the medial edge of the sourcil to the most concave point of the acetabular sourcil (A) to the distance from the medial to the lateral edge of the sourcil (B). The formula for SRI is (A/B) × 100-50 (%), with an SRI of 0% indicating a perfectly spherical acetabulum, and higher SRI values indicating a more aspherical shape. The median SRI was greater in patients with hip dysplasia than in normal hips (5.9% vs. - 1.4%; p |
| 9. |
Kiyoshi Tarukado, Teruaki Ono, Toshio Doi, Katsumi Harimaya, Yasuharu Nakashima, Safety and Clinical Results of Continuous Low-Dose Aspirin in Microendoscopic Laminectomy., Spine surgery and related research, 10.22603/ssrr.2022-0224, 7, 4, 350-355, 2023.07, INTRODUCTION: It remains controversial whether it is better to continue oral low-dose aspirin (LDA) during the perioperative period in spinal surgery. This study aims to evaluate the safety of continued LDA administration in the perioperative periods of microendoscopic laminectomy (MEL) by assessing perioperative complications and clinical outcomes. METHODS: We ultimately included 88 patients (35 males, 53 females) who underwent one level of MEL for lumbar spinal canal stenosis from April 2016 to March 2022. Patients who did not undergo anticoagulation therapy were classified into Group A (65 patients), those who stopped anticoagulation therapy at the perioperative periods were classified into Group B (9 patients), and those who continued oral administration of LDA throughout the perioperative periods were classified into Group C (14 patients). Surgery time, intraoperative estimate blood loss (EBL), differences between hemoglobin (Hb) and platelet (Plt) before and after surgery, perioperative complications, and cross-sectional area of hematoma and dural sac on MRI taken within 1 week and at 6 months or more after surgery were assessed between three groups. The EuroQol-5 dimensions (EQ-5D), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were also evaluated as the clinical outcomes. RESULTS: There was no statistically significant difference between the three groups in operation time, intraoperative EBL, differences between Hb and Plt before and after surgery, and cross-sectional area of hematoma and dural sac on MRI. A case of hematoma removal was confirmed in Group A. There was also no statistically significant difference between the three groups in EQ-5D, ODI, and each domain of JOABPEQ. CONCLUSIONS: The continuation of LDA throughout the perioperative periods did not affect perioperative complications and clinical outcomes of one-level MEL. In MEL, it might be possible to continue oral administration of LDA throughout the perioperative periods.. |
| 10. |
Kazuki Kitade, Kazu Kobayakawa, Hirokazu Saiwai, Yoshihiro Matsumoto, Kenichi Kawaguchi, Keiichiro Iida, Ken Kijima, Hirotaka Iura, Tetsuya Tamaru, Yohei Haruta, Gentaro Ono, Daijiro Konno, Takeshi Maeda, Seiji Okada, Kinichi Nakashima, Yasuharu Nakashima, Reduced Neuroinflammation Via Astrocytes and Neutrophils Promotes Regeneration After Spinal Cord Injury in Neonatal Mice., Journal of neurotrauma, 10.1089/neu.2023.0044, 2023.09, Neonatal spinal cord injury (SCI) shows better functional outcomes than adult SCI. Although the regenerative capability in the neonatal spinal cord may have cues in the treatment of adult SCI, the mechanism underlying neonatal spinal cord regeneration after SCI is unclear. We previously reported age-dependent variation in the pathogenesis of inflammation after SCI. Therefore, we explored differences in the pathogenesis of inflammation after SCI between neonatal and adult mice and their effect on axon regeneration and functional outcome. We established two-day-old spinal cord crush mice as a model of neonatal SCI. Immunohistochemistry of the spinal cord revealed that the nuclear translocation of NF-κB, which promotes the expression of chemokines, was significantly lower in the astrocytes of neonates than in those of adults. Flow cytometry revealed that neonatal astrocytes secrete low levels of chemokines to recruit circulating neutrophils (e.g., Cxcl1 and Cxcl2) after SCI in comparison with adults. We also found that the expression of a chemokine receptor (CXCR2) and an adhesion molecule (β2 integrin) quantified by flow cytometry was lower in neonatal circulating neutrophils than in adult neutrophils. Strikingly, these neonate-specific cellular properties seemed to be associated with no neutrophil infiltration into the injured spinal cord, followed by significantly lower expression of inflammatory cytokines (Il-1β, Il-6 and TNF-α) after SCI in the spinal cords of neonates than in those of adults. At the same time, significantly fewer apoptotic neurons and greater axonal regeneration were observed in neonates in comparison with adults, which led to a marked recovery of locomotor function. This neonate-specific mechanism of inflammation regulation may have potential therapeutic applications in controlling inflammation after adult SCI.. |
| 11. |
Kazuya Yokota, Osamu Kawano, Hiroaki Sakai, Yuichiro Morishita, Muneaki Masuda, Tetsuo Hayashi, Kensuke Kubota, Ryosuke Ideta, Yuto Ariji, Ryuichiro Koga, Satoshi Murai, Ryusei Ifuku, Masatoshi Uemura, Hiroyuki Katoh, Yasuharu Nakashima, Takeshi Maeda, Predicting the progression of spasticity in the early phase of spinal cord injury: A prospective cohort study., Journal of neurotrauma, 10.1089/neu.2023.0191, 2023.09, BACKGROUND: Spasticity defined as involuntary movements caused by insult to upper motor neurons after spinal cord injury (SCI), interferes with patients' activities of daily living. Spasticity is generally identified and treated in the chronic phase of SCI, but few reports have examined the onset of spasticity after injury. The purpose of this study is to elucidate serial changes in spasticity after SCI and clarify the timing of severe spasticity. METHODS: We prospectively examined individuals with acute traumatic SCI admitted within 2 weeks after injury. Severity of spasticity was evaluated using the Modified Ashworth Scale (MAS) at 2, 4, 6, and 8 weeks, followed by 3, 4, 5, and 6 months after injury. After completing evaluation of the cohort, the patients were divided into two groups: a spasticity group with MAS scores ≥ 3 (marked increase in muscle tone through most of the range of motion (ROM)) in at least one joint movement within 6 months of injury and a control group with MAS scores ≤ 2 in all joint movements throughout the 6 months after injury. Neurological findings such as the American Spinal Injury Association (ASIA) impairment scale grades and ASIA motor scores were also assessed at all timepoints, and the correlations between the onset of spasticity, severity of spasticity, and neurological findings were analyzed. RESULTS: There were 175 cases of traumatic SCI that were assessed consecutively for 6 months after injury. The MAS scores of the group significantly increased over time until 4 months after injury. The spasticity group had significantly higher MAS scores compared to the control group as early as 2 weeks post-injury. We found that the patients with earlier onset of spasticity had higher final MAS scores. No correlation was found between the AIS grade and the onset of spasticity. CONCLUSIONS: Our results reveal that the development of severe spasticity may be predictable from as early as 2 weeks after SCI, suggesting that early therapeutic intervention to mitigate problematic spasticity may enhance the benefits of post-injury rehabilitation.. |
| 12. |
Gentaro Ono, Kazu Kobayakawa, Hirokazu Saiwai, Tetsuya Tamaru, Hirotaka Iura, Yohei Haruta, Kazuki Kitade, Keiichiro Iida, Kenichi Kawaguchi, Yoshihiro Matsumoto, Makoto Tsuda, Tomohiko Tamura, Keiko Ozato, Kazuhide Inoue, Dai-Jiro Konno, Takeshi Maeda, Seiji Okada, Yasuharu Nakashima, Macrophages play a leading role in determining the direction of astrocytic migration in spinal cord injury via ADP-P2Y1R axis., Scientific reports, 10.1038/s41598-023-38301-8, 13, 1, 11177-11177, 2023.07, After spinal cord injury (SCI), inflammatory cells such as macrophages infiltrate the injured area, and astrocytes migrate, forming a glial scar around macrophages. The glial scar inhibits axonal regeneration, resulting in significant permanent disability. However, the mechanism through which glial scar-forming astrocytes migrate to the injury site has not been clarified. Here we show that migrating macrophages attract reactive astrocytes toward the center of the lesion after SCI. Chimeric mice with bone marrow lacking IRF8, which controls macrophage centripetal migration after SCI, showed widely scattered macrophages in the injured spinal cord with the formation of a huge glial scar around the macrophages. To determine whether astrocytes or macrophages play a leading role in determining the directions of migration, we generated chimeric mice with reactive astrocyte-specific Socs3-/- mice, which showed enhanced astrocyte migration, and bone marrow from IRF8-/- mice. In this mouse model, macrophages were widely scattered, and a huge glial scar was formed around the macrophages as in wild-type mice that were transplanted with IRF8-/- bone marrow. In addition, we revealed that macrophage-secreted ATP-derived ADP attracts astrocytes via the P2Y1 receptor. Our findings revealed a mechanism through which migrating macrophages attract astrocytes and affect the pathophysiology and outcome after SCI.. |
| 13. |
Hisakata Yamada, Akihisa Haraguchi, Tomomi Tsuru, Masakazu Kondo, Fumiaki Sagawa, Hiroaki Niiro, Yasuharu Nakashima, Low avidity observed for anti-citrullinated peptide antibody is not a general phenomenon for autoantibodies., Annals of the rheumatic diseases, 10.1136/ard-2023-224303, 2023.07. |
| 14. |
Soichiro Yoshino, Ryosuke Yamaguchi, Hidenao Tanaka, Shiro Ikegawa, Yasuharu Nakashima, Chikashi Terao, Family History of Developmental Dysplasia of the Hip is a Risk Factor for the Progression of Hip Osteoarthritis., The Journal of arthroplasty, 10.1016/j.arth.2023.08.026, 2023.08, BACKGROUND: Developmental dysplasia of the hip (DDH) is considered to have genetic predisposition and presents many intrafamilial occurrences. However, there is no report that evaluates the effect of DDH family history on the progression after the onset of hip osteoarthritis (OA). METHODS: Medical interviews about detailed clinical information including family history were conducted on 298 consecutive patients who had undergone surgery for OA due to DDH. Clinical or radiographic items that are associated with the severity of DDH (total hip arthroplasty [THA], involvement of bilateral DDH, onset age of hip pain, and three radiological indices of DDH: center-edge angle, sharp angle, and acetabular roof obliquity) were collected and evaluated in multivariate analyses for their associations with DDH family history in a qualitative or quantitative manner. Survival time analyses for THA as the endpoint was also performed to evaluate the effects of DDH family history on the progression of OA. RESULTS: The DDH family history showed significant associations with bilateral involvement of DDH (odds ratio = 2.09 [95% confidence interval {CI} 1.05 to 4.16]; P = .037), early onset of hip pain (P = .0065), and radiological severity of DDH (P = .016). The DDH family history showed a significant association with undergoing THA (odds ratio = 2.25 [95% CI 1.09 to 4.66]; P = .029), further supported by the Cox regression analyses (hazards ratio = 1.56 [95% CI 1.15 to 2.11]; P = .0044). CONCLUSION: A DDH family history is a risk factor for the progression of hip OA. Stronger genetic predisposition to DDH leads to faster onset and progression of hip OA.. |
| 15. |
Takeshi Hirose, Masachika Ikegami, Shinya Kojima, Akihiko Yoshida, Makoto Endo, Eijiro Shimada, Masaya Kanahori, Ryunosuke Oyama, Yoshihiro Matsumoto, Yasuharu Nakashima, Akira Kawai, Hiroyuki Mano, Shinji Kohsaka, Extensive analysis of 59 sarcoma-related fusion genes identified pazopanib as a potential inhibitor to COL1A1-PDGFB fusion gene., Cancer science, 10.1111/cas.15915, 114, 10, 4089-4100, 2023.08, Sarcomas are malignant mesenchymal tumors that are extremely rare and divergent. Fusion genes are involved in approximately 30% of sarcomas as driver oncogenes; however, their detailed functions are not fully understood. In this study, we determined the functional significance of 59 sarcoma-related fusion genes. The transforming potential and drug sensitivities of these fusion genes were evaluated using a focus formation assay (FFA) and the mixed-all-nominated-in-one (MANO) method, respectively. The transcriptome was also examined using RNA sequencing of 3T3 cells transduced with each fusion gene. Approximately half (28/59, 47%) of the fusion genes exhibited transformation in the FFA assay, which was classified into five types based on the resulting phenotype. The sensitivity to 12 drugs including multityrosine kinase inhibitors was assessed using the MANO method and pazopanib was found to be more effective against cells expressing the COL1A1-PDGFB fusion gene compared with the others. The downstream MAPK/AKT pathway was suppressed at the protein level following pazopanib treatment. The fusion genes were classified into four subgroups by cluster analysis of the gene expression data and gene set enrichment analysis. In summary, the oncogenicity and drug sensitivity of 59 fusion genes were simultaneously evaluated using a high-throughput strategy. Pazopanib was selected as a candidate drug for sarcomas harboring the COL1A1-PDGFB fusion gene. This assessment could be useful as a screening platform and provides a database to evaluate customized therapy for fusion gene-associated sarcomas.. |
| 16. |
Tarukado Kiyoshi, Matsumoto Yoshihiro, Yokota Kazuya, Kobayakawa Kazu, Saiwai Hirokazu, Kawaguchi Kenichi, Nakashima Yasuharu, Dural reconstruction following resection of ventral and lateral spinal cord meningiomas: Fenestrated Durotomy with Oversized Graft technique., Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 10.1016/j.jocn.2023.09.003, 116, 120-124, 2023.10, BACKGROUND: Meningiomas, although benign, often require complete resection due to their tendency for recurrence. However, dural reconstruction poses significant challenges, especially in the case of ventral meningiomas. While some reports have highlighted the usefulness of dural reconstruction using an artificial dura mater, no studies have yet confirmed dural canal enlargement through MRI post-surgically. This study aimed to assess the effectiveness of the Fenestrated Durotomy with Oversized Graft (FDOG) technique in cases of meningiomas and other intradural extramedullary tumors and evaluated dural canal dilation through MRI after using an artificial dura mater. METHODS: This retrospective case series included 8 patients who underwent combined resection of intradural extramedullary tumors and dural repair using the FDOG technique. An artificial dura mater larger than that resected was inserted into the dural defect resulting from complete tumor resection on the ventral or lateral side of the spinal cord. The new dura mater was secured with a single dorsal suture. The dural incision was closed using watertight sutures following standard procedure. Measurement of the extent of dural canal enlargement was achieved via pre- and postoperative MRI scans. RESULTS: None of the patients required additional treatments or lumbar drainage. All achieved independent ambulation without complications, and imaging tests indicated satisfactory dural expansion without signs of cerebrospinal fluid leakage. CONCLUSIONS: The proposed method for dural repair in cases involving large dural defects on the ventral or lateral side of the spinal cord was shown to be a straightforward and effective approach with minimal postoperative complications.. |
| 17. |
Tetsunari Harada, Satoshi Hamai, Daisuke Hara, Tsutomu Fujita, Daisuke Fujiyoshi, Shinya Kawahara, Ryosuke Yamaguchi, Kenichi Kawaguchi, Yasuharu Nakashima, Contralateral Hip Abductor Muscle Strength Associated with Comfort of Getting into and out of the Car after Total Hip Arthroplasty., Journal of clinical medicine, 10.3390/jcm12175515, 12, 17, 2023.08, There are no studies that have investigated the characteristics of car use across THA patients, including those who do not drive. This study aimed to evaluate, in THA patients, (1) postoperative car usage, (2) comfort while entering and exiting a car, and (3) whether lower limb muscle strength affects action comfort. One hundred seventy-two post-THA patients completed the questionnaire in 2020, along with assessments of hip abductor and knee extensor muscle strength before surgery and at discharge. Patients whose overall comfort level was judged as comfortable were defined as the comfort group; others were placed in the discomfort group. Of the 172 patients, 161 reported car usage at a mean of 5.6 years after THA. Of these, 114 and 47 patients were placed in the comfort and discomfort groups, respectively. Patients in the discomfort group were three times more likely to experience discomfort using the contralateral side door than the surgical side door, and about twice as many patients experienced discomfort when entering as when exiting. Lower preoperative contralateral hip abductor muscle strength was the only independent predictor for discomfort. The take-home messages were that prevention of contralateral-side weakness may improve comfort during the action after THA.. |
| 18. |
Hideki Jimbayashi, Keiichiro Iida, Kobayakawa Kazu, Hirokazu Saiwai, Kenichi Kawaguchi, Yoshihiro Matsumoto, Yasuharu Nakashima, Cases requiring reoperation for recurrence of myelopathy by lamina closure after a double-door laminoplasty using a modified Kirita-Miyazaki suture method., Journal of orthopaedics, 10.1016/j.jor.2023.07.024, 44, 12-16, 2023.10, BACKGROUND: Progression of kyphosis after laminoplasty sometimes results in the recurrence of myelopathy with lamina closure. However, only a few case reports have been published on the reoperation of double-door laminoplasty using the suture method. This study investigated the incidence and clinical features of reoperation cases caused by the recurrence of myelopathy with lamina closure after double-door laminoplasty using a modified Kirita-Miyazaki suture method. METHODS: A total of 169 patients who underwent double-door laminoplasty were included in this study, with a mean follow-up duration of 6.6 years (range: 2-16). All surgeries were double-door laminoplasties in which the open lamina was sutured to the paravertebral muscle. The reoperation rate for myelopathy recurrence due to lamina closure and the associated risk factors were investigated. The risk factors included age, history, cervical alignment, C2-7 lordosis, the cervical sagittal vertical axis, and C7 slope. RESULTS: The reoperation rate for recurrence of myelopathy by lamina closure was 3.0% (5/169). All patients showed kyphosis progression after surgery; the spinal cord was more compressed by closed lamina than before the initial surgery. The reoperation group had more patients with neuromuscular or psychiatric disorders (60% [3/5] vs. 2% [4/164]; p |
| 19. |
Yu Soejima, Toshifumi Fujiwara, Masanori Fujii, Hidetoshi Tsushima, Ryosuke Yamaguchi, Yasuharu Nakashima, Arthroscopic Treatment of Septic Arthritis of the Ankle Caused by Group B Streptococcus: A Case Report., The American journal of case reports, 10.12659/AJCR.939719, 24, e939719, 2023.06, BACKGROUND The incidence of septic arthritis of a native joint caused by group B streptococcus (GBS, Streptococcus agalactiae) has been on the rise in non-pregnant women. GBS commonly colonizes the female genital tract. However, only a few reports have discussed serious cases of GBS infection, endocarditis, and joint infection associated with the Papanicolaou (Pap) smear test, which is routinely conducted to detect cervical cancer. Specifically, to the best of our knowledge, there have been few reports about arthroscopic treatment for septic arthritis of the ankle caused by GBS. CASE REPORT A 60-year-old woman, who had previously completed the treatment of total laparoscopic hysterectomy with bilateral adnexectomy and postoperative chemotherapy for ovarian cancer, underwent a routine Pap smear test. Four weeks later, she suddenly presented with high fever and abdominal pain. The pain and swelling in her left ankle gradually worsened. Finally, septic arthritis of the ankle was diagnosed, and thus the patient underwent emergent arthroscopic irrigation and debridement. GBS was isolated from both the ankle fluid and blood culture. After surgical intervention and intravenous antibiotic administration, the patient's symptoms gradually improved. Four months later, the patient had no ankle pain or restriction of ankle motion. CONCLUSIONS Although cervical cytology tests are essential in screening for cervical cancer, transient bacteremia can be induced by the tests. Thus, physicians must watch out for the development of septic arthritis caused by GBS when patients present with fever or swollen joints after a recent Pap smear test. Emergent diagnosis and appropriate surgical intervention is also important.. |
| 20. |
Tetsunari Harada, Satoshi Hamai, Daisuke Hara, Tsutomu Fujita, Kazuya Okazawa, Naoya Kozono, Shinya Kawahara, Ryosuke Yamaguchi, Masanori Fujii, Satoshi Ikemura, Goro Motomura, Yasuharu Nakashima, Reverse dynamics analysis of contact force and muscle activities during the golf swing after total hip arthroplasty., Scientific reports, 10.1038/s41598-023-35484-y, 13, 1, 8688-8688, 2023.05, There are no reports on hip kinetics including contact forces and muscle activities during the golf swing after total hip arthroplasty (THA). The aim of this study was to identify the characteristics of three-dimensional dynamics during the golf swing. Ten unilateral primary THA patients participated in motion capture test of their driver golf swing. The driver swing produced approximately 20-30° of rotation in both lead and trail replaced hips. The mean hip contact forces (HCFs) of lead and trail replaced hips were 5.1 and 6.6 × body weight, respectively. Left and right THAs showed similar HCFs of lead and trail hips. More than 60% of the Percent maximum voluntary isometric contraction was found in bilateral iliopsoas muscles in all unilateral THA. Three factors [female sex, lower modified Harris Hip Score, and higher HCF of surgical side] were associated with the golf-related replacement hip pain. Golf is an admissible sport after THA because driver swings do not contribute excessive rotation or contact forces to hip prostheses. HCF could be reduced through swing adjustments, which may allow patients with golf-related replacement hip pain to develop a comfortable golf game free from pain.. |
| 21. |
Kengo Kawaguchi, Kenichi Kohashi, Taro Mori, Hidetaka Yamamoto, Takeshi Iwasaki, Izumi Kinoshita, Yosuke Susuki, Hiroshi Furukawa, Makoto Endo, Yoshihiro Matsumoto, Yasuharu Nakashima, Yoshinao Oda, Prognostic implications of the immunohistochemical expression of perilipin 1 and adipophilin in high-grade liposarcoma., Journal of clinical pathology, 10.1136/jcp-2023-208814, 2023.05, AIMS: Liposarcoma is a malignant soft tissue tumour with adipocytic differentiation. Dedifferentiated liposarcoma (DDLS) and myxoid liposarcoma (MLS) are classified as high-grade liposarcomas. Lipid droplet-associated protein (also known as perilipin 1 (PLIN1)) is the predominant perilipin and has utility as a specific marker of adipogenic differentiation. Adipose differentiation-related protein (also known as adipophilin (ADRP)) is ubiquitously expressed in a range of tissues. High ADRP expression is reportedly a poor prognostic factor in several cancer types. However, no previous studies have examined the association between PLIN1 or ADRP expression and prognosis in sarcoma. This study therefore aimed to evaluate the association between PLIN1 or ADRP expression and prognosis in liposarcoma. METHODS: In total, 97 primary resection specimens (53 MLS and 44 DDLS) were examined in this study. PLIN1 and ADRP expression was evaluated by immunohistochemistry. Survival analyses were performed for MLS and DDLS. RESULTS: Of the 53 MLS specimens, 15 (28.3%) exhibited high PLIN1 expression. PLIN1 expression was not observed in DDLS specimens. High PLIN1 expression was significantly associated with increased disease-free survival (DFS) among patients with MLS (p=0.045). Distinct ADRP expression was observed in 13 of 53 (24.5%) MLS specimens and 5 of 44 (11.4%) DDLS specimens. High ADRP expression was associated with shorter overall survival (OS) in MLS (p=0.042) and DFS and shorter OS in DDLS (p=0.024 and p |
| 22. |
Toshio Ichiki, Yuichi Yamada, Takamichi Ito, Takeshi Nakahara, Yasuharu Nakashima, Masafumi Nakamura, Tomoharu Yoshizumi, Akira Shiose, Koichi Akashi, Yoshinao Oda, Histological and immunohistochemical prognostic factors of primary angiosarcoma., Virchows Archiv : an international journal of pathology, 10.1007/s00428-023-03572-z, 483, 1, 59-69, 2023.06, Angiosarcoma is a malignant vascular endothelial neoplasm with various histological patterns. Despite its highly malignant potential, histological prognostic prediction has not been adopted for angiosarcoma. This study aimed to establish a method of predicting the prognosis of primary angiosarcoma. Formalin-fixed, paraffin-embedded samples from 104 primary angiosarcomas were prepared. All the cases were reviewed based on histological examinations with H&E staining. Because the French Fédération Nationale des Centres de Lutte Contre Le Cancer system (FNCLCC) is not adopted for angiosarcoma, we experimentally established a modified version of FNCLCC. Immunohistochemical staining for ERG, CD31, CD34, D2-40, HHV-8, p16, C-MYC, and p53 was performed. Fluorescence in situ hybridization (FISH) was performed for 31 cases to assay c-MYC gene amplification. Multivariate analysis revealed that age (> 70 years old) (p = 0.0011), non-cutaneous angiosarcoma (p = 0.0265), metastasis on diagnosis (p |
| 23. |
Yasuhiko Kokubu, Shinya Kawahara, Kenji Kitamura, Satoshi Hamai, Goro Motomura, Satoshi Ikemura, Taishi Sato, Ryosuke Yamaguchi, Daisuke Hara, Masanori Fujii, Yasuharu Nakashima, Evaluation of the anterior acetabular coverage with a false profile radiograph considering appropriate range of positioning., Scientific reports, 10.1038/s41598-023-35514-9, 13, 1, 8288-8288, 2023.05, This study aimed to (1) set a reference value for anterior center edge angle (ACEA) for preoperative planning of periacetabular osteotomy (PAO), (2) investigate the effects of pelvic rotation and inclination from false profile (FP) radiographs on the measured ACEA, and (3) determine the "appropriate range of positioning" for FP radiograph. This single-centered, retrospective study analyzed 61 patients (61 hips) who underwent PAO from April 2018 and May 2021. ACEA was measured in each digitally reconstructed radiography (DRR) image of the FP radiograph reconstructed in different degrees of pelvic rotation. Detailed simulations were performed to determine the "appropriate range of positioning" (0.67 |
| 24. |
Yasuharu Nakashima, Daisuke Hara, Masanobu Ohishi, Goro Motomura, Ichiro Kawano, Satoshi Hamai, Shinya Kawahara, Taishi Sato, Ryosuke Yamaguchi, Takeshi Utsunomiya, Kenji Kitamura, Abductor recovery after muscle-sparing periacetabular osteotomy using a lateral approach., Journal of hip preservation surgery, 10.1093/jhps/hnac047, 9, 4, 259-264, 2022.12, To decrease hip abductor dysfunction after periacetabular osteotomy using a lateral/trochanteric approach, we aimed to modify transposition osteotomy of the acetabulum (TOA) to not cut the greater trochanter and abductor-iliac crest detachment. We subsequently compared abductor muscle strength recovery between TOAs with [conventional TOA (C-TOA)] and without [modified TOA (M-TOA)] trochanteric osteotomy. C-TOA and M-TOA were performed in 27 and 34 hips, respectively. Hip abduction, flexion and knee extension muscle strength were measured preoperatively and at 3, 5, 10, 24 and 52 weeks postoperatively. The muscle strength ratio of the affected and contralateral lower limbs was compared between the C-TOA and M-TOA groups. Neither the mean Merle d'Aubigné-Postel score at the final follow-up nor the postoperative center-edge angle showed significant differences between the M-TOA and C-TOA groups (15.7 versus 16.4 points; P = 0.25 and 38.5° versus P = 0.62 and 39.8°, respectively). The mean muscle strength ratios of hip abduction at 5, 12 and 24 weeks postoperatively were significantly higher in the M-TOA group than in the C-TOA group (0.62 versus 0.39, 0.76 versus 0.59 and 0.94 versus 0.70; P = 0.03, 0.04 and 0.01, respectively). There were no significant differences between groups at Postoperative Week 52 (P = 0.36). Discomfort at the greater trochanter was observed in 18 hips (66.7%) in the C-TOA group but only in 4 hips (11.2%) in the M-TOA group. In conclusion, M-TOA is less invasive than C-TOA and allows an earlier recovery of abductor muscle strength without significant correction loss.. |
| 25. |
Noriko Yamamoto, Goro Motomura, Satoshi Ikemura, Ryosuke Yamaguchi, Takeshi Utsunomiya, Koichiro Kawano, Mingjian Xu, Hidenao Tanaka, Yusuke Ayabe, Yasuharu Nakashima, Relationship between the degree of subchondral collapse and articular surface irregularities in osteonecrosis of the femoral head., Journal of orthopaedic research : official publication of the Orthopaedic Research Society, 10.1002/jor.25539, 41, 9, 1996-2006, 2023.03, Articular surface irregularities are often observed in collapsed femoral heads with osteonecrosis, while the effects of the degree of collapse on the articular surface are poorly understood. We first macroscopically assessed the articular surface irregularities on 2-mm coronal slices obtained using high-resolution microcomputed tomography of 76 surgically resected femoral heads with osteonecrosis. These irregularities were observed in 68/76 femoral heads, mainly at the lateral boundary of the necrotic region. The mean degree of collapse was significantly larger for femoral heads with articular surface irregularities than for those without (p |
| 26. |
Keigo Shibahara, Koichiro Hayashi, Yasuharu Nakashima, Kunio Ishikawa, Reconstruction of Load-Bearing Segmental Bone Defects Using Carbonate Apatite Honeycomb Blocks, ACS Materials Au, 10.1021/acsmaterialsau.3c00008, 3, 4, 321-336, 2023.04. |
| 27. |
Teruaki Ono, Tomohiro Yamashita, Ryota Kano, Mariko Inoue, Shota Okada, Koki Kano, Schuichi Koizumi, Kazuhisa Iwabuchi, Yoshio Hirabayashi, Ichiro Matsuo, Yasuharu Nakashima, Hiroyuki Kamiguchi, Yuta Kohro, Makoto Tsuda, GPR55 contributes to neutrophil recruitment and mechanical pain induction after spinal cord compression in mice., Brain, behavior, and immunity, 10.1016/j.bbi.2023.03.008, 110, 276-287, 2023.05, Pain transmission and processing in the nervous system are modulated by various biologically active substances, including lysophospholipids, through direct and indirect actions on the somatosensory pathway. Lysophosphatidylglucoside (LysoPtdGlc) was recently identified as a structurally unique lysophospholipid that exerts biological actions via the G protein-coupled receptor GPR55. Here, we demonstrated that GPR55-knockout (KO) mice show impaired induction of mechanical pain hypersensitivity in a model of spinal cord compression (SCC) without the same change in the models of peripheral tissue inflammation and peripheral nerve injury. Among these models, only SCC recruited peripheral inflammatory cells (neutrophils, monocytes/macrophages, and CD3+ T-cells) in the spinal dorsal horn (SDH), and GPR55-KO blunted these recruitments. Neutrophils were the first cells recruited to the SDH, and their depletion suppressed the induction of SCC-induced mechanical hypersensitivity and inflammatory responses in compressed SDH. Furthermore, we found that PtdGlc was present in the SDH and that intrathecal administration of an inhibitor of secretory phospholipase A2 (an enzyme required for producing LysoPtdGlc from PtdGlc) reduced neutrophil recruitment to compressed SDH and suppressed pain induction. Finally, by screening compounds from a chemical library, we identified auranofin as a clinically used drug with an inhibitory effect on mouse and human GPR55. Systemically administered auranofin to mice with SCC effectively suppressed spinal neutrophil infiltration and pain hypersensitivity. These results suggest that GPR55 signaling contributes to the induction of inflammatory responses and chronic pain after SCC via the recruitment of neutrophils and may provide a new target for reducing pain induction after spinal cord compression, such as spinal canal stenosis.. |
| 28. |
Hirotaka Iura, Kazu Kobayakawa, Hirokazu Saiwai, Daijiro Konno, Masatake Tanaka, Kazuhiro Hata, Tetsuya Tamaru, Yohei Haruta, Gentaro Ono, Kazuki Kitade, Ken Kijima, Kensuke Kubota, Yutaka Inagaki, Masato Ohtsuka, Ken Okazaki, Koji Murakami, Shusaku Matsuda, Masami Tokunaga, Takaaki Yoshimoto, Takeshi Maeda, Yasuharu Nakashima, Seiji Okada, Bone marrow-derived fibroblast migration via periostin causes irreversible arthrogenic contracture after joint immobilization., FASEB journal : official publication of the Federation of American Societies for Experimental Biology, 10.1096/fj.202201598R, 37, 5, e22842, 2023.05, Joint contracture causes distressing permanent mobility disorder due to trauma, arthritis, and aging, with no effective treatment available. A principal and irreversible cause of joint contracture has been regarded as the development of joint capsule fibrosis. However, the molecular mechanisms underlying contracture remain unclear. We established a mouse model of knee joint contracture, revealing that fibrosis in joint capsules causes irreversible contracture. RNA-sequencing of contracture capsules demonstrated a marked enrichment of the genes involved in the extracellular region, particularly periostin (Postn). Three-dimensional magnetic resonance imaging and immunohistological analysis of contracture patients revealed posterior joint capsule thickening with abundant type I collagen (Col1a2) and POSTN in humans. Col1a2-GFPTG ; Postn-/- mice and chimeric mice with Col1a2-GFPTG ; tdTomatoTG bone marrow showed fibrosis in joint capsules caused by bone marrow-derived fibroblasts, and POSTN promoted the migration of bone marrow-derived fibroblasts, contributing to fibrosis and contracture. Conversely, POSTN-neutralizing antibody attenuated contracture exacerbation. Our findings identified POSTN as a key inducer of fibroblast migration that exacerbates capsule fibrosis, providing a potential therapeutic strategy for joint contracture.. |
| 29. |
Yasuhiko Kokubu, Shinya Kawahara, Satoshi Hamai, Yukio Akasaki, Hidetoshi Tsushima, Shinji Miyachika, Yasuharu Nakashima, "Grand-piano sign" as a femoral rotational indicator in both varus and valgus knees: a simulation study of anterior resection surface in total knee arthroplasty., Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 10.1007/s00167-023-07365-4, 2023.03, PURPOSE: The "Grand-piano sign" is a popular indicator of the appropriate rotational alignment of the femoral component during total knee arthroplasty (TKA). The aim of the study was to investigate the shape of the anterior femoral resection surface of varus and valgus knees. METHODS: A cohort of 80 varus knees and 40 valgus knees (hip-knee-ankle angle > 2° for varus and 0.05). The M/L ratio showed a similar pattern of increasing at IR and decreasing at ER in both varus and valgus knees. The variation in the M/L ratio with malrotation in valgus knees was smaller than in varus knees. CONCLUSION: During TKA, the anterior femoral resection surface was similar in varus and valgus knees; however, the variation with malrotation was smaller in valgus knees than in varus knees. TKA for valgus knees requires precise surgical technique and careful intraoperative assessment. LEVEL OF EVIDENCE: IV, Case series.. |
| 30. |
Hirofumi Bekki, Yoshihiro Matsumoto, Masato Yoshimoto, Shin Ishihara, Kenichi Kawaguchi, Hidetaka Yamamoto, Yoshinao Oda, Yasuharu Nakashima, Katsumi Harimaya, The Expression of Insulin-Like Growth Factor II Messenger RNA-Binding Protein 3 Upregulated in Intradural Extramedullary Schwannomas., Spine surgery and related research, 10.22603/ssrr.2022-0063, 7, 1, 36-41, 2023.01, INTRODUCTION: Tumor size is an important factor in determining the appropriate clinical management of intradural-extramedullary schwannoma. A tumor volume reduction may be achieved by conservative targeted therapy instead of invasive surgery if a molecular event related to tumor size is discovered. Insulin-like growth factor II messenger RNA-binding protein 3 (IMP3), an oncofetal tumor-associated antigen that is expected to be a target for immunotherapy, was focused on in this study. METHODS: The IMP3 status was assessed by immunohistochemistry in 64 samples of intradural-extramedullary schwannoma, and the correlation between IMP3 expression and tumor size was evaluated. RESULTS: Immunohistochemically, high IMP3 expression was observed in ～85% of schwannomas. The maximum tumor diameter of the high IMP3 expression group was significantly larger than that of the low IMP3 expression group (34.3 mm vs 18.5 mm, p=0.002). The receiver operating characteristic curve demonstrated that a maximum tumor diameter of 24 mm was a predictable factor for IMP3 expression (sensitivity, 0.7; 1-specificity, 0.2; area under the curve, 0.82). CONCLUSIONS: Upregulated IMP3 expression was associated with large tumor size, suggesting a possible therapeutic approach.. |
| 31. |
Makoto Endo, Shinya Kawahara, Taishi Sato, Masami Tokunaga, Toshihiko Hara, Taro Mawatari, Tsutomu Kawano, Sadamoto Zenda, Tempei Miyaji, Mototsugu Shimokawa, Sanae Sakamoto, Toshio Takano, Masumi Miyake, Hiroyuki Aono, Yasuharu Nakashima, Protocol for the RETHINK study: a randomised, double-blind, parallel-group, non-inferiority clinical trial comparing acetaminophen and NSAIDs for treatment of chronic pain in elderly patients with osteoarthritis of the hip and knee., BMJ open, 10.1136/bmjopen-2022-068220, 13, 2, e068220, 2023.02, INTRODUCTION: In patients with chronic pain, oral analgesics are essential treatment options to manage pain appropriately, improve activities of daily living abilities and achieve a higher quality of life (QOL). It is desirable to select analgesics for elderly patients based on comparative data on analgesic effect and risk of adverse events; however, there are few comparative studies so far. The purpose of this study is to determine whether the efficacy and safety of acetaminophen are non-inferior to non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of chronic pain associated with osteoarthritis of the hip and knee in elderly patients. METHODS AND ANALYSIS: This study is a multicentre, randomised controlled, double-blind, parallel-group study to compare the analgesic effect and adverse events between acetaminophen or NSAIDs (loxoprofen or celecoxib). A total of 400 elderly patients with osteoarthritis of the hip and knee will be recruited from five institutions in Japan. Patients of 65 years or older with osteoarthritis-related pain will be registered and randomly assigned to acetaminophen, loxoprofen or celecoxib with 2:1:1 allocation. The primary endpoint is change in the Brief Pain Inventory (BPI) item 3 (worst pain) score from baseline to week 8. The secondary endpoints are BPI item 3 score change from baseline to week 4, health-related QOL measured by Short Form-8 Health Survey, and occurrence of adverse events including gastrointestinal disorders and abnormal liver function. Data will be analysed in accordance with a predefined statistical analysis plan. ETHICS AND DISSEMINATION: This study protocol was approved by the Kyushu University Hospital Certified Institutional Review Board for Clinical Trials on 28 January 2021 (KD2020004) and the chief executive of each participating hospital. The results of the study will be submitted to international peer-reviewed journals, and the main findings will be presented at international scientific conferences. TRIAL REGISTRATION NUMBER: jRCTs071200112.. |
| 32. |
Kengo Kawaguchi, Kenichi Kohashi, Takeshi Iwasaki, Takeo Yamamoto, Shin Ishihara, Yu Toda, Hidetaka Yamamoto, Yasuharu Nakashima, Yoshinao Oda, Prognostic value of nuclear morphometry in myxoid liposarcoma., Cancer science, 10.1111/cas.15729, 114, 5, 2178-2188, 2023.01, Myxoid liposarcoma (MLS) accounts for 20%-30% of liposarcoma and the round cell component (RCC) is believed to be a specific poor prognostic factor. However, the RCC assessment criteria are vaguely defined and, therefore, are inconsistently employed by pathologists. In this study, we modified and applied two established grading systems to evaluate nuclear atypia (namely, the World Health Organization / International Society of Urological Pathology and the Fuhrman grading in renal cell carcinoma) in 64 MLS cases. Detailed software-based assessments of the morphology and the cellularity were performed. DNA mutation analysis, comprehensive mRNA expression analysis, and immunohistochemistry were also performed. Our findings revealed that the high nuclear grade group according to the modified Fuhrman grading system exhibited a significantly poor disease-free survival (hazard ratio: 4.43; 95% confidence interval: 0.9-22.6; p = 0.047). On the other hand, the cellularity was significantly higher in the modified Fuhrman high-grade group (p = 0.010 at the percentage of the hypercellular area; p = 0.003 at the maximum cell density), but did not qualify per se as a poor prognostic factor in the survival analyses. Furthermore, the modified Fuhrman high-grade group significantly expressed the cell cycle-related genes (such as FOXM1, PLK1, and CDK1). In conclusion, our analyses suggest that an evaluation focusing on nuclear morphology (rather than on cellular density) can be more reliable in predicting the MLS prognosis.. |
| 33. |
Naohide Takeuchi, Naoya Kozono, Akihiro Nishii, Koumei Matsuura, Eiichi Ishitani, Toshihiro Onizuka, Yasuhiro Mizuki, Takehiro Kimura, Hidehiko Yuge, Taiki Uchimura, Kunio Iura, Tatsuya Mori, Koki Ueda, Go Miake, Takahiro Senju, Akira Nabeshima, Eiji Tashiro, Kenji Takagishi, Yasuharu Nakashima, Prevalence and predisposing factors of neuropathic pain in patients with rotator cuff tears., Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 10.1016/j.jos.2022.10.015, 2023.01, BACKGROUND: The management of pain in patients with rotator cuff tears can be challenging. Neuropathic pain is reportedly associated with pain occurrence in musculoskeletal diseases. However, to date, few studies have reported on the prevalence of neuropathic pain in patients with rotator cuff tears or identified the factors associated with neuropathic pain in a multicenter study. METHODS: A total of 391 patients (205 males and 186 females; median age, 67.7 years; range, 27-92 years) with rotator cuff tears were included in this study. The prevalence of neuropathic pain in rotator cuff tears was investigated using the Japanese version of the painDETECT questionnaire for all patients. In addition, factors significantly associated with the occurrence of neuropathic pain were examined using multivariate logistic regression analysis. RESULTS: Twenty-eight patients (7.2%) were classified into the neuropathic pain group (score ≥19), 97 (24.8%) into the uncertainty regarding neuropathy group (score 13-18), and 266 (68.0%) into the nociceptive pain group (score ≤12). According to the multivariate logistic regression analysis, the independent predictors of neuropathic pain were the VAS score (most severe pain during the past 4 weeks; odds ratio, 1.55; 95% confidence interval [CI], 1.23-2.09) and UCLA shoulder score (odds ratio, 0.81; 95% CI, 0.65-0.97). CONCLUSIONS: Based on the study findings, the prevalence of neuropathic pain in patients with rotator cuff tear was 7.2%. It is important to investigate the presence or absence of neuropathic pain when treating patients with painful rotator cuff tears, because neuropathy associated with rotator cuff tears may adversely affect patient outcomes.. |
| 34. |
Gentaro Ono, Kazu Kobayakawa, Hirokazu Saiwai, Tetsuya Tamaru, Hirotaka Iura, Yohei Haruta, Kazuki Kitade, Kei-Ichiro Iida, Ken-Ichi Kawaguchi, Yoshihiro Matsumoto, Makoto Tsuda, Tomohiko Tamura, Keiko Ozato, Kazuhide Inoue, Dai-Jiro Konno, Takeshi Maeda, Seiji Okada, Yasuharu Nakashima, Macrophages play a leading role in determining the direction of astrocytic migration in spinal cord injury via ADP-P2Y1R axis., Research square, 10.21203/rs.3.rs-2427082/v1, 2023.01, After spinal cord injury (SCI), inflammatory cells such as macrophages infiltrate the injured area, and astrocytes migrate, forming a glial scar around macrophages. The glial scar inhibits axonal regeneration, resulting in significant permanent disability. However, the mechanism by which glial scar-forming astrocytes migrate to the injury site has not been clarified. Here we show that migrating macrophages attract reactive astrocytes toward the center of the lesion after SCI. Chimeric mice with bone marrow lacking IRF8, which controls macrophage centripetal migration after SCI, showed widely scattered macrophages in injured spinal cord with the formation of a huge glial scar around the macrophages. To determine whether astrocytes or macrophages play a leading role in determining the directions of migration, we generated chimeric mice with reactive astrocyte-specific Socs3 -/- mice, which showed enhanced astrocyte migration, and bone marrow from IRF8 -/- mice. In this mouse model, macrophages were widely scattered, and a huge glial scar was formed around the macrophages as in wild-type mice that were transplanted with IRF8 -/ bone marrow. In addition, we revealed that macrophage-secreted ATP-derived ADP attracts astrocytes via the P2Y1 receptor. Our findings revealed a mechanism in which migrating macrophages attracted astrocytes and affected the pathophysiology and outcome after SCI.. |
| 35. |
Hiromi Kumamaru, Yasuharu Nakashima, Katsumi Harimaya, L1 Radiculopathy Caused by L1-L2 Extraforaminal Disc Herniation., Spine surgery and related research, 10.22603/ssrr.2022-0107, 7, 1, 110-112, 2023.01. |
| 36. |
Hidetoshi Tsushima, Sakuragi Takahide, Yukio Akasaki, Toshifumi Fujiwara, Daisuke Hara, Satoshi Ikemura, Kouji Sakuraba, Satoshi Kamura, Hisaaki Miyahara, Hisakata Yamada, Jun-Ichi Fukushi, Yasuharu Nakashima, Is there a reduction in hip destruction under a treat-to-target strategy in patients with rheumatoid arthritis?, Modern rheumatology, 10.1093/mr/road021, 2023.02, OBJECTIVES: The treatments for rheumatoid arthritis (RA) have been greatly improved, and the tight control of disease activity yields superior clinical outcomes. This study aimed to elucidate the accompanying changes in hip destruction following the implementation of a treat-to-target strategy for patients with RA. METHODS: We extracted 190 hips over two periods, i.e., the early period (1998-2003) and late period (2013-2019), with 103 and 87 hips, respectively. The observed rheumatic changes, such as inward migration, upward migration, and femoral head collapse, were quantitatively evaluated, while osteoarthritic changes, such as the formation of a capital drop, were investigated from radiographs before primary total hip arthroplasty. RESULTS: Comparison of the two periods' data showed that the degree of inward migration (-3.44 mm vs. -7.45 mm; P |
| 37. |
Kazuhiro Kai, Toshifumi Fujiwara, Yoshihiro Nagao, Eiji Oki, Tomoharu Yoshizumi, Masatoshi Eto, Yasuharu Nakashima, Evaluation of bone density and skeletal muscle mass after sleeve gastrectomy using computed tomography method., Bone reports, 10.1016/j.bonr.2023.101661, 18, 101661-101661, 2023.06, INTRODUCTION: Sleeve gastrectomy is the most common surgical procedure to reduce weight and treat metabolic complications in patients with moderate-to-severe obesity; however, it affects the musculoskeletal system. Dual-energy X-ray absorptiometry (DXA), which is commonly used to measure bone mineral density (BMD), may be affected by excess fat tissue around the bones, interrupting BMD measurement. Due to the strong correlation between DXA and the Hounsfield units (HU) obtained from computed tomography (CT) scans, BMD assessment using clinical abdominal CT scans has been useful. To date, there has been no report of detailed CT evaluation in patients with severe obesity after sleeve gastrectomy. OBJECTIVE: This study investigated the effect of sleeve gastrectomy in severely obese patients on bone and psoas muscle density, and cross-sectional area using retrospective clinical CT scans. METHODS: This was a retrospective observational study that included 86 patients (35 males and 51 females) who underwent sleeve gastrectomy between March 2012 and May 2019. Patients' clinical data (age at the time of surgery, sex, body weight, body mass index (BMI), comorbidities, and preoperative and postoperative blood test results, HU of the lumbar spine and psoas muscle and psoas muscle mass index (PMI)) were evaluated. RESULTS: The mean age at the time of surgery was 43 years, and the body weight and BMI significantly reduced (p |
| 38. |
Takeshi Utsunomiya, Goro Motomura, Ryosuke Yamaguchi, Satoshi Hamai, Taishi Sato, Shinya Kawahara, Daisuke Hara, Kenji Kitamura, Yasuharu Nakashima, Effects of the location of both anterior and lateral boundaries of the necrotic lesion on collapse progression in osteonecrosis of the femoral head., Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 10.1016/j.jos.2023.01.011, 2023.02, BACKGROUND: The location of the lateral boundary of the necrotic lesion to the weight-bearing portion of the acetabulum (Type classification) is an important factor for collapse in osteonecrosis of the femoral head (ONFH). Recent studies also reported the significance of the location of the anterior boundary of the necrotic lesion on the occurrence of collapse. We aimed to assess the effects of the location of both anterior and lateral boundaries of the necrotic lesion on collapse progression in ONFH. METHODS: We recruited 55 hips with post-collapse ONFH from 48 consecutive patients, who were conservatively followed for more than one year. Using a plain lateral radiograph (Sugioka's lateral view), the location of the anterior boundary of the necrotic lesion to the weight-bearing portion of the acetabulum was classified as follows: Anterior-area I (two hips) occupying the medial one-third or less; Anterior-area II (17 hips) occupying the medial two-thirds or less; and Anterior-area III (36 hips) occupying greater than the medial two-thirds. The amount of femoral head collapse was measured by biplane radiographs at the onset of hip pain and each follow-up period, and Kaplan-Meier survival curves with collapse progression (≥1 mm) as the endpoint were produced. The probability of collapse progression was also assessed by the combination of Anterior-area and Type classifications. RESULTS: Collapse progression was observed in 38 of the 55 hips (69.0%). The survival rate of hips with Anterior-area III/Type C2 was significantly lower. Among hips with Type B/C1, collapse progression occurred more frequently in hips with Anterior-area III (21 of 24 hips) than in hips with Anterior-area I/II (3 of 17 hips, P |
| 39. |
Hiroshi Taneichi, Tokumi Kanemura, Gen Inoue, Yoshiyuki Iwase, Haruki Ueda, Akira Kuzuhara, Taketo Kurozumi, Eiji Takahashi, Hiroshi Takahashi, Atsuo Nakamae, Hiroshi Hashiguchi, Yutaka Hiraizumi, Tatsuo Mae, Hideo Morioka, Mitsuru Yagi, Toshimi Sairenchi, Yuji Nishiwaki, Tokiko Inagaki, Haruhiko Akiyama, Yasuharu Nakashima, Current status and future prospects of the Japanese orthopaedic association national registry (JOANR), Japan's first national registry of orthopaedic surgery., Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 10.1016/j.jos.2023.01.005, 28, 3, 683-692, 2023.02, The Japanese Orthopaedic Association National Registry (JOANR) is Japan's first national registry of orthopaedic surgery, which has been developed after having been selected for the Project for Developing a Database of Clinical Outcome approved by the Health Policy Bureau of the Ministry of Health, Labour and Welfare. Its architecture has two levels of registration, one being the basic items of surgical procedure, disease, information on surgeons, surgery-related information, and outcome, and the other being detailed items in the affiliated registries of partner medical associations. It has a number of features, including the facts that, because it handles medical data, which constitute special care-required personal information, data processing is conducted entirely in a cloud environment with the imposition of high-level data security measures; registration of the implant data required to assess implant performance has been automated via a bar code reader app; and the system structure enables flexible collaboration with the registries of partner associations. JOANR registration is a requirement for accreditation as a core institution or partner institution under the board certification system, and the total number of cases registered during the first year of operation (2020) was 899,421 registered by 2,247 institutions, providing real-world evidence concerning orthopaedic surgery.. |
| 40. |
Tetsunari Harada, Satoshi Hamai, Daisuke Hara, Shinya Kawahara, Masanori Fujii, Satoshi Ikemura, Goro Motomura, Yasuharu Nakashima, Three-dimensional kinematics and kinetics of getting into and out of a car in patients after total hip arthroplasty., Gait & posture, 10.1016/j.gaitpost.2022.10.003, 98, 305-312, 2022.10, BACKGROUND: In modern society, car usage is one of the most important activities of daily living. However, the three-dimensional (3D) mechanics of getting into and out of a car in total hip arthroplasty (THA) patients have not been studied. RESEARCH QUESTION: This study aimed to elucidate the hip kinematics and kinetics of unilateral THA patients while getting into and out of a car. METHODS: 3D motion and ground reaction force data were collected for 40 unilateral primary THA and 30 control participants using motion capture of getting into and out of a car. Normalized joint power was used to determine the individual joint contribution and was calculated by dividing the power of each joint by the total lower-extremity power. These kinematic and kinetic data were compared between unilateral THA and control participants. RESULTS: When getting into the car using the surgical side as the pivot limb, the peak flexion, abduction angle, and normalized power of the pivot hip were significantly lower, and the normalized power of the contralateral ankle was significantly higher. The peak flexion and abduction angle of the pivot hip were significantly lower, and normalized contralateral hip power was significantly higher when getting out of the car. In getting into and out of the car using the contralateral side as the pivot limb, there was no significant difference in the range of motion (RoM) and normalized joint power. SIGNIFICANCE: The restoration of RoM and muscle strength in the surgical hip joint and adopting the normal side as the pivot limb may allow for a more appropriate balance in motion of getting into and out of a car, which will lead to safe mobility, assist in social participation, and improved quality of life. LEVEL OF EVIDENCE: Level III, therapeutic study.. |
| 41. |
Satoshi Ikemura, Goro Motomura, Ryosuke Yamaguchi, Takeshi Utsunomiya, Satoshi Hamai, Masanori Fujii, Shinya Kawahara, Taishi Sato, Daisuke Hara, Kyohei Shiomoto, Takuaki Yamamoto, Yasuharu Nakashima, The influence of bone marrow edema for the assessment of the boundaries of necrotic lesions in patients with osteonecrosis of the femoral head., Scientific reports, 10.1038/s41598-022-23427-y, 12, 1, 18649-18649, 2022.11, This study aimed to investigate the influence of bone marrow edema (BME) for the assessment of the boundaries of necrotic lesions using unenhanced and contrast-enhanced (CE) magnetic resonance (MR) images in patients with osteonecrosis of the femoral head (ONFH). We retrospectively reviewed 72 consecutive hips in 55 patients of ONFH that were Association Research Circulation Osseous (ARCO) stage III or higher and underwent both unenhanced and contrast-enhanced MR imaging between January 2005 and February 2016. The degree of extension of BMEs, and the boundaries of the necrotic lesions were compared using unenhanced and CE MR images on both mid coronal and mid oblique-axial slices. Forty-two percent of the coronal T1 images, 40% of the coronal fat-saturated T2 images, and 48% of the oblique-axial T1 images showed differences in the boundaries of necrotic lesion, by comparison with those of CET1-weighted MR images. The boundaries of necrotic lesions were clearly detected in all hips on CE coronal slices and 97% of all hips on CE oblique-axial slices. The BME grade in the difference group was significantly higher than in the non-difference group on the coronal plane (P = 0.0058). There were significant differences between the BME grade and duration from the onset of hip pain to MR imaging examination. Multivariate analyses revealed that the duration from the onset to MR imaging examination in both coronal (P = 0.0008) and oblique-axial slices (P = 0.0143) were independently associated with differences in the boundary of necrotic lesion between T1 and CET1-weighted MR images. Our findings suggest that unenhanced MR image may be insufficient for a precise assessment of the boundaries of the necrotic lesions for ONFH cases in the early phase of subchondral collapse due to the diffuse BME.. |
| 42. |
So Kuwakado, Kenichi Kawaguchi, Hiroshi Otsuka, Akio Fujita, Ryuichi Kusaba, Miki Tokieda, Daisuke Fujiyoshi, Takahide Kamishima, Eijiro Fujino, Goro Motomura, Satoshi Hamai, Yasuharu Nakashima, Prevalence and Characteristics of Frailty at 6 months FollOwing Total Hip and Knee Arthroplasty in Patients With End-Stage OA., Geriatric orthopaedic surgery & rehabilitation, 10.1177/21514593221126019, 13, 21514593221126019-21514593221126019, 2022.02, Introduction: Lower-limb osteoarthritis (OA) in the elderly can be a risk factor for frailty, which is the preliminary of disability, but it may be reversible with appropriate interventions. We aimed to use the Kihon Check List (KCL) to assess multiple domains of frailty and to identify the characteristics of frailty in patients with hip or knee OA following total joint arthroplasty. Materials and Methods: This study included 136 ≥ 65-year-old patients (mean age: 73.0 years) who underwent total arthroplasty with end-stage hip and knee OA. We assessed frailty status, instrumental activities of daily living (IADL), and health-related quality of life (HRQoL) according to the KCL, functional ambulatory index (FAI) and EuroQol-5 Dimension (EQ5D), respectively, as well as the extent of pain preoperatively and at postoperative 6 months. Results: Using KCL, seventy-eight (57.4%) patients were frail preoperatively, but the prevalence significantly decreased to 52 patients (38.2%) at postoperative 6 months. Total arthroplasty intervention provided significant improvements in the total KCL scores, including the physical domain (P |
| 43. |
Satoshi Yamate, Satoshi Hamai, Shinya Kawahara, Daisuke Hara, Goro Motomura, Satoshi Ikemura, Masanori Fujii, Taishi Sato, Satoru Harada, Tetsunari Harada, Yasuhiko Kokubu, Yasuharu Nakashima, Multiple Imputation to Salvage Partial Respondents: Analysis of the Forgotten Joint Score-12 After Total Hip Arthroplasty., The Journal of bone and joint surgery. American volume, 10.2106/JBJS.21.01547, 104, 24, 2195-2203, 2022.10, BACKGROUND: Missing responses are common when Asian patients complete the Forgotten Joint Score-12 (FJS-12), which is widely used to evaluate total hip arthroplasty (THA). We aimed to provide orthopaedic researchers with a solution for handling missing values in such patient-reported outcome measures (PROMs). METHODS: Patients who had undergone primary THA between 1998 and 2016 (n = 1,021) were investigated in 2020. The FJS-12 and 9 other PROMs, including questions related to Asian lifestyle activities, were administered. Risk factors for missing FJS-12 items were investigated. Partial respondents were matched with complete respondents; then, in each pair, the items not completed by the partial respondent were deleted from the responses of the complete respondent. Predictive mean matching (PMM) was performed in an attempt to recover the deleted items, using 65 sets of imputation models. After the missing values had been imputed, we explored patient characteristics that affected the FJS-12, using data from all complete and partial respondents. RESULTS: A total of 652 patients responded to the survey (393 complete and 193 partial respondents). Partial respondents were older, more often female, and less active. Older respondents were more likely to skip items involving the bed, while those who reported a better ability to sit in the seiza style (traditional Japanese floor sitting) were more likely to skip items about chair sitting. The imputed FJS-12 value exhibited excellent reliability (intraclass correlation coefficient for agreement with the true scores, 0.985). FJS-12 values of complete respondents were significantly higher than those of respondents with 4 to 11 missing items (51.6 versus 32.8, p |
| 44. |
Taisuke Uchida, Yukio Akasaki, Takuya Sueishi, Ichiro Kurakazu, Masakazu Toya, Masanari Kuwahara, Ryota Hirose, Yuki Hyodo, Hidetoshi Tsushima, Martin K Lotz, Yasuharu Nakashima, IκB kinase ε contributes to the pathogenesis of osteoarthritis by promoting cartilage degradation., Arthritis & rheumatology (Hoboken, N.J.), 10.1002/art.42421, 2022.12, OBJECTIVE: Nuclear factor kappa B (NF-κB) signaling is an important modulator in osteoarthritis (OA), and IκB kinase ε (IKKε) regulates the NF-κB pathway. This study was undertaken to identify the functional involvement of IKKε and the effectiveness of IKKε inhibition in OA pathogenesis. METHODS: IKKε expression in normal and OA human knee joints was analyzed immunohistochemically. Gain- or loss-of-function experiments were performed using human chondrocytes. OA was surgically induced in mice, which were then treated with intra-articular injection of BAY-985, an IKKε/TBK1 inhibitor, every 5 days for 8 weeks. Mice were subsequently subjected to histologic examination. RESULTS: IKKε protein expression was increased in human OA cartilage. In vitro, expression levels of OA-related factors were downregulated by knockdown of IKKε in human OA chondrocytes using siRNA or BAY-985. Conversely, IKKε overexpression significantly increased the expression of OA-related catabolic mediators. In western blot analysis, IKKε overexpression increased the phosphorylation of IκBα and p65 in human chondrocytes. In vivo, intra-articular injection of BAY-985 in mice attenuated OA-related cartilage degradation and hyperalgesia via NF-κB signaling. CONCLUSION: These results suggest that IKKε regulates cartilage degradation through a catabolic response mediated by NF-κB signaling, and is a potential target for OA treatment. Furthermore, BAY-985 may serve a major compound in drugs developed for OA. This article is protected by copyright. All rights reserved.. |
| 45. |
Tetsuya Tamaru, Kazu Kobayakawa, Hirokazu Saiwai, Daijiro Konno, Ken Kijima, Shingo Yoshizaki, Kazuhiro Hata, Hirotaka Iura, Gentaro Ono, Yohei Haruta, Kazuki Kitade, Kei-Ichiro Iida, Ken-Ichi Kawaguchi, Yoshihiro Matsumoto, Kensuke Kubota, Takeshi Maeda, Seiji Okada, Yasuharu Nakashima, Glial scar survives until the chronic phase by recruiting scar-forming astrocytes after spinal cord injury., Experimental neurology, 10.1016/j.expneurol.2022.114264, 359, 114264-114264, 2022.11, Spinal cord injury (SCI) causes reactive astrogliosis, the sequential phenotypic change of astrocytes in which naïve astrocytes (NAs) transform into reactive astrocytes (RAs) and subsequently become scar-forming astrocytes (SAs), resulting in glial scar formation around the lesion site and thereby limiting axonal regeneration and motor/sensory functional recovery. Inhibiting the transformation of RAs into SAs in the acute phase attenuates the reactive astrogliosis and promotes regeneration. However, whether or not SAs once formed can revert to RAs or SAs is unclear. We performed selective isolation of astrocytes from glial scars at different time points for a gene expression analysis and found that the expression of Sox9, an important transcriptional factor for glial cell differentiation, was significantly increased in chronic phase astrocytes (CAs) compared to SAs in the sub-acute phase. Furthermore, CAs showed a significantly lower expression of chondroitin sulfate proteoglycan (CSPG)-related genes than SAs. These results indicated that SAs changed their phenotypes according to the surrounding environment of the injured spinal cord over time. Even though the integrin-N-cadherin pathway is critical for glial scar formation, collagen-I-grown scar-forming astrocytes (Col-I-SAs) did not change their phenotype after depleting the effect of integrin or N-cadherin. In addition, we found that Col-I-SAs transplanted into a naïve spinal cord formed glial scar again by maintaining a high expression of genes involved in the integrin-N-cadherin pathway and a low expression of CSPG-related genes. Interestingly, the transplanted Col-I-SAs changed NAs into SAs, and anti-β1-integrin antibody blocked the recruitment of SAs while reducing the volume of glial scar in the chronic phase. Our findings indicate that while the characteristics of glial scars change over time after SCI, SAs have a cell-autonomous function to form and maintain a glial scar, highlighting the basic mechanism underlying the persistence of glial scars after central nervous system injury until the chronic phase, which may be a therapeutic target.. |
| 46. |
Yu Toda, Hidetaka Yamamoto, Takeshi Iwasaki, Shin Ishihara, Yoshihiro Ito, Yosuke Susuki, Kengo Kawaguchi, Izumi Kinoshita, Daisuke Kiyozawa, Yuichi Yamada, Kenichi Kohashi, Atsushi Kimura, Toshifumi Fujiwara, Nokitaka Setsu, Makoto Endo, Yoshihiro Matsumoto, Yasuharu Nakashima, Masaaki Mawatari, Yoshinao Oda, Expression of SATB2, RUNX2, and SOX9 and possible osteoblastic and chondroblastic differentiation in chondroblastoma., Pathology, research and practice, 10.1016/j.prp.2022.154239, 241, 154239-154239, 2022.11, Chondroblastoma (CB) is histologically characterized by oval to polygonal-shaped mononuclear neoplastic cells, multinucleated osteoclastic giant cells, and eosinophilic matrix with occasional calcification. Genetically, the majority of CBs harbor H3F3B p.K36M mutation. Despite the historical nomenclature, it has been reported that the matrix of CB is similar to osteoid rather than true cartilage; however, it remains unclear whether neoplastic cells in CB have the potential for osteoblastic differentiation. To clarify this issue, we immunohistochemically examined the expression of osteogenic and chondrogenic markers (SATB2, RUNX2, p63, and SOX9) as well as H3K36M mutant protein in 33 cases of CB. All 33 cases of CB were positive for H3K36M, while SATB2, RUNX2, p63, and SOX9 were expressed in 30/33 (91%), 33/33 (100%), 29/33 (88%), and 31/32 (97%) CB cases, respectively. Our immunohistochemical results suggest that neoplastic cells in CB frequently express both osteogenic and chondrogenic markers and may have an intermediate feature of osteoblastic and chondroblastic nature.. |
| 47. |
Yuki Nakao, Koji Sakuraba, Katsumi Harimaya, Kazuo Terada, Nobuo Kobara, Ken-Ichi Kawaguchi, Mitsumasa Hayashida, Keiichiro Iida, Yasuharu Nakashima, Jun-Ichi Fukushi, Clinical features and outcomes of spine surgery in patients with ankylosing spondylitis., Modern rheumatology, 10.1093/mr/roac142, 2022.12, OBJECTIVES: The study aimed to comprehend the clinical features and outcomes of surgical treatments for spinal disorders in patients with ankylosing spondylitis. METHODS: This retrospective study enrolled patients with ankylosing spondylitis who underwent spine surgery between 2000 and 2019 in our facility. RESULTS: Thirteen patients with ankylosing spondylitis underwent spine surgeries. The mean age was 56.2 years, and the mean disease duration was 25.1 years at the time of surgery. Nine patients had vertebral fracture, two had kyphotic deformity, and two had myelopathy due to the spinal ligament ossification. Fracture cases included five patients with secondary pseudarthrosis/delayed palsy due to conservative treatment failure. Spinal fixation was performed in all patients. Pedicle subtraction osteotomy for kyphosis and laminectomy for myelopathy were also conducted. All patients improved after surgeries. One patient with kyphotic deformity underwent additional surgery of bilateral hip prosthesis, which resulted in better spine alignment. Four cases of perioperative complications were observed. CONCLUSION: Myelopathy was newly found as the aetiology requiring surgery in patients with ankylosing spondylitis. This summarized case series could help physicians to identify patients with surgically treatable spinal disorders among patients with ankylosing spondylitis.. |
| 48. |
Takahiro Tajimi, Yoshihiko Furuta, Naoki Hirabayashi, Takanori Honda, Jun Hata, Tomoyuki Ohara, Mao Shibata, Tomohiro Nakao, Takanari Kitazono, Yasuharu Nakashima, Toshiharu Ninomiya, Association of gait speed with regional brain volumes and risk of dementia in older Japanese: The Hisayama study., Archives of gerontology and geriatrics, 10.1016/j.archger.2022.104883, 106, 104883-104883, 2022.12, BACKGROUND: To investigate the association of gait speed with regional brain volumes and the risk of incident dementia. METHODS: A total of 1112 dementia-free Japanese residents aged ≥65 years who underwent brain magnetic resonance imaging were followed for 5.0 years (median). The participants were classified into the age- and sex-specific quartile levels of maximum gait speed. Regional gray matter volumes (GMV) and white matter hyperintensities volumes (WMHV) were measured by applying voxel-based morphometry methods. The cross-sectional association of maximum gait speed with regional GMV was examined using an analysis of covariance. We also estimated the association between maximum gait speed level and the risk of developing dementia using a Cox proportional hazards model. Mediation analyses were conducted to determine the contribution of regional brain volumes to the association between maximum gait speed and dementia. RESULTS: Lower maximum gait speed was significantly associated with lower GMV of the total brain, frontal lobe, temporal lobe, cingulate gyrus, insula, hippocampus, amygdala, basal ganglia, thalamus, and cerebellum, and increased WMHV at baseline. During the follow-up, 108 participants developed dementia. The incidence rate of all dementias increased significantly with decreasing maximum gait speed after adjusting for potential confounders (P for trend = 0.03). The mediating effects of the GMV of the hippocampus, GMV of the insula, and WMHV were significant. CONCLUSIONS: Lower maximum gait speed was significantly associated with an increased risk of dementia. Reduced GMV of the hippocampus or insula, and an increase in WMHV was likely to be involved in this association.. |
| 49. |
Kazuki Kitade, Taro Mawatari, Shoji Baba, Reima Sueda, Satoshi Hagio, Shinya Kawahara, Satoshi Ikemura, Yasuharu Nakashima, Vitamin D status-associated postoperative complications in patients with hip dysplasia after periacetabular osteotomy: A case-control study., Modern rheumatology, 10.1093/mr/roac120, 2022.10, OBJECTIVES: This study aimed to clarify the relationship between vitamin D status and complications after periacetabular osteotomy. METHODS: A total of 46 hips of 39 patients (3 men, 36 women; mean age at surgery, 41.0 years; mean postoperative follow-up duration, 63 months) were reviewed to obtain the following information: patients' serum 25-hydroxyvitamin D (25[OH]D) status, prevalence of postoperative delayed union of osteotomy sites in the greater trochanter (DUGT) and ischiopubic stress fractures (IPSF), and risk factors. RESULTS: The mean serum 25(OH)D level was 11.9 ng/mL. DUGT and IPSF were found in four (10.3%) and three (7.7%) patients, respectively. Serum 25(OH)D levels ≤ 11 ng/mL were significantly associated with DUGT in female patients (P = 0.02). Serum 25(OH)D levels ≤ 9 ng/mL and smoking were significantly associated with IPSF (P = 0.01 and 0.02, respectively). Overall, 21.7% of patients with serum 25(OH)D levels ≤ 11 ng/mL developed at least one complication; no complications occurred when serum 25(OH)D levels were > 11 ng/mL. CONCLUSION: Severe vitamin D deficiency was highly prevalent in relatively young patients. Vitamin D deficiency and smoking were independent risk factors for postoperative complications. Proactive supplementation is advisable to reduce postoperative complications, especially in patients with serum 25(OH)D levels ≤ 11 ng/mL.. |
| 50. |
Yasuhiko Kokubu, Toshifumi Fujiwara, Koh Nakagawa, Nokitaka Setsu, Makoto Endo, Jun-Ichi Fukushi, Yoshihiro Matsumoto, Yasuharu Nakashima, Postoperative clinical and functional outcomes in patients with tumor and tumor-like lesion of foot and ankle., Journal of foot and ankle research, 10.1186/s13047-022-00582-z, 15, 1, 75-75, 2022.10, BACKGROUND: Tumors and tumor-like lesions of the foot and ankle are relatively rare and their postoperative clinical outcome has not been well reported. METHODS: This study retrospectively reviewed medical records of all patients who underwent excision of tumors and tumor-like lesions of the foot and ankle from 2008 to 2020. Preoperative and postoperative clinical outcomes were evaluated by the Japanese Society for Surgery of the Foot (JSSF) scales (pain, function, and alignment). RESULTS: A total of 117 consecutive patients were analyzed in this study. Bone lesions accounted for 51 patients (benign: 45, intermediate malignancy: 1, malignant: 5), and soft tissue lesions accounted for 66 patients (benign: 57, intermediate malignancy: 2, malignant: 7). Four patients (8%) presenting with bone tumor and six (9%) soft tissue tumors resulted in recurrence. Eight (67%) patients with malignant lesions were alive continuously disease free and followed for a median of 50.5 (range: 18 to 82) months. Amputation at the first operation was done for five cases (33%) of malignant or intermediate malignancy (below-knee amputation: 1, Chopart disarticulation: 1, forefoot amputation: 3). Postoperative JSSF scores resulted in a significant 'positive' increase (bone lesion, 75.9 ± 13.7 to 91.4 ± 14.9, p |
| 51. |
Mingjian Xu, Goro Motomura, Satoshi Ikemura, Ryosuke Yamaguchi, Koichiro Kawano, Noriko Yamamoto, Hidenao Tanaka, Yusuke Ayabe, Yasuharu Nakashima, Posterior Pelvic Tilt in the Standing Position Might Be Associated with Collapse Progression in Post-Collapse Stage Osteonecrosis of the Femoral Head., Orthopaedic surgery, 10.1111/os.13544, 14, 12, 3201-3208, 2022.10, OBJECTIVE: Excessive pelvic tilt has been reported to impair the biomechanical loading of the hip joint. However, the influence of pelvic tilt in osteonecrosis of the femoral head (ONFH) remains unclear. This study aims to assess whether sagittal pelvic posture in the standing position correlates with progression of femoral head collapse in post-collapse stage ONFH. METHODS: This is a single-center retrospective study. We investigated 107 patients (107 hips; 73 males and 34 females; mean age, 48 years) diagnosed with Association of Research Circulation Osseous (ARCO) stage III ONFH at the first visit and who subsequently underwent surgical treatment in our institution from July 2016 to December 2020. The sagittal pelvic posture in the standing position before surgery was quantified as the angle formed by the anterior pelvic plane and the vertical z-axis in the sagittal view (APP angle). An APP angle |
| 52. |
Kazuki Miyama, Ryoma Bise, Satoshi Ikemura, Kazuhiro Kai, Masaya Kanahori, Shinkichi Arisumi, Taisuke Uchida, Yasuharu Nakashima, Seiichi Uchida, Deep learning-based automatic-bone-destruction-evaluation system using contextual information from other joints., Arthritis research & therapy, 10.1186/s13075-022-02914-7, 24, 1, 227-227, 2022.10, BACKGROUND: X-ray images are commonly used to assess the bone destruction of rheumatoid arthritis. The purpose of this study is to propose an automatic-bone-destruction-evaluation system fully utilizing deep neural networks (DNN). This system detects all target joints of the modified Sharp/van der Heijde score (SHS) from a hand X-ray image. It then classifies every target joint as intact (SHS = 0) or non-intact (SHS ≥ 1). METHODS: We used 226 hand X-ray images of 40 rheumatoid arthritis patients. As for detection, we used a DNN model called DeepLabCut. As for classification, we built four classification models that classify the detected joint as intact or non-intact. The first model classifies each joint independently, whereas the second model does it while comparing the same contralateral joint. The third model compares the same joint group (e.g., the proximal interphalangeal joints) of one hand and the fourth model compares the same joint group of both hands. We evaluated DeepLabCut's detection performance and classification models' performances. The classification models' performances were compared to three orthopedic surgeons. RESULTS: Detection rates for all the target joints were 98.0% and 97.3% for erosion and joint space narrowing (JSN). Among the four classification models, the model that compares the same contralateral joint showed the best F-measure (0.70, 0.81) and area under the curve of the precision-recall curve (PR-AUC) (0.73, 0.85) regarding erosion and JSN. As for erosion, the F-measure and PR-AUC of this model were better than the best of the orthopedic surgeons. CONCLUSIONS: The proposed system was useful. All the target joints were detected with high accuracy. The classification model that compared the same contralateral joint showed better performance than the orthopedic surgeons regarding erosion.. |
| 53. |
Yosuke Susuki, Yuichi Yamada, Yoshihiro Ito, Kengo Kawaguchi, Hiroshi Furukawa, Kenichi Kohashi, Izumi Kinoshita, Kenichi Taguchi, Yasuharu Nakashima, Yoshinao Oda, A new scoring system for the grading of conventional chondrosarcoma: Its clinicopathological significance., Pathology, research and practice, 10.1016/j.prp.2022.154125, 238, 154125-154125, 2022.09, BACKGROUND: Chondrosarcoma is the second most common primary malignant bone tumor, which produces cartilaginous matrix without neoplastic osteoid or bone formation. The histological grade in the WHO Classification of Soft Tissue and Bone (2020 edition) is the most important factor in predicting the clinical outcome of conventional chondrosarcoma, but the lack of clarity in its detailed definition is occasionally problematic. Here, we reviewed conventional chondrosarcoma cases and validated the significance of histological findings. Moreover, we proposed a new scoring system of conventional chondrosarcoma. MATERIAL AND METHODS: Clinicopathological features of 60 cases of conventional chondrosarcoma and 21 cases of dedifferentiated chondrosarcoma were reviewed. RESULTS: Moderate to severe nuclear atypia was correlated with distant metastasis. Moderate and severe nuclear atypia, high cellularity, and >1 % myxoid change were correlated with adverse overall survival. On the other hand, cases with mild nuclear atypia showed no tumor-related death and no metastases. Based on the above results, we proposed a new scoring system based on nuclear atypia (mild: 0, moderate: +1, severe: +2), cellularity (no and mildly increased cellularity: 0, moderately and diffusely increased cellularity: +1), necrosis [(-): 0, (+): + 1], and chondromyxoid area [(-): 0, (+): + 1]. Each grade was defined as follows: cases with only mild nuclear atypia as grade 1, cases with total score 1-3 excluding mild nuclear atypia as grade 2, and cases with total score 4 or 5 as grade 3. There were 18 cases (30 %) of grade 1 including 5 cases (28 %) of local recurrence, but no metastasis or tumor-related death; 26 cases (43 %) of grade 2 including 2 cases (8 %) of local recurrence, 3 cases (12 %) of metastasis, and 1 case (4 %) of tumor-related death; and 16 cases (27 %) of grade 3 including 4 cases (25 %) of local recurrence, 6 cases (38 %) of metastasis, and 5 cases (31 %) of tumor-related death. There was no statistically significant association between the histological findings and dedifferentiation. CONCLUSION: From this study, we propose a new histological scoring system for the grading of conventional chondrosarcoma, based on nuclear atypia, cellularity, necrosis, and myxoid change. Using this system, conventional chondrosarcoma may be clearly classified into three grades: grade 1, non-metastasizing; grade 2, metastasizing but rarely life-threatening; and grade 3, frequently metastasizing and life-threatening.. |
| 54. |
Anterior Interbody Fusion of Cervical Spine with Caspar Plating System. |
| 55. |
Yohei Haruta, Kazu Kobayakawa, Hirokazu Saiwai, Kazuhiro Hata, Tetsuya Tamaru, Hirotaka Iura, Gentaro Ono, Kazuki Kitade, Ken Kijima, Keiichiro Iida, Kenichi Kawaguchi, Yoshihiro Matsumoto, Kensuke Kubota, Takeshi Maeda, Dai-Jiro Konno, Seiji Okada, Yasuharu Nakashima, Zinc chelator treatment in crush syndrome model mice attenuates ischemia-reperfusion-induced muscle injury due to suppressing of neutrophil infiltration., Scientific reports, 10.1038/s41598-022-19903-0, 12, 1, 15580-15580, 2022.09, In crush syndrome, massive muscle breakdown resulting from ischemia-reperfusion muscle injury can be a life-threatening condition that requires urgent treatment. Blood reperfusion into the ischemic muscle triggers an immediate inflammatory response, and neutrophils are the first to infiltrate and exacerbate the muscle damage. Since free zinc ion play a critical role in the immune system and the function of neutrophils is impaired by zinc depletion, we hypothesized that the administration of a zinc chelator would be effective for suppressing the inflammatory reaction at the site of ischemia-reperfusion injury and for improving of the pathology of crush syndrome. A crush syndrome model was created by using a rubber tourniquet to compress the bilateral hind limbs of mice at 8 weeks. A zinc chelator N,N,N',N'-tetrakis-(2-pyridylmethyl)-ethylenediamine (TPEN) was administered immediately after reperfusion in order to assess the anti-inflammatory effect of the chelator for neutrophils. Histopathological evaluation showed significantly less muscle breakdown and fewer neutrophil infiltration in TPEN administration group compared with control group. In addition, the expression levels of inflammatory cytokine and chemokine such as IL-6, TNFα, CXCL1, CXCL2, CXCR2, CCL2 in ischemia-reperfusion injured muscle were significantly suppressed with TPEN treatment. Less dilatation of renal tubules in histological evaluation in renal tissue and significantly better survival rate were demonstrated in TPEN treatment for ischemia-reperfusion injury in crush syndrome. The findings of our study suggest that zinc chelators contributed to the resolution of exacerbation of the inflammatory response and attenuation of muscle breakdown in the acute phase after crush syndrome. In addition, our strategy of attenuation of the acute inflammatory reaction by zinc chelators may provide a promising therapeutic strategy not only for crush syndrome, but also for other diseases driven by inflammatory reactions.. |
| 56. |
Hiromi Kumamaru, Keiichiro Iida, Takeyuki Saito, Shingo Yoshizaki, Yasuharu Nakashima, Katsumi Harimaya, The Posterolaterally Oriented and Laterally Downward Sloping Facet Joint Is a Risk Factor for Degenerative Cervical Spondylolisthesis and Myelopathy., Spine surgery and related research, 10.22603/ssrr.2021-0181, 6, 4, 358-365, 2022.01, Introduction: Facet joints are anatomical structures that are known to be crucial for determining spinal biomechanical motion; however, the potential relationship between facet orientation and the development of cervical spondylolisthesis remains unclear. Thus, in this study, we aimed to explore the relationship between facet orientation and cervical spondylolisthesis as well as myelopathy. Methods: Facet orientation in the cervical spine was investigated using computed tomography in 103 patients with cervical myelopathy, and facet inclination was measured on axial, coronal, and sagittal reconstructed images. Patients were divided into anterolisthesis, retrolisthesis, and no spondylolisthesis groups at each intervertebral level (C2/3-C6/7 levels). Results: Facet joints in the anterolisthesis and retrolisthesis groups tended to slope posterolaterally and downward laterally compared with those in the no spondylolisthesis group at C3/4, C4/5, and C5/6 levels (P |
| 57. |
Takashi Itokawa, Yasuharu Nakashima, Takuaki Yamamoto, Goro Motomura, Masanobu Ohishi, Satoshi Hamai, Mio Akiyama, Masanobu Hirata, Daisuke Hara, Yukihide Iwamoto, Late dislocation is associated with recurrence after total hip arthroplasty, INTERNATIONAL ORTHOPAEDICS, 10.1007/s00264-013-1921-6, 37, 8, 1457-1463, 2013.08, This study was conducted to examine the risk factors for recurrent dislocation after total hip arthroplasty (THA) and test the hypothesis that late dislocations are associated with recurrence.
A total of 1,250 hips in 1,017 patients were retrospectively reviewed. All operations were performed through the posterolateral approach with posterior soft tissue repair. An early or late dislocation was defined as a dislocation occurring before or after one year postoperatively, respectively.
Dislocation occurred in 36 hips (2.9 %) and 20 of them experienced recurrence. Recurrent dislocations were observed in ten out of 25 hips (40.0 %) with early dislocation; however, ten out of 11 hips (90.9 %) with late dislocation experienced recurrence (p = 0.0046). Multivariate analysis revealed that late dislocation was significantly associated with recurrence with odds ratio of 5.94 per year. Seven in 20 hips with recurrent dislocation required surgical treatment.
Late dislocation significantly contributed to the development of recurrent dislocations.. |
| 58. |
Kenta Nio, Kenji Tsuchihashi, Keisuke Taguchi, Tomoyasu Yoshihiro, Kyoko Yamaguchi, Mamoru Ito, Shohei Moriyama, Mitsuhiro Fukata, Toshifumi Fujiwara, Nokitaka Setsu, Makoto Endo, Yoshihiro Matsumoto, Yasuharu Nakashima, Takahiro Wakasaki, Ryuji Yasumatsu, Hiroshi Ariyama, Hitoshi Kusaba, Junji Kishimoto, Koichi Akashi, Eishi Baba, Exploratory retrospective study of risk factors for thromboembolism treated with multi-kinase inhibitor pazopanib or lenvatinib, INTERNATIONAL JOURNAL OF SURGERY-ONCOLOGY, 10.1097/IJ9.0000000000000089, 5, 4, 2020.08, Tyrosine kinase inhibitors (TKI) work against various types of cancer by inhibiting angiogenic signaling. Little is understood about the incidence, characteristics, and risk factors associated with thromboembolism induced by TKI in routine clinical practice. We retrospectively analyzed data derived from 29 patients with thyroid cancer or soft tissue sarcoma (STS) treated with lenvatinib (n=10) and pazopanib (n=19). Eight (arterial n=4; venous n=4) thromboembolic events developed in 6 (20%) patients. Thromboembolisms occurred during a mean of 149 (range, 42-847) days from starting TKI. The primary disease progressed in all patients with thromboembolism. The overall survival durations of patients with and without improved thromboembolism were 572 [95% confidence interval (CI), 225- 918] and 176 (95% CI, 84-394) days, respectively, which did not significantly differ (P=0.33). Patients with and without improved thromboembolism survived after onset for 122 (95% CI, 71-173) versus 27 (95% CI, 21-42) days (P=0.049), which significantly differed. Univariate analysis and variate selection for multivariate analysis selected a history of thromboembolism as the most powerful risk factor for new thromboembolism. In summary, the frequency of thromboembolism in clinical practice was higher than that in previous clinical trials. Furthermore, a history of thromboembolism was a risk factor for the development of new thromboembolism in patients treated with TKI. Thromboembolism developed particularly as the primary disease progressed. Our findings require validation in a large-scale study.. |
| 59. |
Hideki Mizu-Uchi, Yuan Ma, Shojiro Ishibashi, Clifford W Colwell Jr, Yasuharu Nakashima, Darryl D D'Lima, Tibial sagittal and rotational alignment reduce patellofemoral stresses in posterior stabilized total knee arthroplasty., Scientific reports, 10.1038/s41598-022-15759-6, 12, 1, 12319-12319, 2022.07, Patellofemoral joint complications remain an important issue in total knee arthroplasty. We compared the patellofemoral contact status between cruciate-retaining and posterior-stabilized designs with varying degrees of tibial sagittal and rotational alignment using a computer simulation to ensure proper alignments in total knee arthroplasty. Knee kinematics, patellofemoral contact force and quadriceps force were computed using a musculoskeletal modeling program (LifeMOD/KneeSIM 2010; LifeModeler, Inc., San Clemente, California) during a weight-bearing deep knee bend. Two different posterior tibial slope (PTS)s (3° and 7°) and five different tibial tray rotational alignments (neutral, internal 5° and 10°, and external 5° and 10°) were simulated. Patellofemoral contact area and stresses were next computed using finite element analysis. The patellofemoral contact force for the posterior-stabilized design was substantially lower than the cruciate-retaining design after post-cam contact because of increasing femoral roll-back. Neutral rotational alignment of the tibial component resulted in smaller differences in patellofemoral contact stresses between cruciate-retaining and posterior-stabilized designs for PTSs of 3° or 7°. However, the patellar contact stresses in the cruciate-retaining design were greater than those in posterior-stabilized design at 120° of knee flexion with PTS of 3° combined with internal rotation of the tibial component. Our study provides biomechanical evidence implicating lower PTSs combined with internal malrotation of the tibial component and the resultant increase in patellofemoral stresses as a potential source of anterior knee pain in cruciate-retaining design.. |
| 60. |
Mamiko Sakai, Kensuke Hotta, Ko Ikuta, Yasuharu Nakashima, Spinal Subdural Hematoma Migration From a Cranial Subdural Hematoma: Two Case Reports and Literature Review., Cureus, 10.7759/cureus.26028, 14, 6, e26028, 2022.06, Spinal subdural hematoma (SSDH) associated with cranial subdural hematoma (CSDH) is considered extremely rare and the etiology remains unclear. Herein, we report two cases of spontaneous SSDH concomitant with CSDH, with no history of trauma. First, a healthy 35-year-old woman suffered from left leg pain following a headache caused by acute CSDH. Magnetic resonance imaging (MRI) of the lumbar spine showed SSDH extending from the L5 to S2 vertebral levels. The leg symptoms were gradually relieved with conservative treatments within two weeks after onset. The SSDH was completely resolved six months after onset on MRI evaluations. Next, a 69-year-old woman developed a headache and right hemiparesis. Brain computed tomography (CT) demonstrated chronic left-sided CSDH and she underwent a single burr-hole craniotomy. Three weeks after surgery, she experienced difficulty walking because of severe leg pain caused by SSDH extending from the L3 to S1. The clinical symptoms were completely resolved with conservative treatment within one month after onset. At 3 months follow-up, SSDH disappeared on MRI evaluation. Herein, we presented two cases of SSDH associated with CSDH. In both cases, the leg symptoms of SSDH developed following the onset of CSDH. Given that both patients remained active during the interval between CSDH onset and the appearance of SSDH symptoms, the SSDH was likely caused by migration of the CSDH contents to the lumbar spine because of gravity.. |
| 61. |
Mamiko Sakai, Yukio Akasaki, Takenori Akiyama, Tomohiro Horikawa, Ken Okazaki, Satoshi Hamai, Hidetoshi Tsushima, Shinya Kawahara, Ichiro Kurakazu, Kenji Kubota, Hideki Mizu-Uchi, Yasuharu Nakashima, Similar Short-Term KOOS Between Open-Wedge High Tibial Osteotomy and Total Knee Arthroplasty in Patients Over Age 60: A Propensity Score-Matched Cohort Study., Modern rheumatology, 10.1093/mr/roac052, 2022.06, OBJECTIVE: The purpose of the present study was to evaluate improvement in the Knee Injury and Osteoarthritis Outcome Score (KOOS) after open-wedge high tibial osteotomy (HTO) in comparison with total knee arthroplasty (TKA) in cohorts over age 60 matched by pre-operative age, gender, body mass index (BMI), hip-knee-ankle angle (HKAA), KOOS sub-scores, and osteoarthritis (OA) grade. METHODS: Propensity score matching was performed between 162 HTO patients and 134 TKA patients. When calculating the propensity score by multivariate logistic regression analysis, the following pre-operative confounders were included: age, gender, BMI, HKAA, KOOS sub-scores, and OA grade. Consequently, a total of 55 patients were included in each group. The Student's t-test was used to analyse differences in the post-operative KOOS sub-scores between groups. RESULTS: After propensity score matching, all matched pre-operative valuables were identical, with no significant differences between the HTO and TKA group. None of the post-operative KOOS sub-scores at 1 year after surgery showed a significant difference between the HTO and TKA groups. Both groups demonstrated significant and comparable post-operative improvement in every KOOS sub-score. CONCLUSION: In patients over age 60, there was no significant difference in short-term pain relief and improvements in activity and quality of life between HTO and TKA after propensity score matching including pre-operative age, KOOS sub-scores, and OA grade. HTO is a joint preservation procedure that is valid for knee OA even in individuals over age 60.. |
| 62. |
Yasuhiko Kokubu, Shinya Kawahara, Satoshi Hamai, Yukio Akasaki, Hidetoshi Tsushima, Kenta Momii, Yasuharu Nakashima, Sagittal femoral bowing contributes to distal femoral valgus angle deviation in malrotated preoperative radiographs., BMC musculoskeletal disorders, 10.1186/s12891-022-05542-z, 23, 1, 579-579, 2022.06, BACKGROUND: The coronal whole-leg radiograph is generally used for preoperative planning in total knee arthroplasty. The distal femoral valgus angle (DFVA) is measured for distal femoral bone resection using an intramedullary guide rod. The effect of coronal and sagittal femoral shaft bowing on DFVA measurement in the presence of malrotation or knee flexion contracture has not been well reported. The objectives of this study were: (1) to investigate the effects of whole-leg malrotation and knee flexion contracture on the DFVA in detail, (2) to determine the additional effect of coronal or sagittal femoral shaft bowing. METHODS: We studied 100 consecutive varus and 100 valgus knees that underwent total or unicompartmental knee arthroplasty. Preoperative CT scans were used to create digitally reconstructed radiography (DRR) images in neutral rotation (NR, parallel to the surgical epicondylar axis), and at 5° and 10° external rotation (ER) and internal rotation (IR). The images were also reconstructed at 10° femoral flexion. The DFVA was evaluated in each DRR image, and the angular variation due to lower limb malposition was investigated. RESULTS: The DFVA increased as the DRR image shifted from IR to ER, and all angles increased further from extension to 10° flexion. The DFVA variation in each position was 1.3° on average. A larger variation than 2° was seen in 12% of all. Multivariate regression analysis showed that sagittal femoral shaft bowing was independently associated with a large variation of DFVA. Receiver operating characteristic analysis showed that more than 12° of sagittal bowing caused the variation. CONCLUSION: If femoral sagittal bowing is more than 12°, close attention should be paid to the lower limb position when taking whole-leg radiographs. Preoperative planning with whole-leg CT data should be considered.. |
| 63. |
Shojiro Ishibashi, Hideki Mizu-Uchi, Shinya Kawahara, Hidetoshi Tsushima, Yukio Akasaki, Yasuharu Nakashima, Preoperative Virtual Total Knee Arthroplasty Surgery Using a Computed Tomography-based 3-dimensional Model With Variation in Reference Points and Target Alignment to Predict Femoral Component Sizing., Arthroplasty today, 10.1016/j.artd.2022.07.008, 17, 27-35, 2022.10, Background: The purpose of this study was to investigate the size differences of 19 different femoral component placements from the standard position in total knee arthroplasty using 3-dimensional virtual surgery. Methods: Three-dimensional bone models were reconstructed from the computed tomography data of 101 varus osteoarthritic knees. The distal femoral bone was cut perpendicular to the femoral mechanical axis (MA) in the coronal plane. Twenty different component placements consisting of 5 cutting directions (perpendicular to MA, 3° and 5° extension relative to MA [3°E-MA and 5°E-MA, respectively], and 3° and 5° flexion relative to MA [3°F-MA and 5°F-MA, respectively]) in the sagittal plane, 2 rotational alignments (clinical epicondylar axis [CEA] and surgical epicondylar axis [SEA]), and 2 rotational types of anterior reference guide (central [CR] and medial [MR]) were simulated. Results: The mean anteroposterior dimension of femur ranged from 54.3 mm (5°F-MA, SEA, CR) to 62.5 mm (5°E-MA, CEA, MR). The largest and smallest differences of anteroposterior dimension from the standard position (3°F-MA, SEA, and CR) were 7.1 ± 1.3 mm (5°E-MA, CEA, and MR) and -1.2 ± 0.2 mm (5°F-MA, SEA, and CR), respectively. Multiple regression analysis revealed that flexion cutting direction, SEA, and CR were associated with smaller component size. Conclusions: The femoral component size can be affected easily by not only cutting direction but also the reference guide type and the target alignment. Our findings could provide surgeons with clinically useful information to fine-tune for unintended loose or tight joint gaps by adjusting the component size.. |
| 64. |
Kyohei Shiomoto, Satoshi Hamai, Daisuke Hara, Satoru Harada, Goro Motomura, Yasuharu Nakashima, Objective activity levels and patient-reported outcomes after total hip arthroplasty and periacetabular osteotomy: Retrospective matched cohort study at mean 12-year follow-up., The Journal of arthroplasty, 10.1016/j.arth.2022.08.034, 38, 2, 323-328, 2022.08, BACKGROUND: There is increasing interest in improving activity after total hip arthroplasty (THA) and periacetabular osteotomy (PAO). The present study evaluated whether there were differences in the subjective and objective activity levels of THA and PAO patients at mean 12-year follow-up (range 4-20) and what factors influence the objective activity levels. METHODS: THA and PAO patients (30 patients each; mean age: 66 and 63 years, respectively), who had undergone surgery for osteoarthritis due to acetabular dysplasia were included. Patients were retrospectively matched based on age, sex, body mass index (BMI), follow-up duration, and preoperative University of California Los Angeles activity score (UCLA score). Patients were surveyed for the subjective activity levels using the Oxford Hip Score (OHS) and UCLA score. Objective activity levels (the number of steps, upright time, and the number of sit-to-stand transitions) was made using an accelerometer. RESULTS: There was no significant difference in subjective activity level between THA and PAO patients. The number of steps was significantly higher in PAO than in THA patients. Multivariable analyses revealed that THA and low OHS_ADL were negatively associated with the number of steps, that men and high UCLA score were negatively associated with upright time, and that high BMI was negatively associated with sit-to-stand transitions in THA and PAO patients. CONCLUSION: This study suggested that although there was no difference in postoperative subjective activity level between THA and PAO patients, there was a difference in objective activity level. Providing guidance to these patients based on objective activity may lead to higher activity levels.. |
| 65. |
Atsushi Kimura, Yu Toda, Yoshihiro Matsumoto, Hidetaka Yamamoto, Kenichiro Yahiro, Eijiro Shimada, Masaya Kanahori, Ryunosuke Oyama, Suguru Fukushima, Makoto Nakagawa, Nokitaka Setsu, Makoto Endo, Toshifumi Fujiwara, Tomoya Matsunobu, Yoshinao Oda, Yasuharu Nakashima, Nuclear β-catenin translocation plays a key role in osteoblast differentiation of giant cell tumor of bone., Scientific reports, 10.1038/s41598-022-17728-5, 12, 1, 13438-13438, 2022.08, Denosumab is a game-changing drug for giant cell tumor of bone (GCTB); however, its clinical biomarker regarding tumor ossification of GCTB has not been elucidated. In this study, we investigated the relationship between Wnt/β-catenin signaling and the ossification of GCTB and evaluated whether endogenous nuclear β-catenin expression predicted denosumab-induced bone formation in GCTB. Genuine patient-derived primary GCTB tumor stromal cells exhibited osteoblastic characteristics. Identified osteoblastic markers and nuclear β-catenin translocation were significantly upregulated via differentiation induction and were inhibited by treating with Wnt signaling inhibitor, GGTI-286, or selective Rac1-LEF inhibitor, NSC23766. Furthermore, we reviewed the endogenous ossification and nuclear β-catenin translocation of 86 GCTB clinical samples and elucidated that intra-tumoral ossification was significantly associated with the nuclear translocation. Three-dimensional quantitative analyses (n = 13) of tumoral CT images have revealed that the nuclear β-catenin translocation of naïve GCTB samples was significantly involved with the denosumab-induced tumor ossification. Our findings suggest a close relationship between the nuclear β-catenin translocation and the osteoblastic differentiation of GCTB. Investigations of the nuclear β-catenin in naïve GCTB samples may provide a promising biomarker for predicting the ossification of GCTB following denosumab treatment.. |
| 66. |
Masanari Kuwahara, Yukio Akasaki, Norio Goto, Ichiro Kurakazu, Takuya Sueishi, Masakazu Toya, Taisuke Uchida, Tomoaki Tsutsui, Ryota Hirose, Hidetoshi Tsushima, Yasuharu Nakashima, Fluvastatin promotes chondrogenic differentiation of adipose-derived mesenchymal stem cells by inducing bone morphogenetic protein 2., BMC pharmacology & toxicology, 10.1186/s40360-022-00600-7, 23, 1, 61-61, 2022.08, BACKGROUND: Adipose-derived mesenchymal stem cells (ADMSCs) are a promising source of material source for medical regeneration of cartilage. Growth factors, including transforming growth factor-β (TGFβ) subfamily members and bone morphogenetic proteins (BMPs), play important roles in inducing and promoting chondrogenic differentiation of MSCs. However, these exogenous growth factors have some drawbacks related to their cost, biological half-life, and safety for clinical application. Several studies have reported that statins, the competitive inhibitors of 3-hydroxy-2-methylglutaryl coenzyme A (HMG-CoA) reductase, induce the expression of BMP2 in multiple cell types as the pleotropic effects. The objective of this study was to investigate the effects of fluvastatin during chondrogenic differentiation of human ADMSCs (hADMSCs). METHODS: The effects of fluvastatin were analyzed during chondrogenic differentiation of hADMSCs in the pellet culture without exogenous growth factors by qRT-PCR and histology. For functional studies, Noggin, an antagonist of BMPs, mevalonic acid (MVA) and geranylgeranyl pyrophosphate (GGPP), metabolites of the mevalonate pathway, ROCK inhibitor (Y27632), or RAC1 inhibitor (NSC23766) were applied to cells during chondrogenic differentiation. Furthermore, RhoA activity was measured by RhoA pulldown assay during chondrogenic differentiation with or without fluvastatin. Statistically significant differences between groups were determined by Student's t-test or the Tukey-Kramer test. RESULTS: Fluvastatin-treated cells expressed higher levels of BMP2, SOX9, ACAN, and COL2A1 than control cells, and accumulated higher levels of glycosaminoglycans (GAGs). Noggin significantly inhibited the fluvastatin-mediated upregulation of ACAN and COL2A1. Both MVA and GGPP suppressed the effects of fluvastatin on the expressions of BMP2, SOX9, ACAN, and COL2A1. Furthermore, fluvastatin suppressed the RhoA activity, and inhibition of RhoA-ROCK signaling by Y27632 increased the expressions of BMP2, SOX9, ACAN, and COL2A1, as well as fluvastatin. CONCLUSIONS: Our results suggest that fluvastatin promotes chondrogenic differentiation of hADMSCs by inducing endogenous BMP2, and that one of the mechanisms underlying the effects is inhibition of RhoA-ROCK signaling via suppression of GGPP. Fluvastatin is a safe and low-cost compound that holds promise for use in transplantation of hADMSCs for cartilage regeneration.. |
| 67. |
Kenichi Kawaguchi, So Kuwakado, Hiroshi Ohtsuka, Akemi Sakugawa, Masanori Takahashi, Taiji Oda, Nobuto Shimamoto, Satoshi Hamai, Yasuharu Nakashima, Factors affecting short-term functional gain following total knee arthroplasty in patients aged from 75 years at a postacute rehabilitation setting., International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation, 10.1097/MRR.0000000000000538, 45, 3, 260-266, 2022.09, The intensive rehabilitation of older patients after total knee arthroplasty (TKA) is vital for short-term improvement in mobility and daily living activities. We aimed to investigate the effectiveness of multidisciplinary rehabilitation and assess the early postoperative predictors that are associated with functional gain in TKA patients aged from 75 years in a postacute care setting. This study included 190 patients following primary TKA who were admitted at the postacute rehabilitation hospital. The main outcome measures were the motor component of functional independence measure (M-FIM), M-FIM effectiveness, numerical rating scale, knee extension strength and range of motion, 10-m walk test, Berg balance scale (BBS), and mini-mental state examination (MMSE). The functional gain between patient age groups of ≥75 ( n = 105) and |
| 68. |
Kazuya Yokota, Muneaki Masuda, Ryuichiro Koga, Masatoshi Uemura, Tadashi Koga, Yasuharu Nakashima, Osamu Kawano, Takeshi Maeda, Diaphragm pacing implantation in Japan for a patient with cervical spinal cord injury: A case report., Medicine, 10.1097/MD.0000000000029719, 101, 26, e29719, 2022.07, RATIONALE: Traumatic cervical spinal cord injury (SCI) is a devastating condition leading to respiratory failure that requires permanent mechanical ventilation, which is the main driver of increased medical costs. There is a great demand for establishing therapeutic interventions to treat respiratory dysfunction following severe cervical SCI. PATIENT CONCERNS AND DIAGNOSIS: We present a 24-year-old man who sustained a cervical displaced C2-C3 fracture with SCI due to a traffic accident. As the patient presented with tetraplegia and difficulty in spontaneous breathing following injury, he was immediately intubated and placed on a ventilator with cervical external fixation by halo orthosis. The patient then underwent open reduction and posterior fusion of the cervical spine 3 weeks after injury. Although the patient showed significant motor recovery of the upper and lower limbs over time, only a slight improvement in lung capacity was observed. INTERVENTIONS AND OUTCOMES: At 1.5 years after injury, a diaphragmatic pacing stimulator was surgically implanted to support the patient's respiratory function. The mechanical ventilator support was successfully withdrawn from the patient 14 weeks after implantation. We observed that both the vital capacity and tidal volume of the patient were significantly promoted following implantation. The patient finally returned to daily life without any mechanical support. LESSONS: The findings of this report suggest that diaphragmatic pacing implantation could be a promising treatment for improving respiratory function after severe cervical SCI. To our knowledge, this is the first SCI patient treated with a diaphragm pacing implantation covered by official medical insurance in Japan.. |
| 69. |
Shin Ishihara, Takeshi Iwasaki, Kenichi Kohashi, Kengo Kawaguchi, Yu Toda, Toshifumi Fujiwara, Nokitaka Setsu, Makoto Endo, Yoshihiro Matsumoto, Yasuharu Nakashima, Yoshinao Oda, Clinical significance of signal regulatory protein alpha and T cell immunoreceptor with immunoglobulin and immunoreceptor tyrosine-based inhibition motif domain expression in undifferentiated pleomorphic sarcoma., Journal of cancer research and clinical oncology, 10.1007/s00432-022-04078-y, 2022.06, PURPOSE: Undifferentiated pleomorphic sarcoma (UPS) is associated with poor prognosis. Recently, signal regulatory protein alpha (SIRPα), which is the immune checkpoint of macrophages, and T cell immunoreceptor with immunoglobulin and immunoreceptor tyrosine-based inhibition motif domains (TIGIT), which is the immune checkpoint of T cells and natural killer cells, have been considered as potential targets for cancer immunotherapy. This study aimed to assess the value of SIRPα and TIGIT as prognostic factors of UPS. MATERIALS AND METHODS: The cBio Cancer Genomics Portal was used to analyze mRNA expression data of 50 UPS cases in the Cancer Genome Atlas. We retrieved 49 UPS cases and performed immunohistochemistry (IHC) to detect programmed death ligand 1 (PD-L1), SIRPα, CD68, CD163, TIGIT, CD155, and CD8. RESULTS: SIRPα was positively associated with CD163 (Pearson's r = 0.51, p = 0.0002) as per open access data and IHC of the cohort (p = 0.002), which revealed that SIRPα-positive macrophage infiltration was higher in UPS cells with ≥ 1% PD-L1 expression than that in UPS cells with |
| 70. |
Takahiro Senju, Naohide Takeuchi, Naoya Kozono, Hidehiko Higaki, Takeshi Shimoto, Yasuharu Nakashima, Biomechanical Comparison of a Horizontal Mattress, Cross Suture and Vertical Mattress for Repair of a Tendon Weave in a Porcine Model., The journal of hand surgery Asian-Pacific volume, 10.1142/S2424835522500436, 27, 3, 439-446, 2022.06, Background: An effective suture method enables early active motion exercises and optimal post-surgical outcomes. The aim of this study is to evaluate the tensile strength of three suture configurations - horizontal mattress (HM), vertical mattress (VM) and a cross suture for repair of a tendon weave. We hypothesised that the direction of mattress sutures relative to the tendon fibres would affect the tensile strength of tendon repair. Methods: Using porcine flexor tendons and the same number of surgical sutures, three tendon weave constructs differing in the method of suture were compared: HM suture configuration (conventional technique), cross-stitch (CS) configuration (conventional technique) and VM suture configuration (novel technique). Ten pairs of each group were mounted in a material testing machine and subjected to a simple tensile test and a cyclic loading test for their biomechanical comparison. Results: The VM group and CS group had significantly higher ultimate failure load, linear stiffness and fatigue strength as compared to the HM group. The failure mode was suture breakage or tendon rupture for the VM and the CS group, while the suture pullout of the tendon only occurred in the HM group. Conclusion: Among the three techniques used for repair of a tendon weave, the VM suture technique was demonstrated to have the greatest tensile strength and least associated with suture pull-out. The direction of the mattress suture in relation the direction of tendon fibres affects the strength of repair.. |
| 71. |
Yu Toda, Tadatsugu Morimoto, Yoshihiro Matsumoto, Nokitaka Setsu, Tomohito Yoshihara, Shinichi Aishima, Yoshinao Oda, Yasuharu Nakashima, Masaaki Mawatari, Application of contralateral osteotomy for the en bloc resection of paraspinal and spinal tumours: a report of three cases., British journal of neurosurgery, 10.1080/02688697.2022.2076809, 1-7, 2022.05, We herein report the effectiveness of contralateral osteotomy of the pedicle and posterolateral elements for en bloc resection (COPPER) of paraspinal and spinal tumours. This surgical method allows for complete resection of the localized tumour in the lateral posterior lesion without removing the entire vertebral body, as in total en bloc spondylectomy. Complete resection of paraspinal and spinal tumours is challenging for spinal surgeons because of anatomical complexities. Although the COPPER method has been introduced as a less invasive surgical procedure for wide resection of spinal tumours, no studies have reported the usefulness of this technique. We identified three patients with paraspinal or spinal tumours who underwent wide resection using the COPPER method and reviewed their clinical, radiological, and pathological outcomes. In all cases, we resected the spinal and paraspinal tumours extending to the anterior column and extravertebral component using the modified COPPER method. All patients underwent en bloc resection with a negative margin. We report three cases of spinal and paraspinal tumours extending to the anterior column and extravertebral component.. |
| 72. |
Tetsunari Harada, Satoshi Hamai, Kyohei Shiomoto, Daisuke Hara, Goro Motomura, Yasuharu Nakashima, A propensity score-matched comparison of patient satisfaction following periacetabular osteotomy or total hip arthroplasty for developmental dysplasia of the hip in an Asian cohort., Hip international : the journal of clinical and experimental research on hip pathology and therapy, 10.1177/11207000221114272, 33, 4, 11207000221114272-11207000221114272, 2022.07, BACKGROUND: No studies have compared patient satisfaction between periacetabular osteotomy (PAO) and total hip arthroplasty (THA) for osteoarthritis (OA) secondary to developmental dysplasia of the hip (DDH) in Asian cohorts. METHODS: Multivariate analyses were applied to determine whether patient demographics and postoperative patient-reported outcomes were correlated with postoperative patient satisfaction in 737 DDH patients (251 PAO and 486 THA patients). Additionally, postoperative patient satisfaction, Oxford Hip Score (OHS), University of California-Los Angeles (UCLA) activity score, and sports participation were compared between propensity-matched PAO and THA patients for OA secondary to DDH (Kellgren-Lawrence grade II: 32 PAO and 16 THA patients, grade III: 20 PAO and 40 THA patients). RESULTS: Of the 737 patients, 663 patients (90%) were postoperatively satisfied. Multivariate analysis demonstrated that THA was positively correlated with patient satisfaction. Furthermore, high postoperative OHS-pain, OHS-ADL, and UCLA scores were positively correlated with satisfaction. In propensity-matched PAO and THA patients, PAO elicited greater patient satisfaction than THA for KL grade II OA secondary to DDH, with comparable postoperative OHS (including the pain and ADL subscale), UCLA score, and sports participation rate. In contrast, THA resulted in better satisfaction and OHS-pain for KL grade III OA secondary to DDH, with comparable postoperative OHS-ADL, UCLA score, and sports participation rate in the 2 surgeries. CONCLUSIONS: Both PAO and THA procedures offer distinct patient satisfaction advantages based on preoperative OA severity. These findings can assist in the clinical decision-making process for the surgical treatment of middle-aged patients with symptomatic DDH.. |
| 73. |
Yasuharu Nakashima, Shojiro Ishibashi, Kenji Kitamura, Satoshi Yamate, Goro Motomura, Satoshi Hamai, Satoshi Ikemura, Masanori Fujii, 20-year hip survivorship and patient-reported outcome measures after transpositional osteotomy of the acetabulum for dysplastic hips., The bone & joint journal, 10.1302/0301-620X.104B7.BJJ-2021-1767.R1, 104-B, 7, 767-774, 2022.07, AIMS: 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). METHODS: 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 |
| 74. |
Keigo Shibahara, Koichiro Hayashi, Yasuharu Nakashima, Kunio Ishikawa, Effects of Channels and Micropores in Honeycomb Scaffolds on the Reconstruction of Segmental Bone Defects., Frontiers in bioengineering and biotechnology, 10.3389/fbioe.2022.825831, 10, 825831-825831, 2022.01, The reconstruction of critical-sized segmental bone defects is a key challenge in orthopedics because of its intractability despite technological advancements. To overcome this challenge, scaffolds that promote rapid bone ingrowth and subsequent bone replacement are necessary. In this study, we fabricated three types of carbonate apatite honeycomb (HC) scaffolds with uniaxial channels bridging the stumps of a host bone. These HC scaffolds possessed different channel and micropore volumes. The HC scaffolds were implanted into the defects of rabbit ulnar shafts to evaluate the effects of channels and micropores on bone reconstruction. Four weeks postoperatively, the HC scaffolds with a larger channel volume promoted bone ingrowth compared to that with a larger micropore volume. In contrast, 12 weeks postoperatively, the HC scaffolds with a larger volume of the micropores rather than the channels promoted the scaffold resorption by osteoclasts and bone formation. Thus, the channels affected bone ingrowth in the early stage, and micropores affected scaffold resorption and bone formation in the middle stage. Furthermore, 12 weeks postoperatively, the HC scaffolds with large volumes of both channels and micropores formed a significantly larger amount of new bone than that attained using HC scaffolds with either large volume of channels or micropores, thereby bridging the host bone stumps. The findings of this study provide guidance for designing the pore structure of scaffolds.. |
| 75. |
Soichiro Yoshino, Shinya Kawahara, Toshihiko Hara, Tetsuro Nakamura, Satoshi Shin, Taro Mawatari, Goro Motomura, Satoshi Hamai, Satoshi Ikemura, Masanori Fujii, Yasuharu Nakashima, Anterior superior iliac spine is not always reliable as a pelvic reference axis. -3D study of pelvic axis-, Journal of Orthopaedic Science, 10.1016/j.jos.2022.01.011, 2022.01, Background: This study aims to evaluate the accuracy of the axis connecting both anterior superior iliac spines (ASIS axis) as the absolute pelvic axis. No study has ever verified the accuracy of ASIS axis particularly on the AP pelvic radiograph, which cannot be specified on it. Methods: Sixty patients who underwent total knee arthroplasty and fifty patients with femoral neck fracture were recruited as subjects without hip deformities and their CT scan data were collected. We defined the line through both center of femoral heads as absolute reference axis of pelvis three-dimensionally. On the coronal plane, the errors between the femoral head axis and the axes through six pelvic landmarks in total, including ASIS were analyzed. On the axial plane, the errors of the lines through four landmarks were analyzed in the same way. Finally, on the coronal images, the mediolateral diameter of the obturator foramen and the mediolateral distance between the midline of the sacrum and the pelvic cavity were measured to evaluate bilateral symmetry of the pelvis. Results: The errors tended to be smaller as the axes were closer to the femoral head axis (axes connecting bilateral superior aspects of the acetabulum and the teardrops) and the ASIS axis errors were moderate. The obturator foramen based on the ASIS axis was more asymmetrical than the femoral head axis. Conclusion: Adjusting the pelvic tilt and rotation, surgeons should not always rely on the ASIS and refer to appropriate, close to the hip joint references in each case.. |
| 76. |
Satoshi Ikemura, Goro Motomura, Satoshi Hamai, Masanori Fujii, Shinya Kawahara, Taishi Sato, Daisuke Hara, Kyohei Shiomoto, Yasuharu Nakashima, Tapered wedge stems decrease early postoperative subsidence following cementless total hip arthroplasty in Dorr type C femurs compared to fit-and-fill stems., Journal of orthopaedic surgery and research, 10.1186/s13018-022-03111-7, 17, 1, 223-223, 2022.04, BACKGROUND: To compare the degree of stem subsidence between two different femoral component designs and to determine the risk factors associated with stem subsidence after cementless total hip arthroplasty (THA) in Dorr type C femurs. METHODS: We retrospectively reviewed 104 consecutive hips in 100 patients with Dorr type C proximal femoral morphology who underwent primary cementless THA using a fit-and-fill stem or a tapered wedge femoral stem at our institution between January 2012 and June 2021. A fit-and-fill stem was used in 55 hips and a tapered wedge stem was used in 49 hips. Radiologically, the distance between the apex of the major trochanter and the stem shoulder were measured at three different time points (immediately [0W], one week [1W], and six weeks [6W] after surgery) and the degrees of stem subsidence were assessed by comparing the distance between 0 and 1W, 1W and 6W, and 0W and 6W, respectively. RESULTS: The mean degree of stem subsidence (0W vs. 1W) was 0.24 mm (standard deviation [SD] 0.36) in the fit-and-fill stem group, and 0.23 mm (SD 0.41) in the tapered wedge stem group. There was no significant difference between the two groups (P = 0.4862). However, the mean degrees of subsidence were significantly higher in the fit-and-fill stem group (1W vs. 6W, 0.38 mm [SD 0.68]; 0W vs. 6W, 0.65 mm [SD 0.87]) than in the tapered wedge stem group (1W vs. 6W, 0.16 mm [SD 0.32]; 0W vs. 6W, 0.24 mm [SD 0.38]) (P 3 mm subsidence (in which instability can be observed) were 18.2% (10 of 55 hips) and 2.0% (1 of 49 hips), respectively. There was also a significant difference between the two stems (P = 0.0091). Multivariate analysis demonstrated that fit-and-fill stem was a risk factor for > 3 mm subsidence after THA in Dorr type C femurs (P = 0.0050). CONCLUSION: Our findings suggest that the tapered wedge stem is more suitable for Dorr type C femurs than the fit-and-fill stem to avoid early postoperative subsidence in cementless THA.. |
| 77. |
Tadahiro Hotta, Naoya Kozono, Naohide Takeuchi, Akira Nabeshima, Shinya Kawahara, Satoshi Hamai, Yukio Akasaki, Hidetoshi Tsushima, Eiji Tashiro, Toshiki Konishi, Yasuharu Nakashima, Steroid-Induced Osteonecrosis of the Humeral Head in a 20-Year-Old Man Treated with an Osteochondral Autograft: A Case Report., Modern rheumatology case reports, 10.1093/mrcr/rxac037, 2022.04, To our knowledge, only one previous report described the treatment of osteochondral autograft for steroid-induced osteonecrosis of the humeral head (ONHH) in a middle-aged patient. The present report describes a 20-year-old man who was found to have avascular osteonecrosis of the right humeral head after corticosteroid pulse treatment, followed by oral corticosteroid therapy. The patient complained of serious right shoulder pain and limited range of motion (ROM). Anteroposterior (AP) radiographs of the right shoulder revealed a crescent sign at the humeral head, indicating subchondral bone collapse with a linear sclerotic change and normal articular surface of the glenoid. The case was categorized as stage 3 according to the Cruess classification. In general, Cruess classification stage 3 is treated with humeral head replacement and shoulder arthroplasty. The patient underwent surgical treatment involving osteochondral autograft transplantation. Autografts were harvested from the right knee. At the 1.5-year follow up, the patient was pain-free and showed an improved active ROM. Furthermore, AP radiographs demonstrated that the glenohumeral joint space was maintained, and no progression of humeral head collapse was observed. This case may be helpful in decision making if young patients with ONHH require surgical treatment. Further, osteochondral autograft transplantation may be an effective treatment for ONHH.. |
| 78. |
Shinya Kawahara, Daisuke Hara, Koji Murakami, Satoshi Hamai, Yukio Akasaki, Hidetoshi Tsushima, Scott A Banks, Yasuharu Nakashima, Smaller femoral neck anteversion in varus knees than in healthy and valgus knees., Clinical anatomy (New York, N.Y.), 10.1002/ca.23862, 35, 8, 1044-1050, 2022.03, It is important to investigate anatomical differences of the femur and tibia three-dimensionally between varus and valgus knees to enhance surgical approaches and better understand structural factors related to specific patterns of osteoarthritis progression. Three-dimensional femoral and tibial bone models were reconstructed from transverse computed-tomography scans in varus osteoarthritis (43 knees), valgus osteoarthritis (40 knees), and healthy (32 knees) groups. Different coordinate systems were defined in each femoral bone model ("Knee" and "Hip" Coordinate System). Femoral neck inclination, lateral bowing, anterior bowing, and neck anteversion were measured and compared between knee and hip coordinate systems. Those parameters were also compared between varus, valgus, and healthy groups. The tibial anterior and lateral bowing, external torsion and the fibular axis relative to the tibial mechanical axis were measured and compared between varus and valgus groups. Femoral neck anteversion was significantly 1-2° greater in the hip coordinate system compared to the knee coordinate system. Femoral neck anteversion was significantly smaller in varus knees than in healthy or valgus knees, with average difference of approximately 5°. The knee and hip joint are often rotated externally relative to the trunk axis in patients with varus osteoarthritis, perhaps maintaining the geometric relations between pelvis and proximal femur (including peripheral hip muscles) regardless of knee deformities. The fibular axis was inclined slightly valgus and posteriorly in two groups. The results may inform hypotheses on, and future studies of, skeletal morphologic development and factors contributing to the progression of knee osteoarthritis.. |
| 79. |
Shinya Kawahara, Taro Mawatari, Gen Matsui, Satoshi Hamai, Yukio Akasaki, Hidetoshi Tsushima, Yasuharu Nakashima, Improved surgical procedure of primary constrained total knee arthroplasty which enables use of the femoral diaphyseal straight extension stem., BMC musculoskeletal disorders, 10.1186/s12891-022-05367-w, 23, 1, 408-408, 2022.05, BACKGROUND: In performing primary constrained total knee arthroplasties (TKA) to imbalanced knees, the offset stem is sometimes compelled to use, although this is associated with surgical difficulties. We developed a modified procedure which might be able to fit the anteroposterior (AP) and mediolateral (ML) position of the femoral component simultaneously with the straight stem. Purposes of this study were to evaluate usefulness of the modified procedure both in computer simulations and actual surgeries. METHODS: We included 32 knees that had undergone primary TKA using constrained implants because of the coronal imbalance. In the component-first procedure, the distal femur was prepared to fit the AP and ML position of the femoral component simultaneously at first, as in primary TKA. Finally, the stem hole is created based on the femoral component position (the component-first procedure). The femoral component and extension stem were simulated using the three-dimensional planning software (ZedKnee) following the component-first procedure. We investigated the suitability of the straight stem through computer simulation and evaluation of actual surgeries. Clinical and radiographical outcomes were also evaluated at the latest follow-up. RESULTS: The component-first procedure enabled the AP and ML position of the femoral component to be fitted simultaneously with the straight stem in simulations and actual surgeries in all cases. The stem diameter was not significantly different between simulations and actual surgeries (13.9 and 13.7 mm on average, respectively, p = 0.479) and almost similar from intraclass correlation coefficient analysis (kappa value 0.790). Clinical and radiographical outcomes were almost similar to primary TKA cases and there was no case of component loosening, cortical bone hypertrophy around the stem and stem-tip pain. CONCLUSIONS: Our improved surgical procedure may facilitate use of the constrained implant for more cases of primary TKA in imbalanced knees without the usual surgical difficulties. TRIAL REGISTRATION: Retrospectively registered.. |
| 80. |
Kenji Kitamura, Masanori Fujii, Satoshi Ikemura, Satoshi Hamai, Goro Motomura, Yasuharu Nakashima, Factors Associated with Abnormal Joint Contact Pressure after Periacetabular Osteotomy: A Finite-Element Analysis1., The Journal of arthroplasty, 10.1016/j.arth.2022.04.045, 37, 10, 2097-2105, 2022.05, BACKGROUND: Identifying factors associated with poor hip-contact mechanics after periacetabular osteotomy (PAO) may help surgeons optimize acetabular corrections in individual patients. We performed individual-specific finite-element analyses to identify preoperative morphological and surgical correction factors for abnormal contact pressure (CP) after PAO. METHODS: We performed finite-element analyses before and after PAO with reference to the standing pelvic position on individual-specific three-dimensional hip models created from computed tomography images of 51 dysplastic hips. Nonlinear contact analyses were performed to calculate the joint CP of the acetabular cartilage during a single-leg stance. RESULTS: The maximum CP decreased in 50 hips (98.0%) after PAO compared to preoperative values, and the resulting maximum CP was within the normal range (54.3°, a postoperative anterior CEA 27.0° in the standing pelvic position predicted abnormal CP after PAO. CONCLUSION: PAO normalized joint CP in 64.7% of the patients but was less likely to normalize joint CP in patients with aspheric femoral heads. Successful surgical treatment depends on obtaining adequate anterior coverage and avoiding excessive lateral correction, while considering the physiological pelvic tilt in a weight-bearing position.. |
| 81. |
Ryunosuke Oyama, Nokitaka Setsu, Yoshihiro Matsumoto, Makoto Endo, Toshifumi Fujiwara, Keiichiro Iida, Akira Nabeshima, Yasuharu Nakashima, Efficacy and safety of tranexamic acid in patients undergoing surgery for bone and soft tissue tumors: a propensity score matching analysis., Japanese journal of clinical oncology, 10.1093/jjco/hyac078, 52, 9, 1029-1038, 2022.05, OBJECTIVE: The aim of this study was to investigate the efficacy and safety of tranexamic acid in patients undergoing surgery for bone and soft tissue tumors. METHODS: Data were retrospectively collected from 454 consecutive patients with bone and soft tissue tumors who underwent open biopsy, marginal resection, curettage or wide resection between January 2017 and December 2018. We performed propensity score matching of patients who received tranexamic acid with those who did not. The primary outcome variables were intra-operative, peri-operative and estimated blood loss (IBL, PBL and EBL, respectively). RESULTS: Tranexamic acid (+) and tranexamic acid (-) groups were defined according to whether patients received tranexamic acid or not. Among the 454 patients, open biopsy was performed in 102, marginal resection in 175, curettage in 54 and wide resection in 123. Intra-operative blood loss was significantly lower in the tranexamic acid (+) group than in the tranexamic acid (-) group for both marginal and wide resection (marginal resection: 17.3 vs. 70.3 g, respectively, P = 0.045; wide resection: 128.8 vs. 273.1 g, respectively, P = 0.023). Peri-operative blood loss and estimated blood loss were also significantly lower in the tranexamic acid (+) group for wide resection (peri-operative blood loss: 341.5 vs. 686.5 g, respectively, P = 0.0039; estimated blood loss: 320.7 vs. 550.6 ml, respectively, P = 0.030). No venous thromboembolism occurred in either group. CONCLUSION: This study suggests that TXA administration safely and effectively reduces blood loss, in particular for wide resection, with no increase in the rate of adverse events.. |
| 82. |
Masato Kiyohara, Satoshi Hamai, Kyohei Shiomoto, Satoru Harada, Tetsunari Harada, Goro Motomura, Satoshi Ikemura, Masanori Fujii, Shinya Kawahara, Yasuharu Nakashima, Does accelerometer-based portable navigation provide more accurate and precise cup orientation without prosthetic impingement than conventional total hip arthroplasty? A randomized controlled study., International journal of computer assisted radiology and surgery, 10.1007/s11548-022-02592-5, 17, 6, 1007-1015, 2022.03, PURPOSE: This prospective randomized controlled study examined whether accelerometer-based navigation resulted in more accurate or precise cup orientation than a conventional mechanical guide. We used a simulation to evaluate how cup orientation affected potential hip range of motion (RoM) and freedom from prosthetic impingement. METHODS: Sixty hips were randomly allocated 1:1 to accelerometer-based portable navigation or conventional guidance. Procedures were performed through a standard posterolateral approach and combined anteversion technique. Cup inclination, cup anteversion, and stem anteversion were measured using computed tomography (CT). Using CT-based simulation, we evaluated impingement-free potential RoM and the proportion of hips with potential RoM required for daily activities. RESULTS: Absolute cup inclination and anteversion error averaged 4.3° ± 3.2° and 4.4° ± 2.9° for the navigation cohort and 5.6° ± 3.7° and 5.7° ± 4.2° for the conventional cohort, with no significant differences. Navigation resulted in significantly less variation in anteversion error than the conventional guide (p = .0049). Flexion, internal rotation (IR) at 90° of flexion, extension, and external rotation (ER) averaged 123° ± 12°, 46° ± 13°, 50° ± 10°, and 73° ± 23°, respectively, in the navigation cohort and 127° ± 10°, 52° ± 14°, 45° ± 10°, and 63° ± 12°, respectively, in the conventional cohort (p = .15, .15, .03, and .03, respectively). Flexion > 110°, IR > 30° at 90° of flexion, extension > 30°, and ER > 30° were achieved by 93%, 90%, 100%, and 100% of hips, respectively, in the navigation cohort and 97%, 93%, 97%, and 100% of hips, respectively, in the conventional cohort, with no significant differences. CONCLUSIONS: Cup anteversion with the navigation system was more precise, but not more accurate, than with the conventional guide. The navigation cohort exhibited greater potential extension and ER than the conventional cohort, but no significant difference in impingement within the potential RoM required for daily activities. TRIAL REGISTRATION NUMBER: 29036. Date of registration: November 14, 2017.. |
| 83. |
Ryunosuke Oyama, Keiichiro Iida, Hirokazu Saiwai, Yoshihiro Matsumoto, Yasuharu Nakashima, Destructive Cervical Spondylitis due to Cutibacterium acnes with Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO) Syndrome: A Case Report., Modern rheumatology case reports, 10.1093/mrcr/rxac035, 7, 1, 267-270, 2022.04, INTRODUCTION: Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a spectrum of heterogeneous diseases commonly recognized by skin and osteoarticular lesions. There have been reports of some surgical cases of the progressive, destructive spondylitis associated with SAPHO syndrome, wherein the destructive spondylitis was considered to have developed due to the progression of spondylitis with SAPHO syndrome as the pathogenic bacteria were not isolated. We herein report a surgical case of destructive cervical spondylitis associated with SAPHO syndrome. CASE REPORT: A 54-year-old woman with a history of palmoplantar pustulosis suffered severe neck pain for 6 months. Radiography and computerized tomography (CT) showed sclerosed and collapsed cervical vertebrae, and the patient was referred to our hospital for further evaluation and management upon suspicion of infection or spondylitis with SAPHO syndrome. For the severe neck pain and progressive destruction of cervical vertebrae, we performed posterior fusion surgery with subsequent anterior fusion. Cutibacterium acnes (C. acnes) was isolated by enrichment culture with thioglycolate broth from both the anterior and posterior tissue samples. We diagnosed pyogenic spondylitis secondary to P. acnes infection and administered doxycycline for 6 weeks after the first surgery. The neck pain was resolved and cervical fusion was achieved one year postoperatively. CONCLUSION: C. acnes infection could elicit destructive spondylitis. An enrichment culture should be performed to isolate the pathogenic bacteria in cases of destructive spondylitis with SAPHO syndrome.. |
| 84. |
Makoto Nakagawa, Makoto Endo, Yosuke Susuki, Nobuhiko Yokoyama, Akira Maekawa, Akira Nabeshima, Keiichiro Iida, Toshifumi Fujiwara, Nokitaka Setsu, Tomoya Matsunobu, Yoshihiro Matsumoto, Ryohei Yokoyama, Yuichi Yamada, Kenichi Kohashi, Hidetaka Yamamoto, Yoshinao Oda, Yukihide Iwamoto, Yasuharu Nakashima, Clinical, Radiological, and Histopathological Characteristics of Periosteal Chondrosarcoma with a Focus on the Frequency of Medullary Invasion., Journal of clinical medicine, 10.3390/jcm11072062, 11, 7, 2022.04, Periosteal chondrosarcoma is an extremely rare malignant cartilage-forming tumour that originates from the periosteum and occurs on the surface of bone. Often, it is difficult to distinguish periosteal chondrosarcoma from other tumours, and reports in the literature are scarce. This study aims to investigate the characteristics of periosteal chondrosarcoma, focusing particularly on medullary invasion. Among 33 periosteal cartilaginous tumours, seven patients with pathologically proven periosteal chondrosarcoma were identified retrospectively. The average tumour size was 5.4 cm in the long axis; two tumours were smaller than 3.0 cm. Six tumours were resected with a wide margin, and the remaining tumour had a marginal margin. Histology revealed that six tumours (85.7%) had invaded the medullary cavity; three of these did not show invasion into the medullary cavity on MRI evaluation. Neither local recurrence nor metastasis was observed among these patients. The frequency of invasion of the medullary cavity was higher than that reported previously. The recommended treatment for periosteal chondrosarcoma is resection with an adequate margin. Therefore, surgeons should consider the possibility of medullary invasion when attempting to achieve a histologically negative margin, even if the tumour does not show invasion into the medullary cavity on MRI.. |
| 85. |
Tetsunari Harada, Satoshi Hamai, Kyohei Shiomoto, Daisuke Hara, Shinya Kawahara, Masanori Fujii, Goro Motomura, Yasuharu Nakashima, Analysis of Factors That Influence Patient Satisfaction After Periacetabular Osteotomy: An Asian Cohort Study., Orthopedics, 10.3928/01477447-20220425-02, 45, 5, 1-7, 2022.04, Periacetabular osteotomy (PAO) is an effective joint-preserving procedure for developmental dysplasia of the hip. However, some patients report dissatisfaction after PAO. Because patient satisfaction is increasingly used as a health care quality metric, it is important to gain a better understanding of factors associated with patient satisfaction after PAO. The goal of this study was to investigate patient satisfaction among a cohort of Asian patients undergoing PAO. This study included 227 Asian patients who had undergone PAO at our institution between 1998 and 2016. The study participants completed a questionnaire assessing patient satisfaction, reasons for dissatisfaction, and postoperative Oxford Hip Score (OHS) and University of California, Los Angeles (UCLA), activity scale score. Based on their satisfaction levels, the participants were divided into 4 subgroups, and their demographic characteristics and postoperative patient-reported outcomes were compared. Of the 227 patients, 190 expressed satisfaction that correlated with OHS-pain, OHD-activities of daily living, and UCLA activity scale scores. Primary reasons for dissatisfaction after PAO were persistent pain (24 of 49, 49%), functional limitations (14 of 49, 29%), stiffness around the hip (4 of 49, 8%), unmet expectations (4 of 49, 8%), conversion to total hip arthroplasty (2 of 49, 4%), and complications (1 of 49, 2%). Multivariate analysis showed that preoperative Kellgren-Lawrence grades 1 and 3 were the significant predictive factors for satisfaction and dissatisfaction, respectively. The potential for lower patient satisfaction associated with Kellgren-Lawrence grade 3 because of persistent pain and functional limitations postoperatively suggests that consideration of preoperative severity of osteoarthritis could enhance patient satisfaction after PAO. [Orthopedics. 20XX;4X(X):xx-xx.].. |
| 86. |
Hideki Mizu-Uchi, Shinya Kawahara, Shojiro Ishibashi, Clifford W Colwell Jr, Yasuharu Nakashima, Darryl D D'Lima, Postoperative valgus laxity and medial pivot kinematics are significantly associated with better clinical outcomes., The Journal of arthroplasty, 10.1016/j.arth.2022.02.088, 37, 6S, S187-S192-S192, 2022.02, BACKGROUND: The relative impact of soft-tissue balance and knee laxity on clinical outcomes after total knee arthroplasty (TKA) is not fully understood. We analyzed associations between knee laxity, kinematics, and patient reported outcomes. METHODS: Knee Society Scores were recorded in 67 patients before and after primary TKA for osteoarthritis with varus deformity (N=78). Varus and valgus laxity was measured in 78 knees using stress radiographs. Knee kinematics were measured fluoroscopically during stair ascent in 16 knees. RESULTS: On average, varus laxity decreased significantly, and valgus laxity increased significantly after TKA, although the net combined varus-valgus laxity did not change significantly. Postoperatively, the magnitude of valgus laxity correlated significantly with greater patient symptoms and satisfaction scores. Patients with medial pivot kinematics scored higher on patient satisfaction and standard activities. CONCLUSION: We found that postoperative valgus laxity and medial pivot kinematics were significantly associated with better clinical outcomes. These results emphasize the importance of careful preoperative planning and attention to intraoperative alignment and ligament balancing.. |
| 87. |
Ryosuke Yamaguchi, Tomoyuki Nakamura, Haruhisa Yanagida, Toru Yamaguchi, Kazuyuki Takamura, Akifusa Wada, Yasuharu Nakashima, Hip Prognosis in Patients With Congenital Diastasis of the Pubic Symphysis., Journal of pediatric orthopedics, 10.1097/BPO.0000000000002114, 42, 5, 246-252, 2022.02, BACKGROUND: Congenital diastasis of the pubic symphysis (CDPS) is a rare musculoskeletal malformation in the exstrophy-epispadias complex that is potentially associated with the development of hip dysplasia. The purpose of this study was to investigate the incidence and prognostic factors of hip dysplasia in patients with CDPS. METHODS: Fifty-four hips in 27 patients with CDPS initially evaluated between 1983 and 2016 were retrospectively reviewed. The mean age at the first visit was 2.3 (0 to 8) years. The mean follow-up duration was 10.5 (1 to 36) years. Patient characteristics at the first visit, the clinical course at the most recent follow-up, and radiologic parameters on pubic malformation and hip dysplasia during at least 2 time points (first visit or age 1, and either the most recent visit or before hip surgery) were evaluated. Prognostic factors associated with the development of hip dysplasia were analyzed using univariate/multivariate analysis. The Kaplan-Meier survival curves were generated and compared based on these factors. RESULTS: Nine of 27 patients (33%) and 13 of 54 hip joints (24%) with CDPS developed hip dysplasia. Paraplegia (odds ratio, 10.0; 95% confidence interval, 1.7-76.6) and center-edge angle of |
| 88. |
Toshifumi Fujiwara, Masakazu Kondo, Hisakata Yamada, Akihisa Haraguchi, Kenjiro Fujimura, Koji Sakuraba, Satoshi Kamura, Jun-Ichi Fukushi, Hisaaki Miyahara, Yasushi Inoue, Tomomi Tsuru, Toshihide Shuto, Seiji Yoshizawa, Eiichi Suematsu, Tomoya Miyamura, Masahiro Ayano, Hiroki Mitoma, Yojiro Arinobu, Hiroaki Niiro, Masanobu Ohishi, Akie Hirata, Shoji Tokunaga, Atsushi Takada, Daisuke Hara, Hidetoshi Tsushima, Yukio Akasaki, Satoshi Ikemura, Takuya Sueishi, Masakazu Toya, Takahide Sakuragi, Tomoko Tsutsui, Kazuhiro Kai, Shinkichi Arisumi, Yasuharu Nakashima, Factors affecting patient satisfaction related to cost and treatment effectiveness in rheumatoid arthritis: results from the multicenter observational cohort study, FRANK Registry., Arthritis research & therapy, 10.1186/s13075-022-02746-5, 24, 1, 53-53, 2022.02, BACKGROUND: To further improve rheumatoid arthritis (RA) treatment, it is necessary to understand each RA patient's satisfaction and to identify the factors affecting their satisfaction. Despite the rise in medical costs for RA, little is known about the factors that influence patient satisfaction with the cost of treatment in RA patients. METHODS: This is a multicenter observational study of Japanese RA patients from the FRANK Registry with data analyzed from March 2017 to August 2020. We collected data on demographic characteristics, clinical data, quality of life which was evaluated using the EuroQol 5-dimensional questionnaire (EQ5D), and patient satisfaction. The four categories of patient satisfaction were evaluated individually (i.e., cost, treatment efficacy, activities of daily living [ADL], and global treatment satisfaction). We analyzed the factors that affected each patient's satisfaction, such as age, sex, EQ5D, disease duration, disease activity, and treatment. RESULTS: This study included 2235 RA outpatients (406 males, 1829 females). In RA patients, "very satisfied" and "satisfied" were given for nearly half of each satisfaction aspect (cost 49%; efficacy 72%; ADL 58%; global treatment 66%) at the time of the initial registration. To investigate the factors influencing each satisfaction, multivariate analysis has revealed that the use of b/tsDMARDs increased satisfaction of treatment effect (odds ratio [OR] 0.66) and ADL (OR 0.78) but decreased cost satisfaction (OR 2.21). Age (50-64 years; OR 0.91; 65-74 years, 0.55: ≥ 75 years, 0.35), female (OR 0.81), and history of musculoskeletal surgery (OR 0.60) all increased cost satisfaction. Patients with lower disease activity and higher EQ5D scores had higher levels of satisfaction in all areas. CONCLUSIONS: In this study, patient satisfaction in terms of cost, treatment effect, ADL, and overall treatment was generally higher, but some patients were dissatisfied. The cost of satisfaction increased with age and a history of musculoskeletal surgery, while it decreased with a lower EQ5D score and the use of b/tsDMARDs.. |
| 89. |
Tsutomu Fujita, Satoshi Hamai, Kyohei Shiomoto, Kazuya Okazawa, Yu-Ki Nasu, Daisuke Hara, Satoru Harada, Goro Motomura, Satoshi Ikemura, Masanori Fujii, Shinya Kawahara, Ken-Ichi Kawaguchi, Yasuharu Nakashima, Analysis of factors influencing patient satisfaction after total hip arthroplasty in a Japanese cohort: the significant effect of postoperative physical activity., Journal of physical therapy science, 10.1589/jpts.34.76, 34, 2, 76-84, 2022.02, [Purpose] To determine patient satisfaction after total hip arthroplasty in a Japanese cohort and to identify factors that significantly influence patient satisfaction. [Participants and Methods] This study included 285 patients who underwent primary total hip arthroplasty for osteoarthritis. Postoperative satisfaction, Oxford hip score, short form-12 mental component summary score, and University of California Los Angeles activity score were investigated. Muscle strength and daily step counts were determined using a hand-held dynamometer (μ-Tas F1) and activity monitor (ActivPAL) in 89 and 26 patients, respectively. Factors associated with postoperative satisfaction, Oxford hip score-activities of daily living, and University of California Los Angeles activity score were identified. The relationship between the Oxford hip score-activities of daily living and daily step counts was examined. [Results] Overall, 94.7% of the patients reported satisfaction with total hip arthroplasty. The Oxford hip score-activities of daily living and University of California Los Angeles activity score were significantly associated with patient satisfaction. Younger age and hip abductor strength were significantly associated with a higher Oxford hip score-activities of daily living and University of California Los Angeles activity score. The average daily step count was significantly correlated with the Oxford hip score-activities of daily living. [Conclusion] Self-reported physical activity levels significantly influenced patient satisfaction and were correlated with objective muscle strength and daily step count measurements. These findings can guide total hip arthroplasty patient counseling on the importance of muscle strength and activity levels.. |
| 90. |
T Hara, K Hayashi, Y Nakashima, Y Iwamoto, Effect of hydroxyapatite-coating on the bonding of bone to titanium implants in the femur of ovariectomized rats, BIOCERAMICS, VOL 10, 471-473, 1997.01, Twelve rats were ovariectomized, and 12 rats were control. After 24 weeks, all rats had HA-coated titanium cylindrical implants inserted into the medullary canal of the right femurs and uncoated implants inserted into the left femurs. Four weeks later, the implants were harvested and subjected to mechanical push-out test. The dissected left tibias were subjected to dual energy X-ray absorptiometry (DEXA). DEXA showed a 13.4% reduction in bone density in the ovariectomized group as compared with control. The push-out strength of HA-coated implants was higher than uncoated implants in both groups. No significant difference in the push-out strength of uncoated implants was measured between the control and ovariectomized group. HA-coated implants showed a 40.3% reduction in push-out strength in the ovariectomized group compared with control.. |
| 91. |
Y Nakashima, DH Sun, M Trindade, WJ Maloney, SB Goodman, DJ Schurman, RL Smith, M Ushijima, Y Iwamoto, Expression of inflammatory mediators by human macrophages in response to particulate debris in vitro, JOINT ARTHROPLASTY, 65-75, 1999.01, This paper reports the induction of proinflammatory mediators in human macrophages in response to orthopedic biomaterial wear particles. Human macrophages from healthy subjects were exposed to titanium alloy and polymethylmethacrylate (PMMA) particles in vitro. Expression of proinflammatory cytokines and matrix metalloproteinases (MMPs) were analyzed biochemically. Titanium alloy particles induced macrophage release of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha). Titanium alloy and PMMA particles also stimulated macrophage release of monocyte chemoattractant protein-1 (MCP-1) and macrophage inflammatory protein-1 alpha (MIP-1 alpha) in a dose- and time-dependent manner. Particulate debris also induced increased levels of MMP-1, -2 and -9 in a dose- and time-dependent manner. These data demonstrated that particulate debris induced proinflammatory mediator expression in isolated macrophages. Expression of these mediators by wear debris may accelerate periprosthetic bone resorption and granuloma formation.. |
| 92. |
NAGAMINE Ryuji, MAEDA Takeshi, SHUTO Toshihide, NAKASHIMA Yasuharu, HIRATA Go, IWAMOTO Yukihide, Menopausal syndrome in female patients with rheumatoid arthritis, Modern rheumatology, 10.3109/s101650170009, 11, 3, 230-233, 2001.01. |
| 93. |
SUENAGA EIJI, NOGUCHI YASUO, JINGUSHI SEIYA, SHUTO TOSHIHIDE, NAKASHIMA YASUHARU, MIYANISHI KEITA, IWAMOTO YUKIHIDE, Relationship between the maximum flexion-internal rotation test and the torn acetabular labrum of a dysplastic hip, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 10.1007/s776-002-8409-8, 7, 1, 26-32, 2002.01. |
| 94. |
特発性大腿骨頭壊死症の診断・治療・予防法の開発を目的とした全国学際的研究 非典型的な画像所見を呈した大腿骨頭壊死症の1例. |
| 95. |
Yasuharu Nakashima, Masakazu Kondo, Hisaaki Miyahara, Yukihide Iwamoto, Drug delivery options to increase patient adherence and satisfaction in the management of rheumatoid arthritis - focus on subcutaneous tocilizumab, DRUG DESIGN DEVELOPMENT AND THERAPY, 10.2147/DDDT.S52099, 8, 913-919, 2014.01, Rheumatoid arthritis (RA) is a chronic, progressive, inflammatory disease associated with joint destruction. Tocilizumab (TCZ) is a humanized monoclonal anti-interleukin-6 receptor antibody that was initially developed for use as an intravenous (IV) infusion. Previous studies have shown that TCZ-IV is an important treatment option in patients with moderate-to-severe RA. A subcutaneous (SC) formulation of 162 mg TCZ that was recently developed and approved provides an additional treatment option for RA patients. In the present review, we provide an update on the efficacy and safety of TCZ-SC, compared with TCZ-IV. The TCZ-SC doses of 162 mg every 2 weeks (q2w) or weekly (qw) were selected based on pharmacokinetic and pharmacodynamic studies. Both TCZ-SC q2w and qw regimens showed equivalent effects to TCZ-IV in most patients; however, the TCZ-SC qw regimen consistently showed a more rapid effect in terms of C-reactive protein normalization. Randomized controlled studies showed that TCZ-SC monotherapy or combined with disease-modifying antirheumatic drugs demonstrated comparable efficacy to TCZ-IV in patients who were both biologic-naive and refractory to tumor necrosis factor inhibitors. TCZ-SC at both qw and q2w were generally well-tolerated for up to 24 weeks. There was a low rate of withdrawal due to adverse events, and their incidence was comparable with that seen with TCZ-IV. An injection site reaction was seen in approximately 10% of patients who received the subcutaneous formulation. In conclusion, although clinical results are still limited, the currently available evidence suggests that TCZ-SC is a promising treatment for moderate-to-severe RA, both as monotherapy and combination therapy. More data is needed to determine the optimal dosing schedule.. |
| 96. |
Abdul Halim Abdullah, Mitsugu Todo, Yasuharu Nakashima, Stress and damage formation analysis in hip arthroplasties using CT-based finite element method, Journal of Engineering and Applied Sciences, 10.3923/jeasci.2017.2715.2719, 12, 10, 2715-2719, 2017.01, Femoral neck fractures and prosthesis loosening are several biomechanical concerns in promoting the long term stability of hip arthroplasties. External high impact loading due to sideway falls may contribute to the risk of femoral fractures and joint failures. The purpose of this study is to investigate the biomechanical effects of hip resurfacing and total hip arthroplasty on the resulting stress and damage formation. Four loading conditions are considered in the analysis to represent sideway falls at different configurations. Finite element analysis is performed using CT-based femoral bone model to predict the stress and damage formation in both arthroplasties. Stress shielding effects and potential of femoral fractures are observed in the cortical bone adjacent to the prosthesis. The results show that stress adaptation is predicted at both hip arthroplasties cases which lead to stress shielding problems especially in total hip arthroplasty. The variation of damage formation at trochanteric region suggested for femoral neck fractures and potential of implant loosening in both cases.. |
| 97. |
Masanori Fujii, Yasuharu Nakashima, Tetsuro Nakamura, Yoshihiro Ito, Toshihiko Hara, Minimum Lateral Bone Coverage Required for Securing Fixation of Cementless Acetabular Components in Hip Dysplasia, BIOMED RESEARCH INTERNATIONAL, 10.1155/2017/4937151, 2017, 4937151-4937151, 2017.01, Objectives. To determine the minimum lateral bone coverage required for securing stable fixation of the porous-coated acetabular components (cups) in hip dysplasia. Methods. In total, 215 primary total hip arthroplasties in 199 patients were reviewed. The average follow-up period was 49months (range: 24-77months). The lateral bone coverage of the cups was assessed by determining the cup center-edge (cup-CE) angle and the bone coverage index (BCI) from anteroposterior pelvic radiographs. Further, cup fixation was determined using the modified DeLee and Charnley classification system. Results. All cups were judged to show stable fixation by bone ingrowth. The cup-CE angle was less than 0 degrees in 7 hips (3.3%) and the minimum cup-CE angle was-9.2 degrees(BCI: 48.8%). Thin radiolucent lines were observed in 5 hips (2.3%), which were not associated with decreased lateral bone coverage. Loosening, osteolysis, dislocation, or revision was not observed in any of the cases during the follow-up period. Conclusion. A cupCE angle greater than -10 degrees (BCI > 50%) was acceptable for stable bony fixation of the cup. Considering possible errors in manual implantation, we recommend that the cup position be planned such that the cup-CE angle is greater than 0 degrees (BCI > 60%).. |
| 98. |
Hirofumi Bekki, Katsumi Harimaya, Yoshihiro Matsumoto, Kenichi Kawaguchi, Mitsumasa Hayashida, Seiji Okada, Toshio Doi, Yasuharu Nakashima, Which side-bending X-ray position is better to evaluate the preoperative curve flexibility in adolescent idiopathic scoliosis patients, supine or prone?, Asian Spine Journal, 10.31616/ASJ.2018.12.4.632, 12, 4, 632-638, 2018.01, © 2018 by Korean Society of Spine Surgery. Study Design: Prospective cohort study. Purpose: The present study aimed to evaluate the difference in the preoperative curve flexibility between the supine and prone positions in patients with adolescent idiopathic scoliosis (AIS). Overview of Literature: In AIS, a side-bending view is necessary to differentiate a structural curve from a nonstructural curve using the Lenke classification system. However, there are no published studies about which position, supine or prone, is more effective when evaluating preoperative curve flexibility using side-bending X-ray images in AIS patients. Methods: Radiographs were analyzed for 32 AIS patients (26 females, six males) who underwent posterior correction and fusion of their main thoracic (MT) curves. Cobb angles of MT, proximal thoracic (PT), and thoracolumbar/lumbar (TL/L) curves were measured preoperatively using upright, supine (anteroposterior and side-bending), and prone (posteroanterior and side-bending) X-rays. Results: The average Cobb angles of PT, MT, and TL/L curves on preoperative upright/supine/prone X-rays were 29.1°/26.7°/26.6°, 60.7°/48.5°/48.2°, and 41.0°/32.6°/33.1°, respectively. The average Cobb angles of PT, MT, and TL/L curves on supine/prone sidebending X-rays were 19.2°/20.3°, 36.3°/36.4°, and 13.9°/15.7°, respectively. The flexibility rates of PT, MT, and TL/L curves in supine/ prone positions were 35.3%/32.5%, 40.6%/40.2%, and 71.7%/68.2%, respectively. Comparing flexibility rates in the prone position with those in the supine position in each case, the average ratios of PT, MT, and TL/L curves were found to be 1.0, 1.0, and 0.9, respectively. There were no statistically significant differences between supine and prone side-bending X-ray measurements. However, the Lenke classification in six of 32 patients (18.8%) differed between supine and prone positions because the TL/L curve in the supine position was slightly more flexible than in the prone position. Conclusions: Supine side-bending films may be suitable for the evaluation of preoperative curve flexibility in AIS, especially for lumbar modifier C.. |
| 99. |
Koichiro Kawano, Goro Motomura, Satoshi Ikemura, Yusuke Kubo, Hiroyuki Hatanaka, Takeshi Utsunomiya, Shoji Baba, Yasuharu Nakashima, Subchondral insufficiency fracture of the femoral head in an elderly woman with symptomatic osteoarthritis of the contralateral hip, Journal of Orthopaedic Science, 10.1016/j.jos.2018.02.001, 25, 6, 1116-1118, 2018.01. |
| 100. |
Movement analysis of acetabulum before and after transposition osteotomy of the acetabulum using image matching method. |
| 101. |
Satoru Harada, Satoshi Hamai, Kyohei Shiomoto, Daisuke Hara, Masanori Fujii, Satoshi Ikemura, Goro Motomura, Yasuharu Nakashima, Patient-reported outcomes after primary or revision total hip arthroplasty: A propensity score-matched Asian cohort study., PloS one, 10.1371/journal.pone.0252112, 16, 5, e0252112, 2021.01, BACKGROUND: Few studies have compared patient-reported outcome measures (PROMs) between primary and revision total hip arthroplasty (THA). We investigated and compared PROMs between propensity score-matched primary and revision THA in an Asian cohort. METHODS: The Oxford Hip Score (OHS) and University of California-Los Angeles (UCLA) activity score, satisfaction score, and Short Form-12 Health Survey (SF-12) were compared between 110 primary and 110 revision THAs after propensity score matching. Multivariate analyses were performed to determine which factors, including patients' demographics, indication for revision, and pre-operative PROMs, were associated with post-operative PROMs in the revision THA cohort. RESULTS: The revision THA cohort demonstrated significantly lower post-operative OHS, UCLA activity score, and satisfaction score (10% decrease on average) than those in the primary THA cohort (P |
| 102. |
So Kuwakado, Kenichi Kawaguchi, Akemi Sakugawa, Masanori Takahashi, Taiji Oda, Nobuto Shimamoto, Goro Motomura, Satoshi Hamai, Yasuharu Nakashima, Factors Affecting the Length of Convalescent Hospital Stay Following Total Hip and Knee Arthroplasty., Progress in rehabilitation medicine, 10.2490/prm.20210033, 6, 20210033-20210033, 2021.01, Objectives: : An important role of convalescent rehabilitation wards is the short-term improvement of mobility and activities of daily living (ADL). We aimed to identify predictors associated with the length of stay (LOS) in a convalescent hospital after total hip and knee arthroplasty. Methods: : This study included 308 patients hospitalized in a convalescent ward following total hip or total knee arthroplasty. The following factors were examined: age, sex, orthopedic comorbidities, motor component of the functional independence measure (M-FIM), M-FIM gain, pain, 10-m walk test, timed up and go (TUG) test, functional ambulation category (FAC), cognitive function, and nutritional status. LOS was categorized as shorter (≤40 days) or longer (>40 days), based on the national average LOS in a convalescent ward, and was statistically analyzed with predictor variables. Results: : In our hospital, the average LOS was 36.9 ± 21.4 days, and the average M-FIM at admission to the convalescent ward and the M-FIM gain were 71.1 ± 7.0 and 16.3 ± 6.9, respectively. In univariate analysis, there was a significant correlation between LOS and M-FIM at admission and M-FIM gain, pain, TUG time, and FAC. Logistic multivariate analysis identified M-FIM at admission (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.88-0.98) and TUG time (OR 1.10, 95% CI 1.03-1.18) as independent predictors of LOS. Conclusions: : The M-FIM and TUG test can be used to accurately estimate LOS and to plan rehabilitation treatment in a convalescent rehabilitation ward after lower-limb arthroplasty. Furthermore, preoperative or early postoperative intervention may lead to better quality motor activity and shorter LOS during the convalescent period.. |
| 103. |
Two Cases of Thoracic Spinal Cysts.
Two cases of spinal arachnoid cysts are reported, one with Syringomyelia, Spondylosis and tethered cord syndrome, which is considered to be a congenital cyst, the other with RA and Lumbar disc herniation. The former was treated by cyst resection, S-S shunting, transpedicular fusion and resection of the terminal film. The latter was treated by cyst resection and nucleotomy. Treatment in these cases led to improvement in neurological symptoms.. |
| 104. |
Y NAKASHIMA, K HAYASHI, T INADOME, Y SUGIOKA, HYDROXYAPATITE COATING ON TITANIUM-SPRAYED TITANIUM IMPLANT, BIOCERAMICS, VOL 6, 449-453, 1993.01. |
| 105. |
A Study of Hybrid Total Hip Replacement. Mid-term Results and Problems.:Mid-term Results and Problems
Sixty-five hybrid total hip replacements (THRs) in 58 patients with osteoarthritis (OA) and rheumatoid arthritis (RA) were analysed with regard to chinical and radiographical findings more than one year after surgery. The mean follow-up period was 22.2 months. Results are as follows; (1) Thigh pain occurred in 5.5% of OA cases (55 cases) and 10% of RA cases (10 cases). (2) Radiolucent lines were found in zone 1 (21.5%). (3) Bone cement gaps were found in 14.5% of OA cases and 0% of RA cases. (4) No osteolysis was found in any cases.. |
| 106. |
Radiographic Evaluation of Nishio Type Surface Total Hip Arthroplasty.
We performed radiographic evaluation of the Nishio type surface total hip arthroplasty. This type of replacement has been performed in 138 hips in 127 patients. Almost all cases showed aseptic loosening. Typical findings were sinking of the femoral component and migration of the acetabular component.
Eighty-seven hips in 83 patients were followed-up, and, at an average of 9 years after initial surgery, 57% of these patients had already had revision surgery. However, the average follow-up period for the remaining patients is 15.7 years, therefore this procedure achieved our initial aim of time-saving.. |
| 107. |
Clinical Research of Surgical Treatment for Metastatic Spinal Tumors.
From May 1989 to May 1992, twenty patients were surgically treated for metastatic spinal tumors. Metastasis was from primary lesions of the breast in seven cases, kidney in four cases, liver in three cases, digestive tract in two cases and others in four cases. Nineteen cases had pain and 16 cases showed neurologic deficits. Two cases were treated by posterior fixation, ten cases by posterior fixation and decompression, and 12 cases by a combined anterior and posterior procedure.
As a result, all cases had pain relief, and neurological improvement was obtained in seven cases. Ten cases (breast: six, kidney: three, other: one) survived, while the remaining ten cases died. If the primary lesion is one of low malignancy, surgical treatment is recommended because of the improvement of QOL and life expectancy.. |
| 108. |
Y Nakashima, T Shuto, K Hayashi, T Hotokebuchi, T Inadome, T Hara, Y Sugioka, Stimulatory effects of ceramic particles on the production of bone resorbing mediators, BIOCERAMICS, VOL 7, 305-309, 1994.01. |
| 109. |
K Hayashi, Y Nakashima, Inadome, I, Y Sugioka, Noda, I, Comparison of hydroxyapatite-coated with Harris/Galante porous uncemented total hip replacement - A retrospective matched study and experimental study for the improvement of HA-coating, BIOCERAMICS, VOL 7, 441-446, 1994.01. |
| 110. |
S Jingushi, Y Noguchi, T Shuto, Y Nakashima, Y Iwamoto, Uncemented femoral revision, ARTHROPLASTY 2000, 75-79, 2001.01, Loss of bone stock is the most difficult problem in femoral revision surgery. Even when the bone defect is moderate or severe, immediate fixation of the femoral component should be mainly supported by native bone. Additionally, in the remaining bone loss, bone tissue is grafted as much as possible. According to these principles, we prefer uncemented femoral revisions rather than cemented revisions. This chapter shows short-term clinical results of femoral revisions in our department mainly using an uncemented femoral component. From 1993 until 1999, 53 femoral revisions have been performed. We reviewed 50 hips. Mean age at operation was 64 (range, 41-82) years. All revisions were due to aseptic loosening. Twenty-one patients were followed for at least 2 years (range, 2-6 years; mean, 3.8 years) for clinical evaluation. Intraoperative complications occurred in 9 hips (18%); 7 hips had perforation, and 2 hips had fracture. All the complications occurred in revision of failed cemented components. Using the scoring system of Merle d'Aubigne and Postel as modified by Charnley, average pain and gait scores at the latest evaluation were 5.1 and 4.0, respectively. No rerevision was undergone. Six hips (29%) were radiographically loosened. The advantages of uncemented femoral revisions are to enable restoration of bone stock and biological fixation by native bone. Furthermore, an uncemented component could be removed relatively easily if it failed in the future. The survival rate of revision arthroplasty is low compared with that of primary THA. In addition to the present revision, a possible next operation in the future should be considered when we plan revision surgery.. |
| 111. |
Yuka Otera, Seiichi Morokuma, Yasuo Yumoto, Satoshi Hojo, Takako Gotoh, Toshiro Hara, Yasuhiro Ushijima, Yasuharu Nakashima, Kiyomi Tsukimori, Norio Wake, Prenatal Three-Dimensional Images of Proximal Focal Femoral Deficiency Produced by Helical Computed Tomography, FETAL DIAGNOSIS AND THERAPY, 10.1159/000235884, 25, 3, 349-353, 2009.01, Introduction: Proximal focal femoral deficiency (PFFD) is a rare skeletal disorder characterized by failure in development of the subtrochanteric region of the femoral shaft, with varying degrees of shortening of the proximal femur. Objective: To investigate the potential of helical computed tomography as a prenatal diagnostic tool for bony abnormalities. Case: A 37-year-old Japanese woman was referred to our hospital at 32 weeks of gestation for the evaluation of fetal growth restriction with short femurs. An ultrasound examination revealed the fetus to have short femurs bilaterally with normal echogenicity, and a normal facial profile. Assessment by 3D CT confirmed the absence of the femoral heads bilaterally and also revealed bilateral hip dislocations and oligodactyly of the right hand. The baby was delivered by cesarean section at 37 weeks of gestation, whereupon the diagnosis of PFFD was confirmed. Conclusion: Helical CT is a useful prenatal diagnostic alternative for bony abnormalities that is superior to the conventional sonographic approach. Copyright (C) 2009 S. Karger AG, Basel. |
| 112. |
Ikuo Wada, Eisuke Sakuma, Takanobu Otsuka, Kenjiro Wakabayashi, Kinya Ito, Osamu Horiuchi, Yoshimi Asagai, Makoto Kamegaya, Eiji Goto, Shinichi Satsuma, Daisuke Kobayashi, Susumu Saito, Mayuki Taketa, Kazuharu Takikawa, Yasuharu Nakashima, Tadashi Hattori, Shigeru Mitani, Akifusa Wada, The Pavlik harness in the treatment of developmentally dislocated hips: Results of Japanese multicenter studies in 1994 and 2008, Journal of Orthopaedic Science, 10.1007/s00776-013-0432-z, 18, 5, 749-753, 2013.01, Background: It has already been more than 50 years since the Pavlik harness was introduced in Japan, and today the Pavlik harness is widely recognized as the standard initial treatment modality for developmental dysplasia of the hip. We performed a multicenter nationwide questionnaire study concerning the results of Pavlik harness treatment twice in 1994 and 2008. Methods: In 1994 and in 2008, we sent questionnaires to 12 institutes in Japan specializing mainly in pediatric orthopedics. We compare the results of these two studies and discuss differences in reduction rates, incidence of avascular necrosis in the femoral epiphysis and the percentage of joints with acceptable morphology (Severin grade I + II/total) at skeletal maturity. We statistically assessed these results to see whether there were changes in the treatment outcomes over this 14-year period. Results: Reduction of the dislocated hips was obtained by the Pavlik harness in 80.2 % (1990/2481 hips
1994) and 81.9 % (1248/1523 hips
2008). The incidences of avascular necrosis of the proximal femoral epiphysis in the dysplastic hips were 14.3 % (119/835 hips
1994) and 11.5 % (76/663 hips
2008). The type of avascular necrosis in hips from the 2008 study was determined according to the classification of Kalamchi and MacEwen: 24/69 hips (34.8 %) were classified as group I
20/69 hips (29.0 %) as group II
11/69 hips (15.9 %) as group Ill
14/69 hips (20.3 %) as group IV. The percentages of hips with acceptable outcomes at skeletal maturity discerned from Severin X-ray changes (grade I + II/total) were 72.3 % (604/835 hips
1994) and 77.7 % (488/628 hips
2008). Conclusion: Reduction rates and the incidence of avascular necrosis in 2008 were statistically similar to the results in 1994. The rate of acceptable outcome (Severin grade I + II/total) in 2008 was statistically higher than that of 1994. © 2013 The Author(s).. |
| 113. |
Taishi Sato, Yasuharu Nakashima, Mio Akiyama, Takuaki Yamamoto, Taro Mawatari, Takashi Itokawa, Masanobu Ohishi, Goro Motomura, Masanobu Hirata, Yukihide Iwamoto, Comparison of polyethylene wear between highly crosslinked and annealed UHMWPE and conventional UHMWPE against ceramic heads in total hip arthroplasty, Key Engineering Materials, 10.4028/www.scientific.net/KEM.529-530.279, 529-530, 1, 279-284, 2013.01, The purpose of this study was to examine the effects of ceramic femoral head material on the wear of annealed, crosslinked ultra-high molecular weight polyethylene (UHMWPE) (XLPE) in total hip arthroplasty compared to non-crosslinked conventional UHMWPE (CPE). XLPE was fabricated by crosslinking with 60 kGy irradiation and annealing. Femoral heads made from zirconia and alumina ceramics, and cobalt-chrome (CoCr) of 22 mm or 26 mm diameter were used. In this study, the femoral head penetration into the cup was measured digitally on radiographs of 70 hips with XLPE and 50 hips with CPE. The average follow-up periods were 6.1 and 12.7 years, respectively. The steady wear rate of XLPE was significantly lower than those of CPE (0.002 versus 0.08 mm/year, respectively). Zirconia displayed increased wear rates compared to alumina in CPE
however, there was no difference among head materials in XLPE (0.0028, 0.011 and 0.009 mm/year for zirconia, alumina and CoCr, respectively). Neither head size or implantation period impacted XLPE wear. In contrast to CPE, XLPE displayed low wear rates surpassing the effects of varying femoral head material, size, implantation period and patient demographics. © (2013) Trans Tech Publications, Switzerland.. |
| 114. |
Keiichiro Iida, Satoshi Hamai, Takuaki Yamamoto, Yasuharu Nakashima, Goro Motomura, Masanobu Ohishi, Kazuyuki Karasuyama, Yukihide Iwamoto, Subchondral fracture of the femoral head after acetabular fracture: A case report, Journal of Medical Case Reports, 10.1186/1752-1947-8-447, 8, 1, 447-447, 2014.01, Introduction: Preventing post-traumatic osteoarthritis is a challenging problem following acetabular fracture. Progressive osteoarthritis is considered to be caused by an irregular articular surface of the acetabular roof or cartilage injury, but little is known about the pathogenesis of collapse of the femoral head after acetabular fracture. We report a case of post-traumatic osteoarthritis after acetabular fracture in which subchondral fracture of the femoral head contributed to the progressive collapse of the femoral head and osteoarthritis. To the best of our knowledge, there has been no previous report of subchondral fracture of the femoral head after acetabular fracture. Case presentation: A 58-year-old Japanese man fell from a ladder. He was diagnosed with a left acetabular fracture, which was managed conservatively. He developed left coxalgia six months after injury and was seen at our institution one year after the onset of pain. The left acetabular fracture had fused, but his left femoral head had collapsed. The images at the time of injury showed a fracture of the acetabular roof, and an approximately 2mm step-off existed in the articular surface. Retrospective evaluation of the plain radiographs and computed tomography images showed that his femoral head had progressively collapsed. Our patient underwent total hip arthroplasty. Histopathologic findings demonstrated that the collapse of his femoral head was caused by a subchondral fracture of his femoral head. Conclusion: Our experience with this case indicates that in addition to post-traumatic osteonecrosis, subchondral fracture may need to be considered in cases with progressive collapse of the femoral head after acetabular fracture.. |
| 115. |
Yasuharu Nakashima, Masakazu Kondo, Takaaki Fukuda, Hiroshi Harada, Takahiko Horiuchi, Takashi Ishinishi, Hiroshi Jojima, Koji Kuroda, Hisaaki Miyahara, Masayuki Maekawa, Hiroaki Nishizaka, Ryuji Nagamine, Hitoshi Nakashima, Takeshi Otsuka, Eisuke Shono, Eiichi Suematsu, Takashi Shimauchi, Tomomi Tsuru, Ken Wada, Shigeru Yoshizawa, Seiji Yoshizawa, Yukihide Iwamoto, Remission in patients with active rheumatoid arthritis by tocilizumab treatment in routine clinical practice: Results from 3 years of prospectively registered data, Modern Rheumatology, 10.3109/14397595.2013.854069, 24, 2, 258-264, 2014.01, Objectives. This study aimed to evaluate the remission in rheumatoid arthritis (RA) patients treated with tocilizumab (TCZ), based on prospectively registered data in clinical practice. Methods. We studied 114 consecutive RA patients treated with TCZ for an average of 3.5 years. Remission was evaluated by using the EULAR criteria and the new ACR/EULAR Boolean-based criteria. Results. Among 114 patients (average age 52.2 years
average disease duration 10.6 years), 76 (67 %) had previously received anti-TNF biologics. Mean baseline DAS28-ESR of 5.4 and improved to 2.4 at 36 months. Overall, DAS28-ESR <
2.6 was attained by 66.7 %, while ACR/EULAR remission was attained by 35.1 %. ACR/EULAR remission rate was significantly higher in the patients who were biologics-naïve and had good response at the first month. Among 23 patients who completed the treatment for 3 years and had ACR/EULAR remission at 1 year, 15 (65 %) remained in the remission and 16 (70 %) had a DAS28-ESR <
2.6 at the final follow-up. The retention rate at 36 months was 68.2 %. Conclusions. In patients with RA, TCZ is highly effective for both biologics-naïve patients and patients previously exposed to biologics, achieving a high remission rate and drug continuation rate (68.2 %) in clinical practice. © 2014 Japan College of Rheumatology.. |
| 116. |
Daisuke Hara, Yasuharu Nakashima, Satoshi Hamai, Hidehiko Higaki, Satoru Ikebe, Takeshi Shimoto, Masanobu Hirata, Masayuki Kanazawa, Yusuke Kohno, Yukihide Iwamoto, Kinematic Analysis of Healthy Hips during Weight-Bearing Activities by 3D-to-2D Model-to-Image Registration Technique, BIOMED RESEARCH INTERNATIONAL, 10.1155/2014/457573, 2014, 457573-457573, 2014.01, Dynamic hip kinematics during weight-bearing activities were analyzed for six healthy subjects. Continuous X-ray images of gait, chair-rising, squatting, and twisting were taken using a flat panel X-ray detector. Digitally reconstructed radiographic images were used for 3D-to-2D model-to-image registration technique. The root-mean-square errors associated with tracking the pelvis and femur were less than 0.3mm and 0.3 degrees for translations and rotations. For gait, chair-rising, and squatting, the maximum hip flexion angles averaged 29.6 degrees, 81.3 degrees, and 102.4 degrees, respectively. The pelvis was tilted anteriorly around 4.4 degrees on average during full gait cycle. For chair-rising and squatting, the maximum absolute value of anterior/posterior pelvic tilt averaged 12.4 degrees /11.7 degrees and 10.7 degrees/10.8 degrees, respectively. Hip flexion peaked on the way of movement due to further anterior pelvic tilt during both chair-rising and squatting. For twisting, the maximum absolute value of hip internal/external rotation averaged 29.2 degrees /30.7 degrees. This study revealed activity dependent kinematics of healthy hip joints with coordinated pelvic and femoral dynamic movements. Kinematics' data during activities of daily living may provide important insight as to the evaluating kinematics of pathological and reconstructed hips.. |
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Takanori Yamashita, Brendan Flanagan, Yoshifumi Wakata, Satoshi Hamai, Yasuharu Nakashima, Yukihide Iwamoto, Naoki Nakashima, Sachio Hirokawa, Visualization of Key Factor Relation in Clinical Pathway., 19th International Conference in Knowledge Based and Intelligent Information and Engineering Systems(KES), 10.1016/j.procs.2015.08.139, 60, 1, 342-351, 2015.01, The secondary use of medical data to improve medical care is gaining much attention. We have analyzed electronic clinical pathways for improving the medical process. The analysis of clinical pathways so far has used statistics analysis models, however as issue remains that the order, and multistory spatial and time relations of the each factor could not be analyzed. We constructed an Outcome tree system that shows the greatest significant relation for each factor. The Hip replacement arthroplasty clinical pathway was analyzed by the system, and the outcome variance of the clinical pathway was visualized. The results indicate the path of patient's who have a long hospitalization stay and extracted four critical indicators.. |
| 118. |
Takanori Yamashita, Yoshifumi Wakata, Satoshi Hamai, Yasuharu Nakashima, Yukihide Iwamoto, Brendan Flanagan, Naoki Nakashima, Sachio Hirokawa, Temporal Relation Extraction in Outcome Variances of Clinical Pathways., MEDINFO 2015: eHealth-enabled Health - Proceedings of the 15th World Congress on Health and Biomedical Informatics, São Paulo, Brazil, 19-23 August 2015, 10.3233/978-1-61499-564-7-1077, 216, 1077-1077, 2015.01. |
| 119. |
Masayuki Kanazawa, Yasuharu Nakashima, Masanobu Ohishi, Satoshi Hamai, Goro Motomura, Takuaki Yamamoto, Jun-ichi Fukushi, Takahiro Ushijima, Daisuke Hara, Yukihide Iwamoto, Pelvic tilt and movement during total hip arthroplasty in the lateral decubitus position, MODERN RHEUMATOLOGY, 10.3109/14397595.2015.1092914, 26, 3, 435-440, 2016.01, Objectives: Total hip arthroplasty (THA) is often performed in the lateral decubitus (lateral) position. In this position, the pelvis may have various degrees of tilt leading to implant malposition. We sought to quantify the pelvic tilt in lateral position and further pelvic movement during surgery.
Methods: In 95 cases with primary THA, three-dimensional pelvic tilts were quantified by superimposing images reconstructed from CT data onto antero-posterior radiographs taken in lateral position at set-up and after cup placement. Pelvises were fixed with a device compressing anterior superior iliac spines and sacrum.
Results: Various degrees of pelvic tilt occurred compared to the supine position; sagittal: -3.1 degrees (-25.5 degrees to 10.2 degrees), axial: 3.9 degrees (-8.4 degrees to 17 degrees), coronal: 0.9 degrees (-11.9 degrees to 13.2 degrees). Absolute changes more than 5 degrees were observed 43%, 47%, and 12% in the sagittal, axial, and coronal planes, respectively. The more preoperative posterior pelvic tilt resulted in the more change in the sagittal plane. Further pelvic movement of about 3 degrees in three planes were observed ranging from -11 degrees to 20 degrees after cup placement.
Conclusion: This study showed various pelvic tilt and movement during THA. As pelvic tilt directly alters the cup orientation, its changes should be well understood. Improved tools for positioning and holding the pelvis are required.. |
| 120. |
Hiroki Kobayashi, Yasuharu Nakashima, Takuaki Yamamoto, Goro Motomura, Masayuki Kanazawa, Kenji Takagishi, Yukihide Iwamoto, Late Anterior Dislocation Due to Posterior Pelvic Tilt in Total Hip Arthroplasty., The open orthopaedics journal, 10.2174/1874325001610010206, 10, 206-12, 2016.01, BACKGROUND: Excessive pelvic tilt may be one of the factors leading to instability in total hip arthroplasty (THA), even when the acetabular cup is placed properly. To our knowledge, only a few studies have described late anterior dislocation due to posterior pelvic tilt. We present 3 cases with late anterior dislocations possibly due to posterior pelvic tilt. CASES PRESENTATIONS: Case-1: An 84-years-old woman fell and presented with an anterior dislocation 12-years after THA. Her pelvis had tilted to approximately 30° posteriorly in a supine position. After conservative treatment, she presented with 10 recurrent anterior dislocations. She had thoracolumbar kyphosis due to multiple compression fractures. Revision with anterior placement of an elevated liner and a 32-mm head corrected the dislocation, and no further dislocations occurred. Case-2: A 78-years-old woman fell and presented with an anterior dislocation 4-years after THA. Her posterior pelvic tilt had increased 23° due to a lumbar compression fracture. Revision by decreasing the cup anteversion was performed, but recurrent posterior dislocations occurred. Owing to her worsened general condition, further treatment was abandoned. Case-3: A 79-years-old woman twisted her body and presented an anterior dislocation 3-years after THA. After manual reduction and conservative treatment, the dislocation recurred. Her posterior pelvic tilt had increased 16°. CONCLUSION: Although minor trauma triggered the anterior instability in these patients, the underlying pathomechanism existed in the progressive pelvic posterior tilt due to thoracolumbar kyphosis. As longer life expectancy as well as implant survivorship is predicted, attention must be paid to the change of pelvic tilt in elderly patients.. |
| 121. |
Nakashima Y, Ohishi M, Okazaki K, Fukushi J, Oyamada A, Hara D, Doi T, Akasaki Y, Yamada H, Iwamoto Y, Delayed diagnosis of ankylosing spondylitis in a Japanese population., Modern rheumatology, 10.3109/14397595.2015.1088679, 26, 3, 421-425, 2016.01. |
| 122. |
Yasuharu Nakashima, Yuma Sakamoto, Gen Nishimura, Shiro Ikegawa, Yukihide Iwamoto, A novel type II collagen gene mutation in a family with spondyloepiphyseal dysplasia and extensive intrafamilial phenotypic diversity., Human genome variation, 10.1038/hgv.2016.7, 3, 16007-16007, 2016.01, The purpose of this study was to describe a family with spondyloepiphyseal dysplasia caused by a novel type II collagen gene (COL2A1) mutation and the family's phenotypic diversity. Clinical and radiographic examinations of skeletal dysplasia were conducted on seven affected family members across two generations. The entire coding region of COL2A1, including the flanking intron regions, was analyzed with PCR and direct sequencing. The stature of the subjects ranged from extremely short to within normal height range. Hip deformity and advanced osteoarthritis were noted in all the subjects, ranging from severe coxa plana to mild acetabular dysplasia. Atlantoaxial subluxation combined with a hypoplastic odontoid process was found in three of the subjects. Various degrees of platyspondyly were confirmed in all subjects. Genetically, a novel COL2A1 mutation (c.1349G>C, p.Gly450Ala) was identified in all the affected family members; however, it was not present in the one unaffected family member tested. We described a family with spondyloepiphyseal dysplasia and a novel COL2A1 mutation (c.1349G>C, p.Gly450Ala). Phenotypes were diverse even among individuals with the same mutation and within the same family.. |
| 123. |
Hiroyuki Hatanaka, Goro Motomura, Satoshi Ikemura, Kazuhiko Sonoda, Yusuke Kubo, Takeshi Utsunomiya, Takuaki Yamamoto, Yasuharu Nakashima, Use of a long distally fixed intramedullary stem to treat a periprosthetic femoral fracture following total hip arthroplasty using a thrust plate hip prosthesis: A case report, International Journal of Surgery Case Reports, 10.1016/j.ijscr.2017.06.010, 37, 65-68, 2017.01, Introduction The thrust plate hip prosthesis (TPP
Zimmer, Winterthur, Switzerland) is a hip prosthesis that is no longer in production. Few reports have focused on periprosthetic fractures following total hip arthroplasty (THA) with the use of a TPP. Presentation of case We report a 57-year-old woman with a periprosthetic femoral fracture 13 years after THA with the use of a TPP. A plain radiograph showed a displaced subtrochanteric fracture of the right femur just below the distal tip of the lateral plate without implant loosening. She underwent revision surgery with a long distally fixed intramedullary stem in conjunction with a plate and cable system. Three months after surgery, bone union was confirmed using radiography and the patient was clinically asymptomatic. Discussion We encountered three major problems while planning surgical treatment, these being, discontinuation of the TPP system, loss of proximal femoral cancellous bone, and difficulties with the type of subtrochanteric fracture. After considering these problems, we planned revision surgery using a long distally fixed intramedullary stem in conjunction with a plate and cable system. Conclusion This case shows that sufficient implant preparation based on precise preoperative planning is necessary to obtain good clinical results for the surgical treatment of periprosthetic femoral fractures following THA with the use of a TPP.. |
| 124. |
Akihisa Haraguchi, Yasuharu Nakashima, Hisaaki Miyahara, Yukio Esaki, Ken Okazaki, Jun-ichi Fukushi, Go Hirata, Satoshi Ikemura, Satoshi Kamura, Koji Sakuraba, Kenjiro Fujimura, Yukio Akasaki, Hisakata Yamada, Minimum 10-year results of cementless total hip arthroplasty in patients with rheumatoid arthritis, MODERN RHEUMATOLOGY, 10.1080/14397595.2016.1256024, 27, 4, 598-604, 2017.01, Objectives: To retrospectively evaluate the long-term results of cementless total hip arthroplasty (THA) in patients with rheumatoid arthritis (RA) and postoperative patient mortality after THA.
Methods: This study included 191 hips in 149 RA patients who underwent cementless THA between 1998 and 2005. Mean age at surgery was 54.2 years, and mean follow-up was 12.6 years. Implant and patient survivorships were determined using the Kaplan-Meier method, and the associated influencing factors were determined.
Results: Implant survivals at 17 years were 99.5% for stems, 93.9% for cups, and 90.8% for liners. Among the liners used, THAs with highly cross-linked polyethylene showed better survivals compared with those with conventional polyethylene and alumina-bearing surface (93.4%, 90.9%, and 52.2%, respectively). A total of 64 deaths occurred; 45 patients died within 10 years and 19 patients died between 10 and 17 years. Malignancy (25.0%) was the leading cause of death, followed by pneumonia (20.8%) and sepsis (20.8%). The patient survival rate was 36.9% at 17 years after THA. Multivariate analysis exhibited that older age at operation and greater dose of concomitant corticosteroid resulted in shorter patient survivals.
Conclusions: Cementless THA worked well in patients with RA. Mortality remained high among RA patients who needed THA.. |
| 125. |
Yoshihiro Matsumoto, Shingo Baba, Makoto Endo, Nokitaka Setsu, Keiichiro Iida, Jun-Ichi Fukushi, Kenichi Kawaguchi, Seiji Okada, Hirofumi Bekki, Takuro Isoda, Yoshiyuki Kitamura, Hiroshi Honda, Yasuharu Nakashima, Metabolic Tumor Volume by F-18-FDG PET/CT Can Predict the Clinical Outcome of Primary Malignant Spine/Spinal Tumors, BIOMED RESEARCH INTERNATIONAL, 10.1155/2017/8132676, 2017, 8132676-8132676, 2017.01, Background and Purpose. Primary malignant spine/spinal tumors (PMSTs) are rare and life-threatening diseases. In this study, we demonstrated the advantage of volume-based F-18-FDG PET/CT metabolic parameter, metabolic tumor volume (MTV), for assessing the aggressiveness of PMSTs. Materials and Methods. We retrospectively reviewed 27 patients with PMSTs and calculated SUVmax, MTV, and total lesion glycolysis (TLG) to compare their accuracy in predicting progression-free survival (PFS) and overall survival (OS) by receiver operating characteristic (ROC) curve analysis. Univariate and multivariate analyses were used to compare the reliability of the metabolic parameters and various clinical factors. Results. MTV exhibited greater accuracy than SUVmax or TLG. The cut-off values for PFS and OS derived from the AUC data were MTV 45ml and 83ml and TLG 250 SUV*ml and 257 SUV*ml, respectively. MTV above cut-off value, but not TLG, was identified as significant prognostic factor for PFS by log-lank test (p = 0.04). In addition, MTV was the only significant predictive factors for PFS and OS in the multivariate analysis. Conclusions. MTV was a more accurate predictor of PFS and OS in PMSTs compared to TLG or SUVmax and helped decision-making for guiding rational treatment options.. |
| 126. |
Takeyuki Saito, Kazuya Yokota, Kazu Kobayakawa, Masamitsu Hara, Kensuke Kubota, Katsumi Harimaya, Kenichi Kawaguchi, Mitsumasa Hayashida, Yoshihiro Matsumoto, Toshio Doi, Keiichiro Shiba, Yasuharu Nakashima, Seiji Okada, Experimental Mouse Model of Lumbar Ligamentum Flavum Hypertrophy., PloS one, 10.1371/journal.pone.0169717, 12, 1, e0169717, 2017.01, Lumbar spinal canal stenosis (LSCS) is one of the most common spinal disorders in elderly people, with the number of LSCS patients increasing due to the aging of the population. The ligamentum flavum (LF) is a spinal ligament located in the interior of the vertebral canal, and hypertrophy of the LF, which causes the direct compression of the nerve roots and/or cauda equine, is a major cause of LSCS. Although there have been previous studies on LF hypertrophy, its pathomechanism remains unclear. The purpose of this study is to establish a relevant mouse model of LF hypertrophy and to examine disease-related factors. First, we focused on mechanical stress and developed a loading device for applying consecutive mechanical flexion-extension stress to the mouse LF. After 12 weeks of mechanical stress loading, we found that the LF thickness in the stress group was significantly increased in comparison to the control group. In addition, there were significant increases in the area of collagen fibers, the number of LF cells, and the gene expression of several fibrosis-related factors. However, in this mecnanical stress model, there was no macrophage infiltration, angiogenesis, or increase in the expression of transforming growth factor-β1 (TGF-β1), which are characteristic features of LF hypertrophy in LSCS patients. We therefore examined the influence of infiltrating macrophages on LF hypertrophy. After inducing macrophage infiltration by micro-injury to the mouse LF, we found excessive collagen synthesis in the injured site with the increased TGF-β1 expression at 2 weeks after injury, and further confirmed LF hypertrophy at 6 weeks after injury. Our findings demonstrate that mechanical stress is a causative factor for LF hypertrophy and strongly suggest the importance of macrophage infiltration in the progression of LF hypertrophy via the stimulation of collagen production.. |
| 127. |
Yoshihiro Matsumoto, Makoto Shinoto, Makoto Endo, Nokitaka Setsu, Keiichiro Iida, Jun-Ichi Fukushi, Kenichi Kawaguchi, Seiji Okada, Hirofumi Bekki, Reiko Imai, Tadashi Kamada, Yoshiyuki Shioyama, Yasuharu Nakashima, Evaluation of Risk Factors for Vertebral Compression Fracture after Carbon-Ion Radiotherapy for Primary Spinal and Paraspinal Sarcoma, BIOMED RESEARCH INTERNATIONAL, 10.1155/2017/9467402, 2017, 9467402-9467402, 2017.01, Background and Purpose. Carbon-ion radiotherapy (C-ion RT) was effective therapy for inoperable spinal and paraspinal sarcomas. However, a significant adverse event following radiotherapies is vertebral compression fractures (VCFs). In this study, we investigated the incidence of and risk factors for post-C-ion RT VCFs in patients with spinal or paraspinal sarcomas. Material and Methods. Thirty consecutive patients with spinal or paraspinal sarcomas treated with C-ion RT were retrospectively reviewed. Various clinical parameters and the Spinal Instability Neoplastic Score (SINS) were used to evaluate the risk factors for post-C-ion RT VCFs. Results. The overall incidence of VCFs was 23% (median time: 7 months). Patients with VCFs showed a markedly higher SINS score (median value, 9 points) than those without VCF (5 points). The area under the receiver operating characteristic curve for the SINS score was 0.88, and the optimum SINS cut-off score was 8 points. The cumulative incidence of VCFs at 1 year was 9% for patients with a SINS score under 8 points, versus 80% for those with a SINS score of 8 points or higher (P |
| 128. |
Yasuharu Nakashima, Masanori Fujii, Yasuo Noguchi, Kenya Suenaga, Takuaki Yamamoto, Jun-ichi Fukushi, Goro Motomura, Satoshi Hamai, Daisuke Hara, Yukihide Iwamoto, Arthroscopic validation of radiographic minimum joint space width associated with the subchondral bone exposure in symptomatic hip dysplasia, MODERN RHEUMATOLOGY, 10.1080/14397595.2016.1222663, 27, 3, 524-528, 2017.01, Objective: The purpose of this study was to clarify the minimum joint space width (MJSW) that leads to subchondral bone exposure (SBE) in patients with hip dysplasia.Methods: We included 82 subjects (86 hips) who had hip dysplasia with center-edge angle less than 20 degrees and who underwent periacetabular osteotomy combined with hip arthroscopy. The acetabular and femoral cartilages were divided into three regions: anterosuperior, superior, and posterosuperior; for each region, we analyzed the correlation between the incidence of SBE and the MJSW measured on plain radiographs. The disease stage was defined according to the Kellgren and Lawrence grades (KL grade).Results: SBE was found in 51 hips (59.3%) in total, involved the acetabulum in 49 hips (57.0%), and involved the femoral head in 26 hips (30.2%). SBE was more frequent in the acetabulum, with the highest incidence in the anterosuperior region, followed by the superior region. SBE was present in six hips (22.2%), 17 hips (56.7%), and 28 hips (96.5%), at KL-1, KL-2, and KL-3, respectively. MJSW of hips with SBE was significantly smaller than those without SBE (2.3 vs 4.0mm, p |
| 129. |
Teruaki Ono, Kiyoshi Tarukado, Osamu Tono, Katsumi Harimaya, Yuichiro Morishita, Yasuharu Nakashima, Toshio Doi, The morphological relationship between lumbosacral transitional vertebrae and lumbosacral pedicle asymmetry., Spine surgery and related research, 10.22603/ssrr.2017-0019, 2, 1, 77-81, 2018.01, Introduction: The clinical significance of lumbosacral transitional vertebrae (LSTV) has been reported. However, the association between LSTV and lumbosacral pedicle anatomical anomaly has not been investigated. We hypothesized that LSTV might be associated with lumbosacral anatomical anomaly. The purpose of this study was to examine the morphological association between LSTV and lumbosacral pedicle asymmetry (PA) using computed tomography (CT). Methods: A retrospective review of CT images of 347 lumbosacral degenerative disease patients was performed. We divided the subjects into two groups: the normal and LSTV groups. LSTV was classified based on Castellvi's classification. PA was defined as a difference of more than 20° between the right and left angles of the pedicle. Results: Seventy out of 347 lumbosacral degenerative disease patients (20.17%) were diagnosed with LSTV. In the normal group, only a 0.54% incidence of PA was seen; however, with respect to the LSTV group, a 9.29% incidence of PA was seen. A significant difference in PA incidence was observed between the groups (p |
| 130. |
Satoshi Baba, Yoshihiro Matsumoto, Shinji Tomari, Takahiro Yasuhara, Hirokazu Saiwai, Akinobu Matsushita, Tatsuya Yufu, Mitsumasa Hayashida, Seiji Okada, Kenichi Kawaguchi, Kenichi Seo, Yasumasa Ito, Yasuharu Nakashima, Radiological examination of postoperative cervical alignment and stability in patients with dialysis-associated spondylosis excluding destructive spondyloarthropathy: Comparison with patients with cervical spondylotic myelopathy, Spine Surgery and Related Research, 10.22603/ssrr.2017-0068, 2, 3, 202-209, 2018.01, Copyright © 2018 The Japanese Society for Spine Surgery and Related Research. Introduction: Several reports have demonstrated the surgical treatment strategy for patients with dialysis-associated spondylosis in the cervical spine (CDAS) with destructive spondyloarthropathy (DSA). However, studies focusing on the clinical outcome of patients with CDAS without DSA remain scarce. We aimed to review the treatment strategy of patients with CDAS but without DSA. Methods: The clinical data and surgical records of consecutive patients with CDAS without DSA (n = 9; D-group) and cervical spondylotic myelopathy (CSM) (n = 30; C-group) who underwent modified double-door laminoplasty(DDL) were reviewed retrospectively. We investigated four radiologic factors in the pre-and postoperative periods that have been reported to be the risk factors for worsening of clinical symptoms in various studies and examined statistical comparison between the D and C groups. Results: In the D group, the pre- versus postoperative C2-C7 sagittal angles were not significantly different, and only two patients (22%) had kyphosis postoperatively. There was a significant difference in the pre- and postoperative C2-C7 angles in the two groups (P = 0.031). Regarding the change in segmental alignment, the local open angle increased at the C4/C5 level in the D group. Also there was a significant difference in the local angles between the two groups at C4/5 and C5/6 (P = 0.00038, and 0.037), suggesting that postoperative segmental mobility at C4/5 and C5/6 was higher in the D group than in the C group. Conclusions: In the present study, DDL in patients with CDAS without DSA did not adversely affect the postoperative alignment and stability compared with CSM patients with CSM. However, patients in the D group may have a chance to develop DSA change at the C4/5 level in the future, and careful long-term follow-up is warranted.. |
| 131. |
Kensei Yoshimoto, Satoshi Hamai, Hidehiko Higaki, Hirotaka Gondo, Satoru Ikebe, Yasuharu Nakashima, Pre- and post-operative evaluation of pincer-type femoroacetabular impingement during squat using image-matching techniques: A case report., International journal of surgery case reports, 10.1016/j.ijscr.2017.12.007, 42, 121-127, 2018.01, INTRODUCTION: Although combined evaluation of hip joint kinematics and bone morphology is necessary for accurate assessment of femoroacetabular impingement (FAI), there are no report which evaluated hip kinematics of pincer-type FAI. PRESENTATION OF CASE: The pre- and postoperative hip kinematics of a 46-year-old man, with a pincer-type FAI during squat were evaluated using image-matching techniques and the rim-neck distance was measured. Preoperative simulation of squatting was also performed using patient's bone models and healthy subject's kinematics data to detect the overlapping lesion between the acetabulum and the femur. Post-acetabuloplasty, right coxalgia during squat disappeared, and the Harris Hip Score improved from 79 to 92 at one year after surgery. Posterior pelvic tilt, femoral and hip flexion angle changed from 24.0°, 101.1°, and 70.8° to 23.3°, 92.6°, and 63.3°, respectively. The minimum rim-neck distance at maximum hip flexion improved from 1.8mm to 7.3mm. DISCUSSION: We could evaluate both of hip kinematics and morphology with image-matching techniques, and could visualize the clearance between the femoral head-neck junction and the acetabular rim. CONCLUSION: Image-matching techniques were clinically useful to assist surgeons in detecting the location of the impingement and confirming resection of the pincer lesion post-operatively.. |
| 132. |
Daisuke Abe, Satoshi Hamai, Ken Okazaki, Masato Yoshimoto, Takashi Komatsu, Yasuharu Nakashima, Inverted V-shaped high tibial osteotomy for severe tibia vara associated with Turner syndrome: A case report and review of literature., International journal of surgery case reports, 10.1016/j.ijscr.2017.12.008, 42, 128-132, 2018.01, INTRODUCTION: Severe cases of genu varum represent a major challenge in obtaining normal configuration of the proximal tibia and overall limb alignment. PRESENTATION OF CASE: We performed inverted V-shaped high tibial osteotomy (HTO) by using a locking plate for recurrent severe bilateral tibia vara in a 15-year-old female patient with Turner syndrome. Preoperative medial proximal tibial angle (MPTA) and standing femorotibial angle (FTA) of the right/left legs were 67°/69° and 197°/203°, respectively. In order to obtain overall neutral alignment, the correction angle in the right/left knees was required to be 23°/32°. Preoperative planning demonstrated that inverted V-shaped HTO could provide sufficient correction angle with large bone stock and wide bony contact. A postoperative full-standing radiograph showed that the mechanical axes passed through the center of right/left knees with 87°/88° of MPTA. DISCUSSION: Inverted V-shaped HTO has advantages, as it requires a smaller amount of bone resection and smaller opening gap compared to the closing-wedge and opening-wedge osteotomies. CONCLUSION: Inverted V-shaped HTO can be a useful surgical method to treat severe tibia vara in order to obtain adequate configuration of the proximal tibia and overall limb alignment.. |
| 133. |
Shoji Baba, Goro Motomura, Satoshi Ikemura, Kazuhiko Sonoda, Yusuke Kubo, Takeshi Utsunomiya, Hiroyuki Hatanaka, Yasuharu Nakashima, Femoral head fracture similar to slipped capital femoral epiphysis in an elderly woman with antecedent hip osteoarthritis after subchondral insufficiency fracture: A case report, Journal of Orthopaedic Science, 10.1016/j.jos.2017.09.009, 25, 3, 533-536, 2018.01. |
| 134. |
Suguru Fukushima, Makoto Endo, Yoshihiro Matsumoto, Jun-Ichi Fukushi, Tomoya Matsunobu, Ken-Ichi Kawaguchi, Nokitaka Setsu, Keiichiro IIda, Nobuhiko Yokoyama, Makoto Nakagawa, Kenichiro Yahiro, Yoshinao Oda, Yukihide Iwamoto, Yasuharu Nakashima, Correction: Hypoxia-inducible factor 1 alpha is a poor prognostic factor and potential therapeutic target in malignant peripheral nerve sheath tumor., PloS one, 10.1371/journal.pone.0194508, 13, 3, e0194508, 2018.01, [This corrects the article DOI: 10.1371/journal.pone.0178064.].. |
| 135. |
Kenichiro Yahiro, Yoshihiro Matsumoto, Jun-Ichi Fukushi, Ken-Ichi Kawaguchi, Makoto Endo, Nokitaka Setsu, Keiichiro IIda, Suguru Fukushima, Makoto Nakagawa, Atsushi Kimura, Yoshinao Oda, Yasuharu Nakashima, Class III β-Tubulin Overexpression Induces Chemoresistance to Eribulin in a Leiomyosarcoma Cell Line., Analytical cellular pathology (Amsterdam), 10.1155/2018/8987568, 2018, 8987568-8987568, 2018.01, Eribulin is a new drug to treat soft tissue sarcoma (STS) that exerts antitumor activity by binding to microtubules. The prognosis of STS is poor, and eribulin is expected to improve the treatment outcome. We observed several cases that exhibited resistance to eribulin and developed an eribulin-resistant leiomyosarcoma cell line to investigate the mechanism of resistance. The IC50 of eribulin was 125 times higher in the resistant cell line than in the parental cell line, and eribulin did not induce G2/M arrest in resistant cells. The resistant cell line showed increased expression of MDR1 transcript, but protein levels and functional analysis results were similar to the parental cell line. We found that class III β-tubulin (TUBB3) was overexpressed in the resistant cell line, and siRNA knockdown of TUBB3 partially recovered sensitivity to eribulin. TUBB3 expression in clinical samples varied, suggesting that TUBB3 has the potential to be a biomarker for selection of anticancer drugs and may be a target for overcoming resistance to eribulin.. |
| 136. |
Satoshi Baba, Kenichi Kawaguchi, Kazuhito Itamoto, Takeshi Watanabe, Mitsumasa Hayashida, Takao Mae, Yasuharu Nakashima, Go Kato, Use of an inertial measurement unit sensor in pedicle screw placement improves trajectory accuracy., PloS one, 10.1371/journal.pone.0242512, 15, 11, e0242512, 2020.01, Ascertaining the accuracy of the pedicle screw (PS) trajectories is important as PS malpositioning can cause critical complications. We aimed to determine the angle range over which estimation is unreliable; build a low-cost PS placement support system that uses an inertial measurement unit (IMU) to enable the monitoring of surgical tools and PS trajectories, and determine the situations where IMU support would be most beneficial. In PS insertion experiments, we used cadaver samples that included lumbar porcine spines. Computed tomography images obtained before and after PS insertion were viewed. Offsets between the planned and implanted PS trajectories in the freehand and IMU-assisted groups were analyzed. The PS cortical bone breaches were classified according to the Gertzbein and Robbins criteria (GRC). Added head-down tilted sample experiments were repeated wherein we expected a decreased rostro-caudal rotational accuracy of the PS according to the angle estimation ability results. Evaluation of the PS trajectory accuracy revealed no significant advantage of IMU-assisted rostro-caudal rotational accuracy versus freehand accuracy. According to the GRC, IMU assistance significantly increased the rate of clinically acceptable PS positions (RoCA) than the freehand technique. In the head-down tilted sample experiments, IMU assist provided increased accuracies with both rostro-caudal and medial rotational techniques when compared with the freehand technique. In the freehand group, RoCA was significantly decreased in samples with rostral tilting relative to that in the samples without. However, In the IMU-assisted group, no significant difference in RoCA between the samples with and without head-down tilting was observed. Even when the planned PS medial and/or rostro-caudal rotational angle was relatively large and difficult to reproduce manually, IMU-support helped maintain the PS trajectory accuracy and positioning safety. IMU assist in PS placement was more beneficial, especially for larger rostro-caudal and/or medial rotational pedicle angles.. |
| 137. |
Noriko Oyama, Kanako Kojima-Ishii, Naoko Toda, Terumichi Matsuo, Vlad Tocan, Kazuhiro Ohkubo, Utako Oba, Yuhki Koga, Nokitaka Setsu, Yuichi Yamada, Kenichi Kohashi, Yasuharu Nakashima, Yoshinao Oda, Kenji Ihara, Shouichi Ohga, Malignant transformation of phosphaturic mesenchymal tumor: a case report and literature review., Clinical pediatric endocrinology : case reports and clinical investigations : official journal of the Japanese Society for Pediatric Endocrinology, 10.1297/cpe.29.69, 29, 2, 69-75, 2020.01, Phosphaturic mesenchymal tumor, mixed connective tissue variant (PMT-MCT) causes tumor-induced osteomalacia (TIO). Most cases follow a benign clinical course, with rare occurrences of malignant transformation. We report a case of malignant PMT-MCT and review previous malignant cases to identify predictive factors for transformation. A 13-yr-old female, who presented with hypophosphatemic rickets, elevated serum intact fibroblast growth factor 23 (FGF23) levels, and a nodule in the back, received a diagnosis of TIO because of the benign PMT histopathology. After resection of the primary tumor, regular imaging analyses did not indicate any relapse. At 17 years of age, a tumor developed in the left leg and increased in size. The resected tumor showed a histopathology of pleomorphic sarcoma positive for the TP53 mutation. Despite amputation of the affected leg, the patient died due to multiple metastases at 18 years of age. A literature review revealed that 14 out of 15 reported malignant PMT-MCT tumors occurred in adults, and found no predictive factors for malignant transformation and treatment outcome. Changes in size or number of the tumors along with intact FGF23 levels have been considered as the only sign of malignant transformation. This pediatric case report and literature review indicate the need for prolonged regular monitoring for PMT-MCT.. |
| 138. |
Satoshi Baba, Mitsumasa Hayashida, Kazuki Kitade, Eiji Kinoshita, Kenji Urata, Yu Matsushita, Waichirou Oka, Norihiro Komiya, Nobuaki Tsukamoto, Takao Mae, Yasuharu Nakashima, A Case of Central Posterior Epidural Cyst Associated with Baastrup's Disease Punctured Percutaneously Using Fluoroscopy with a Good Outcome., Spine surgery and related research, 10.22603/ssrr.2020-0023, 4, 4, 365-368, 2020.01. |
| 139. |
Genome analysis for osteonecrosis of the femoral head: present and future. |
| 140. |
A clinical trial for the prevention of the occurrence of osteonecrosis of the femoral head. |
| 141. |
Current knowledge on transtrochanteric rotational osteotomy of the femoral head. |
| 142. |
BCG骨関節炎の３例. |
| 143. |
T INADOME, K HAYASHI, Y NAKASHIMA, H TSUMURA, Y SUGIOKA, COMPARISON OF BONE-IMPLANT INTERFACE SHEAR-STRENGTH OF HYDROXYAPATITE-COATED AND ALUMINA-COATED METAL IMPLANTS, JOURNAL OF BIOMEDICAL MATERIALS RESEARCH, 10.1002/jbm.820290104, 29, 1, 19-24, 1995.01, We performed a transcortical push-out test to determine the effect of surface roughness of hydroxyapatite (HA)-coated implants on bone-implant shear strength in a canine model. Hydroxyapatite- and alumina-coated SUS316L with the same surface roughness (roughness average: Ra = 5 mu m) and HA-coated Ti-6Al-4V (Ra = 8.4 mu m), sintered HA (Ra = 0.9 mu m), and dense alumina (Ra = 1.3 mu m) were inserted into the dog's femur. The interface shear strength of the dense alumina was significantly lower than that of other implants at both 4 and 12 weeks after implantation. At 4 weeks after implantation, the interface shear strength of the alumina-coated SUS316L was significantly lower than that of other implants (P <.05 except the dense alumina but at weeks there was no significant difference between implant types alumina. this indicates that surface roughness of ha coating affects enhancement bone-implant interface shear strength early period after implantation and a several micrometers does not influence bond bone ha. scanning electron microscopic study indicated in almost all cases failure site push-out testing coating-substrate coating-bone interface. therefore protection from direct loading is needed. john wiley sons inc.. id="gencho_ronbuns10176237" class="qir_handle_link"> |
| 144. |
Signaling Pathway of Particulate Debris-induced Cytokine Expression in Human Macrophages. |
| 145. |
WJ Maloney, DH Sun, Y Nakashima, R James, RL Smith, Effects of serum protein opsonization on cytokine release by titanium-alloy particles, JOURNAL OF BIOMEDICAL MATERIALS RESEARCH, 10.1002/(SICI)1097-4636(19980905)41:33.0.CO;2-9, 41, 3, 371-376, 1998.09, This study tested whether macrophages respond differently to retrieved titanium-alloy particles than they do to machined titanium-alloy particles and assessed whether pretreatment of machined titanium-alloy particles with human serum would influence macrophage activation and cytokine release in vitro. Human monocyte/macrophages were isolated from normal healthy donors and exposed to increasing concentrations of machined and retrieved titanium-alloy particles. The profile of cytokine release was determined by commercially available ELISA kits. Machined titanium-alloy particles were opsonized with human serum and added to macrophage cultures. Serum protein binding was confirmed by SDS-PAGE analysis. The results showed that machined titanium-alloy particles and retrieved titanium-alloy particles stimulate a similar level of cytokine release when tested at comparable concentrations. Opsonization of the machined particles with human serum increased the macrophage release of cytokines in the first 12 h after exposure compared to nonopsonized particles. At 24 h, the opsonized particles stimulated significantly higher levels of cytokine release, but only at the greatest particle concentrations. This study demonstrates that machined titanium alloy induces a metabolic response in macrophages similar to that of titanium-alloy particles retrieved from failed total hip arthroplasty. In addition, these data show that serum protein binding to orthopedic biomaterial debris alters the macrophage reaction to the particles. (C) 1998 John Wiley & Sons, Inc.. |
| 146. |
BCG骨関節炎の３例. |
| 147. |
BCG骨関節炎の３例. |
| 148. |
Y Nakashima, K Hayashi, T Inadome, K Uenoyama, T Hara, T Kanemaru, Y Sugioka, Noda, I, Hydroxyapatite-coating on titanium arc sprayed titanium implants, JOURNAL OF BIOMEDICAL MATERIALS RESEARCH, 10.1002/(SICI)1097-4636(19970605)35:33.3.CO;2-U, 35, 3, 287-298, 1997.06, We developed a new titanium spray technique using an inert gas shielded are spray (titanium are spray). Hydroxyapatite (HA)-coating can be applied to the implant without any surface pore obstruction after the rough surface is made by this technique. Scanning electron microscopy (SEM) of various porous implant surfaces after HA-coating revealed that the bead and fiber metal-coated implants had either a pore obstruction or an uneven HA-coating. On the other hand, the titanium are sprayed implant demonstrated an even HA-coating all the way to the bottom of the surface pore. In the first set of animal experiments (Exp. 1), the interfacial shear strength to bone of four kinds of cylindrical Ti-6Al-4V (Ti) implants were compared using a canine transcortical push-out model 4 and 12 weeks after implantation. The implant surfaces were roughened by titanium are spray (group A-C) and sand blasting (group D) to four different degrees (roughness average, Ra = group A: 56.1, B: 44.9, C: 28.3, D: 3.7 mu m) The interfacial shear strength increased in a surface roughness-dependent manner at both time periods. However, the roughest implants (group A) showed some failed regions in the sprayed layers after push-out test. In the second set of animal experiments (Exp. 2), four kinds of Ti implants; HA-coated smooth Ti (sHA) with Ra of 3.4 mu m, bead-coated Ti (Beads), titanium are sprayed Ti (Ti-spray) with Ra of 38.1 mu m and HA-coated Ti-spray (HA + Ti-spray) with Ra of 28.3 mu m were compared using the same model as that in Exp. 1. The interfacial shear strength of HA + Ti-spray was significantly greater than that of sHA and Beads at both time periods, and that of Ti-spray at 4 weeks. Although a histological examination revealed that HA-coating enhanced bone ingrowth, sHA showed the lowest shear strength at both time periods. SEM after push-out test showed that sHA consistently demonstrated some regional failure at the HA-implant substrate interface. HA + Ti-spray had many failed regions either at the HA-bone interface or within the bone tissue rather than at the HA-implant substrate interface. These results suggested that the HA-coated smooth surfaced implants had a mechanical weakness at the HA-substrate interface. Therefore, HA should be coated on the rough surfaced implants to avoid a detachment of the HA-coating layer from the substrate and thus obtain a mechanical anchoring strength to bone. HA-coating on this new type of surface morphology may thus lead to a solution to the problems of conventional HA-coated and porous-coated implants. (C) 1997 John Wiley & Sons, Inc.. |
| 149. |
術後40年で人工股関節再置換術を行った大腿骨頸部骨巨細胞腫の1例. |
| 150. |
Arthroscopic Removal of Intra-articular Bone Fragment in Patient with Traumatic Posterior Fracture-dislocation of Hip Joint : A Case Report
A twenty one-year old man was hit by a car and his left hip joint was dislocated posteriorly.
After manual reduction, a small bone fragment was found between the joint space. Arthroscopic removal of the fragment was carried out successfully. The osteochondral fragment was 4cm long, 1cm wide, and 0.5cm thick, and derived from the posterior rim of the acetabulum. Full weight-bearing was permitted one week after the operation, and his hip function was recovered completely at a follow-up of four months post-operatively. Arthroscopic surgery proved to be less invasive and more useful than open surgery for the extraction of free bodies in the hip joint.. |
| 151. |
The pathogenesis of transient osteoporosis of the hip. |
| 152. |
T INADOME, K HAYASHI, Y NAKASHIMA, H TSUMURA, Y SUGIOKA, COMPARISON OF BONE-IMPLANT INTERFACE SHEAR-STRENGTH OF HYDROXYAPATITE-COATED AND ALUMINA-COATED METAL IMPLANTS, JOURNAL OF BIOMEDICAL MATERIALS RESEARCH, 29, 1, 19-24, 1995.01, We performed a transcortical push-out test to determine the effect of surface roughness of hydroxyapatite (HA)-coated implants on bone-implant shear strength in a canine model. Hydroxyapatite- and alumina-coated SUS316L with the same surface roughness (roughness average: Ra = 5 mu m) and HA-coated Ti-6Al-4V (Ra = 8.4 mu m), sintered HA (Ra = 0.9 mu m), and dense alumina (Ra = 1.3 mu m) were inserted into the dog's femur. The interface shear strength of the dense alumina was significantly lower than that of other implants at both 4 and 12 weeks after implantation. At 4 weeks after implantation, the interface shear strength of the alumina-coated SUS316L was significantly lower than that of other implants (P <.05 except the dense alumina but at weeks there was no significant difference between implant types alumina. this indicates that surface roughness of ha coating affects enhancement bone-implant interface shear strength early period after implantation and a several micrometers does not influence bond bone ha. scanning electron microscopic study indicated in almost all cases failure site push-out testing coating-substrate coating-bone interface. therefore protection from direct loading is needed. john wiley sons inc.. id="gencho_ronbuns10176172" class="qir_handle_link"> |
| 153. |
Y Nakashima, K Hayashi, T Inadome, K Uenoyama, T Hara, T Kanemaru, Y Sugioka, Noda, I, Hydroxyapatite-coating on titanium arc sprayed titanium implants, JOURNAL OF BIOMEDICAL MATERIALS RESEARCH, 10.1002/(SICI)1097-4636(19970605)35:33.3.CO;2-U, 35, 3, 287-298, 1997.06, We developed a new titanium spray technique using an inert gas shielded are spray (titanium are spray). Hydroxyapatite (HA)-coating can be applied to the implant without any surface pore obstruction after the rough surface is made by this technique. Scanning electron microscopy (SEM) of various porous implant surfaces after HA-coating revealed that the bead and fiber metal-coated implants had either a pore obstruction or an uneven HA-coating. On the other hand, the titanium are sprayed implant demonstrated an even HA-coating all the way to the bottom of the surface pore. In the first set of animal experiments (Exp. 1), the interfacial shear strength to bone of four kinds of cylindrical Ti-6Al-4V (Ti) implants were compared using a canine transcortical push-out model 4 and 12 weeks after implantation. The implant surfaces were roughened by titanium are spray (group A-C) and sand blasting (group D) to four different degrees (roughness average, Ra = group A: 56.1, B: 44.9, C: 28.3, D: 3.7 mu m) The interfacial shear strength increased in a surface roughness-dependent manner at both time periods. However, the roughest implants (group A) showed some failed regions in the sprayed layers after push-out test. In the second set of animal experiments (Exp. 2), four kinds of Ti implants; HA-coated smooth Ti (sHA) with Ra of 3.4 mu m, bead-coated Ti (Beads), titanium are sprayed Ti (Ti-spray) with Ra of 38.1 mu m and HA-coated Ti-spray (HA + Ti-spray) with Ra of 28.3 mu m were compared using the same model as that in Exp. 1. The interfacial shear strength of HA + Ti-spray was significantly greater than that of sHA and Beads at both time periods, and that of Ti-spray at 4 weeks. Although a histological examination revealed that HA-coating enhanced bone ingrowth, sHA showed the lowest shear strength at both time periods. SEM after push-out test showed that sHA consistently demonstrated some regional failure at the HA-implant substrate interface. HA + Ti-spray had many failed regions either at the HA-bone interface or within the bone tissue rather than at the HA-implant substrate interface. These results suggested that the HA-coated smooth surfaced implants had a mechanical weakness at the HA-substrate interface. Therefore, HA should be coated on the rough surfaced implants to avoid a detachment of the HA-coating layer from the substrate and thus obtain a mechanical anchoring strength to bone. HA-coating on this new type of surface morphology may thus lead to a solution to the problems of conventional HA-coated and porous-coated implants. (C) 1997 John Wiley & Sons, Inc.. |
| 154. |
Y Nakashima, K Hayashi, T Inadome, K Uenoyama, T Hara, T Kanemaru, Y Sugioka, Noda, I, Hydroxyapatite-coating on titanium arc sprayed titanium implants, JOURNAL OF BIOMEDICAL MATERIALS RESEARCH, 10.1002/(SICI)1097-4636(19970605)35:33.3.CO;2-U, 35, 3, 287-298, 1997.06, We developed a new titanium spray technique using an inert gas shielded are spray (titanium are spray). Hydroxyapatite (HA)-coating can be applied to the implant without any surface pore obstruction after the rough surface is made by this technique. Scanning electron microscopy (SEM) of various porous implant surfaces after HA-coating revealed that the bead and fiber metal-coated implants had either a pore obstruction or an uneven HA-coating. On the other hand, the titanium are sprayed implant demonstrated an even HA-coating all the way to the bottom of the surface pore. In the first set of animal experiments (Exp. 1), the interfacial shear strength to bone of four kinds of cylindrical Ti-6Al-4V (Ti) implants were compared using a canine transcortical push-out model 4 and 12 weeks after implantation. The implant surfaces were roughened by titanium are spray (group A-C) and sand blasting (group D) to four different degrees (roughness average, Ra = group A: 56.1, B: 44.9, C: 28.3, D: 3.7 mu m) The interfacial shear strength increased in a surface roughness-dependent manner at both time periods. However, the roughest implants (group A) showed some failed regions in the sprayed layers after push-out test. In the second set of animal experiments (Exp. 2), four kinds of Ti implants; HA-coated smooth Ti (sHA) with Ra of 3.4 mu m, bead-coated Ti (Beads), titanium are sprayed Ti (Ti-spray) with Ra of 38.1 mu m and HA-coated Ti-spray (HA + Ti-spray) with Ra of 28.3 mu m were compared using the same model as that in Exp. 1. The interfacial shear strength of HA + Ti-spray was significantly greater than that of sHA and Beads at both time periods, and that of Ti-spray at 4 weeks. Although a histological examination revealed that HA-coating enhanced bone ingrowth, sHA showed the lowest shear strength at both time periods. SEM after push-out test showed that sHA consistently demonstrated some regional failure at the HA-implant substrate interface. HA + Ti-spray had many failed regions either at the HA-bone interface or within the bone tissue rather than at the HA-implant substrate interface. These results suggested that the HA-coated smooth surfaced implants had a mechanical weakness at the HA-substrate interface. Therefore, HA should be coated on the rough surfaced implants to avoid a detachment of the HA-coating layer from the substrate and thus obtain a mechanical anchoring strength to bone. HA-coating on this new type of surface morphology may thus lead to a solution to the problems of conventional HA-coated and porous-coated implants. (C) 1997 John Wiley & Sons, Inc.. |
| 155. |
WJ Maloney, DH Sun, Y Nakashima, R James, RL Smith, Effects of serum protein opsonization on cytokine release by titanium-alloy particles, JOURNAL OF BIOMEDICAL MATERIALS RESEARCH, 41, 3, 371-376, 1998.09, This study tested whether macrophages respond differently to retrieved titanium-alloy particles than they do to machined titanium-alloy particles and assessed whether pretreatment of machined titanium-alloy particles with human serum would influence macrophage activation and cytokine release in vitro. Human monocyte/macrophages were isolated from normal healthy donors and exposed to increasing concentrations of machined and retrieved titanium-alloy particles. The profile of cytokine release was determined by commercially available ELISA kits. Machined titanium-alloy particles were opsonized with human serum and added to macrophage cultures. Serum protein binding was confirmed by SDS-PAGE analysis. The results showed that machined titanium-alloy particles and retrieved titanium-alloy particles stimulate a similar level of cytokine release when tested at comparable concentrations. Opsonization of the machined particles with human serum increased the macrophage release of cytokines in the first 12 h after exposure compared to nonopsonized particles. At 24 h, the opsonized particles stimulated significantly higher levels of cytokine release, but only at the greatest particle concentrations. This study demonstrates that machined titanium alloy induces a metabolic response in macrophages similar to that of titanium-alloy particles retrieved from failed total hip arthroplasty. In addition, these data show that serum protein binding to orthopedic biomaterial debris alters the macrophage reaction to the particles. (C) 1998 John Wiley & Sons, Inc.. |
| 156. |
Anterolateral-approach Open Reduction Combined with Pemberton Pericapsular Osteotomy and/or Femoral Osteotomy for Hip Dislocation in Children
We combined Tanabe's extensive anterolateral-approach open reduction involving 360-degree circumferential capsulotomy with Pemberton pericapsular osteotomy and/or femoral osteotomy for the reduction of 7 dislocated hip joints in 5 toddlers. patients were placed in the lateral decubitus position. After Tanabe's original procedure of open reduction, femoal osteotomy (shortening/derotation/varus) and/or Pemberton's pericapsular osteotomy were performed easily via this approach. After surgery, X-ray showed the femoral head to be perfectly reduced and excellent acetabular coverage. The latest follow-up X-ray demonstrated no sign of avascular necrosis of the femoral head or acetabulum, and that excellent reduction and acetabular coverage had been maintained. The combination of Tanabe's open reduction with femoral and/or Pemberton pericapsular osteotomies thus appears to present a feasible, safe, practical option in treating hip dislocation in children who have already begun walking.. |
| 157. |
Y Nakashima, DH Sun, WJ Maloney, SB Goodman, DJ Schurman, RL Smith, Induction of matrix metalloproteinase expression in human macrophages by orthopaedic particulate debris in vitro, JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, 10.1302/0301-620X.80B4.8374, 80B, 4, 694-700, 1998.07, We exposed human macrophages isolated from the peripheral blood of healthy donors to metal and bone-cement particles from 0.2 to 10 mu m in size.
Zymography showed that macrophages exposed to titanium alloy and polymethylmethacrylate (PMMA) particles released a 92- and 72-kDa gelatinase in a dose- and time-dependent manner. Western immunoblotting confirmed that the 92- and 72-kDa gelatinolytic activities corresponded to matrix metalloproteinase-9 and matrix metalloproteinase-2 (MMP-9, MMP-2), respectively. Western immunoblotting also indicated that titanium alloy and PMMA particles increased the release of MMP-1. Northern blotting showed elevated mRNA signal levels for MMP-1, MMP-2, and MMP-9 after exposure to both types of particle. collagenolytic activity also increased in the macrophage culture medium in response to both types of particle.
Our findings support the hypothesis that macrophages release MMPs in proportion to the amount of particulate debris within periprosthetic tissues.. |
| 158. |
WJ Maloney, DH Sun, Y Nakashima, R James, RL Smith, Effects of serum protein opsonization on cytokine release by titanium-alloy particles, JOURNAL OF BIOMEDICAL MATERIALS RESEARCH, 41, 3, 371-376, 1998.09, This study tested whether macrophages respond differently to retrieved titanium-alloy particles than they do to machined titanium-alloy particles and assessed whether pretreatment of machined titanium-alloy particles with human serum would influence macrophage activation and cytokine release in vitro. Human monocyte/macrophages were isolated from normal healthy donors and exposed to increasing concentrations of machined and retrieved titanium-alloy particles. The profile of cytokine release was determined by commercially available ELISA kits. Machined titanium-alloy particles were opsonized with human serum and added to macrophage cultures. Serum protein binding was confirmed by SDS-PAGE analysis. The results showed that machined titanium-alloy particles and retrieved titanium-alloy particles stimulate a similar level of cytokine release when tested at comparable concentrations. Opsonization of the machined particles with human serum increased the macrophage release of cytokines in the first 12 h after exposure compared to nonopsonized particles. At 24 h, the opsonized particles stimulated significantly higher levels of cytokine release, but only at the greatest particle concentrations. This study demonstrates that machined titanium alloy induces a metabolic response in macrophages similar to that of titanium-alloy particles retrieved from failed total hip arthroplasty. In addition, these data show that serum protein binding to orthopedic biomaterial debris alters the macrophage reaction to the particles. (C) 1998 John Wiley & Sons, Inc.. |
| 159. |
T Hara, K Hayashi, Y Nakashima, T Kanemaru, Y Iwamoto, The effect of hydroxyapatite coating on the bonding of bone to titanium implants in the femora of ovariectomised rats, JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, 10.1302/0301-620X.81B4.9138, 81B, 4, 705-709, 1999.07, We have studied the effect of hydroxyapatite (HA) coating in 15 ovariectomised and 15 normal rats which had had a sham procedure. Twenty-four weeks after operation, HA-coated implants were inserted into the intramedullary canal of the right femur and uncoated implants into the left femur. The prostheses mere removed four weeks after implantation. Twelve specimens in each group had mechanical push-out tests. Sagittal sections of the other three were evaluated by SEM.
The bone mineral density (BMD) of the dissected left tibia was measured by dual-energy x-ray absorptiometry, The difference in BMD between the control and ovariectomised tibiae was 35.01 mg/cm(2) (95% CI, 26.60 to 43.42). The push-out strength of the HA-coated implants was higher than that of the uncoated implants in both groups (p Our findings suggest that HA-coated implants may improve the fixation of a cementless total hip prosthesis but that the presence of osteoporosis may limit the magnitude of this benefit.. |
| 160. |
T Hara, K Hayashi, Y Nakashima, T Kanemaru, Y Iwamoto, The effect of hydroxyapatite coating on the bonding of bone to titanium implants in the femora of ovariectomised rats, JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, 81B, 4, 705-709, 1999.07, We have studied the effect of hydroxyapatite (HA) coating in 15 ovariectomised and 15 normal rats which had had a sham procedure. Twenty-four weeks after operation, HA-coated implants were inserted into the intramedullary canal of the right femur and uncoated implants into the left femur. The prostheses mere removed four weeks after implantation. Twelve specimens in each group had mechanical push-out tests. Sagittal sections of the other three were evaluated by SEM.
The bone mineral density (BMD) of the dissected left tibia was measured by dual-energy x-ray absorptiometry, The difference in BMD between the control and ovariectomised tibiae was 35.01 mg/cm(2) (95% CI, 26.60 to 43.42). The push-out strength of the HA-coated implants was higher than that of the uncoated implants in both groups (p Our findings suggest that HA-coated implants may improve the fixation of a cementless total hip prosthesis but that the presence of osteoporosis may limit the magnitude of this benefit.. |
| 161. |
Y Nakashima, DH Sun, MCD Trindade, WJ Maloney, SB Goodman, DJ Schurman, RL Smith, Signaling pathways for tumor necrosis factor-alpha and interleukin-6 expression in human macrophages exposed to titanium-alloy particulate debris in vitro, JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 10.2106/00004623-199905000-00002, 81A, 5, 603-615, 1999.05, Background: Loosening of the implant after total joint arthroplasty remains a serious problem. The activation of macrophages by wear debris from implants, mediated by the release of cytokines that elicit bone resorption, may lead to loosening. The purpose of the present study was to elucidate the mechanisms of macrophage activation by titanium particles from the components of implants and to identify the signaling pathways involved in particle-mediated release of cytokines.
Methods: Macrophages were isolated from mononuclear leukocytes obtained from healthy human donors and were exposed to titanium-alloy particles that had been obtained from periprosthetic membranes collected at revision total joint arthroplasties and then enzymatically prepared. The experimental protocols included examination of the effects of the inhibition of phagocytosis and the binding of antibodies to macrophage complement receptors on particle-induced macrophage activation. The release of the proinflammatory cytokines TNF-alpha (tumor necrosis factor-alpha) and IL-6 (interleukin-6) was used to assess macrophage activation. The signaling pathways involved in the induction of cytokine release were analyzed by identification of phosphorylated proteins with use of the Western blot technique and by translocation of the transcription factors nuclear factor-kappa B (NF-kappa B) and nuclear factor-interleukin-6 (NF-IL-6) into the nuclear protein fraction with use of electrophoretic mobility shift assays. The role of serine/threonine and tyrosine kinase pathways in the activation of nuclear factors and the release of cytokines was examined with use of selective pharmacological agents.
Results: Exposure of macrophages to titanium-alloy particles in vitro for forty-eight hours resulted in a fortyfold increase in the release of TNF-alpha and a sevenfold increase in the release of IL-6 (p Macrophage release of TNF-alpha and IL-6 in response to particles coincided with increased tyrosine phosphorylation and mitogen-activated protein kinase activation. Inhibition of tyrosine and serine/threonine kinase activity decreased the particle-induced release of cytokines. Exposure of macrophages to either titanium-alloy particles or to antibodies to the receptor proteins CD11b and CD18 for thirty minutes activated the transcription factors NF-kappa B and NF-IL-6. Inhibition of particle phagocytosis did not block activation of the transcription factors. However, inhibition of tyrosine and serine/threonine kinase activity decreased the activation of NF-kappa B and NF-IL-6.
Conclusions These data suggest that particle-induced macrophage release of TNF-alpha and IL-6 does not require phagocytosis but is dependent on tyrosine and serine/threonine kinase activity culminating in activation of the transcription factors NF-kappa B and NF-IL-6.
Clinical Relevance: Retrieval studies have documented numerous macrophages in association with particulate debris in granulomatous tissue surrounding failed total joint replacements. However, the molecular basis on which wear particles induce macrophage expression of proinflammatory cytokines and bone-resorbing factors remains unclear. This in vitro study showed that particles incite the release of proinflammatory cytokines from macrophages in the absence of phagocytosis. These results imply that contact of wear particles with macrophage cell-surface membrane proteins, such as the complement receptor CD11b/CD18, is sufficient signal for release of proinflammatory cytokines, The data further suggest that release of proinflammatory cytokines follows transmission of a membrane recognition event through intracellular signaling pathways that effect gene activation and protein synthesis. Therefore, these data indicate that a reduction in the formation of wear particles can be expected to improve the outcome after total joint arthroplasty by decreasing macrophage activation.. |
| 162. |
Y Nakashima, DH Sun, MCD Trindade, WJ Maloney, SB Goodman, DJ Schurman, RL Smith, Signaling pathways for tumor necrosis factor-alpha and interleukin-6 expression in human macrophages exposed to titanium-alloy particulate debris in vitro, JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 81A, 5, 603-615, 1999.05, Background: Loosening of the implant after total joint arthroplasty remains a serious problem. The activation of macrophages by wear debris from implants, mediated by the release of cytokines that elicit bone resorption, may lead to loosening. The purpose of the present study was to elucidate the mechanisms of macrophage activation by titanium particles from the components of implants and to identify the signaling pathways involved in particle-mediated release of cytokines.
Methods: Macrophages were isolated from mononuclear leukocytes obtained from healthy human donors and were exposed to titanium-alloy particles that had been obtained from periprosthetic membranes collected at revision total joint arthroplasties and then enzymatically prepared. The experimental protocols included examination of the effects of the inhibition of phagocytosis and the binding of antibodies to macrophage complement receptors on particle-induced macrophage activation. The release of the proinflammatory cytokines TNF-alpha (tumor necrosis factor-alpha) and IL-6 (interleukin-6) was used to assess macrophage activation. The signaling pathways involved in the induction of cytokine release were analyzed by identification of phosphorylated proteins with use of the Western blot technique and by translocation of the transcription factors nuclear factor-kappa B (NF-kappa B) and nuclear factor-interleukin-6 (NF-IL-6) into the nuclear protein fraction with use of electrophoretic mobility shift assays. The role of serine/threonine and tyrosine kinase pathways in the activation of nuclear factors and the release of cytokines was examined with use of selective pharmacological agents.
Results: Exposure of macrophages to titanium-alloy particles in vitro for forty-eight hours resulted in a fortyfold increase in the release of TNF-alpha and a sevenfold increase in the release of IL-6 (p Macrophage release of TNF-alpha and IL-6 in response to particles coincided with increased tyrosine phosphorylation and mitogen-activated protein kinase activation. Inhibition of tyrosine and serine/threonine kinase activity decreased the particle-induced release of cytokines. Exposure of macrophages to either titanium-alloy particles or to antibodies to the receptor proteins CD11b and CD18 for thirty minutes activated the transcription factors NF-kappa B and NF-IL-6. Inhibition of particle phagocytosis did not block activation of the transcription factors. However, inhibition of tyrosine and serine/threonine kinase activity decreased the activation of NF-kappa B and NF-IL-6.
Conclusions These data suggest that particle-induced macrophage release of TNF-alpha and IL-6 does not require phagocytosis but is dependent on tyrosine and serine/threonine kinase activity culminating in activation of the transcription factors NF-kappa B and NF-IL-6.
Clinical Relevance: Retrieval studies have documented numerous macrophages in association with particulate debris in granulomatous tissue surrounding failed total joint replacements. However, the molecular basis on which wear particles induce macrophage expression of proinflammatory cytokines and bone-resorbing factors remains unclear. This in vitro study showed that particles incite the release of proinflammatory cytokines from macrophages in the absence of phagocytosis. These results imply that contact of wear particles with macrophage cell-surface membrane proteins, such as the complement receptor CD11b/CD18, is sufficient signal for release of proinflammatory cytokines, The data further suggest that release of proinflammatory cytokines follows transmission of a membrane recognition event through intracellular signaling pathways that effect gene activation and protein synthesis. Therefore, these data indicate that a reduction in the formation of wear particles can be expected to improve the outcome after total joint arthroplasty by decreasing macrophage activation.. |
| 163. |
MCD Trindade, Y Nakashima, M Lind, DH Sun, SB Goodman, WJ Maloney, DJ Schurman, RL Smith, Interleukin-4 inhibits granulocyte-macrophage colony-stimulating factor, interleukin-6, and tumor necrosis factor-alpha expression by human monocytes in response to polymethylmethacrylate particle challenge in vitro, JOURNAL OF ORTHOPAEDIC RESEARCH, 10.1002/jor.1100170602, 17, 6, 797-802, 1999.11, The outcome of total joint arthroplasty is determined by biological events at the bone-implant interface. Macrophages phagocytose implant or wear debris at the interface and release proinflammatory mediators such as interleukins 1 and 6, tumor necrosis factor-alpha, and prostaglandin E-2 These mediators are thought to contribute to the resorption of periprosthetic bone. Previous studies of tissues harvested from the bone-implant interface of failed orthopaedic implants demonstrated a possible role for two other cytokines, granulocyte-macrophage colony-stimulating factor and interleukin-4. The present study examined the effects of in vitro challenge with polymethylmethacrylate p articles on the expression of granulocyte-macrophage colony-stimulating factor by primary human monocytes/macrophages and the role of interleukin-4 in regulating this expression. The polymethylmethacrylate particles caused a dose-dependent release of granulocyte macrophage colony-stimulating factor at 48 hours. This release was accompanied by increased expression of interleukins 6 and 1beta and tumor necrosis factor-alpha. Release of the lysosomal enzyme hexosaminidase also increased in response to the particles. Interleukin-4, inhibited the expression of,granulocyte-macrophage colony-stimulating factor, interleukin-6, and tumor necrosis factor-alpha at 48 hours in a dose-dependent manner. The data presented in this study confirm the hypothesis that interleukin-4 downregulates particle-induced activation of macrophages, as demonstrated by the decreased release of proinflammatory mediators.. |
| 164. |
MCD Trindade, Y Nakashima, M Lind, DH Sun, SB Goodman, WJ Maloney, DJ Schurman, RL Smith, Interleukin-4 inhibits granulocyte-macrophage colony-stimulating factor, interleukin-6, and tumor necrosis factor-alpha expression by human monocytes in response to polymethylmethacrylate particle challenge in vitro, JOURNAL OF ORTHOPAEDIC RESEARCH, 17, 6, 797-802, 1999.11, The outcome of total joint arthroplasty is determined by biological events at the bone-implant interface. Macrophages phagocytose implant or wear debris at the interface and release proinflammatory mediators such as interleukins 1 and 6, tumor necrosis factor-alpha, and prostaglandin E-2 These mediators are thought to contribute to the resorption of periprosthetic bone. Previous studies of tissues harvested from the bone-implant interface of failed orthopaedic implants demonstrated a possible role for two other cytokines, granulocyte-macrophage colony-stimulating factor and interleukin-4. The present study examined the effects of in vitro challenge with polymethylmethacrylate p articles on the expression of granulocyte-macrophage colony-stimulating factor by primary human monocytes/macrophages and the role of interleukin-4 in regulating this expression. The polymethylmethacrylate particles caused a dose-dependent release of granulocyte macrophage colony-stimulating factor at 48 hours. This release was accompanied by increased expression of interleukins 6 and 1beta and tumor necrosis factor-alpha. Release of the lysosomal enzyme hexosaminidase also increased in response to the particles. Interleukin-4, inhibited the expression of,granulocyte-macrophage colony-stimulating factor, interleukin-6, and tumor necrosis factor-alpha at 48 hours in a dose-dependent manner. The data presented in this study confirm the hypothesis that interleukin-4 downregulates particle-induced activation of macrophages, as demonstrated by the decreased release of proinflammatory mediators.. |
| 165. |
Y Nakashima, DH Sun, MCD Trindade, LE Chun, Y Song, SB Goodman, DJ Schurman, WJ Maloney, RL Smith, Induction of macrophage C-C chemokine expression by titanium alloy and bone cement particles, JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, 10.1302/0301-620X.81B1.8884, 81B, 1, 155-162, 1999.01, Particulate wear debris is associated with I periprosthetic inflammation and loosening in total joint arthroplasty, We tested the effects of titanium alloy (Ti-alloy) and PMMA particles on monocyte/macrophage expression of the C-C chemokines, monocyte chemoattractant protein-1 (MCP-1), monocyte inflammatory protein-1 alpha (MIP-1 alpha), and regulated upon activation normal T expressed and secreted protein (RANTES). Periprosthetic granulomatous tissue was analysed for expression of macrophage chemokines by immunohistochemistry. Chemokine expression in human monocytes/macrophages exposed to Ti-alloy and PMMA particles in vitro was determined by RT-PCR, ELISA and monocyte migration.
We observed MCP-1 and MIP-1 alpha expression in all tissue samples from failed arthroplasties, Ti-alloy and PMMA particles increased expression of MCP-1 and MIP-1 alpha in macrophages in vitro in a dose- and time-dependent manner whereas RANTES was not detected. mRNA signal levels for MCP-1 and MIP-1 alpha were also observed in cells after exposure to particles. Monocyte migration was stimulated by culture medium collected from macrophages exposed to Ti-alloy and PMMA particles, Antibodies to MCP-1 and MIP-1 alpha: inhibited chemotactic activity of the culture medium samples.
Release of C-C chemokines by macrophages in response to wear particles may contribute to chronic inflammation at the bone-implant interface in total joint arthroplasty.. |
| 166. |
Y Nakashima, DH Sun, MCD Trindade, LE Chun, Y Song, SB Goodman, DJ Schurman, WJ Maloney, RL Smith, Induction of macrophage C-C chemokine expression by titanium alloy and bone cement particles, JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, 10.1302/0301-620X.81B1.8884, 81B, 1, 155-162, 1999.01, Particulate wear debris is associated with I periprosthetic inflammation and loosening in total joint arthroplasty, We tested the effects of titanium alloy (Ti-alloy) and PMMA particles on monocyte/macrophage expression of the C-C chemokines, monocyte chemoattractant protein-1 (MCP-1), monocyte inflammatory protein-1 alpha (MIP-1 alpha), and regulated upon activation normal T expressed and secreted protein (RANTES). Periprosthetic granulomatous tissue was analysed for expression of macrophage chemokines by immunohistochemistry. Chemokine expression in human monocytes/macrophages exposed to Ti-alloy and PMMA particles in vitro was determined by RT-PCR, ELISA and monocyte migration.
We observed MCP-1 and MIP-1 alpha expression in all tissue samples from failed arthroplasties, Ti-alloy and PMMA particles increased expression of MCP-1 and MIP-1 alpha in macrophages in vitro in a dose- and time-dependent manner whereas RANTES was not detected. mRNA signal levels for MCP-1 and MIP-1 alpha were also observed in cells after exposure to particles. Monocyte migration was stimulated by culture medium collected from macrophages exposed to Ti-alloy and PMMA particles, Antibodies to MCP-1 and MIP-1 alpha: inhibited chemotactic activity of the culture medium samples.
Release of C-C chemokines by macrophages in response to wear particles may contribute to chronic inflammation at the bone-implant interface in total joint arthroplasty.. |
| 167. |
M Lind, MCD Trindade, Y Nakashima, DJ Schurman, SB Goodman, RL Smith, Chemotaxis and activation of particle-challenged human monocytes in response to monocyte migration inhibitory factor and C-C chemokines, JOURNAL OF BIOMEDICAL MATERIALS RESEARCH, 10.1002/(SICI)1097-4636(1999)48:33.0.CO;2-X, 48, 3, 246-250, 1999.06, Cytokines that regulate monocyte migration were found in;membrane tissue surrounding loosened prosthetic implants. Monocyte migration inhibition factor (MIF) is able to inhibit macrophage migration. Monocyte chemoattractant protein (MCP) and macrophage inflammatory protein (MIP) are potent macrophage chemoattractants. These cytokines may be expressed as part of the foreign body response to prosthetic particulate debris. Chemotaxis analysis and macrophage activation experiments were performed to determine the effects of MIF, MCP-1, and MIP-1 alpha on macrophage migration and activation in vitro. We demonstrated that MIF had its maximal migration inhibitory effect for unchallenged add particle challenged macrophages at 1 ng/mL. MCP-1 and MIP-1 alpha stimulated macrophage chemotaxis maximally at 1 to 10 ng/mL, Dose-response studies with MIF, MCP-1, and MIP-1 alpha demonstrated that these cytokines did not modulate activation of unchallenged or particle challenged macrophages as evaluated by IL-6 and TNF-alpha release. However, these cytokines do not appear to affect macrophage release of proinflammatory mediators in vitro. (C) 1999 John Wiley & Sons, Inc.. |
| 168. |
M Lind, MCD Trindade, Y Nakashima, DJ Schurman, SB Goodman, RL Smith, Chemotaxis and activation of particle-challenged human monocytes in response to monocyte migration inhibitory factor and C-C chemokines, JOURNAL OF BIOMEDICAL MATERIALS RESEARCH, 48, 3, 246-250, 1999.06, Cytokines that regulate monocyte migration were found in;membrane tissue surrounding loosened prosthetic implants. Monocyte migration inhibition factor (MIF) is able to inhibit macrophage migration. Monocyte chemoattractant protein (MCP) and macrophage inflammatory protein (MIP) are potent macrophage chemoattractants. These cytokines may be expressed as part of the foreign body response to prosthetic particulate debris. Chemotaxis analysis and macrophage activation experiments were performed to determine the effects of MIF, MCP-1, and MIP-1 alpha on macrophage migration and activation in vitro. We demonstrated that MIF had its maximal migration inhibitory effect for unchallenged add particle challenged macrophages at 1 ng/mL. MCP-1 and MIP-1 alpha stimulated macrophage chemotaxis maximally at 1 to 10 ng/mL, Dose-response studies with MIF, MCP-1, and MIP-1 alpha demonstrated that these cytokines did not modulate activation of unchallenged or particle challenged macrophages as evaluated by IL-6 and TNF-alpha release. However, these cytokines do not appear to affect macrophage release of proinflammatory mediators in vitro. (C) 1999 John Wiley & Sons, Inc.. |
| 169. |
A Case of Reiter's Syndrome
Here we report a case of 30 years old man with Reiter's syndrome. He complained of pain in his left great toe with swelling. Radiograph showed erosive changes of interphalangeal joint of his great toe with periosteal reaction and no joint space narrowing. He had not only arthritis of left great toe but also prostitis, balanitis circinata and conjunctivitis. Erythrocyte sedimentation rate, C-reactive protein and serum uric acid concentration were normal, and serum rheumatoid factor was negative. Typing of his HLA showed B27 positive. Titer of anti-serum against clamydia trachomatis was significantly increased.. |
| 170. |
Case Report : Vena Cava Filter Implantation to Prevent Lethal Pulmonary Embolism in Patients with Deep Venous Thrombosis after Transfer of Acetabulum Operation
We treated a patient who had been suffering from a wide range of deep venous thrombosis (DVT) in the lower right extremity after the right transfer of the acetabulum. The patient noticed swelling and pain in the lower right extremity two weeks after the operation. The defects of the contrast medium were seen between the right common iliac vein and calf venula when venography was performed. A slight wedgeshaped defect was also seen in the lower left lung when lung blood flow scintigram was performed. The patient was diagnosed as DVT with slight pulmonary embolism (PE). Immediately we routinely treated this patient with anticoagulant therapy that consists of intravenous heparin medication. In order to prevent lethal PE during the therapy, we implanted a percutaneous infra vena cava filter (IVC filter) capable of trapping large thrombus and inducing spontaneous fibrinolysis at this site. Furthermore, fibrinolytic therapy consisting of intravenous urokinase medication was added. During the therapy, swelling and pain of the lower right extremity improved with the decreasing in the serum D-dimer. The IVC filter seems to be useful for preventing acute lethal PE following a wide range of DVT after hip surgery. However, long term follow-up of this patient seems to be required.. |
| 171. |
Arthroscopic Findings in Osteonecrosis of Femoral Head. |
| 172. |
Influence of Postoperative Hip Position after Transtrochanteric Rotational Osteotomy of Femoral Head on Blood Flow of Nutritional Artery
For several weeks, a hip joint is usually kept in a slightly flexed position after transtrochanteric anterior rotational osteotomy of the femoral head because of possible necessity of relaxation of a stretched nutritional artery of the femoral head; a branch of the medial femoral circumflex artery. We measured the blood flow of the nutritional artery by using Doppler ultrasound sonography at various hip flexion positions intraoperatively to analyze the necessity of postoperative hip flexion. Between July 1998 and July 1999, 16 hips underwent transtrochanteric rotational osteotomy for the treatment of 15 osteonecrosis of the femoral head and 1 osteochondritis dissecans. There were 14 male and 2 femalepatients with the mean age of 39 years (age range, 17-54 years). After rotating femoral head, the nutritional artery was checked by using ultrasound sonography in fibrofatty tissue beneath divided quadratus femoris muscles and the blood flow was continuously measured while decreasing the angle of hip flexion. In 14 hips (88%), the nutritional artery blood flow was able to measured at the 30-degree flexed position, but not in other two hips (12%). This study provides further evidence of the importance of postoperative flexed hip positions.. |
| 173. |
Look-up View of Osteoarthrosis of Hip
Arthroscopic and arthrographic studies of the osteoarthritic hip joint showed that cartilage degeneration generally originates in the anterosuperior position of the weigth-bearing area. We evaluated the usefulness of a “look-up” plane X-ray view of osteoarthrotic hip joints for early detection of joint space narrowing or articular cartilage wear in the anterosuperior weight-bearing area of the joints. We examined 34 hips of 23 patients consisting of 6 normal joints and 28 coxarthrosis. The coxarthrosis were classified into four stages according to joint space narrowing: prearthritic stage (6 patients), early-stage (5 patients), advanced-stage (10 patients), and end-stage (7 patients). The wiath of the joint space was measured on four types of radiographs in each patient; lying down view, standing up view, lying down look-up view, and standing up look-up view. The joint space on the look-up view in most hips in the prearthritic stage tended to increase in comparison with anteroposterior radiograpf, while one hip joint judged as prearthritic stage showed narrowing of the jont space. The joint space of the hips in the early and advanced stages tended to decrease. There were two cases of early-stage whose look-up views showed joint space narrowing and were judged as advanced stage. In conclusion, the lool-up view reflects cartilage wear in the anterosuperior position and is useful for early detection of joint space narrowing.. |
| 174. |
Magnification of Templating Scale for Components of Total Hip Arthroplasty
Hip joints in radiographs were magnified in order to examine the appropriate magnification of templates for preoperative planning in total hip arthroplasty (THA). The magnification of each hip joint, in postoperative radiographs after THA, was calcurated using inserted implants (socket or femoral stem) as scales. The relationship between the magnifications and grade of obesity or hip flexion contracture was also examined. In most hips, the percentage of magnification was between 110 and 120. Obesity or hip flexion contracture did not influence the magnification. These date suggest that degrees above 110% are more appropriate than 110% for the magnification of templates.. |
| 175. |
Correlation between the onset of secondary osteoarthritis of the hip and the acetabular neck angle : radiographical measurement. |
| 176. |
Ultrasonographic findings for Lower Extremity Blood Flow with the Deep Venous Thrombosis
We observed lower extremity blood flow in deep venous thrombosis (DVT) patients using ultrasonography after orthopaedic hip joint operation. Between July 1999 and June 2000, four patients underwent total hip arthoplasty and hemi-surface arthroplasty was performed on one. We measured the flow volume of the femoral vein and the great saphenous vein using ultrasonography on all patients after venography. The patients consisted of one male and four females with a mean age of 67 years (age range: 47 to 74 years). Deep venous thrombosis was identified in two (40 percent) of the five patients. There was no significant difference in the flow volume of the femoral vein between the DVT (+) group and DVT (-) groups (129±33ml/m, 165±89ml/m). The flow volume of the great saphenous vein in the DVT (+) group increased significantly (189±108ml/m, 51±22ml/m p |
| 177. |
A case with stress fracture in femoral neck and iliac wing in a man
We report a case with stress fracture in femoral neck and iliac wing that occurred in 29-year old man after his starting to work for a forwarding agent in March 1999. His bone mineral density was remarkably decreased in lumbar spine and femoral neck. We discuss the mechanism of the stress fracture in this case.. |
| 178. |
A case with stress fracture in femoral neck and iliac wing in a man. |
| 179. |
A case with stress fracture in femoral neck and iliac wing in a man. |
| 180. |
Look-up X-ray View of Osteonecrosis of Femoral Head
It is well known that in femoral head osteonecrosis patients, necrosis and collapse are usually located in the anterosuperior portion of the femoral head. We evaluated the usefulness of a “look-up” plane X-ray view of osteonecrosis for early detection of femoral head collapse. We examined 20 joints in 17 patients. Osteonecrosis was classified into four stages according to radiographic signs (demarcation line, crescent line, collapse and joint space narrowing). Eight joints were classified as stage 2 and 12 joints as stage 3. Collapse, crescent line and demarcation line were evaluated on three types of radiographs; ordinary anteroposterior (AP) and lateral views and the “look-up” view. Seventeen of the 20 hips clearly showed more than 2mm collapse on the “look-up” view. The incidence of clear collapse was higher than that on the AP view. The incidence of crescent line was also higher. There were no significant differences in the demarcation line between the look-up view and AP view. Magnetic resonance imaging and tomography are useful and routinely used to define necrotic lesions. However, the “look-up” view is a simple and inexpensive method for the early detection of femoral head collapse in osteonecrotic patients.. |
| 181. |
Acetabular Revisions with Allografts
Bone defect is a serious problem in revision arthroplasty. Allograft serves as a solution for restoring bone defects. This paper describes the incidence of allograft for acetabular revisions in our department and examines the clinical outcomes. Between 1992 and 1999, 72 acetabular revisions were performed. Forty-eight (67%) revisions were with bone grafts, and, in 36 grafts, allogenic bones were used. In cases with allografts that had at least one-year follow-up after operation (mean follow-up period: 3.8 years), there were no re-revisions or cases in which radiographical loosening was observed.. |
| 182. |
H Kubota, Y Noguchi, K Urabe, T Itokawa, Y Nakashima, Y Iwamoto, Flexor digitorum longus accessorius in the club foot of an infant with Nager syndrome, ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY, 10.1007/s004020000167, 121, 1-2, 95-96, 2001.01, The case of a male infant is reported who had club foot on the right side and pes adductus on the left side in combination with acrofacial dysostosis; he also demonstrated preaxial anomalies of the upper limbs indicative of Nager syndrome, In addition, an unusual aberrant muscle was discovered during surgical correction of the right club foot.. |
| 183. |
H Kubota, Y Noguchi, K Urabe, T Itokawa, Y Nakashima, Y Iwamoto, Flexor digitorum longus accessorius in the club foot of an infant with Nager syndrome, ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY, 121, 1-2, 95-96, 2001.01, The case of a male infant is reported who had club foot on the right side and pes adductus on the left side in combination with acrofacial dysostosis; he also demonstrated preaxial anomalies of the upper limbs indicative of Nager syndrome, In addition, an unusual aberrant muscle was discovered during surgical correction of the right club foot.. |
| 184. |
Arthroscopic Findings of Acetabular Labrum Compared with Radial MR Findings
Between February and September of 2000, we carried out radial magneic resonance imaging (MRI) on 8 hips consisting of 5 pre-osteoarthritis and 3 early stage osteoarthritis. There were 7 female patients with a mean age of 28 years (age range: 16-50 years). The radial MRI results were compared with intraoperative arthroscopic findings. In the weight-bearing portion, from 45° ante rosuperior to 45° posterosuperior, all patients had various tears of the acetabular labrum. In the anterosuperior portion, 4 hips (50%) showed imcomplete tears, 3 hips (38%) showed complete tears, and only 1 hips (18%) showed intact labrum. In the superior portion, each of the 3 hips (38%) showed imcomplate and complete tears. In the posterosuperior portion, each of the 3 hips (38%) showed imcomplete tears and intact labrum. The arthroscopic normal labrum was clearly depicted as a homogenous triangular area of low signal intensity. The incomplete tears were depicted as a moderate signal intensity or central high signal intensity. The complete tears were depicted as a diffuse and obscure high signal intensity. We conclude that radial MRI may be a useful non-invasive diagnostic method for tears of the acetabular labrum in oseoarthritis.. |
| 185. |
Arthroscopic Findings Have No Relation to Short-term Results of Bipolar Hip Prosthesis for Osteonecrosis of the Femoral Head.
Recent reports show that in patients with osteonecrosis of the femoral head (ONFH), degenerative changes were already present in the acetabular cartilage, even when radiographs of the acetabulum show no abnormalities. We performed 17 hip arthroscopies to assess whether intra-articular pathological changes of ONFH are associated with the short-term results of hips treated by bipolar hip prosthesis. There were 10 female patients and 6 male patients with a mean age at the operation of 53 years (range: 20 to 82 years) and a mean follow-up of 1.9 years (range: 1.0 to 3.0 years). Eight hips were classified as stage 3A collapse of less than 3mm, 8 hips were determined to be at stage 3B collapse of 3mm or more, and one hip was categorized as stage 4 (associated with osteoarthritic changes). Following arthroscopy, 9 hips (53%) demonstrated more than mild degenerative change of the acetabulum, and 9 hips (53%) exhibited radial fibrillated labral tears. At final follow-up, no hips showed acetabular migration, component loosening, osteolysis, or increased pain. We suggest that short-term results of hips treated by bipolar hip prosthesis are not associated with intra-articular pathological changes of ONFH.. |
| 186. |
A Case of Reiter's Syndrome with Achilles Tendon Rupture
A 30-year-old man presented with a history of mono-arthritis at the IP joint of his left great toe accompanied with conjunctivitis and balanitis circinata, following enthesopathy at multiple sites. He had Achilles tendon rupture near insertion at the calcaneal bone, when he slipped on a grass slope. The tendon rupture end appeared swollen and denatured in reconstruction surgery. Histologically, numerous neovascularizations were seen in the tendon fiber and loss of staining of the collagen fiber with inflammatory cells, suggesting prolonged inflammation at the Achilles tendon near the insertion site weakened the strength of the Achilles tendon, leading to rupture with minor trauma. Sulphasalazine and low-dose predonizolone were not effective for this patient. But, interestingly, bucillamine was effective for decreasing symptoms due to multiple enthesopathy with decreased serum level of c-reactive protein.. |
| 187. |
Akio Sakamoto, Ryuji Nagamine, Takeshi Maeda, Takeshi Shuto, Go Hirata, Yasuharu Nakashima, Shuichi Matsuda, Yukihide Iwamoto, Multicentric reticulohistiocytosis with hydrarthrosis in both knee joints: Disease stabilization with synovectomy, and medication with a steroid and low-dose methotrexate, Modern Rheumatology, 10.1007/s101650200026, 12, 2, 155-159, 2002.08, Multicentric reticulohistiocytosis is a rare systemic disease characterized by the infiltration of histiocytes and multinucleated giant cells with cutaneous nodules, and severe destructive arthritis. It is commonly the peripheral joints which are affected, and therefore symptoms in large joints have not been fully investigated. We describe the case of a 44-year-old woman with multicentric reticulohistiocytosis, who was suffering from swelling in both knee joints and cutaneous nodules, in addition to arthritis in the elbow, hip, and peripheral joints. Magnetic resonance imaging of both knee joints showed hydrarthrosis associated with a tumor-like overgrowth of synovial tissue. These symptoms were reduced following a resection of the synovial tissue and subsequent medication with prednisone and low-dose methotrexate. It should be noted that swelling in the knee joints can be one of the symptoms caused by multicentric reticulohistiocytosis, in addition to cutaneous nodules and arthritis in the peripheral joints. Resection of synovial tissue, and medication with prednisone and low-dose methotrexate were effective in the present case.. |
| 188. |
Multicentric reticulohistiocytosis with hydrarthrosis in both knee joints: Disease stabilization with synovectomy, and medication with a steroid and low-dose methotrexate
Multicentric reticulohistiocytosis is a rare systemic disease characterized by the infiltration of histiocytes and multinucleated giant cells with cutaneous nodules, and severe destructive arthritis. It is commonly the peripheral joints which are affected, and therefore symptoms in large joints have not been fully investigated. We describe the case of a 44-year-old woman with multicentric reticulohistiocytosis, who was suffering from swelling in both knee joints and cutaneous nodules, in addition to arthritis in the elbow, hip, and peripheral joints. Magnetic resonance imaging of both knee joints showed hydrarthrosis associated with a tumor-like overgrowth of synovial tissue. These symptoms were reduced following a resection of the synovial tissue and subsequent medication with prednisone and low-dose methotrexate. It should be noted that swelling in the knee joints can be one of the symptoms caused by multicentric reticulohistiocytosis, in addition to cutaneous nodules and arthritis in the peripheral joints. Resection of synovial tissue, and medication with prednisone and low-dose methotrexate were effective in the present case.. |
| 189. |
Physical Examination for Diagnosing Labral Tears of the Acetabrum.
To determine the relationship between pain at maximum flexion-rotation and the status of labral tear, a physical examination we refer to as “limbus sign” and hip arthroscopy were carried out. Between February 1998 and 1999, 30 patients with dysplastic osteoarthritis (2 males and 28 females) with a mean age of 42 years (range, 18 to 64 years), underwent 30 hip arthroscopies following physical examination. All hip joints arthroscoped demonstrated incomplete or complete detaching tears of the acetabular labrum in the weight-bearing area. Ten patients experienced pain during the maximum flexion-internal rotation test, and 10 patients were positive in the maximum flexion-external rotation test. Positive maximum flexion-external rotation test results correlated with early stage osteoarthritis. Positive maximum flexion-internal rotation test results were associated with incomplete detaching tears; however, there was no statistically significant relationship between maximum flexion-rotation test and arthroscopic findings of labral tears. This test may therefore be influenced by the degeneration of joint cartilage. We conclude that the maximum flexion-rotation test may be used to assess the labral tear of the acetabulum in early stage dysplastic hips, but not in advanced stage osteoarthritis.. |
| 190. |
T Maeda, H Yamada, R Nagamine, T Shuto, Y Nakashima, G Hirata, Y Iwamoto, Involvement of CD4+,CD57+T cells in the disease activity of rheumatoid arthritis, ARTHRITIS AND RHEUMATISM, 10.1002/art.10133, 46, 2, 379-384, 2002.02, Objective. To evaluate the relationship between the frequency of peripheral CD57+ T cells and the physical status of rheumatoid arthritis (RA) patients, and to perform cytokine analysis of these CD57+ T cells.
Methods. Four-color fluorescence-activated cell sorter analysis was performed to detect both cell surface antigens and intracellular cytokines in peripheral blood leukocytes, using monoclonal antibodies against CD3, CD4, CD8, CD57, interferon-gamma (IFNgamma), and interleukin-4 (IL-4). RA patients were clinically evaluated with a modified Health Assessment Questionnaire (M-HAQ), joint score, face scale, and visual analog scale (VAS) assessing pain and disease activity.
Results. There was a significant correlation between the frequency of CD4+,CD57+ T cells and erythrocyte sedimentation rate (ESR), whereas a correlation was not found between the frequency of CD8+,CD57+ T cells and ESR. The frequency of CD4+,CD57+ T cells also showed a significant correlation with the mHAQ score, VAS, and face scale. Again, there was no significant correlation between the above-mentioned clinical scores and the frequency of CD8+,CD57+ T cells. Flow cytometric analysis of intracellular cytokines revealed that 14.5% of the CD57+ T cells produced IFNgamma, whereas only 2.8% of the CD57+ T cells produced IL-4 in RA patients.
Conclusion. Evidence showing that the frequency of CD4+,CD57+ T cells among CD3+ cells of RA patients had a significant correlation not only with ESR but also with the physical status of the patients, and that a large proportion of the CD4+,CD57+ T cells had the capacity to produce IFNgamma, strongly suggests that these CD4+,CD57+ T cells are involved in the immunopathogenesis of RA.. |
| 191. |
T Maeda, H Yamada, R Nagamine, T Shuto, Y Nakashima, G Hirata, Y Iwamoto, Involvement of CD4+,CD57+T cells in the disease activity of rheumatoid arthritis, ARTHRITIS AND RHEUMATISM, 10.1002/art.10133, 46, 2, 379-384, 2002.02, Objective. To evaluate the relationship between the frequency of peripheral CD57+ T cells and the physical status of rheumatoid arthritis (RA) patients, and to perform cytokine analysis of these CD57+ T cells.
Methods. Four-color fluorescence-activated cell sorter analysis was performed to detect both cell surface antigens and intracellular cytokines in peripheral blood leukocytes, using monoclonal antibodies against CD3, CD4, CD8, CD57, interferon-gamma (IFNgamma), and interleukin-4 (IL-4). RA patients were clinically evaluated with a modified Health Assessment Questionnaire (M-HAQ), joint score, face scale, and visual analog scale (VAS) assessing pain and disease activity.
Results. There was a significant correlation between the frequency of CD4+,CD57+ T cells and erythrocyte sedimentation rate (ESR), whereas a correlation was not found between the frequency of CD8+,CD57+ T cells and ESR. The frequency of CD4+,CD57+ T cells also showed a significant correlation with the mHAQ score, VAS, and face scale. Again, there was no significant correlation between the above-mentioned clinical scores and the frequency of CD8+,CD57+ T cells. Flow cytometric analysis of intracellular cytokines revealed that 14.5% of the CD57+ T cells produced IFNgamma, whereas only 2.8% of the CD57+ T cells produced IL-4 in RA patients.
Conclusion. Evidence showing that the frequency of CD4+,CD57+ T cells among CD3+ cells of RA patients had a significant correlation not only with ESR but also with the physical status of the patients, and that a large proportion of the CD4+,CD57+ T cells had the capacity to produce IFNgamma, strongly suggests that these CD4+,CD57+ T cells are involved in the immunopathogenesis of RA.. |
| 192. |
Ultrasonographic Blood Flow Examination of the Nutritional Artery in Transtrochanteric Rotational Osteotomy of the Femoral Head
We observed ultrasonographic blood flow findings of the nutritional artery of the recollapsed femoral head in patients with osteonecrosis treated by transtrochanteric rotational osteotomy of the femoral head. Between July 1998 and September 2000, the nutritional artery of 26 hips (23 patients) were observed intraoperatively by ultrasonography. After rotating the femoral head, the nutritional artery was checked by ultrasonography in fibrofatty tissue beneath divided quadratus femoris muscle seven times while changing the angle of hip flexion. The patients consisted of 16 males and seven females with a mean age of 41 years (age range: 23 to 60 years). Recollapsed femoral head was identified in five (19%) of the 26 patients after one year or more followup. The hips of the recollapsed femoral head confirmed ultrasonographic flow at an average of one (range: 0 to 3 times), and the hips without recollapsed femoral heads demonstrated a mean four times (range: 2 to 7 times). There was significant difference between with and without recollapse. We conclude that ultrasonographic findings of the nutritional artery is helpful for assessing the short-term results of hips treated by transtrochanteric rotational osteotomy of the femoral head.. |
| 193. |
Sun DH, Trindade MC, Nakashima Y, Maloney WJ, Goodman SB, Schurman DJ, Smith RL, Human serum opsonization of orthopedic biomaterial particles: protein-binding and monocyte/macrophage activation in vitro., Journal of biomedical materials research. Part A, 10.1002/jbm.a.10477, 65, 2, 290-298, 2003.05. |
| 194. |
M Taketa, T Fujii, H Kubota, Y Nakashima, Y Noguchi, Y Iwamoto, Correlation between center-edge angle and acetabulum-head index in developmental dysplasia of the hip with avascular necrosis of the femoral head, JOURNAL OF PEDIATRIC ORTHOPAEDICS-PART B, 10.1097/01.bpb.0000063529.40368.b3, 12, 3, 215-218, 2003.05, In order to clarify the relationship between the center-edge angle and the acetabulum-head index, we reviewed 97 hips in 86 patients suffering from developmental dysplasia of the hip. We measured the center edge angle and the acetabulum-head index, and evaluated avascular necrosis of the femoral head according to Kalamchi classification. The center-edge angle correlated highly with the acetabulum-head index in non-avascular necrosis, and in Kalamchi groups I and II, but not in Kalamchi groups III and IV. Because of difficulties in measurement, it is possible that the center-edge angle does not precisely indicate acetabular coverage of developmental dysplasia of the hip with avascular necrosis. (C) 2003 Lippincott Williams Wilkins.. |
| 195. |
DH Sun, MCD Trindade, Y Nakashima, WJ Maloney, SB Goodman, DJ Schurman, RL Smith, Human serum opsonization of orthopedic biomaterial particles: Protein-binding and monocyte/macrophage activation in vitro, JOURNAL OF BIOMEDICAL MATERIALS RESEARCH PART A, 10.1002/jbm.a.10477, 65A, 2, 290-298, 2003.05, Wear particles generated after total joint arthroplasty activate monocyte/macrophages and incite formation of a granulomatous periprosthetic tissue associated with bone loss and implant loosening. This study tested the hypothesis that selective opsonization of orthopedic implant biomaterial wear particles by human serum proteins influences monocyte/macrophage activation. Serum protein binding to metallic, polymeric, and ceramic particles was determined by one-dimensional sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Individual proteins bound to particles were subsequently identified using two-dimensional SDS-PAGE, microsequencing techniques, and SWISS-PROT analysis. Effects of selective protein opsonization on particle-induced monocyte/macrophage activation were assessed by quantification of interleukin-1beta, interleukin-6, and tumor necrosis factor-alpha release. Results from one-dimensional gel analyses revealed distinct serum protein-binding patterns specific for each material tested. Two-dimensional gel analysis together with amino acid sequencing of the prominent protein species confirmed the presence of albumin and alpha-l-antitrypsin bound to all particles tested. In contrast to the metallic particles, apolipoprotein was a major species associated with polymeric particles. Opsonization of PMMA particles with purified preparations of each of the identified proteins showed that albumin significantly enhanced particle-induced monocyte/macrophage activation. These data confirm orthopedic biomaterial specific binding of human serum proteins and demonstrate that albumin exacerbates particle-induced monocyte/macrophage activation. Alterations in the chemical and surface properties of orthopedic biomaterials to modulate protein interactions may improve implant longevity. (C) 2003 Wiley Periodicals, Inc.. |
| 196. |
[Bone quantity and quality to its mechanical integrity].
Bone strength is made up of quantity (mass, mineralization), geometry (anatomy, micro architecture, collagen structure), and turnover/damage accumulation. While most of the mechanical behavior can be explained by measures of porosity, several additional descriptors of the geometry have been proposed for better predictions of fracture risk. This review introduces various aspects of these relationships between bone quantity and quality to its mechanical integrity.. |
| 197. |
T Shuto, T Kuwano, Y Nakashima, H Yamada, K Okazaki, T Mawatari, T Maeda, Y Iwamoto, Effect of alendronate on radiographic progression in rheumatoid arthritis., JOURNAL OF BONE AND MINERAL RESEARCH, 19, S333-S333, 2004.10. |
| 198. |
Transtrochanteric anterior rotational osteotomy for the patients with severe Legg-Calve-Perthes disease. |
| 199. |
Acetabular Dysplasia in Hips with Idiopathic Osteonecrosis of the Femoral Head
Acetabular dysplasia may influence the incidence of collapse in the osteonecrosis of the femoral head. The degree of dysplasia was investigated by measuring the Sharp angle, acetabular oblique angle, acetabular head index, and center edge angle in hips which collapsed and underwent operations except for THA, and comparing with the normal range reported. There was a tendency for collapsed to have more acetabular dysplasia than normal hips. Acetabular dysplasia may be involved in the collapse mechanism.. |
| 200. |
The Pathophysiology of Rapidly Destructive Arthrosis of the Hip. |
| 201. |
Effects of head diameter and femoral offset on the range of motion and the impingement in total hip arthroplasty. |
| 202. |
Biologic responses to the orthopaedic wear particles. |
| 203. |
H Yagi, K Fukushima, S Satoh, Y Nakashima, M Nozaki, H Nakano, Postpartum retroperitoneal fasciitis: A case report and review of literature, AMERICAN JOURNAL OF PERINATOLOGY, 10.1055/s-2005-861573, 22, 2, 109-113, 2005.02, We present a case of a postpartum female with iliopsoas fasciitis in the puerperium. Two days after a spontaneous vaginal delivery at 38 weeks without any complications, the patient complained of pain in the left thigh and hip, associated with a temperature of 38degreesC. Consequently, she could not walk 4 days after delivery and her body temperature had increased to 39degreesC. Extreme left flank pain and tenderness in the left pelvic wall were prominent, whereas the tenderness in the pelvis was moderate. Magnetic resonance imaging led us to diagnose illopsoas fasciitis. This was complicated by sepsis but improved after a protracted antibiotic treatment without any surgical intervention. A literature review revealed that serious complications, including sepsis or permanent functional disturbance, could arise although retroperitoneal fasciitis and/or abscesses are very rare after vaginal delivery. Iliopsoas fasciitis could be considered when patients complain of extreme pain in the pelvic wall, sacroiliac joint region, or thigh-symptoms that are uncommon in uncomplicated endometritis.. |
| 204. |
K Nishida, T Yamamoto, G Motomura, T Shuto, Y Nakashima, S Jingushi, Y Iwamoto, Early MRI findings of the acetabulum and femoral head in a dysplastic hip resulting in a rapid destruction of the hip joint, ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY, 10.1007/s00402-005-0053-x, 125, 8, 567-570, 2005.10, We documented a case of rapidly destructive arthrosis of the hip joint (RDA), in whom abnormal findings were observed not only in the femoral head but also in the acetabulum on magnetic resonance images (MRI) in the early stage. Radiographs made 1 month after the onset of pain showed a slight narrowing of the joint space. MRI obtained 2 months after the onset detected small foci of low signal intensity in the subchondral area of the femoral head on the T1-weighted images, and a linear pattern of high signal intensity in the lateral side of the acetabulum on the T2-weighted images. During the 17-month follow-up period, this case eventually underwent massive destruction of the femoral head as well as the acetabulum.. |
| 205. |
S Ikemura, T Yamamoto, Y Nakashima, T Shuto, S Jingushi, Y Iwamoto, Bilateral subchondral insufficiency fracture of the femoral head after renal transplantation - A case report, ARTHRITIS AND RHEUMATISM, 10.1002/art.20994, 52, 4, 1293-1296, 2005.04, This report describes the case of a 47-year-old woman who was found to have subchondral insufficiency fractures in both femoral heads after renal transplantation. Initially, plain radiographs showed no obvious changes, but magnetic resonance imaging (MRI) revealed an irregular, discontinuous, low-intensity band on the T1-weighted image of both hips. The patient was treated nonsurgically. Ten months after onset, the pain in both hips disappeared, and plain radiographs and MRI showed no abnormalities. Subchondral insufficiency fracture should be considered in the diagnosis of patients who have hip pain after renal transplantation.. |
| 206. |
Goro Motomura, Takuaki Yamamoto, Yasuharu Nakashima, Toshihide Shuto, Seiya Jingushi, Yukihide Iwamoto, Outcome of the contralateral hip in rapidly destructive arthrosis after total hip arthroplasty - A preliminary report, JOURNAL OF ARTHROPLASTY, 10.1016/j.arth.2005.08.007, 21, 7, 1026-1031, 2006.10, We investigated the outcome of the contralateral hip in patients with rapidly destructive arthrosis of the hip after total hip arthroplasty. Twenty-four patients were included, and the mean duration of radiographic follow-up was 7.0 years (range, 3.8-17.8 years). To assess the capable parameters for predicting the development of osteoarthritis, we evaluated the receiver operating characteristic curves. Three (12.5%) of 24 patients developed osteoarthritis and underwent total hip arthroplasty within 3.8 to 6.5 years. In these 3 patients, both the acetabular-head index and the center-edge angle were significantly lower than those in patients without osteoarthritis (P |
| 207. |
H. Yamada, N. Kaibara, S. Okano, T. Maeda, T. Shuto, Y. Nakashima, K. Okazaki, Y. Iwamoto, IL-15 selectively expands and activates CD57+CD28-CD4+T cells in active rheumatoid arthritis, ANNALS OF THE RHEUMATIC DISEASES, 65, 141-142, 2006.07. |
| 208. |
林 哲生, 神宮司 誠也, 首藤 敏秀, 中島 康晴, 山本 卓明, 岩本 幸英, 骨盤固定器を用いた人工股関節全置換術の寛骨臼ソケット設置の正確性について エアー抜き固定マットと比較して(The Accuracy of Socket Orientation using a Pelvic Fixation Device for Total Hip Arthroplasty with the Patient in the Lateral Decubitus Position in Comparison to the Vacuum Bag Fixation Method), 福岡医学雑誌, 98, 1, 19-25, 2007.01, はじめに:人工股関節全置換術をするうえで、骨盤を確実に固定することは寛骨臼ソケット設置をコントロールする上で重要である。当科では以前、エアー抜き固定マットを用いた体位固定法を用いていたが術中骨盤の位置が変わることがあり寛骨臼ソケットの位置が充分にコントロールできていない印象があった。最近、両上前腸骨棘と仙骨にて固定する骨盤固定器を使った方法に変え、比較的良好にコントロールできていると思われる。今回、両方法による人工股関節全置換術をretrospectiveに比較し、寛骨臼ソケット設置が実際に改善しているかを検討した。対象:エアー抜き固定マットを用いた1群では1997年1～12月に行われた初回THAの症例を対象とした。骨盤固定器を用いた2群は2000年1月から12月に行われた初回THAを対象とした。固定前に水平にした手術台に側臥位の状態で両上前腸骨棘を結んだ線が前額面において何度傾いているかを測定した。つぎに骨盤が前後どちらにも傾かないように注意しながら、両上前腸骨棘と仙骨を骨盤固定器にて挟んで手術台に固定した。寛骨臼ソケットの設置位置は、術後3ヵ月以内の臥位における両股関節正面像X線写真にて外方開角と前方開角で評価した。また術後3年以内の術後脱臼の有無と再脱臼予防のために再手術した症例数についても調査した。結果:エアー抜き固定マットを用いた群では、外方開角の平均値は40°、骨盤固定器を用いた群は42°であった。45°からどれくらい離れたかを反映する45°からの差の絶対値はエアー抜き固定マットを用いた群では6.7°、骨盤固定器を用いた群では4.5°であり、骨盤固定器を用いた群がエアー抜き固定マットを用いた群に比べて、統計学的に有意に45°に近い外方開角となっていた(p |
| 209. |
Use of a screw and plate system for a transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head. |
| 210. |
Clinical Outcome of Transposition Osteotomy of Acetabulum in Patients over 60 Years at Operation
Pelvic osteotomy for osteoarthritis hips secondary to acetabular dysplasia is usually indicated for young patients under 50 years of age. In our department, transposition osteotomy of the acetabulum (TOA), a kind of pelvic osteotomy, is carried out even for patients over 50 years. In this study, the clinical outcomes of patients over 60 years were retrospectively examined in order to discuss the indication of TOA according to age. Between 1994 and 2004, TOA was performed on six hips of patients over 60 years. All patients were female, whose mean age was 62 years. The mean duration of follow-up was 61 months. All hips showed excellent clinical outcome except for one in the advanced stage with relatively short rehabilitation schedule. Our results suggest that TOA could be indicated for patients over 60 years if the osteoarthritis stage was early or preosteoarthritis, and if rehabilitation would take time.. |
| 211. |
Bilateral Osteotomy for Bilateral Osteonecrosis of Femoral Head
Eleven patients, who underwent bilateral osteotomy for idiopathic osteonecrosis of the femoral head, were examined retrospectively. Due to previous osteotomy, the rehabilitation period of the next one may take longer, or the clinical outcome may be worse. The clinical outcome and treatment period were compared with those in the matched control cases that underwent osteotomy for unilateral symptomatic osteonecrosis. The JOA score at the last follow-up was similar, and the ratio of postoperative complications including collapse progression and osteoarthritis was similarly at low levels in both groups. These indicate that similar clinical outcome and treatment period can be expected in cases undergoing bilateral osteotomy compared to those undergoing unilateral osteotomy.. |
| 212. |
Minimum 10 years follow-up of Kyocera PerFix HA total hip arthroplasty. |
| 213. |
IKEMURA SATOSHI, YAMAMOTO TAKUAKI, JINGUSHI SEIYA, NAKASHIMA YASUHARU, MAWATARI TARO, IWAMOTO YUKIHIDE, Use of a screw and plate system for a transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 10.1007/s00776-007-1123-4, 12, 3, 260-264, 2007.05. |
| 214. |
Hayashi T, Jingushi S, Shuto T, Nakashima Y, Yamamoto T, Iwamoto Y, The accuracy of socket orientation using a pelvic fixation device for total hip arthroplasty with the patient in the lateral decubitus position in comparison to the vacuum bag fixation method., Fukuoka igaku zasshi = Hukuoka acta medica, 10.15017/3610, 98, 1, 19-25, 2007.01. |
| 215. |
Takuaki Yamamoto, Yasuharu Nakashima, Toshihide Shuto, Seiya Jingushi, Yukihide Iwamoto, Subchondral insufficiency fracture of the femoral head in younger adults, Skeletal Radiology, 10.1007/s00256-006-0178-1, 36, 1, 38-42, 2007.06, We report two cases of subchondral insufficiency fracture of the femoral head observed in younger adults without any history of overexertion. In both cases, MRI revealed an irregular, discontinuous low-intensity band on the T1-weighted images. Both patients were treated operatively, and histological examination confirmed the diagnosis of subchondral fracture. A diagnosis of subchondral insufficiency fracture needs to be put in as one of the diagnoses in younger patients with a hip pain. © ISS 2006.. |
| 216. |
S. Ikemura, T. Yamamoto, S. Jingushi, Y. Nakashima, T. Mawatari, Y. Iwamoto, Leg-length discrepancy after transtrochanteric curved varus osteotomy for osteonecrosis of the femoral head, JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, 10.1302/0301-620X.89B6.18499, 89B, 6, 725-729, 2007.06, Transtrochanteric curved varus osteotomy was designed to avoid some of the disadvantages of varus wedge osteotomy, such as post-operative leg-length discrepancy. In this retrospective study we investigated the leg-length discrepancy and clinical outcome after transtrochanteric curved varus osteotomy undertaken in patients with osteonecrosis of the femoral head. Between January 1993 and March 2004, this osteotomy was performed in 42 hips of 36 patients with osteonecrosis of the femoral head. There were 15 males and 21 females with a mean age at surgery of 34 years (15 to 68). The mean follow-up was 5.9 years (2.0 to 12.5). The mean pre-operative Harris hip score was 64.0 (43 to 85) points, which improved to a mean of 88.7 (58 to 100) points at final follow-up. The mean varus angulation post-operatively was 25 degrees (12 degrees to 38 degrees) and the post-operative mean leglength discrepancy was 13 mm (4 to 25). The post-operative leg-length discrepancy showed a strong correlation with varus angulation ( Pearson's correlation coefficient; r = 0.9530, p |
| 217. |
Hisakata Yamada, Nobutaka Kaibara, Shinji Okano, Takeshi Maeda, Toshihide Shuto, Yasuharu Nakashima, Ken Okazaki, Yukihide Iwamoto, Interleukin-15 selectively expands CD57(+)CD28(-)CD4(+) T cells, which are increased in active rheumatoid arthritis, CLINICAL IMMUNOLOGY, 10.1016/j.clim.2007.06.001, 124, 3, 328-335, 2007.09, Proinflammatory cytokines as well as CD4(+) T cells play critical roles in the pathogenesis of rheumatoid arthritis (RA). Recently, an increase of CD57(+) or CD28(-)CD4(+) T cells was demonstrated in RA, although the mechanism of the increase of these T cells is unclear. In this study, we first examined the relationship between CD57(+)CD4(+) T cells and CD28(-)CD4(+) T cells and found CD57(+)CD28(-)CD4(+) T cells, but neither CD57(+)CD28(+) nor CD57(-)CD28(+) cells, expanded in the peripheral blood of active RA. In vitro experiments revealed that CD57(+)CD28(-)CD4(+) T cells selectively expanded in response to IL-15. Furthermore IL-15-stimulated CD57(+)CD28(-)CD4(+) T cells induced TNF-alpha production from monocytes. These results suggest that CD57(+)CD28(-)CD4(+) T cells are involved in the pathogenesis of RA by responding to IL-15. (c) 2007 Elsevier Inc. All. rights reserved.. |
| 218. |
Seiya Jingushi, Hideki Mizu-Uchi, Yasuharu Nakashima, Takuaki Yamamoto, Taro Mawatari, Yukihide Iwamoto, Computed tomography-based navigation to determine the socket location in hip anthroplasty of an osteoarthritis hip with a large leg length discrepancy doe to severe acetabular dysplasia, JOURNAL OF ARTHROPLASTY, 10.1016/j.arth.2007.04.022, 22, 7, 1074-1078, 2007.10, For osteoarthritis hips due to severe acetabular dysplasia such as Crowe type 3 or 4, placement of the socket is a difficult procedure in total hip arthroplasty. Because the acetabular bone stock is poor, suitable location for the socket is very limited with respect to achieving good coverage with the host bone. A 51-year-old woman who had an osteoarthritis hip with a large leg length discrepancy due to severe acetabular dysplasia required total hip arthroplasty. The purpose of the total hip arthroplasty was to improve the hip disorder as well as to reduce the leg length discrepancy to achieve good gait function. We present technical solutions to aid the surgeons in placing the acetabular socket at the proper location by using computed tomography-based navigation system.. |
| 219. |
The Japanese Translation of "Nosology and Classification of Genetic Skeletal Disorders : 2006 Revision". |
| 220. |
Taro Mawatari, Hiromasa Miura, Satoshi Hamai, Toshihide Shuto, Yasuharu Nakashima, Ken Okazaki, Naoko Kinukawa, Shuji Sakai, Paul F. Hoffmann, Yukihide Iwamoto, Tony A. Keaveny, Vertebral Strength Changes in Rheumatoid Arthritis Patients Treated With Alendronate, as Assessed by Finite Element Analysis of Clinical Computed Tomography Scans A Prospective Randomized Clinical Trial, ARTHRITIS AND RHEUMATISM, 10.1002/art.23988, 58, 11, 3340-3349, 2008.11, Objective. Finite element analysis of clinical computed tomography (CT) scans provides a noninvasive means of assessing vertebral strength that is superior to dual x-ray absorptiometry (DXA)-measured areal bone mineral density. The present study was undertaken to compare strength changes, measured using this newer method, in rheumatoid arthritis (RA) patients who were treated with alendronate (ALN) versus those who were not.
Methods. Thirty female RA patients without radiologic signs of L3 compression fractures or a history of osteoporosis medication were enrolled in a prospective randomized clinical trial. Patients were randomly assigned to the ALN group (5 mg orally, once daily) or the control group not receiving antiresorptive treatment. All patients were evaluated by DXA and quantitative CT at baseline and reevaluated after a mean of 12.2 months. Nonlinear finite element analysis was performed on the CT scans (n = 29 available for analysis) to compute an estimate of vertebral compressive strength and to assess strength changes associated with changes in the trabecular compartment and the outer 2 mm of bone (peripheral compartment).
Results. On average, vertebral strength was significantly decreased from baseline in the control group (n = 15) (median change -10.6%; P = 0.008) but was maintained in the ALN group (n = 14) (median change +0.4%; P = 0.55), with a significant difference between the 2 groups (P Conclusion. Our results indicate that patients with RA can lose a substantial amount of vertebral strength over a relatively short period of time, and this loss can be prevented by ALN, primarily via its positive effect on the outer 2 mm of vertebral bone.. |
| 221. |
Satoshi Ikemura, Takuaki Yamamoto, Seiya Jingushi, Yasuharu Nakashima, Taro Mawatari, Yukihide Iwamoto, Recurrent transient osteoporosis of the hip, European Journal of Radiology Extra, 10.1016/j.ejrex.2008.03.002, 66, 2, e65-e69, 2008.05, A 49-year-old woman had suffered from a left hip pain. Radiographs showed a focal loss of radiodensity in the left femoral head and neck, and magnetic resonance imaging revealed a bone marrow edema in the femoral head. She was diagnosed as transient osteoporosis of the hip and was treated conservatively. Three years later, right hip pain occurred. Based on the imaging appearances, she was diagnosed as transient osteoporosis of the hip in the right and was treated conservatively. Five years after the onset of right hip pain, she suffered from a recurrent right hip pain. Imaging findings were similar to those obtained 5 years before. Five months after the onset of pain, both hip pain and imaging abnormalities disappeared by the same treatments as the previous episodes. This case was considered to have recurrent transient osteoporosis of the hip. © 2008 Elsevier Ireland Ltd. All rights reserved.. |
| 222. |
N. Kaibara, H. Yamada, T. Shuto, Y. Nakashima, K. Okazaki, H. Miyahara, Y. Esaki, G. Hirata, Y. Iwamoto, Comparative histopathological analysis between tenosynovitis and joint synovitis in rheumatoid arthritis, HISTOPATHOLOGY, 10.1111/j.1365-2559.2008.03050.x, 52, 7, 856-864, 2008.06, Aims: To clarify the histological and biological features of tenosynovitis accompanying rheumatoid arthritis (RA).
Methods and results: Synovial tissue was obtained from the wrist joint and extensor tendon of the digits of six RA patients and the sections were examined by haematoxylin and eosin staining and immunohistochemical analysis. RA tenosynovitis exhibited the typical histological features of RA joint synovitis, including hyperplasia of the synovial lining and infiltration of leucocytes, largely CD4+ T cells and CD68+ macrophages. Notably, there was a significant correlation in the number of CD4+ T cells and CD68+ macrophages between the tenosynovium and joint synovium in each individual. Real-time reverse transcriptase-polymerase chain reaction analysis revealed similar mRNA expression patterns of various inflammatory mediators in tenosynovitis and joint synovitis. It was also observed that synovial fibroblasts isolated from the tenosynovium behaved in a manner similar to those isolated from the joint synovium with regard to proliferation and the production of inflammatory mediators.
Conclusions: The histopathological features of RA tenosynovitis were indistinguishable from those of joint synovitis. Therefore, it is suggested that the ongoing inflammation is driven by similar mechanisms in the tenosynovium and joint synovium and that RA is probably a tissue-specific disease which targets systemic synovial tissues.. |
| 223. |
Treatment of the joint disorders in the skeletal dysplasia. |
| 224. |
Biomechanical Simulation of Transpositional Osteotomy of Acetabulum. |
| 225. |
Osteotomy for the osteoarthritis of hip. |
| 226. |
Satoshi Ikemura, Takuaki Yamamoto, Yasuharu Nakashima, Taro Mawatari, Goro Motomitra, Yukihide Iwamoto, Transtrochanteric Anterior Rotational Osteotomy for Osteonecrosis of the Femoral Head in Patients 20 Years or Younger, JOURNAL OF PEDIATRIC ORTHOPAEDICS, 10.1097/BPO.0b013e31819bc746, 29, 3, 219-223, 2009.04, Background: For young patients with osteonecrosis of the femoral head, especially those younger than 20 years, a joint-preserving operation may be one of the surgical treatment options to be considered. We investigated the clinical and radiological results of transtrochanteric anterior rotational osteotomy for the treatment of osteonecrosis of the femoral head in patients 20 years or younger.
Methods: Between 1976 and 2001, a transtrochanteric anterior rotational osteotomy was performed in 28 hips of 23 patients aged 20 years or younger with osteonecrosis of the femoral head. Among them, 27 hips of 22 patients with a minimum follow-up duration of 2 years were investigated (follow-up rate, 96.4%). They included 7 males and 15 females with a mean age of 16 years at the time of surgery. The mean follow-up period was 14.7 years (range, 2.0-31.7 years). The clinical assessment was made based on the Merle d'Aubigne-Postel score. The postoperative intact ratio, joint-space narrowing, and progression of collapse were all investigated radiographically.
Results: Two (7.4%) of the 27 hips required total hip arthroplasty because of restrictions in the range of motion, whereas the original hip joints in 25 (92.6%) of the 27 hips were preserved at the time of final follow-Lip. The mean preoperative Merle d'Aubigne-Postel score was 10.4 points, which improved to 15.9 points at the final follow-up (P Conclusions: Transtrochanteric anterior rotational osteotomy appears to be a useful joint-preserving operation for patients younger than 20 years.. |
| 227. |
MATSUO ATSUSHI, JINGUSHI SEIYA, NAKASHIMA YASUHARU, YAMAMOTO TAKUAKI, MAWATARI TARO, NOGUCHI YASUO, SHUTO TOSHIHIDE, IWAMOTO YUKIHIDE, Transposition osteotomy of the acetabulum for advanced-stage osteoarthritis of the hips, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 10.1007/s00776-009-1327-x, 14, 3, 266-273, 2009.05. |
| 228. |
Kenyu Iwasaki, Takuaki Yamamoto, Yasuharu Nakashima, Taro Mawatari, Goro Motomura, Satoshi Ikemura, Yukihide Iwamoto, Subchondral insufficiency fracture of the femoral head after liver transplantation, SKELETAL RADIOLOGY, 10.1007/s00256-009-0706-x, 38, 9, 925-928, 2009.09, A 53-year-old woman developed a subchondral insufficiency fracture of the right femoral head after undergoing a liver transplantation. Radiographs obtained at her first visit demonstrated a slight subchondral collapse in the superolateral portion of the femoral head. Magnetic resonance imaging (MRI) disclosed an irregular, discontinuous, low-intensity band on the T1-weighted image. After 7 months of conservative treatment, the hip pain and the radiograph abnormalities had both disappeared. On the follow-up T1-weighted MR image obtained 17 months after the onset, the band of low signal intensity was not obvious. A subchondral insufficiency fracture is one of the diagnoses to be considered in patients presenting with hip pain after a liver transplantation.. |
| 229. |
Masanori Fujii, Yasuharu Nakashima, Seiya Jingushi, Takuaki Yamamoto, Yasuo Noguchi, Eiji Suenaga, Yukihide Iwamoto, Intraarticular Findings in Symptomatic Developmental Dysplasia of the Hip, JOURNAL OF PEDIATRIC ORTHOPAEDICS, 10.1097/BPO.0b013e318190a0be, 29, 1, 9-13, 2009.01, Background: The purpose of this study was to examine intraarticular pathology in patients Younger than 20 years with symptomatic developmental dysplasia of the hip.
Methods: We performed hip arthroscopy during corrective osteotomy in 23 hips in 22 patients. All patients were female, and the average age at operation was 16.4 years. Eighteen hips were in a prearthritic stage, and 5 hips were in an early stage. The presence and location of cartilage degeneration and labral tears were evaluated. Second-look arthroscopy was performed in 13 hips in 12 patients.
Results: Fourteen hips (77.8%) in the prearthritic stage had cartilage degeneration. Cartilage lesions were more frequent in the acetabulum than in the femoral head (72.2% vs 16.7%). Sixty-one percent of acetabular lesions were located at the anterosuperior area. Labral tears were observed in 77.8% of hips in prearthritic stages located at the anterosuperior (72.2%) and Superior (44.4%) areas. The degree of cartilage and labral lesions in the early stage was more severe than in the prearthritic stage. Oil second-look arthroscopy, there were no changes in the state of the cartilage and labrum in the majority (84.6%.) of hips.
Conclusions: The incidence of intraarticular lesions in developmental dysplasia of the hip was high, even in the prearthritic stage. These lesions tended to originate in the anterosuperior area of the acetabulum and were generally progressive.. |
| 230. |
Akinobu Matsushita, Yasuharu Nakashima, Seiya Jingushi, Takuaki Yamamoto, Akio Kuraoka, Yukihide Iwamoto, Effects of the Femoral Offset and the Head Size on the Safe Range of Motion in Total Hip Arthroplasty, JOURNAL OF ARTHROPLASTY, 10.1016/j.arth.2008.02.008, 24, 4, 646-651, 2009.06, The purpose of this study was to quantify the effects of femoral offset and head size on range of motion (ROM) after total hip arthroplasty. modular prostheses were implanted into 11 cadaveric hips using a posterolateral approach and tested for ROM with 3 different offsets and 5 different femoral head sizes. Increasing the femoral offset to 4 and 8 unit resulted in 21.1 degrees and 26.7 degrees of improved flexion, and 13.7 degrees and 21.2 degrees of improved internal rotation, respectively. The ROM improved in a head size-dependent manner primarily because of increasing the jumping distance of the femoral head rather than delaying any impingement. In contrast, the effectiveness of femoral offset was driven by delayed osseous impingement.. |
| 231. |
Toru Fukuda, Masakazu Kohda, Kazuhiro Kanomata, Junya Nojima, Atsushi Nakamura, Jyunji Kamizono, Yasuo Noguchi, Kiyofumi Iwakiri, Takeo Kondo, Junichi Kurose, Ken-ichi Endo, Takeshi Awakura, Junichi Fukushi, Yasuharu Nakashima, Tomohiro Chiyonobu, Akira Kawara, Yoshihiro Nishida, Ikuo Wada, Masumi Akita, Tetsuo Komori, Konosuke Nakayama, Akira Nanba, Yuichi Maruki, Tetsuya Yoda, Hiroshi Tomoda, Paul B. Yu, Eileen M. Shore, Frederick S. Kaplan, Kohei Miyazono, Masaru Matsuoka, Kenji Ikebuchi, Akira Ohtake, Hiromi Oda, Eijiro Jimi, Ichiro Owan, Yasushi Okazaki, Takenobu Katagiri, Constitutively Activated ALK2 and Increased SMAD1/5 Cooperatively Induce Bone Morphogenetic Protein Signaling in Fibrodysplasia Ossificans Progressiva, JOURNAL OF BIOLOGICAL CHEMISTRY, 10.1074/jbc.M801681200, 284, 11, 7149-7156, 2009.03, Fibrodysplasia ossificans progressiva (FOP) is a rare autosomal dominant disorder characterized by congenital malformation of the great toes and by progressive heterotopic bone formation in muscle tissue. Recently, a mutation involving a single amino acid substitution in a bone morphogenetic protein (BMP) type I receptor, ALK2, was identified in patients with FOP. We report here that the identical mutation, R206H, was observed in 19 Japanese patients with sporadic FOP. This mutant receptor, ALK2(R206H), activates BMP signaling without ligand binding. Moreover, expression of Smad1 and Smad5 was up-regulated in response to muscular injury. ALK2(R206H) with Smad1 or Smad5 induced osteoblastic differentiation that could be inhibited by Smad7 or dorsomorphin. Taken together, these findings suggest that the heterotopic bone formation in FOP may be induced by a constitutively activated BMP receptor signaling through Smad1 or Smad5. Gene transfer of Smad7 or inhibition of type I receptors with dorsomorphin may represent strategies for blocking the activity induced by ALK2(R206H) in FOP.. |
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Effects of Acetabular Dysplasia on the Stress State of Hip Joint. |
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[Cytokines in bone diseases. BMP signaling and fibrodysplasia ossificans progressiva].
Fibrodysplasia ossificans progressiva (FOP) is a rare autosomal dominant disorder characterized by progressive heterotopic bone formation in skeletal muscle tissue. In 2007, FOP was authorized as one of the Intractable Disorders by the Ministry of Health, Labour and Welfare of Japan. The Research Committee on FOP is working on the molecular mechanisms underlying heterotopic bone formation and the development of new treatments for FOP.. |
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Pelvic Inclination in Lateral Position during Total Hip Arthroplasty
The purpose of this study was to investigate the changes in the pelvic inclination angle (PIA) by lateral positioning during total hip arthroplasty (THA). Between January 2008 and September 2009, primary THA for osteoarthritis of the hip were performed on 84 hips in 84 patients. They consisted of 12 men 12 hips, and 72 women 72 hips with the mean age of 63.7 years. We measured the sagittal and coronal PIA pre-, intra- and post-operatively using antero-posterior pelvic X-ray films and also measured the anteversion and abduction angles of the acetabular components.
Lateral positioning resulted in 26.2% of cases with posterior sagittal tilt over five degrees compared to preoperative PIA in the supine position and 9.5% anterior tilt more than five degrees. It also resulted in 17.9% with cranial coronal over five degrees and 4.7% caudal tilt over five degrees. The factors influencing these changes were difference between the sagittal PIA in the standing and supine positions, and preoperative adduction contracture. The intraoperative anteversion of acetabular component in the posterior and anterior pelvic tilt groups decreased by 6.3° and 1.7°, respectively at the postoperative supine position. The intraoperative abduction angle of the acetabular component in the posterior pelvic tilt group decreased by 0.9°, but increased by 5.5° in the pelvic anterior tilt group.
Change of pelvic inclination by more than five degrees by lateral positioning occurred in 20 to 30% of the patients and significantly affected the placement of the acetabular component.. |
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G. Zhao, T. Yamamoto, S. Ikemura, G. Motomura, T. Mawatari, Y. Nakashima, Y. Iwamoto, Radiological outcome analysis of transtrochanteric curved varus osteotomy for osteonecrosis of the femoral head at a mean follow-up of 12.4 years, JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, 10.1302/0301-620X.92B6.23621, 92B, 6, 781-786, 2010.06, We investigated the factors related to the radiological outcome of a transtrochanteric curved varus osteotomy in patients with osteonecrosis of the hip. We reviewed 73 hips in 62 patients with a mean follow-up of 12.4 years (5 to 31.1). There were 28 men and 34 women, with a mean age of 33.3 years (15 to 68) at the time of surgery. The 73 hips were divided into two groups according to their radiological findings: group 1 showed progression of collapse and/or joint-space narrowing; group 2 had neither progressive collapse nor joint-space narrowing. Both of these factors and the radiological outcomes were analysed by a stepwise discriminant analysis. A total of 12 hips were categorised as group 1 and 61 as group 2. Both the post-operative intact ratio and the localisation of the necrotic lesion correlated with the radiological outcome. The cut-off point of the postoperative intact ratio to prevent the progression of collapse was 33.6%, and the cut-off point to prevent both the progression of collapse and joint-space narrowing was 41.9%.
The results of this study indicate that a post-operative intact ratio of 33.0% is necessary if a satisfactory outcome is to be achieved after this varus osteotomy.. |
| 236. |
Akinobu Matsushita, Yasuharu Nakashima, Masanori Fujii, Taishi Sato, Yukihide Iwamoto, Modular Necks Improve the Range of Hip Motion in Cases with Excessively Anteverted or Retroverted Femurs in THA, CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, 10.1007/s11999-010-1385-6, 468, 12, 3342-3347, 2010.12, Background Anteversion of an acetabular component often is difficult to ascertain in patients with THA in whom excessively anteverted or retroverted femurs may result in limited ROM or risk of dislocation. Restriction of motion, however, is determined by the combination of version of both components.
Questions/purposes We therefore determined the combined anteversion values that provide adequate ROM. We varied acetabular version by differing implantations and varied femoral version with modular necks.
Methods ROM was tested by changing cup anteversion after setting the femoral version to 20 degrees or 60 degrees anteversion or 20 degrees retroversion. The angle of the modular neck was adjusted in 11 increments of 5 degrees each. Range of internal rotation (IR) at 90 degrees flexion, external rotation (ER) at 0 degrees extension, and flexion (Flex) were measured when any impingement occurred before dislocation. We defined a required ROM as having 40 degrees IR, 30 degrees ER, and 110 degrees Flex.
Results At 60 degrees anteversion, ER was less than 10 degrees even when the acetabular component was set at 10 degrees retroversion because of posterior impingement. When a modular neck with 25 degrees retroversion was used, ER improved to greater than 30 degrees. At 20 degrees retroversion, IR was 31 degrees even when the acetabular component was opened to 35 degrees anteversion. IR improved to 34 degrees and 40 degrees with 20 degrees and 25 degrees anteverted modular necks, respectively.
Conclusions and Clinical Relevance In cases with excessive femoral anteversion or retroversion, the required ROM could not be achieved by simply changing the version of acetabular components. The adjustment of femoral versions using the modular necks allowed additional improvement of ROM.. |
| 237. |
Satoshi Ikemura, Takuaki Yamamoto, Goro Motomura, Yasuharu Nakashima, Taro Mawatari, Yukihide Iwamoto, MRI Evaluation of Collapsed Femoral Heads in Patients 60 Years Old or Older: Differentiation of Subchondral Insufficiency Fracture From Osteonecrosis of the Femoral Head, AMERICAN JOURNAL OF ROENTGENOLOGY, 10.2214/AJR.09.3271, 195, 1, W63-W68, 2010.07, OBJECTIVE. The purpose of this article is to verify the hypothesis that osteonecrosis and subchondral insufficiency fracture of the femoral head can be differentiated on the basis of their appearance on MRI.
SUBJECTS AND METHODS. Between May 1998 and February 2009, we reviewed 30 consecutive hips in 30 patients, 60 years old or older at the time of onset of hip pain, with radiologic evidence of subchondral collapse of the femoral head and with both MR images and histologic results available. Both clinical and radiologic appearances were investigated. The patients were divided into two groups according to the shape of low-intensity bands on T1-weighted images. The first group showed concavity of the articular surface, which is characteristic of osteonecrosis, and the second group showed an irregular convexity of the articular surface, which is characteristic of subchondral insufficiency fracture.
RESULTS. Sixteen hips (53.3%) showed evidence of osteonecrosis, and 14 (46.7%) showed evidence of subchondral insufficiency fracture, which was consistent with the corresponding histopathologic diagnoses. In all cases of osteonecrosis, the patient had a history of either corticosteroid intake or alcohol abuse. Among patients with subchondral insufficiency fracture, the proportion of women was significantly higher than that among patients with osteonecrosis. A crescent sign (subchondral fracture) was present radiographically in about half of all cases in both groups.
CONCLUSION. The results of the present study suggest that the shape of the low-intensity band on MRI is useful for the differentiating subchondral insufficiency fracture from osteonecrosis. In addition, among osteoporotic elderly women without any history of corticosteroid intake or alcohol abuse, a diagnosis of subchondral insufficiency fracture should be considered.. |
| 238. |
G. Motomura, T. Yamamoto, K. Suenaga, Y. Nakashima, T. Mawatari, S. Ikemura, Y. Iwamoto, Long-term outcome of transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head in patients with systemic lupus erythematosus, LUPUS, 10.1177/0961203310361896, 19, 7, 860-865, 2010.06, This study sought to examine the long-term outcomes of transtrochanteric anterior rotational osteotomy (ARO) as treatment for osteonecrosis of the femoral head (ONFH) in patients with systemic lupus erythematosus (SLE). Twenty-one patients (33 hips), aged 20-40 years, underwent ARO between 1980 and 1988. We examined 16 patients (25 hips), a 76% follow-up rate. A Kaplan-Meier curve was used for survivorship analysis. Patients with surviving hips were evaluated by the modified Oxford hip score and Short Form 36 (SF-36). Twelve hips in eight patients had survived at the final follow-up. The average length of hip survival was 24.6 years (range: 20.1-27.2 years). Three patients (six hips) had died of unrelated causes without any subsequent operation. Based on Kaplan-Meier analysis with the endpoint defined as the need for a subsequent operation, the hip survival rate at 25 years was 73.7% (95% confidence interval, +/- 19.8%). Based on classification by the modified Oxford hip score, five hips were classified as excellent, two hips were good, and the remaining five hips were fair. The average SF-36 summary score for the physical and mental components was 38.7 and 47.2 points, respectively. The physical component summary scores for three patients exceeded the normal level of the Japanese population. Lupus (2010) 19, 860-865.. |
| 239. |
Jun-ichi Fukushi, Yasuharu Nakashima, Yukihide Iwamoto, Gynecomastia associated with low-dose methotrexate therapy for rheumatoid arthritis ameliorated by folate supplement, RHEUMATOLOGY INTERNATIONAL, 10.1007/s00296-009-1062-9, 30, 10, 1371-1372, 2010.08, A 62-year-old male with a 10-year history of seropositive rheumatoid arthritis (RA) developed gynecomastia 8 months after beginning oral low-dose methotrexate (MTX) therapy. Two months after folate supplementation, the gynecomastia symptoms improved. Gynecomastia associated with low-dose MTX is a rare occurrence, with only nine cases previously reported in the literature. This is the first report showing folate supplementation to be effective against gynecomastia following low-dose MTX. Although it occurs infrequently, gynecomastia associated with low-dose MTX therapy should be considered in male patients with RA.. |
| 240. |
Yasuharu Nakashima, Nobuhiko Haga, Hiroshi Kitoh, Junji Kamizono, Koji Tozawa, Takenobu Katagiri, Takafumi Susami, Jun-ichi Fukushi, Yukihide Iwamoto, Deformity of the great toe in fibrodysplasia ossificans progressiva, JOURNAL OF ORTHOPAEDIC SCIENCE, 10.1007/s00776-010-1542-5, 15, 6, 804-809, 2010.11, As invasive medical procedures can induce permanent heterotopic ossification in fibrodysplasia ossificans progressiva (FOP), caution should be exercised in clinical practice. The present study was conducted to examine the characteristics of the great toe deformity in patients with FOP, which may lead to an early diagnosis of this condition.
The subjects consisted of 31 feet from 16 FOP patients (8 males, 8 females) with an average age of 17.3 years (range 1-47 years) at the time of this study. Gross and radiographic findings, including the hallux valgus angles (HVA), intermetatarsal angles (IMA), and the deformity of the proximal phalanx and metatarsal bone, were examined.
Of the 31 feet, 29 (93.5%) showed several degrees of great toe deformity. A shortened great toe was the typical gross finding and was observed in 20 feet (64.5%). The mean HVA and IMA were 19.7A degrees and 8.5A degrees, respectively; and 22 (71.0%) feet satisfied the radiographic definition of hallux valgus (HVA a parts per thousand yen 20A degrees or IMA a parts per thousand yen 10A degrees). The proximal phalanx was consistently shortened but morphologically dissimilar from case to case. The metatarsal bone was also shortened and sharpened to the medial side, deviating the proximal phalanx laterally from the metatarsal axis. Fusion between the distal and proximal phalanx occurred with advancing age. Only two feet in one patient showed no obvious deformity of the great toe.
A shortened great toe and hallux valgus were frequently found in patients with FOP. Shortening and sharpening of the proximal phalanx and metatarsal bone consistently existed and contributed to the great toe deformity. These findings were thought to exist from birth and may be a key to an early diagnosis.. |
| 241. |
NAKASHIMA Yasuharu, KONDO Masakazu, HARADA Hiroshi, HORIUCHI Takahiko, ISHINISHI Takashi, JOJIMA Hiroshi, KURODA Koji, MIYAHARA Hisaaki, NAGAMINE Ryuji, NAKASHIMA Hitoshi, OTSUKA Takeshi, SAIKAWA Isao, SHONO Eisuke, SUEMATSU Eiichi, TSURU Tomomi, WADA Ken, IWAMOTO Yukihide, Clinical evaluation of tocilizumab for patients with active rheumatoid arthritis refractory to anti-TNF biologics : tocilizumab in combination with methotrexate, Modern rheumatology, 10.1007/s10165-010-0290-x, 20, 4, 343-352, 2010.08. |
| 242. |
Masanori Fujii, Yasuharu Nakashima, Takuaki Yamamoto, Taro Mawatari, Goro Motomura, Akinobu Matsushita, Shuichi Matsuda, Seiya Jingushi, Yukihide Iwamoto, Acetabular Retroversion in Developmental Dysplasia of the Hip, JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 10.2106/JBJS.I.00046, 92A, 4, 895-903, 2010.04, Background: Patients with developmental dysplasia of the hip are prone to the development of degenerative changes in the affected hip. The aim of this study was to evaluate the prevalence, morphological features, and clinical relevance of acetabular retroversion in these patients.
Methods: We investigated the version and morphological features of the acetabulum using pelvic radiographs and computed tomography images of ninety-six hips in fifty-nine patients with developmental dysplasia of the hip. A diagnosis of acetabular retroversion was based on the presence of a positive cross-over sign on the pelvic radiograph. Using computed tomography images, we determined the acetabular anteversion angle at various levels in the axial plane. The acetabular sector angle served as an indicator of acetabular coverage of the femoral head. We evaluated the association between acetabular version and the patient's age at the onset of pain. Fifty normal hips were examined as controls.
Results: We observed acetabular retroversion in 18% (seventeen) of the ninety-six hips in the patients with developmental dysplasia of the hip. The mean acetabular anteversion angle in the hips with acetabular retroversion was significantly smaller, at all levels, than that in the hips with acetabular anteversion; this tendency was more evident at proximal levels. There was significantly less posterior and posterosuperior coverage in the hips with acetabular retroversion than in those with acetabular anteversion, but superior acetabular coverage did not differ between the groups. Multivariate analysis showed that the onset of pain occurred at a significantly earlier age in patients with acetabular retroversion (27.9 years) than in those with acetabular anteversion (40.5 years), regardless of the severity of the dysplasia (p = 0.003).
Conclusions: In patients with developmental dysplasia of the hip, acetabular retroversion results from relatively deficient coverage by the posterior portion of the acetabulum. Developmental dysplasia with acetabular retroversion is associated with an earlier onset of pain than is developmental dysplasia with anteversion, suggesting a correlation between deficiency of the posterior acetabular wall and the earlier onset of pain.. |
| 243. |
Garida Zhao, Takuaki Yamamoto, Satoshi Ikemura, Yasuharu Nakashima, Taro Mawatari, Goro Motomura, Yukihide Iwamoto, A histopathological evaluation of a concave-shaped low-intensity band on T1-weighted MR images in a subchondral insufficiency fracture of the femoral head, SKELETAL RADIOLOGY, 10.1007/s00256-009-0750-6, 39, 2, 185-188, 2010.02, A 73-year-old female suffered from right hip pain without any history of antecedent trauma. The initial radiograph showed a slight narrowing of the joint space in the right hip. The patient was treated by non-weight bearing for 5 weeks. Radiographs obtained 3 months after the onset of pain showed the progression of both the joint-space narrowing and subchondral collapse at the superior portion. T1-weighted MR (magnetic resonance) images obtained 3 months after the onset revealed an irregular-shaped low-intensity area just beneath the articular cartilage as well as a low-intensity band, which was concave to the articular surface. A total hip replacement was performed. A histopathological examination revealed fracture callus and granulation tissue in the subchondral area. This subchondral fractured area was surrounded by vascular rich granulation tissue and fibrous tissue, which corresponded to the concave-shaped low-intensity band observed on the T1-weighted image.. |
| 244. |
有限要素接触解析を用いた臼蓋形成不全股および寛骨臼移動術の評価. |
| 245. |
Ossification disorder of the proximal femoral epiphysis: report of two cases. |
| 246. |
Yasuharu Nakashima, Hideaki Kubota, Takuaki Yamamoto, Taro Mawatari, Goro Motomura, Yukihide Iwamoto, Transtrochanteric rotational osteotomy for late-onset Legg-Calve-Perthes disease, Journal of Pediatric Orthopaedics, 10.1097/BPO.0b013e318223b4f3, 31, 2, S223-S228, 2011.09, Background: The pathology of late-onset Legg-Calve-Perthes disease (LCPD) is similar to that of avascular necrosis of the femoral head in adult and is associated with poorer prognosis of the hip. The optimal treatment for this condition is still controversial. The purpose of this study was to evaluate the long-term clinical results of the transtrochanteric rotational osteotomy for the patients with LCPD onset at more than 9 years of age. Methods: Individuals included 14 hips in 13 cases with the mean age at onset of the disease and operation of 10 years 9 months and 12 years. Average follow-up periods were 12 years. All cases were resistant to the conservative treatments and did not have our indications for varus osteotomy. Clinical results were evaluated using Merle d'Aubigne Postel score and the modified Stulberg criteria. Results: Average Merle d'Aubigne Postel score at the final follow-up was 16.2 points ranging from 12 to 18 points. All patients did not have additional treatment except nail removal. Stulberg class II, III, and IV were obtained in 5, 2, and 7 hips, respectively. More spherical femoral head was obtained in patients with less head involvement and more bone preservation or new bone formation at posterior pillar. Three hips showed slight narrowing of joint space without severe osteoarthritic changes. Conclusions: Transtrochanteric rotational osteotomy is an effective procedure to salvage the hips of the late-onset LCPD. Amount of head involvement, posterior and lateral pillar had influences on the surgical outcomes. Copyright © 2011 by Lippincott Williams &
Wilkins.. |
| 247. |
Minimum 5-year Results of Tantalum Porous Acetabular Components in THA. |
| 248. |
Kenyu Iwasaki, Takuaki Yamamoto, Goro Motomura, Taro Mawatari, Yasuharu Nakashima, Yukihide Iwamoto, Subchondral insufficiency fracture of the femoral head in young adults, CLINICAL IMAGING, 10.1016/j.clinimag.2010.05.005, 35, 3, 208-213, 2011.05, A subchondral insufficiency fracture of the femoral head (SIF) is generally observed in elderly women. In addition, SIF has been reported to occur in young military trainees, which are considered to be due to a fatigue stress fracture. This report reviewed five cases of SIF in young adults without any history of overexertion or antecedent trauma. The clinical findings, time to the initial radiograph, time to the initial magnetic resonance imaging (MRI), and follow-up period were investigated. Radiographs and MRI were obtained in both hips. Bone mineral density and bone scintigram were performed. Measurements of a bone mineral density indicated presence of osteopenia in three patients. MRI disclosed a discontinuous irregular-shaped low-intensity band surrounded by bone marrow edema in all cases. After conservative treatments, one patient's condition resolved, while four patients underwent femoral head collapse resulting in surgical treatment. In these four patients, the diagnosis of SIF was histologically confirmed. In addition, the histological findings showed thin disconnected bone trabeculae, thus indicating the presence of some degree of osteopenia. These patients were considered to demonstrate an insufficiency fracture rather than a fatigue stress fracture based on both clinical findings and histological findings. SIF needs to be considered in patients presenting with hip pain even in young cases. (C) 2011 Elsevier Inc. All rights reserved.. |
| 249. |
Hisakata Yamada, Yasuharu Nakashima, Ken Okazaki, Taro Mawatari, Jun-Ichi Fukushi, Akiko Oyamada, Kenjiro Fujimura, Yukihide Iwamoto, Yasunobu Yoshikai, Preferential Accumulation of Activated Th1 Cells Not Only in Rheumatoid Arthritis But Also in Osteoarthritis Joints, JOURNAL OF RHEUMATOLOGY, 10.3899/jrheum.101355, 38, 8, 1569-1575, 2011.08, Objective. It was previously found that Th1 but not Th17 cells were predominant in the joints of rheumatoid arthritis (RA). To verify whether this is a unique feature of CD4 T cells in RA joints, we performed comparative flow cytometric analysis of CD4 T cells in RA and osteoarthritis (OA) joints.
Methods. Mononuclear cells were isolated from peripheral blood (PB), synovial membrane (SM), and synovial fluid (SF) from a total of 18 RA and 12 OA patients. The expression of surface molecules and cytokine production of CD4 T cells was examined by a flow cytometer.
Results. Most CD4 T cells in RA joints expressed memory/activation markers, such as CD45RO. HLA-DR, and CD69. CCR5 was highly expressed on CD4 T cells in SF but not in PB or SM. With regard to Th17-related molecules, CD4 T cells expressing CCR6 were not enriched in either SF or SM. In contrast, CD161-positive cells were abundant in the joint, many of which, however, produced inter-feron-gamma but not interleukin 17A. Virtually all T cells in OA joints, although much less numerous than in RA joints, expressed activation markers. Th1 cells were predominant in both OA and RA joints, while there were a few Th17 cells. The frequency of Th17 cells in the joint tended to be lower in OA than RA.
Conclusion. There was a quantitative but not qualitative difference in CD4 T cells, including the expression of activation markers and cytokine profiles, between RA and OA joints. (First Release May 1 2011; J Rheumatol 2011;38:1569-75; doi:10.3899/jrheum.101355). |
| 250. |
Masanori Fujii, Yasuharu Nakashima, Taishi Sato, Mio Akiyama, Yukihide Iwamoto, Pelvic Deformity Influences Acetabular Version and Coverage in Hip Dysplasia, CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, 10.1007/s11999-010-1746-1, 469, 6, 1735-1742, 2011.06, Although a wide variety of acetabular deformities in developmental dysplasia of the hip (DDH) have been reported, the morphologic features of the entire pelvis in DDH are not well characterized and their correlation with acetabular deformity is unknown.
We determined whether there was a rotational deformity of the entire innominate bone, and if so, whether it related to acetabular version and coverage.
We examined the morphologic features of the pelvis using CT for 50 patients with DDH (82 hips). Forty normal hips were used as controls. The innominate rotation angle was determined at three levels in the axial plane. The acetabular sector angle served as an indicator of acetabular coverage of the femoral head. We evaluated the association between innominate rotation angles and acetabular version and coverage.
We observed greater internal rotation of the innominate bone in patients with DDH than in the control subjects. Internal rotation of the innominate bone was associated with increased acetabular anteversion angle and acetabular inclination angle. In hips with acetabular retroversion (nine of 82 hips; 11.0 %), the entire innominate bone was externally rotated, compared with hips with acetabular anteversion. Internal rotation of the innominate bone also was associated with decreased anterior and superior acetabular coverage.
Our observations suggest structural abnormalities exist throughout the pelvis in DDH, and the morphologic abnormalities of the acetabulum are not caused solely by local dysplasia around the hip, but are influenced by the morphologic features of the entire pelvis.
Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.. |
| 251. |
G. Motomura, T. Yamamoto, R. Yamaguchi, S. Ikemura, Y. Nakashima, T. Mawatari, Y. Iwamoto, Morphological analysis of collapsed regions in osteonecrosis of the femoral head, JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, 10.1302/0301-620X.93B2.25476, 93B, 2, 184-187, 2011.02, In order to investigate the mechanisms of collapse in osteonecrosis of the femoral head, we examined which part of the femoral head was the key point of a collapse and whether a collapsed region was associated with the size of the necrotic lesion. Using 30 consecutive surgically removed femoral heads we retrospectively analysed whole serial cut sections, specimen photographs, specimen radiographs and histological sections.
In all of the femoral heads, collapse consistently involved a fracture at the lateral boundary of the necrotic lesion. Histologically, the fractures occurred at the junction between the thickened trabeculae of the reparative zone and the necrotic bone trabeculae. When the medial boundary of the necrotic lesion was located lateral to the fovea of the femoral head, 18 of 19 femoral heads collapsed in the subchondral region. By contrast, when the medial boundary was located medial to the fovea, collapse in the subchondral region was observed in four of 11 femoral heads (p = 0.0011). We found that collapse began at the lateral boundary of the necrotic lesion and that the size of the necrotic lesion seemed to contribute to its distribution.. |
| 252. |
M. Fujii, Y. Nakashima, Y. Noguchi, T. Yamamoto, T. Mawatari, G. Motomura, Y. Iwamoto, Effect of intra-articular lesions on the outcome of periacetabular osteotomy in patients with symptomatic hip dysplasia, JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, 10.1302/0301-620X.93B11.27314, 93B, 11, 1449-1456, 2011.11, In order to clarify how intra-articular lesions influence the survival of a periacetabular osteotomy in patients with dysplasia of the hip, we performed an observational study of 121 patients (121 hips) who underwent a transposition osteotomy of the acetabulum combined with an arthroscopy. Their mean age was 40.2 years (13 to 64) and the mean follow-up was 9.9 years (2 to 18). Labral and cartilage degeneration tended to originate from the anterosuperior part of the acetabulum, followed by the femoral side. In all, eight hips (6.6%) had post-operative progression to Kellgren-Lawrence grade 4 changes, and these hips were associated with the following factors: moderate osteoarthritis, decreased width of the joint space, joint incongruity, and advanced intra-articular lesions (subchondral bone exposure in the cartilage and a full-thickness labral tear). Multivariate analysis indicated subchondral bone exposure on the femoral head as an independent risk factor for progression of osteoarthritis (p = 0.003). In hips with early stage osteoarthritis, femoral subchondral bone exposure was a risk factor for progression of the grade of osteoarthritis.
Although the outcome of transposition osteotomy of the acetabulum was satisfactory, post-operative progression of osteoarthritis occurred at a high rate in hips with advanced intra-articular lesions, particularly in those where the degenerative process had reached the point of femoral subchondral bone exposure.. |
| 253. |
Jun-ichi Fukushi, Yasuharu Nakashima, Ken Okazaki, Taro Mawatari, Masanobu Ohishi, Yasutaka Tashiro, Yukihide Iwamoto, Clinical Features of Pustulotic Arthro-Osteitis, ARTHRITIS AND RHEUMATISM, 63, 10, S207-S207, 2011.10. |
| 254. |
Satoshi Ohte, Masashi Shin, Hiroki Sasanuma, Katsumi Yoneyama, Masumi Akita, Kenji Ikebuchi, Eijiro Jimi, Yuichi Maruki, Masaru Matsuoka, Akira Namba, Hiroshi Tomoda, Yasushi Okazaki, Akira Ohtake, Hiromi Oda, Ichiro Owan, Tetsuya Yoda, Hirokazu Furuya, Jyunji Kamizono, Hiroshi Kitoh, Yasuharu Nakashima, Takafumi Susami, Nobuhiko Haga, Tetsuo Komori, Takenobu Katagiri, A novel mutation of ALK2, L196P, found in the most benign case of fibrodysplasia ossificans progressiva activates BMP-specific intracellular signaling equivalent to a typical mutation, R206H, BIOCHEMICAL AND BIOPHYSICAL RESEARCH COMMUNICATIONS, 10.1016/j.bbrc.2011.03.001, 407, 1, 213-218, 2011.04, Fibrodysplasia ossificans progressiva (FOP) is a rare autosomal dominant congenital disorder characterized by progressive heterotopic ossification in muscle tissues. Constitutively activated mutants of a bone morphogenetic protein (BMP) receptor, ALK2, have been identified in patients with FOP. Recently, a novel ALK2 mutation, L196P, was found in the most benign case of FOP reported thus far. In the present study, we examined the biological activities of ALK2(L196P) in vitro. Over-expression of ALK2(L196P) induced BMP-specific activities, including the suppression of myogenesis, the induction of alkaline phosphatase activity, increased BMP-specific luciferase reporter activity, and increased phosphorylation of Smad1/5 but not Erk1/2 or p38. The activities of ALK2(L196P) were higher than those of ALK2(G356D), another mutant ALK2 allele found in patients with FOP and were equivalent to those of ALK2(R206H), a typical mutation found in patients with FOP. ALK2(L196P) was equally or more resistant to inhibitors in comparison to ALK2(R206H). These findings suggest that ALK2(L196P) is an activated BMP receptor equivalent to ALK2(R206H) and that ALK2(L196P) activity may be suppressed in vivo by a novel molecular mechanism in patients with this mutation. (C) 2011 Elsevier Inc. All rights reserved.. |
| 255. |
Pubic Fractures after Tranposition Osteotomy of Acetabulum. |
| 256. |
High Prevalence of Acetabular Retroversion after Legg-Calve-Perthes Disease. |
| 257. |
Taishi Sato, Yasuharu Nakashima, Mio Akiyama, Takuaki Yamamoto, Taro Mawatari, Takashi Itokawa, Masanobu Ohishi, Goro Motomura, Masanobu Hirata, Yukihide Iwamoto, Wear resistant performance of highly cross-linked and annealed ultra-high molecular weight polyethylene against ceramic heads in total hip arthroplasty, JOURNAL OF ORTHOPAEDIC RESEARCH, 10.1002/jor.22148, 30, 12, 2031-2037, 2012.12, The purpose of this study was to examine the effects of ceramic femoral head material, size, and implantation periods on the wear of annealed, cross-linked ultra-high molecular weight polyethylene (UHMWPE) (XLPE) in total hip arthroplasty compared to non-cross-linked conventional UHMWPE (CPE). XLPE was fabricated by cross-linking with 60?kGy irradiation and annealing. Femoral heads made from zirconia and alumina ceramics and cobaltchrome (CoCr) of 22 or 26?mm diameter were used. In this retrospective cohort study, the femoral head penetration into the cup was measured digitally on radiographs of 367 hips with XLPE and 64 hips with CPE. The average follow-up periods were 6.3 and 11.9 years, respectively. Both XLPE creep and wear rates were significantly lower than those of CPE (0.19?mm vs. 0.44?mm, 0.0001?mm/year vs. 0.09?mm/year, respectively). Zirconia displayed increased wear rates compared to alumina in CPE; however, there was no difference among head materials in XLPE (0.0008, 0.00007, and -0.009?mm/year for zirconia, alumina, and CoCr, respectively). Neither head size or implantation period impacted XLPE wear. In contrast to CPE, XLPE displayed low wear rates surpassing the effects of varying femoral head material, size, implantation period, and patient demographics. Further follow-up is required to determine the long-term clinical performance of the annealed XLPE. (c) 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 30:20312037, 2012. |
| 258. |
K. Iwasaki, T. Yamamoto, G. Motomura, S. Ikemura, T. Mawatari, Y. Nakashima, Y. Iwamoto, Prognostic factors associated with a subchondral insufficiency fracture of the femoral head, BRITISH JOURNAL OF RADIOLOGY, 10.1259/bjr/44936440, 85, 1011, 214-218, 2012.03, Objective: The aim of this study was to identify the risk factors associated with the prognosis of a subchondral insufficiency fracture of the femoral head (SIF).
Methods: Between June 2002 and July 2009, 25 patients diagnosed with SIF were included in this study. Sequential radiographs were evaluated for the progression of collapse. Clinical profiles, including age, body mass index, follow-up period and Singh's index, were documented. The morphological characteristics of the low-intensity band on T-1 weighted MRI were also examined with regards to four factors: band length, band thickness, the length of the weight-bearing portion and the band length ratio (defined as the proportion of the band length to the weight-bearing portion of the femoral head in the slice through the femoral head centre).
Results: Radiographically, a progression of collapse was observed in 15 of 25 (60.0%) patients. The band length in patients with progression of collapse [22.5 mm; 95% confidence interval (CI) 17.7, 27.3] was significantly larger than in patients without a progression of collapse (13.4 mm; 95% CI 7.6, 19.3; p Conclusion: These results indicate that the band length and the band length ratio might be predictive for the progression of collapse in SIF.. |
| 259. |
Makoto Hamasaki, Yoshinobu Hashizume, Yoshinori Yamada, Tomohiko Katayama, Hirohiko Hohjoh, Noemi Fusaki, Yasuharu Nakashima, Hirokazu Furuya, Nobuhiko Haga, Yoichiro Takami, Takumi Era, Pathogenic Mutation of ALK2 Inhibits Induced Pluripotent Stem Cell Reprogramming and Maintenance: Mechanisms of Reprogramming and Strategy for Drug Identification, STEM CELLS, 10.1002/stem.1221, 30, 11, 2437-2449, 2012.11, Fibrodysplasia ossificans progressiva (FOP) is a rare congenital disorder characterized by progressive ossification of soft tissues. FOP is caused by mutations in activin receptor-like kinase 2 (ALK2) that cause its constitutive activation and result in dysregulation of BMP signaling. Here, we show that generation of induced pluripotent stem cells (iPSCs) from FOP-derived skin fibroblasts is repressed because of incomplete reprogramming and inhibition of iPSC maintenance. This repression was mostly overcome by specific suppression of ALK2 expression and treatment with an ALK2 inhibitor, indicating that the inhibition of iPSC generation and maintenance observed in FOP-derived skin fibroblasts results from constitutive activation of ALK2. Using this system, we identified an ALK2 inhibitor as a potential candidate for future drug development. This study highlights the potential of the inhibited production and maintenance of iPSCs seen in diseases as a useful phenotype not only for studying the molecular mechanisms underlying iPS reprogramming but also for identifying drug candidates for future therapies. STEM CELLS2012; 30:24372449. |
| 260. |
Goro Motomura, Takuaki Yamamoto, Yasuharu Nakashima, Ryosuke Yamaguchi, Taro Mawatari, Yukihide Iwamoto, Midterm results of transtrochanteric anterior rotational osteotomy combined with shelf acetabuloplasty for osteonecrosis with acetabular dysplasia: a preliminary report, JOURNAL OF ORTHOPAEDIC SCIENCE, 10.1007/s00776-012-0205-0, 17, 3, 239-243, 2012.05, Transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head should be performed to obtain > 34% of the ratio of transposed intact posterior articular surface to the acetabular weight-bearing area. Therefore, the presence of acetabular dysplasia is unfavorable in obtaining this ratio. Between 1999 and 2005, we performed the modified Spitzy shelf acetabuloplasty combined with anterior rotational osteotomy for three patients (four hips) with acetabular dysplasia. In this study, we retrospectively evaluated the midterm results of this combined surgery.
Patients comprised one man and two women with a mean age of 29 years at the time of surgery. Mean follow-up was 7.5 years. The average preoperative Harris hip score of 65.5 points increased to an average of 79.3 points at the latest follow-up. None of the hips required conversion to total hip arthroplasty during the follow-up periods. The average postoperative intact ratio without a shelf procedure was 23%, and with a shelf procedure, this ratio increased to be 58%. As a result, collapse progression was not observed in any of the four hips.
Our results suggest that anterior rotational osteotomy combined with shelf acetabuloplasty may be a surgical option for osteonecrosis of the femoral head with acetabular dysplasia. Further studies with a larger patient population are necessary to clarify appropriate indications and limitations of this combined surgery.. |
| 261. |
Kawahara S, Nakashima Y, Oketani H, Wada A, Fujii M, Yamamoto T, Mawatari T, Motomura G, Sato T, Akiyama M, Fujii T, Takamura K, Iwamoto Y, High prevalence of acetabular retroversion in both affected and unaffected hips after Legg-Calvé-Perthes disease., Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 10.1007/s00776-012-0213-0, 17, 3, 226-232, 2012.05. |
| 262. |
Mio Akiyama, Yasuharu Nakashima, Masanori Fujii, Taishi Sato, Takuaki Yamamoto, Taro Mawatari, Goro Motomura, Shuichi Matsuda, Yukihide Iwamoto, Femoral anteversion is correlated with acetabular version and coverage in Asian women with anterior and global deficient subgroups of hip dysplasia: a CT study, SKELETAL RADIOLOGY, 10.1007/s00256-012-1368-7, 41, 11, 1411-1418, 2012.11, Morphological correlation between the acetabulum and femur at the hip joint is still controversial. We tested the hypothesis that femoral anteversion correlates with acetabular version and coverage in patients with developmental dysplasia of the hip (DDH).
Using pelvic computed tomography (CT) images of 79 hips in 49 Asian women with DDH and 49 normal hips, we measured femoral anteversion, the axial and vertical acetabular version and the acetabular sector angle (ASA) to demarcate femoral head coverage. Depending on the location of the acetabular bone defect, dysplastic hips were divided into three subgroups: the anterior, global and posterior deficiency groups. We performed a comparative analysis between dysplastic and normal hips using the Wilcoxon rank sum test, and a relative analysis between femoral anteversion and acetabular measurements in dysplastic hips using Pearson's correlation coefficient.
The amount of femoral anteversion in dysplastic hips was greater and more variable than in normal hips (p Our results showed significantly greater and more variable femoral anteversion in DDH, and a significant correlation between femoral anteversion and acetabular version and coverage in DDH with anterior and global acetabular bone deficiency.. |
| 263. |
Tsushima H, Okazaki K, Takayama Y, Hatakenaka M, Honda H, Izawa T, Nakashima Y, Yamada H, Iwamoto Y, Evaluation of cartilage degradation in arthritis using T1ρ magnetic resonance imaging mapping., Rheumatology international, 10.1007/s00296-011-2140-3, 32, 9, 2867-2875, 2012.09. |
| 264. |
Garida Zhao, Takuaki Yamamoto, Satoshi Ikemura, Goro Motomura, Kenyu Iwasaki, Ryosuke Yamaguchi, Yasuharu Nakashima, Taro Mawatari, Yukihide Iwamoto, Clinico-radiological factors affecting the joint space narrowing after transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head, JOURNAL OF ORTHOPAEDIC SCIENCE, 10.1007/s00776-012-0238-4, 17, 4, 390-396, 2012.07, The purpose of this study was to investigate the factors that affect the joint space narrowing after transtrochanteric anterior rotational osteotomy (ARO) for osteonecrosis of the femoral head (ONFH).
We reviewed 39 cases (43 hips) of ONFH in patients who underwent ARO between 2000 and 2004. Their mean age was 42 years (23-61) at the time of surgery. The mean follow-up period was 7.3 years (3-10). The following clinical and radiological factors were investigated: the preoperative stage, localization and extent of the necrotic lesion, and the postoperative intact ratio (transposed intact articular surface of the femoral head to the weight-bearing surface of the acetabulum). The 43 hips were divided into two groups: a joint space narrowing (JSN) group and a non-joint space narrowing (non-JSN) group.
Thirty-seven hips (86 %) were categorized as non-JSN and six (14 %) as having JSN. The preoperative Japanese Orthopaedic Association score was significantly higher in the non-JSN group than in the JSN group (P = 0.01). In the non-JSN group, the rate of early stage disease was significantly higher than in the JSN group (P = 0.03). The postoperative intact ratio was significantly higher in the non-JSN group than in the JSN group (P = 0.002). A multivariate analysis revealed that the postoperative intact ratio was an independent predictor of the progression of joint space narrowing after ARO, and the cutoff point was 39.2 %.
The results of this study suggest that the postoperative intact ratio is one of factors determining the progression of joint space narrowing after ARO and that an approximately 40 % or higher postoperative intact ratio is recommended to prevent joint space narrowing.. |
| 265. |
Three Cases of Osteomyelitis and Arthritis as a Complication of BCG Vaccination. |
| 266. |
Masanori Fujii, Yasuharu Nakashima, Taishi Sato, Mio Akiyama, Yukihide Iwamoto, Acetabular Tilt Correlates with Acetabular Version and Coverage in Hip Dysplasia, CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, 10.1007/s11999-012-2370-z, 470, 10, 2827-2835, 2012.10, The rotational position of the acetabulum to the pelvis (acetabular tilt) may influence acetabular version and coverage of the femoral head. To date, the pathologic significance of acetabular tilt in hip dysplasia is unknown.
We determined whether acetabular tilt in hip dysplasia is different from that in normal hips and whether this correlates with acetabular version and coverage.
We measured the acetabular tilt angle on the lateral view of three-dimensional pelvic CT images of 40 patients (72 hips) with hip dysplasia. Forty normal hips from 40 patients were used as controls. The acetabular sector angle was measured as an index for acetabular coverage of the femoral head.
The mean acetabular tilt angle was increased in dysplastic hips compared with controls. In dysplastic hips, a posteriorly rotated acetabulum (increased acetabular tilt) was associated with increased acetabular anteversion and with decreased anterior and anterosuperior acetabular coverage. No correlation was found in controls. In dysplastic hips with a posterior acetabular deficiency, the acetabulum was rotated anteriorly (decreased acetabular tilt) compared with hips with anterior and lateral deficiencies.
We observed a correlation between the rotational position of the acetabulum in the pelvis with acetabular version and coverage in hip dysplasia. Our observations confirmed anterior rotation of the acetabular fragment during periacetabular osteotomies is an anatomically reasonable maneuver for hips with anterolateral acetabular deficiencies, while the maneuver can exacerbate posterior coverage and should be avoided in hips with a posterior acetabular deficiency.
Level IV, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.. |
| 267. |
The safety and efficacy of Abatacept for the treatment of rheumatoid arthritis in a real world routine care registry-The Fukuoka RA Biologics Registry (FRAB Registry). |
| 268. |
田代 泰隆, 中島 康晴, 岡崎 賢, Mawatari Taro, Fukushi Junichi, Oishi Masanobu, Oyamada Akiko, Yamada Hisakata, Iwamoto Yukihide, 関節リウマチのバイオナイーブおよびスイッチ症例に対するアダリムマブの使用成績 : 実地臨床における2年成績, 福岡医学雑誌 = Fukuoka acta medica, 10.15017/1430774, 104, 11, 413-423, 2013.11, Aims : To investigate the impact of adalimumab on the biologic-naïve (bio-naïve) and bio-switch rheumatoid arthritis (RA) patients, and to clarify the appropriate indications for adalimumab treatment. Methods : The retention rate, efficacy and safety of adalimumab in twenty-one RA patients were analyzed. Fourteen of the patients were bio-naïve and seven were bio-switched from other biologics. Concomitant methotrexate was used in 85% of the bio-naïve and 71% of the bio-switch patients. The radiographic findings before and after the 1 year and the two years treatment were also surveyed. Results : In the bio-naïve group, 63% of patients continued adalimumab for 2 years, and remission was achieved in approximately 50% of patients. The mean 28-joint Disease Activity Scores improved from 5. 2 to 2. 6. Radiographically, the joint damage did not progress in either erosions or joint space narrowing. In the bio-switch group, the retention rate was 29%, and only patients who were switched from infliximab showed responses to the treatment. Herpes zoster requiring hospitalization occurred in two cases and injection site reactions were noted in other two cases. Conclusion : Adalimumab combined with methotrexate would be a useful first choice biologic regimen in bio-naïve RA patients. As a second biologic, adalimumab could be useful only when treatments are switched from infliximab.【はじめに】完全ヒト型抗TNF-αモノクローナル抗体のアダリムマブ(ADA)は皮下注射製剤で，外来治療が可能である．本研究では，関節リウマチ(RA)に対するADA の2年間の使用成績をバイオナイーブ例および他バイオ製剤からのスイッチ例で評価し，成績と適応について検討した．【対象と方法】当科で2009 年～2011 年にRA へA DA を開始した連続21 症例に関し，バイオナイーブ14例(男性2例，女性12 例，平均53 歳，罹病期間8年，メトトレキサートMTX併用85％，平均6.6mg)とスイッチ7 例(全例女性，平均67 歳，罹病期間14 年，MTX 併用71%，平均5.7mg)での治療継続率・効果・安全性を検討した．またX線で関節破壊の進行を評価した．【結果】バイオナイーブ例では12，24ヶ月での継続率は79％，63％と良好で，疾患活動性DAS28-ESR は平均5.2 から2.6 へと改善し(p |
| 269. |
診断に難渋した股関節炎を伴った若年者大腿骨頚部類骨骨腫の2例. |
| 270. |
ペルテス病後に発生したFemoroacetabular impingementの一例. |
| 271. |
Satoshi Ikemura, Takuaki Yamamoto, Goro Motomura, Yasuharu Nakashima, Taro Mawatari, Yukihide Iwamoto, The utility of clinical features for distinguishing subchondral insufficiency fracture from osteonecrosis of the femoral head, ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY, 10.1007/s00402-013-1847-x, 133, 12, 1623-1627, 2013.12, Subchondral insufficiency fractures of the femoral head (SIF) need to be differentiated from osteonecrosis of the femoral head (ON), since these two conditions have several overlapping characteristics especially in their radiological findings. The purpose of this study was to determine the useful clinical features for differentiating SIF from ON.
This study reviewed 44 consecutive patients, aged 60 years or older with a radiological evidence of subchondral collapse of the femoral head. According to the histopathological diagnosis, 22 patients were grouped as SIF and 22 patients as ON. A 2 x 2 contingency table analysis was used to obtain the odd ratios (ORs) for SIF compared to ON.
The age, proportion of females, the rate of a history of either corticosteroid intake or alcohol abuse, and the presence of vertebral compression fracture in subchondral insufficiency fracture were significantly higher than those with osteonecrosis (p = 0.0001, 0.0212, 0.0001, and 0.0040, respectively). ORs for SIF were 12.01 [95 % confidence intervals (CI) 1.35-106.80] and 7.29 (95 % CI 1.91-27.86), if the patient were female and 70 years of age or older, respectively. In addition, OR for SIF was extremely high (OR 56.01, 95 % CI 6.12-512.87) compared to ON, if the patients have a history of either corticosteroid intake or alcohol abuse.
The results of this study indicate that osteoporotic elderly women without any history of corticosteroid intake or alcohol abuse need to first be considered to have subchondral insufficiency fracture when radiographs show a collapse of the femoral head.. |
| 272. |
Masanobu Hirata, Yasuharu Nakashima, Masanobu Ohishi, Satoshi Hamai, Daisuke Hara, Yukihide Iwamoto, Surgeon Error in Performing Intraoperative Estimation of Stem Anteversion in Cementless Total Hip Arthroplasty, JOURNAL OF ARTHROPLASTY, 10.1016/j.arth.2013.03.006, 28, 9, 1648-1653, 2013.10, To examine the accuracy of intraoperative estimation of stem anteversion in total hip arthroplasty (THA), we compared the intraoperatively estimated stem anteversion (estimated prosthetic anteversion) to stem anteversion measured by postoperative computed tomography (true anteversion) in 73 hips in 73 patients. Estimated prosthetic anteversion was significantly greater than true anteversion by 5.8 degrees, and the mean absolute value of surgeon error was 7.3 degrees ranging from 11 degrees underestimation to 25 degrees overestimation. Surgeons tended to overestimate when the true anteversion was smaller. A multivariate analysis showed that advanced knee osteoarthritis significantly increased surgeon error. These results indicated that estimated prosthetic anteversion was generally larger than true anteversion and that the grade of knee osteoarthritis affected the degree of surgeon error. (C) 2013 Elsevier Inc. All rights reserved.. |
| 273. |
Nakashima Y, Sato T, Yamamoto T, Motomura G, Ohishi M, Hamai S, Akiyama M, Hirata M, Hara D, Iwamoto Y, Results at a minimum of 10 years of follow-up for AMS and PerFix HA-coated cementless total hip arthroplasty: impact of cross-linked polyethylene on implant longevity., Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 10.1007/s00776-013-0456-4, 18, 6, 962-968, 2013.11. |
| 274. |
Mio Akiyama, Yasuharu Nakashima, Toshio Kitano, Tomoyuki Nakamura, Kazuyuki Takamura, Yusuke Kohno, Takuaki Yamamoto, Goro Motomura, Masanobu Ohishi, Satoshi Hamai, Yukihide Iwamoto, Remodelling of femoral head-neck junction in slipped capital femoral epiphysis: A multicentre study, International Orthopaedics, 10.1007/s00264-013-2047-6, 37, 12, 2331-2336, 2013.12, Purpose: We examined the remodelling of the femoral head-neck junction in patients with slipped capital femoral epiphysis (SCFE) and the frequency of residual cam deformities. Methods: We reviewed 69 hips in 56 patients with stable SCFE who had undergone in situ pinning. Mean age at slip was 11.7 years and the follow-up period 63.4 months. Cam deformity was evaluated using the anterior offset alpha (α) angle and head-neck offset ratio (HNOR). Results: The average α angle and HNOR significantly improved from 76.2 to 51.3 and 0.086 to 0.135, respectively
25 hips (36.2 %) still had an α angle greater than 50, and 32 hips (46.4 %) had an HNOR of under 0.145. A multivariate analysis selected age at onset and slip angle as risk factors for cam deformity, with cutoff values 11.1 years and 21.0, respectively. Conclusions: Although most hips had remodelling of the head-neck junction, 29.4 % had residual cam deformities that may be susceptible to femoroacetabular impingement. © 2013 Springer-Verlag Berlin Heidelberg.. |
| 275. |
Nakashima Y, Kondo M, Fukuda T, Harada H, Horiuchi T, Ishinishi T, Jojima H, Kuroda K, Miyahara H, Maekawa M, Nishizaka H, Nagamine R, Nakashima H, Otsuka T, Shono E, Suematsu E, Shimauchi T, Tsuru T, Wada K, Yoshizawa S, Yoshizawa S, Iwamoto Y, Remission in patients with active rheumatoid arthritis by tocilizumab treatment in routine clinical practice: results from 3 years of prospectively registered data., Modern rheumatology / the Japan Rheumatism Association, 10.1007/s10165-013-0878-z, 2013.04. |
| 276. |
Jun-ichi Fukushi, Yasuharu Nakashima, Yukihide Iwamoto, Osteitis pubis ameliorated after tooth extraction: a case report, CLINICAL RHEUMATOLOGY, 10.1007/s10067-010-1451-1, 32, 1, S63-S65, 2013.03, Osteitis pubis is a non-infective inflammation of the symphysis pubis, which is known to be associated with trauma, athletic exertion, urological or gynecological surgery, or with rheumatic conditions such as seronegative spondyloarthropathies. In this report, we describe a case of osteitis pubis whose symptoms were completely ameliorated following tooth extraction attributable to periodontitis. A 57-year-old female patient developed osteitis pubis, presenting with pain in the groin area with an elevated Creactive protein (CRP; 4.4 mg/dl) and radiological erosive changes in symphysis pubis. Prednisolone (5 mg/day) and etodolac were prescribed, but the patient's symptoms improved only partially and remained persistent. One year from the patient's first visit, three teeth were extracted due to severe chronic periodontitis, which she had been suffering from for years. Soon after the above tooth extraction, her symptoms appeared completely resolved, and the patient's CRP was decreased to nearly normal levels in 4 weeks. Human leukocyte antigen (HLA)-typing analysis revealed a positive result for HLA-A11, A24, and B54. Because HLA-B54 cross-reacts with HLA-B27, the patient's osteitis pubis was considered to be a form of reactive arthritis associated with periodontitis.. |
| 277. |
Daisuke Hara, Yasuharu Nakashima, Takuaki Yamamoto, Shinshichiro Higashihara, Mitsugu Todo, Masanobu Hirata, Mio Akiyama, Yukihide Iwamoto, Late failure of annealed highly cross-linked polyethylene acetabular liner, JOURNAL OF THE MECHANICAL BEHAVIOR OF BIOMEDICAL MATERIALS, 10.1016/j.jmbbm.2013.08.003, 28, 206-212, 2013.12, Highly cross-linked polyethylene (HXPE) in total hip arthroplasty (THA) has been shown to significantly decrease wear rates compared with conventional polyethylene (CPE). However, crosslinking, thermal treatment and oxidation can decrease the mechanical properties of PE, and several cases of fracture of remelted HXPE liners were reported. We present, for the first time, unexpected failures of THA with the use of annealed HXPE liners in two patients occurring at 7 and 8 years after operation. Operative findings revealed dislocated liners from the metal shell and a fracture of the superior rim at the rim-dome junction in both liners. Scanning electron microscopy showed that the cracks initiated at the rim and propagated toward the articular surface. Both liners showed generally a low amount of oxidation (less than 1.00) at the articular surface and low wear rates; however, oxidation at the rim was relatively higher (mean 1.55). These findings suggested that decreased mechanical properties at the rim-dome junction due to cross-linking, annealing and oxidation might have been caused breakage of the HXPE liners after a long implantation time, although the annealed HXPE achieved low degree of wear. (C) 2013 Elsevier Ltd. All rights reserved.. |
| 278. |
Satoshi Ikemura, Takuaki Yamamoto, Goro Motomura, Yasuharu Nakashima, Taro Mawatari, Yukihide Iwamoto, Erratum: The utility of clinical features for distinguishing subchondral insufficiency fracture from osteonecrosis of the femoral head (Archives of Orthopaedic and Trauma Surgery (DOI 10.1007/s00402-013-1847-x), Archives of Orthopaedic and Trauma Surgery, 10.1007/s00402-013-1863-x, 133, 12, 1629, 2013.12. |
| 279. |
Taishi Sato, Yasuharu Nakashima, Akinobu Matsushita, Masanori Fujii, Yukihide Iwamoto, Effects of posterior pelvic tilt on anterior instability in total hip arthroplasty: A parametric experimental modeling evaluation, CLINICAL BIOMECHANICS, 10.1016/j.clinbiomech.2012.12.011, 28, 2, 178-181, 2013.02, Background: Anterior dislocation is one of the concerns of patients with posterior pelvic tilt undergoing total hip arthroplasty. This study aimed to evaluate the magnitude of posterior pelvic tilt constituting a risk for anterior dislocation by measuring the range of motion until impingement and dislocation under various pelvic tilt.
Methods: Using a jig mounted prosthetic hip model, the ranges of external rotation at extension and internal rotation at flexion until reaching dislocation were tested. The site of impingement prior to dislocation was also recorded. Posterior pelvic tilt and the cup version were changed with 10 degrees increments from 0 degrees to 40 degrees and from 10 degrees retroversion to 30 degrees anteversion, respectively. Effects of increasing femoral offset were also tested. We defined a required range of motion as having 30 degrees external rotation at extension and 40 degrees internal rotation at 90 degrees flexion.
Findings: External rotation decreased in a posterior pelvic tilt-dependent manner. In the case with more than 20 degrees posterior pelvic tilt, available external rotation extended beyond required range with the cup anteversion of 20 degrees. Decreasing cup anteversion improved external rotation, however, internal rotation decreased simultaneously. In the case with posterior pelvic tilt more than 20 degrees, only cup anteversion with 0 degrees or 10 degrees satisfied the required range of motion. A + 4 mm horizontal offset improved external rotation by 10 degrees with delaying bony impingement.
Interpretation: More than 20 degrees of posterior pelvic tilt may cause anterior instability and diminish the optimal range of cup version. Increasing the femoral offset improved external rotation without reducing internal rotation. (C) 2012 Elsevier Ltd. All rights reserved.. |
| 280. |
Tashiro Y, Nakashima Y, Okazaki K, Mawatari T, Fukushi J, Ohishi M, Oyamada A, Yamada H, Iwamoto Y, Effects of adalimumab administration in bio-naïve and bio-switch rheumatoid arthritis patients in daily clinical practice : two-year results from single center., Fukuoka igaku zasshi = Hukuoka acta medica, 10.15017/1430774, 104, 11, 413-423, 2013.11, Aims : To investigate the impact of adalimumab on the biologic-naïve (bio-naïve) and bio-switch rheumatoid arthritis (RA) patients, and to clarify the appropriate indications for adalimumab treatment. Methods : The retention rate, efficacy and safety of adalimumab in twenty-one RA patients were analyzed. Fourteen of the patients were bio-naïve and seven were bio-switched from other biologics. Concomitant methotrexate was used in 85% of the bio-naïve and 71% of the bio-switch patients. The radiographic findings before and after the 1 year and the two years treatment were also surveyed. Results : In the bio-naïve group, 63% of patients continued adalimumab for 2 years, and remission was achieved in approximately 50% of patients. The mean 28-joint Disease Activity Scores improved from 5. 2 to 2. 6. Radiographically, the joint damage did not progress in either erosions or joint space narrowing. In the bio-switch group, the retention rate was 29%, and only patients who were switched from infliximab showed responses to the treatment. Herpes zoster requiring hospitalization occurred in two cases and injection site reactions were noted in other two cases. Conclusion : Adalimumab combined with methotrexate would be a useful first choice biologic regimen in bio-naïve RA patients. As a second biologic, adalimumab could be useful only when treatments are switched from infliximab.【はじめに】完全ヒト型抗TNF-αモノクローナル抗体のアダリムマブ(ADA)は皮下注射製剤で，外来治療が可能である．本研究では，関節リウマチ(RA)に対するADA の2年間の使用成績をバイオナイーブ例および他バイオ製剤からのスイッチ例で評価し，成績と適応について検討した．【対象と方法】当科で2009 年～2011 年にRA へA DA を開始した連続21 症例に関し，バイオナイーブ14例(男性2例，女性12 例，平均53 歳，罹病期間8年，メトトレキサートMTX併用85％，平均6.6mg)とスイッチ7 例(全例女性，平均67 歳，罹病期間14 年，MTX 併用71%，平均5.7mg)での治療継続率・効果・安全性を検討した．またX線で関節破壊の進行を評価した．【結果】バイオナイーブ例では12，24ヶ月での継続率は79％，63％と良好で，疾患活動性DAS28-ESR は平均5.2 から2.6 へと改善し(p |
| 281. |
NAKASHIMA Yasuharu, MASHIMA Naohiko, IMAI Hiroshi, MITSUGI Naoto, TAKI Naoya, MOCHIDA Yuichi, OWAN Ichiro, ARAKAKI Kaoru, YAMAMOTO Takuaki, MAWATARI Taro, MOTOMURA Goro, OHISHI Masanobu, DOI Toshio, KANAZAWA Masayuki, IWAMOTO Yukihide, Clinical and radiographic evaluation of total hip arthroplasties using porous tantalum modular acetabular components : 5-year follow-up of clinical trial, Modern rheumatology, 10.1007/s10165-012-0618-9, 23, 1, 112-118, 2013.01. |
| 282. |
32mm径骨頭は人工股関節置換術後の脱臼率を低下させる. |
| 283. |
Yusuke Kohno, Yasuharu Nakashima, Toshio Kitano, Tomoyuki Nakamura, Kazuyuki Takamura, Mio Akiyama, Daisuke Hara, Takuaki Yamamoto, Goro Motomura, Masanobu Ohishi, Satoshi Hamai, Iwamoto Yukihide, Subclinical bilateral involvement of the hip in patients with slipped capital femoral epiphysis-a multicentre study, INTERNATIONAL ORTHOPAEDICS, 10.1007/s00264-013-2131-y, 38, 3, 477-482, 2014.03, Purpose This study was conducted to assess the posterior inclination of the contralateral femoral epiphysis in patients with unilateral slipped capital femoral epiphysis (SCFE).
Methods The posterior sloping angle (PSA) was measured using lateral radiographs in 67 patients with a unilateral SCFE and in 41 age-matched normal controls. A symptomatic epiphyseal slip was defined as the development of SCFE.
Results The contralateral PSA in SCFE patients was more widely distributed and significantly larger compared to controls (15.0 degrees vs. 9.0 degrees, p Conclusions These findings suggested the possibility of bilateral hip involvement in SCFE patients. Hips with greater degrees of PSA (> 19 degrees) are likely to become symptomatic.. |
| 284. |
Goro Motomura, Takuaki Yamamoto, Koichiro Abe, Yasuharu Nakashima, Masanobu Ohishi, Satoshi Hamai, Toshio Doi, Hiroshi Honda, Yukihide Iwamoto, Scintigraphic assessments of the reparative process in osteonecrosis of the femoral head using SPECT/CT with Tc-99m hydroxymethylene diphosphonate, NUCLEAR MEDICINE COMMUNICATIONS, 10.1097/MNM.0000000000000166, 35, 10, 1047-1051, 2014.10, ObjectiveThe aim of the study was to assess the degree and location of the reparative process in early osteonecrosis of the femoral head on the basis of single-photon emission computed tomography/computed tomography (SPECT/CT) with technetium-99m hydroxymethylene diphosphonate.Materials and methodsThis study was approved by the institutional review board. We retrospectively evaluated SPECT/CT scans of 23 consecutive hips. On the basis of the classification system used, 12 hips were classified as stage 1 (no radiographic abnormality), six hips as stage 2 (demarcating sclerosis without femoral head collapse), and five hips as stage 3A ( |
| 285. |
Mio Akiyama, Yasuharu Nakashima, Masanobu Oishi, Taishi Sato, Masanobu Hirata, Daisuke Hara, Yukihide Iwamoto, Risk factors for acetabular retroversion in developmental dysplasia of the hip: does the Pemberton osteotomy contribute?, JOURNAL OF ORTHOPAEDIC SCIENCE, 10.1007/s00776-013-0473-3, 19, 1, 90-96, 2014.01, The purpose of this study was to investigate residual acetabular retroversion after skeletal maturity in patients with Pemberton osteotomy.
We compared 40 hips in 36 patients treated with a Pemberton osteotomy (Pemberton group) and 30 hips in 26 patients treated only with a Pavlik harness (Rb group) for developmental dysplasia of the hip. The average age at operation in the Pemberton group was 94.5 months and the follow-up duration was 151.8 months. Radiographic parameters included the acetabular index (alpha angle) and the center-edge angle of Wiberg, preoperatively and at skeletal maturity. We examined the crossover sign (COS) at the latest follow-up as a sign of acetabular retroversion (AR). We compared the parameters between the two groups and examined the risk factors for acetabular retroversion using a multivariate Cox model.
A COS (+) was significantly more frequent in the Pemberton group compared to the Rb group [15 hips (37.5 %) vs 3 hips (10 %); p = 0.0077]. In the Pemberton group, the average age at operation in COS (+) hips was significantly older than that in COS (-) hips (126.9 vs 72.8 months; p = 0.0005). The preoperative alpha angle did not vary between hips with and without COS; however, the postoperative alpha angle was significantly smaller in COS (+) hips. A multiple logistic regression analysis for prediction of COS (+) showed that the age at operation and the amount change of alpha angle were significant predictors for COS (+) hips. The cut-off of the age at operation was 7 years and 9 months old.
AR was present in 37.5 % of the hips in the Pemberton group after skeletal maturity. Remodeling of acetabular version was observed in younger patients; however, hips in older patients (> 8 years) at the time of operation and greater degrees of correction tended to result in AR.. |
| 286. |
Kenichi Mishima, Hiroshi Kitoh, Nobuhiko Haga, Yasuharu Nakashima, Junji Kamizono, Takenobu Katagiri, Takafumi Susami, Masaki Matsushita, Naoki Ishiguro, Radiographic characteristics of the hand and cervical spine in fibrodysplasia ossificans progressiva., Intractable & rare diseases research, 10.5582/irdr.2014.01009, 3, 2, 46-51, 2014.05, Fibrodysplasia ossificans progressiva (FOP) is a disabling heritable disorder of connective tissue characterized by progressive heterotopic ossification in various extraskeletal sites. Early correct diagnosis of FOP is important to prevent additional iatrogenic harm or trauma. Congenital malformation of the great toes is a well-known diagnostic clue, but some patients show normal-appearing great toes. The thumb shortening and cervical spine abnormalities are other skeletal features often observed in FOP. This study aimed to address the quantitative assessment of these features in a cohort of patients with FOP, which potentially helps early diagnosis of FOP. Radiographs of the hand and cervical spine were retrospectively analyzed from a total of 18 FOP patients (9 males and 9 females) with an average age of 13.9 years (range 0.7-39.3 years). The elevated ratio of the second metacarpal bone to the distal phalanx of the thumb (> +1SD) was a consistent finding irrespective of the patient's age and gender. Infant FOP patients, in addition, exhibited an extremely high ratio of the second metacarpal bone to the first metacarpal bone (> +3SD). The height/depth ratio of the C5 vertebra increased in patients over 4 years of age (> +2SD). Additionally, the ratio of (height+depth) of the C5 spinous process to the C5 vertebral depth was markedly elevated in young patients (> +2SD). We quantitatively demonstrated the hand and cervical spine characteristics of FOP. These findings, which can be seen from early infancy, could be useful for early diagnosis of FOP even in patients without great toe abnormalities.. |
| 287. |
Kazuyuki Karasuyama, Takuaki Yamamoto, Goro Motomura, Yasuharu Nakashima, Akio Sakamoto, Ryosuke Yamaguchi, Yukihide Iwamoto, Osteonecrosis of the femoral head with collapsed medial lesion, Clinical Medicine Insights: Case Reports, 10.4137/CCRep.S18171, 7, 103-106, 2014.09, A 60-year-old female experienced the gradual onset of left hip pain without any triggering event. Radiographs showed vertical sclerosis in the center of the femoral head and the lesion inside the boundary demonstrated diffuse bony sclerosis. No collapse was observed at the weight-bearing portion on radiograph. However, computed tomography showed a subchondral collapse at the medial lesion. On T2-weighted magnetic resonance imaging, the necrotic lesion showed diffuse high-intensity signals that indicated a prominent repair process. Bone biopsy diagnosed osteonecrosis with associated prominent appositional bone and vascular granulation tissue.. |
| 288. |
Satoshi Hamai, Yasuharu Nakashima, Mio Akiyama, Umito Kuwashima, Takuaki Yamamoto, Goro Motomura, Masanobu Ohishi, Yukihide Iwamoto, Ischio-pubic stress fracture after peri-acetabular osteotomy in patients with hip dysplasia, INTERNATIONAL ORTHOPAEDICS, 10.1007/s00264-014-2375-1, 38, 10, 2051-2056, 2014.10, Ischio-pubic stress fracture is one of the potential complications after peri-acetabular osteotomy (PAO) in patients with hip dysplasia. The purpose of this study was to examine the prevalence of and risk factors for ischio-pubic fractures following PAO.
A total of 296 hips in 275 patients who underwent transposition osteotomy of the acetabulum between 2001 and 2012 were retrospectively reviewed. Patient characteristics and radiographic parameters were compared between patients with and without fracture.
Fourteen ipsilateral hips (4.7 %) in 14 female patients had fracture of the inferior pubic ramus (11 hips) or the ischial ramus (three hips) on the same side as the surgery at an average of 4.6 weeks after PAO. Multivariate analysis indicated that younger age at operation (odds ratio of 1.43 per five years, p = 0.0169) and greater degree of correction (odds ratio of 1.98 per five degrees, p = 0.0005) were significantly associated with ischio-pubic fracture as independent risk factors. All fractures healed conservatively with partial weight-bearing.
Younger female patients and greater deformity corrections increased the risk of ischio-pubic stress fracture after PAO.. |
| 289. |
Masanobu Hirata, Yasuharu Nakashima, Takashi Itokawa, Masanobu Ohishi, Taishi Sato, Mio Akiyama, Daisuke Hara, Yukihide Iwamoto, Influencing factors for the increased stem version compared to the native femur in cementless total hip arthroplasty, INTERNATIONAL ORTHOPAEDICS, 10.1007/s00264-014-2289-y, 38, 7, 1341-1346, 2014.07, Stem version is not always equivalent to femoral neck version (native version) in cementless total hip arthroplasty (THA). We therefore examined the discrepancy of version between the native femoral neck and stem using pre- and postoperative computed tomography (CT), the level of the femur where the canal version most closely fit the stem version, and the factors influencing version discrepancy between the native femoral neck and stem.
A total of 122 hips in 122 patients who underwent primary THA using a metaphyseal-fit stem through the postero-lateral approach were included. Pre- and postoperative CT images were utilized to measure native and stem version, and the version of the femoral canal at four levels relative to the lesser trochanter.
The mean native and stem versions were 28.1 +/- 11.0A degrees and 38.0 A +/- 11.2A degrees, respectively, revealing increased stem version with a mean difference of 9.8A degrees (p Since a cementless stem has little version adjustability in the femoral canal, these findings are useful for surgeons in preoperative planning and to achieve proper component placement in THA.. |
| 290. |
Yasuharu Nakashima, Masanobu Hirata, Mio Akiyama, Takashi Itokawa, Takuaki Yamamoto, Goro Motomura, Masanobu Ohishi, Satoshi Hamai, Yukihide Iwamoto, Combined anteversion technique reduced the dislocation in cementless total hip arthroplasty, INTERNATIONAL ORTHOPAEDICS, 10.1007/s00264-013-2091-2, 38, 1, 27-32, 2014.01, The combined anteversion (CA) technique is a method in which the cup is placed according to the stem anteversion in total hip arthroplasty (THA). We examined whether the CA technique reduced the dislocation rate, and the distribution of CA with the manual placement of the cup.
We retrospectively reviewed 634 hips in 579 patients with primary cementless THA. In 230 hips using the CA technique [CA(+)], a CA of 50 +/- 10A degrees was the aim. In the remaining 404 hips [CA(-)], the cup was first placed targeting 20A degrees of anteversion. The post-operative CA was measured using the computed tomography (CT) images in 111 hips.
One hip (0.4 %) had a dislocation in the CA(+) group, whereas ten hips (2.5 %) had a dislocation in the CA(-) group. A multivariate analysis showed that primary diagnosis, head size and CA technique significantly influenced the dislocation rate. Patients in the CA(-) group were 5.8 times more likely to have a dislocation compared to the CA(+) group. In the 111 hips with CT images, 81 hips (73.0 %) achieved the intended CA.
Although the manual placement of the cup resulted in 27 % of outliers from the intended CA, the CA technique significantly reduced the dislocation after primary THA.. |
| 291. |
Masanobu Ohishi, Hisaaki Miyahara, Masakazu Kondo, Yasuharu Nakashima, Kazumasa Terada, Yukio Esaki, Nobuo Kobara, Katsumi Harimaya, Yoshihiro Matsumoto, Yukihide Iwamoto, Characteristics of lumbar scoliosis in patients with rheumatoid arthritis, JOURNAL OF ORTHOPAEDIC SURGERY AND RESEARCH, 10.1186/1749-799X-9-30, 9, 1, 30-30, 2014.04, Background: Although a substantial percentage of patients with rheumatoid arthritis ( RA) experience low back pain, the characteristics of lumbar spine pathology in RA patients has been poorly investigated. In our institutions, lumbar spine radiographs indicated scoliosis in 26 patients. The present study aimed to clarify the characteristics of lumbar scoliosis in RA patients.
Methods: This is a retrospective study of 26 RA patients with lumbar scoliosis. Patient characteristics such as disease duration, disease stage and class according to Steinbrocker's classification, and medication for RA and osteoporosis were reviewed. Radiologic evaluation of scoliosis was performed at two different time points by measuring Cobb angles. The progression of scoliosis per year was calculated by dividing the change in Cobb angles by the number of years. Apical vertebral rotation, lateral listhesis, and the level of the intercrestal line at the first observation were also measured. The correlation between different factors and changes in the Cobb angles per year was analyzed.
Results: Majority of the patients had a long disease duration and were classified as stage 3 or 4 according to Steinbrocker's classification. During the observation period, most patients were treated with glucocorticoids. Unlike the previous studies on degenerative scoliosis, apical vertebral rotation, lateral listhesis, and the level of the intercrestal line at initial observation were not significantly related to the progression of scoliosis. Initial Cobb angles were inversely related to the progression of scoliosis. Patients who were treated with bisphosphonates showed slower progression of scoliosis.
Conclusions: Our results indicate that the characteristics of lumbar scoliosis in RA patients differ from those of degenerative lumbar scoliosis. Bone fragility due to the long disease duration, poor control of disease activity, and osteoporosis is possibly related to its progression.. |
| 292. |
The knack and pitfall of THA after the osteotomy. |
| 293. |
Yongseung Lee, Goro Motomura, Takuaki Yamamoto, Yasuharu Nakashima, Masanobu Ohishi, Satoshi Hamai, Kunio Iura, Yukihide Iwamoto, Rapidly destructive arthrosis of the hip joint in a young adult with systemic lupus erythematosus, RHEUMATOLOGY INTERNATIONAL, 10.1007/s00296-015-3304-3, 35, 10, 1753-1757, 2015.10, A 37-year-old female had been treated with corticosteroids for systemic lupus erythematosus clinically diagnosed at age 10. She suddenly had right hip pain without any antecedent trauma. Four months after the onset of pain, she visited her primary care physician. On magnetic resonance imaging, joint space narrowing at the weight-bearing area was already seen with bone marrow edematous lesions in both the femoral head and acetabulum. She was treated non-operatively; however, her pain continued to worsen in severity. Thirteen months after the onset of pain, she was referred to our hospital. A plain radiograph showed subluxation of the collapsed femoral head accompanied by destruction of the acetabular rim. Because of her severe intractable pain, she underwent total hip arthroplasty 1 month after her first visit. Histological examination of the resected femoral head revealed pseudogranulomatous lesions along with prominent callus formation, suggesting rapid destruction of the femoral head.. |
| 294. |
Akiyama M, Mawatari T, Nakashima Y, Miyahara H, Yamada H, Okazaki K, Fukushi J, Kondo M, Kishimoto J, Hashimura C, Iwamoto Y, Prevalence of dyslipidemia in Japanese patients with rheumatoid arthritis and effects of atorvastatin treatment., Clinical rheumatology, 10.1007/s10067-015-3049-0, 34, 11, 1867-1875, 2015.11. |
| 295. |
Kazuhiko Sonoda, Takuaki Yamamoto, Goro Motomura, Yasuharu Nakashima, Ryosuke Yamaguchi, Yukihide Iwamoto, Outcome of transtrochanteric rotational osteotomy for posttraumatic osteonecrosis of the femoral head with a mean follow-up of 12.3 years, ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY, 10.1007/s00402-015-2282-y, 135, 9, 1257-1263, 2015.09, This study examined the outcomes of applying transtrochanteric rotational osteotomy (TRO) for posttraumatic osteonecrosis of the femoral head (ON).
We retrospectively reviewed 28 hips in 28 patients (male, n = 17; female n = 11) with a mean age of 34.8 years (12-61 years) at the time of TRO. Transtrochanteric anterior rotational osteotomy (ARO) was used when the lesion was localized on the anterior aspect of the femoral head, and transtrochanteric posterior rotational osteotomy (PRO) was indicated in patients with lesions limited to the posterior aspect of the femoral head. The mean follow-up period was 12.3 years (5.0-21.3 years). We investigated the patients' clinical and radiological factors, including age, sex, body mass index, preoperative Harris Hip Score (HHS), type of antecedent trauma, preoperative stage, and postoperative intact ratio (the ratio of the intact articular surface of the femoral head to the weight-bearing surface of the acetabulum). We divided the patients into a hip-survival group and a conversion-to-total hip arthroplasty (THA) group and then compared these factors between the two groups.
At the final follow-up, 22 hips had survived with a mean HHS of 85.8. The remaining six hips underwent THA at a mean of 10.2 years after TRO. The preoperative stage was correlated with hip survival. Furthermore, the postoperative intact ratio was significantly lower in the conversion-to-THA group. Based on the receiver operating characteristic curve, a ratio of less than 33.6 % was found to be associated with the need to convert to THA.
TRO to correct posttraumatic ON resulted in favorable midterm results. The possible risk factors for conversion to THA were an advanced preoperative stage and a postoperative intact ratio of less than 33.6 %.. |
| 296. |
Masanobu Hirata, Yasuharu Nakashima, Daisuke Hara, Masayuki Kanazawa, Yusuke Kohno, Kensei Yoshimoto, Yukihide Iwamoto, Optimal anterior femoral offset for functional range of motion in total hip arthroplasty-a computer simulation study, INTERNATIONAL ORTHOPAEDICS, 10.1007/s00264-014-2538-0, 39, 4, 645-651, 2015.04, Purpose Compared to medial femoral offset (MFO), the role of anterior femoral offset (AFO) on range of motion (ROM) in total hip arthroplasty (THA) has not been fully examined. We therefore defined AFO as the anterior distance from the centre of the femoral head to the proximal femoral axis in the sagittal plane and determined the optimal AFO required for ROM needed for activities of daily living using a computer-simulated THA model.
Methods Various AFOs were obtained by changing stem anteversion (stem-AV) and stem tilt in the sagittal plane (stem-tilt) using a CT-based simulation software. The required ROM was defined as: flexion >= 110A degrees, internal rotation at 90 degrees flexion (IR)>= 30A degrees, external rotation (ER)>= 30A degrees, and extension >= 30A degrees, and we determined AFO and MFO to satisfy required ROM.
Results AFO was positively correlated with stem-AV and anterior stem-tilt. MFO was negatively correlated with stem-AV and not influenced by stem-tilt. Flexion and IR increased with both increased AFO and MFO, whereas extension and ER decreased with increased AFO. A smoothing spline curve showed the optimal AFO and MFO for required ROM to be from 15 mm to 25 mm on average and more than 32.1 mm, respectively.
Conclusions This is the first study to show that AFO directly influenced ROM in THA. Optimal AFO as well as MFO should be reconstructed to achieve sufficient ROM.. |
| 297. |
Kensei Yoshimoto, Yasuharu Nakashima, Akihiro Nakamura, Taro Mawatari, Mitsugu Todo, Daisuke Hara, Yukihide Iwamoto, Neck fracture of femoral stems with a sharp slot at the neck: biomechanical analysis, JOURNAL OF ORTHOPAEDIC SCIENCE, 10.1007/s00776-015-0745-1, 20, 5, 881-887, 2015.09, Background Fracture of the femoral stem in total hip arthroplasty (THA) is a rare complication. We have encountered 2 cases of neck fractures of the femoral stem occurring 9 and 12 years after THA. Morphological and biomechanical analysis were performed to investigate the mechanism of these fractures.
Method A titanium alloy femoral stem having a slot with sharp corners (R = 0.2 mm) at the neck had been implanted in both cases. Fracture surfaces were examined by use of scanning electron microscopy (SEM). Stress concentration was simulated by using a finite element method (FEM) to compare slots with sharp (R = 0.2 mm) and smooth (R = 2 mm) corners.
Results Study of the retrieved stems revealed that neck fractures had occurred at the distal end of the slot in both cases. SEM revealed numerous fine fissures extending from the anterolateral edge, striations on the middle of the fracture surface, and dimples on the posteromedial surface, suggesting that the fractures had occurred from the anterolateral aspect toward the posteromedial aspect because of metallic fatigue. FEM analysis showed that mechanical stress was concentrated at the distal and anterolateral corners of the slot. Under 3500-N loading force, the stress at the sharp corner was 556 MPa, which was approximately twofold that at the smooth corner and exceeded the fatigue strength of titanium alloy.
Conclusion These findings showed that the sharp corner of slot increased stress concentrations at the anterolateral aspect and led to the neck fractures.. |
| 298. |
Tomomi Kamada, Naohiko Mashima, Yasuharu Nakashima, Hiroshi Lmai, Jun Takeba, Hiromasa Miura, Mid-Term Clinical and Radiographic Outcomes of Porous Tantalum Modular Acetabular Components for Hip Dysplasia, JOURNAL OF ARTHROPLASTY, 10.1016/j.arth.2014.11.007, 30, 4, 607-610, 2015.04, It is still challenging to perform successful cementless cup fixation during total hip arthroplasty for hip dysplasia. In this multicenter study we evaluated the clinical results of porous tantalum modular acetabular cups (TM cups) in 45 dysplastic hips with a mean follow-up period of 9.8 years. The mean Japanese Orthopaedic Association hip score improved from 48.2 preoperatively to 92.1 at the most recent follow-up. All of the cups were radiographically stable with no evidence of progressive radiolucencies or osteolysis regardless of bone grafting. Sixteen hips with bone grafts showed the integration of grafted bone without any radiolucencies. There were no revisions of TM cups. The use of TM cups for dysplastic hips provided satisfactory 10-year clinical and radiographic results. (C) 2014 Elsevier Inc. All rights reserved.. |
| 299. |
Toru Ishibashi, Miki Ichikawa, Bunpei Sato, Shinji Shibata, Yuichi Hara, Yuji Naritomi, Ken Okazaki, Yasuharu Nakashima, Yukihide Iwamoto, Samon Koyanagi, Hiroshi Hara, Tetsuhiko Nagao, Improvement of psoriasis-associated arthritis and skin lesions by treatment with molecular hydrogen: A report of three cases, MOLECULAR MEDICINE REPORTS, 10.3892/mmr.2015.3707, 12, 2, 2757-2764, 2015.08, Psoriasis, a chronic inflammatory skin disease, is caused by infiltrating lymphocytes and associated cytokines, including tumor necrosis factor (TNF)alpha, interleukin (IL)-6, and IL-17. Effective treatments, including pathogenesis-based biological agents against psoriasis, are currently under development. Although the role of reactive oxygen species (ROS) in the pathogenesis of psoriasis has been investigated, it remains to be fully elucidated; ROS-targeted therapeutic strategies are also lacking at present. Therefore, the objective of the present study was to assess whether H-2, a ROS scavenger, has a therapeutic effect on psoriasis-associated inflammation by reducing hydroxyl radicals or peroxynitrite in the immunogenic psoriasis cascade. Three methods were used to administer H-2: Drop infusion of saline containing 1 ppm H-2 (H-2-saline), inhalation of 3% H-2 gas, and drinking of water containing a high concentration (5-7-ppm) of H-2 (high-H-2 water). Treatment efficacy was estimated using the disease activity score 28 (DAS28) system, based on C-reactive protein levels, and the psoriasis area and severity index (PASI) score, determined at baseline and following each H-2 treatment. Furthermore, levels of TNF alpha, IL-6, and IL-17 were analyzed. The DAS28 and PASI score of the three patients decreased during H2 treatment, regardless of the administration method. The psoriatic skin lesions almost disappeared at the end of the treatment. IL-6 levels decreased during H2 treatment in Case 1 and 2. IL-17, whose concentration was high in Case 1, was reduced following H-2 treatment, and TNFa also decreased in Case 1. In conclusion, H-2 administration reduced inflammation associated with psoriasis in the three cases examined and it may therefore be considered as a treatment strategy for psoriasis-associated skin lesions and arthritis.. |
| 300. |
Kubo Y, Ohishi M, Nakashima Y, Okazaki K, Fukushi J, Oyamada A, Iwamoto Y, Efficacy and Safety of Infliximab for Ankylosing Spondylitis in Japanese Patients: A Retrospective Study of 11 Cases., Fukuoka igaku zasshi = Hukuoka acta medica, 10.15017/1650606, 106, 12, 316-322, 2015.12, 【背景】インフリキシマブ（IFX）やアダリムマブといったTNF 阻害剤は関節リウマチだけでなく，強直性脊椎炎（AS）でも有効であることが示されている．しかしながら，本邦におけるTNF 阻害剤のASに対する有効性に関する報告はほとんどないが現状である．【材料と方法】我々は11 例のAS 症例にIFXを投与し，その有効性と安全性について検討を行った．【結果】平均観察期間は19 カ月であった．疾患活動性の評価指標であるBASDAI は投与開始前の4.7 ± 2.2から最終観察時には1.7 ± 1.2 まで低下した．また，CRPは投与開始前の1.62 ± 1.94 mg/dL から最終観察時には0.23 ± 0.45 mg/dLまで低下した．アナフィラキシーや重篤感染症を合併した症例は認めなかった．【結論】日本人においてもIFXはASに対して有効かつ安全であると考えられた．. |
| 301. |
Masanori Fujii, Tetsuro Nakamura, Toshihiko Hara, Yasuharu Nakashima, Yukihide Iwamoto, Does Radiographic Coxa Profunda Indicate Increased Acetabular Coverage or Depth in Hip Dysplasia?, CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, 10.1007/s11999-014-4084-x, 473, 6, 2056-2066, 2015.06, Although radiographic coxa profunda has been considered an indicator of acetabular overcoverage, recent studies suggest that radiographic coxa profunda is a nonspecific finding seen even in hip dysplasia. The morphologic features of coxa profunda in hip dysplasia and the frequency with which the two overlap are not well defined.
We determined (1) the prevalence of radiographic coxa profunda in patients with hip dysplasia; (2) the morphologic differences of the acetabulum and pelvis between patients with hip dysplasia and control subjects; and (3) the morphologic differences between hip dysplasia with and without coxa profunda.
We retrospectively reviewed the pelvic radiographs and CT scans of 70 patients (70 hips) with hip dysplasia. Forty normal hips were used as controls. Normal hips were defined as those with a lateral center-edge angle between 25A degrees and 40A degrees. Coxa profunda was defined as present when the acetabular fossa was observed to touch or was medial to the ilioischial line on an AP pelvic radiograph. CT measurements included acetabular version, acetabular coverage, acetabular depth, and rotational alignment of the innominate bone.
The prevalence of coxa profunda was 44% (31 of 70 hips) in dysplastic hips and 73% (29 of 40 hips) in the control hips (odds ratio, 3.32; 95% CI, 1.43-7.68). Dysplastic hips had a more anteverted and globally shallow acetabulum with inwardly rotated innominate bone compared with the control hips (p Radiographic coxa profunda was not a sign of increased acetabular coverage and depth in patients with hip dysplasia, but rather indicates classic acetabular dysplasia, defined by an anteverted acetabulum with anterolateral acetabular deficiency and an inwardly rotated pelvis. Thus, the presence of coxa profunda does not indicate a disease in addition to hip dysplasia, and the conventional maneuvers during periacetabular osteotomy are adequate for these patients.
Level IV, diagnostic study.. |
| 302. |
Yusuke Kohno, Yasuharu Nakashima, Mio Akiyama, Masanori Fujii, Yukihide Iwamoto, Does Native Combined Anteversion Influence Pain Onset in Patients With Dysplastic Hips?, CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, 10.1007/s11999-015-4373-z, 473, 12, 3716-3722, 2015.12, Background Combined anteversion is the sum of femoral and acetabular anteversion and represents their morphological relationship in the axial plane. Few studies have investigated the native combined anteversion in patients with symptomatic dysplastic hips.
Questions/purposes We hypothesized the following: (1) dysplastic hips have two distinct populations, which differ from each other and from normal hips in their combined anteversion; and (2) these populations differ clinically in terms of correlation between age of onset of symptoms and amount of anteversion.
Methods We measured radiographic parameters by CT of 100 dysplastic hips in 76 patients who were symptomatic enough to undergo periacetabular osteotomy and of 50 normal hips in 44 patients who had CT scans as part of preparation for computer-navigated TKAs; these patients had no visible hip arthritis or dysplasia and no hip symptoms. Dysplastic hips were divided into the anteversion (83 hips) and retroversion groups (17 hips) based on acetabular version. Age at pain onset was determined from their medical charts.
Results Combined anteversion in the anteversion group was greater than that in the retroversion and control groups: 47 degrees +/- 12 degrees, 30 degrees +/- 16 degrees, and 36 degrees +/- 9 degrees, respectively. In the anteversion group, combined anteversion (r = -0.49; 95% confidence interval [CI], -0.66 to -0.27; p Conclusions These results suggest that not only lateral coverage of the femoral head, but also axial joint morphology is important for the development of pain in the anteversion group. Optimal combined anteversion should be considered during periacetabular osteotomy.. |
| 303. |
Yasuharu Nakashima, CORR Insights((R)): How are Dysplastic Hips Different? A Three-dimensional CT Study, CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, 10.1007/s11999-015-4165-5, 473, 5, 1724-1725, 2015.05. |
| 304. |
Sakuraba K, Fujimura K, Nakashima Y, Okazaki K, Fukushi J, Ohishi M, Oyamada A, Esaki Y, Miyahara H, Iwamoto Y, Yoshikai Y, Yamada H, Brief report: successful in vitro culture of rheumatoid arthritis synovial tissue explants at the air-liquid interface., Arthritis & rheumatology (Hoboken, N.J.), 10.1002/art.39019, 67, 4, 887-892, 2015.04. |
| 305. |
Kinematic analysis before and after total hip arthroplasty during a trunk-twisting motion. |
| 306. |
Yasuharu Nakashima, Takuaki Yamamoto, Jun-ichi Fukushi, Goro Motomura, Satoshi Hamai, Yusuke Kohno, Yukihide Iwamoto, Transtrochanteric rotational osteotomy for avascular necrosis of the femoral head after unstable slipped capital femoral epiphysis: 10-year clinical results, JOURNAL OF ORTHOPAEDIC SCIENCE, 10.1016/j.jos.2016.06.014, 21, 6, 831-835, 2016.11, Background: Avascular necrosis of the femoral head (AVN) is the most serious complication after unstable slipped capital femoral epiphysis (SCFE), and is often unsalvageable. We report a minimum 10 years of clinical results for transtrochanteric rotational osteotomy of the femoral head (TRO) for AVN.
Methods: This study included 7 patients (7 hips) with a mean age at surgery of 13.3 years, and the followup period was 15.8 years. All patients had prior treatment via closed reduction and pinning of the unstable SCFE, and showed severely collapsed femoral heads. The direction of rotation was anterior in 3 hips and posterior in 4. The Merle d'Aubigne-Postel score (MDPS) was used for clinical assessment, and joint degeneration was assessed with the Kellgren and Lawrence classification (KL-grade).
Results: The spherical intact area of the femoral head was moved to the weight-bearing portion, and subluxation was corrected via rotation combined with intentional varus positioning. The mean MDPS improved from 10.3 points to 15.6 points at 5 years, and it was maintained at 15.0 points by 10 years; 3 hips were excellent, 1 was good, 2 were fair, and 1 showed poor outcomes. No patient experienced re collapse after TRO or required conversion to hip replacement or arthrodesis. After 10 years, degenerative changes became evident over time, and 2 hips progressed to KL-4 with a decreased MDPS.
Conclusions: Although some joint degeneration is inevitable in the long-term, TRO is an effective salvage procedure for treating AVN after unstable SCFE. (C) 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.. |
| 307. |
Taishi Sato, Yasuharu Nakashima, Keisuke Komiyama, Takuaki Yamamoto, Goro Motomura, Yukihide Iwamoto, The Absence of Hydroxyapatite Coating on Cementless Acetabular Components Does Not Affect Long-Term Survivorship in Total Hip Arthroplasty, JOURNAL OF ARTHROPLASTY, 10.1016/j.arth.2015.11.034, 31, 6, 1228-1232, 2016.06, Background: Hydroxyapatite (HA) has been applied to joint prostheses as a bioactive coating to prolong their durability. However, HA benefits for cup survival in total hip arthroplasty (THA) remain controversial. In this study, we compared the survival of cups with and without HA coating during a minimum follow-up of 18 years.
Methods: In total, 183 THA cases in 163 patients were analyzed, including 73 cups with HA coating (HA(+) group) and 110 without HA coating (HA(-) group); otherwise, the cups had identical titanium-sprayed rough surfaces and were fixed with screws. In both groups, the same conventional polyethylene liners were applied. Zirconia and alumina ceramic heads were used in the HA(+) and HA(-) groups, respectively. We retrospectively analyzed cup survival based on cup revision for any reason or aseptic loosening as end points.
Results: In total, 7 and 8 revisions were performed in the HA(-) and HA(+) groups with survival rates of 86.3% and 90.1%, respectively. Among them, 3 cups in the HA(-) group and 1 cup in the HA(+) group were revised for aseptic loosening in 20 years (survival rates 94.1% and 98.7%, respectively). No significant difference was detected in cup survival rates between the groups based on both end points. There were no stem revisions during the observation period.
Conclusion: The results suggested that HA coating did not have either beneficial or adverse effects on the long-term cup survival in primary cementless THA. (C) 2015 Elsevier Inc. All rights reserved.. |
| 308. |
T. Yamamoto, G. Motomura, K. Karasuyama, Y. Nakashima, T. Doi, Y. Iwamoto, Results of the Sugioka transtrochanteric rotational osteotomy for osteonecrosis: Frequency and role of a defect of the quadratus femoris muscle in osteonecrosis progression, ORTHOPAEDICS & TRAUMATOLOGY-SURGERY & RESEARCH, 10.1016/j.otsr.2016.01.017, 102, 3, 387-390, 2016.05, Background: During transtrochanteric rotational osteotomy (RO), it is important to preserve the posterior column artery (PCA), which is generally located in the adipose tissue underneath the quadratus femoris muscle (QF). If there is a defect in the QF, the risk of injuring the PCA, subsequently resulting in total necrosis of the femoral head, may increase. Therefore, we investigated: (1) the frequency of defects of the QF at the time of RO, and (2) clinical outcome of RO based upon a defect of the QF.
Hypothesis: The presence of defects of the QF at the time of RO could be detected pre-operatively by magnetic resonance imaging.
Methods: RO was performed in 124 hips between 2001 and 2010. In all, 95 of the hips were in male patients and 29 in female patients. The mean age was 45.4 years (range: 11-61 years) at the time of surgery and MRI was performed before RO in all cases. We retrospectively evaluated the progression of a collapse through 3 years after RO.
Results: MRI showed a defect in the QF in four hips (3.2%) (2 males, 2 females), all of which were confirmed intra-operatively. Among the four patients, one (25%) underwent total hip arthroplasty because of varus deformity of the osteotomy site due to total necrosis of the femoral head 1 year after RO. The 120 hips with a normal QF showed no evidence of total necrosis or progression of necrosis of the femoral head, indicating that the presence of defects of the QF may increase the risk of poor survivorship of this procedure.
Conclusions: Defects of the QF have been reported to occur in 1-2% of all patients, whereas in our study the incidence in ON was approximately 3%. In ON patients with QF defects, pre-operative MRI evaluation of the QF appears to be important when planning RO, followed by a carefully performed surgical procedure.
Level of evidence: IV; retrospective case series without control group. (c) 2016 Elsevier Masson SAS. All rights reserved.. |
| 309. |
Masayuki Kanazawa, Yasuharu Nakashima, Takayuki Arai, Takahiro Ushijima, Masanobu Hirata, Daisuke Hara, Yukihide Iwamoto, Quantification of pelvic tilt and rotation by width/height ratio of obturator foramina on anteroposterior radiographs, HIP INTERNATIONAL, 10.5301/hipint.5000374, 26, 5, 462-467, 2016.09, Objective: Compared to sagittal pelvic tilt, only a few studies have examined axial rotation on anteroposterior radiographs. We therefore quantified 3-D pelvic rotation using the width and height ratio of the obturator foramina under the various pelvic tilts.
Methods: Using CT reconstructions of 10 healthy pelvises, anterior pelvic planes (APPs) were rotated by 20 degrees in 5 degrees increments on the axial plane with various degrees of sagittal pelvic tilt. The correlation between the pelvic rotation angle and the width ratio (WR) in the axial plane and the height/width ratio (H/W) in the sagittal plane were examined.
Results: Axial pelvic rotation and WR showed a high linear correlation regardless of the sagittal tilt, with the correlation coefficient ranging from 0.93 to 0.98 in males and 0.87 to 0.95 in females. The angle that resulted in a WR of 1: 2 was approximately 13 degrees in males and 18 degrees in females. H/W also showed a linear regression with sagittal tilt. Axial rotation was determined by the following equation incorporating pelvic tilts; axial rotation (male: female) = (19.9:24.2) + (2.1:3.6) x H-right/W-right + (0.9:1.5) x H-left/W-left - (23.2:25.1) x WR.
Conclusions: Pelvic tilt and rotation could be quantified by the equation using width and height ratios of the obturator foramina on a plain anteroposterior radiograph. Width and height ratios of the obturator foramina proved to be useful parameters in clinical practice for understanding pelvic rotation.. |
| 310. |
Fukushi J, Nakashima Y, Okazaki K, Yamada H, Mawatari T, Ohishi M, Oyamada A, Akasaki Y, Iwamoto Y, Outcome of Joint-Preserving Arthroplasty for Rheumatoid Forefoot Deformities., Foot & ankle international, 10.1177/1071100715609981, 37, 3, 262-268, 2016.03. |
| 311. |
Masayuki Kanazawa, Yasuharu Nakashima, Satoshi Hamai, Masanobu Hirata, Yukihide Iwamoto, Is a Stem Version on the Crosstable Lateral Radiograph Accurate in Total Hip Arthroplasty?, JOURNAL OF ARTHROPLASTY, 10.1016/j.arth.2015.12.022, 31, 6, 1356-1360, 2016.06, Background: In contrast to the acetabular cup version (CV), stem version (SV) measurement on the crosstable lateral radiograph has not been validated. We, therefore, investigated: (1) the difference of SV on the crosstable lateral radiograph from that measured using computed tomography data and (2) the reliability of SV measurement on the crosstable lateral radiograph.
Methods: We examined the correlations of the crosstable-CV and crosstable-SV with true-CV (operative cup anteversion) and true-SV (neck version relative to the posterior condylar line) obtained using computed tomography data from 103 patients. We also produced the digital reconstructed crosstable lateral radiograph with adjusted hip flexion and rotation and defined SV on this image as the true-crosstable SV.
Results: Significant positive correlations were noted between the crosstable-CV and true-CV, with a correlation coefficient of 0.79. In contrast, the correlation between the crosstable-SV and true-SV was very low (r = 0.30), with significantly higher deviation from the true-SV values when compared with the crosstable-CV (standard deviation, 11.6 degrees vs 6.5 degrees, P < .001). The true-crosstable SV was correlated with true-SV (r = 0.81); however, the average difference was 23.5 degrees +/- 8.9 degrees.
Conclusion: Crosstable-SV differed from true-SV in the measurement plane and did not correlate well with the true-SV, suggesting the unreliability of its measurements. Therefore, the crosstable-SV is not recommended for clinical use. (C) 2015 Elsevier Inc. All rights reserved.. |
| 312. |
Yusuke Kohno, Yasuharu Nakashima, Takashi Hatano, Mio Akiyama, Masanori Fujii, Daisuke Hara, Masayuki Kanazawa, Akihisa Haraguchi, Yukihide Iwamoto, High prevalence of cam deformity in dysplastic hips: A three-dimensional CT study, JOURNAL OF ORTHOPAEDIC RESEARCH, 10.1002/jor.23147, 34, 9, 1613-1619, 2016.09, Cam deformity could lead to suboptimal articulation by causing secondary femoroacetabular impingement after periacetabular osteotomy; however, the inherent femoral head-neck morphology in dysplastic hips and the effect of an additional osteoarthritic deformity have not been well described. We compared femoral head-neck morphology using three-dimensional imaging of normal and dysplastic hips in pre/early (Tonnis grade 0 and 1) and advanced stage osteoarthritis (Tonnis grade 2). Using computed tomography, we measured the circumferential -angle and head-neck offset ratio in 68 dysplastic hips and 24 normal hips. Locations of the head-neck junction were represented by the clock position. In the pre/early group, the -angle was significantly larger at the anterosuperior and inferior aspects (1, 2, and 5-7 o'clock) and head-neck offset ratio was smaller at the anterosuperior aspect (2 o'clock) than in the control group. The -angle was significantly larger at the anterior aspects (1-4 o'clock) in the advanced group than in the pre/early group. The maximum -angle was most commonly found at 2 o'clock (60%, 41/68 hips) in dysplastic hips. The prevalence of cam deformity (maximum -angle >55 degrees) was 4.2% (1/24 hips) in the control group, 22% (11/50 hips) in the pre/early group, and 50% (9/18 hips) in the advanced group. Cam deformity, inherent in the pre/early group, was found with relatively high frequency. The higher prevalence in the advanced group reflected degeneration-modified changes. When performing periacetabular osteotomy, preoperative radiographic assessments should include the femoral head-neck junction to prevent secondary femoroacetabular impingement, especially in patients with advanced stage osteoarthritis. (c) 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1613-1619, 2016.. |
| 313. |
Masanori Fujii, Yasuharu Nakashima, Yasuo Noguchi, Takuaki Yamamoto, Goro Motomura, Satoshi Hamai, Yukihide Iwamoto, Factors Associated With Severity of Intra-articular Lesions in Patients With Severe Hip Dysplasia, ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY, 10.1016/j.arthro.2016.01.060, 32, 8, 1581-1589, 2016.08, Purpose: To identify demographic and morphologic factors associated with the severity of intra-articular lesions in patients with severe hip dysplasia. Methods: One hundred twenty-one patients (134 hips) with symptomatic hip dysplasia were retrospectively reviewed. The cartilage and labral lesions were scored according to the Outerbridge and the original classification systems, respectively. The association of the cartilage and labrum scores with patient demographics (age, gender, body mass index, bilateral hip dysplasia, and treatment history for developmental hip dislocation) and morphologic factors (the lateral center-edge angle, Sharp angle, acetabular index, acetabular head index, acetabular depth ratio, Shenton line disruption, roundness index of the femoral head, and femoral neck shaft angle) were determined using a multiple linear regression analysis. Results: The cartilage and labral scores were significantly associated with radiographic osteoarthritis; however, these scores showed wide distribution among hips with equivalent degrees of radiographic osteoarthritis. Age (38.4 +/- 12.8 years) (P < .001), lateral center-edge angle (0.2 +/- 9.0 degrees) (P = .014), acetabular head index (54.4 +/- 9.1%) (P = .001), and the roundness index of the femoral head (55.6 +/- 4.6%) (P = .022) were identified as independent factors associated with the cartilage score. Age (P < .001), having a medical history of developmental hip dislocation (P = .002), acetabular index (27.8 +/- 6.8 degrees) (P = .011), and the roundness index of the femoral head (P = .022) were identified as independent factors associated with the labral score. Conclusions: Our findings suggest that the morphologic factors responsible for severe intra-articular lesions differ for cartilage degeneration and labral tears in patients with severe hip dysplasia. Decreased acetabular coverage of the femoral head was responsible for cartilage degeneration severity, whereas an increased acetabular index was responsible for labral tear severity.. |
| 314. |
Fukushi J, Tokunaga S, Nakashima Y, Motomura G, Mitoma C, Uchi H, Furue M, Iwamoto Y, Effects of dioxin-related compounds on bone mineral density in patients affected by the Yusho incident., Chemosphere, 10.1016/j.chemosphere.2015.11.091, 145, 25-33, 2016.02. |
| 315. |
Daisuke Hara, Yasuharu Nakashima, Satoshi Hamai, Hidehiko Higaki, Satoru Ikebe, Takeshi Shimoto, Kensei Yoshimoto, Yukihide Iwamoto, Dynamic hip kinematics in patients with hip osteoarthritis during weight-bearing activities, CLINICAL BIOMECHANICS, 10.1016/j.clinbiomech.2015.11.019, 32, 150-156, 2016.02, Background: There is an interest in quantifying the hip kinematics of patients with end-stage hip disorders before total hip arthroplasty. The purpose of the present study was to obtain dynamic hip kinematics under four different conditions, including deep flexion and rotation, in patients with osteoarthritis of the hip.
Methods: Continuous X-ray images were obtained in 14 patients during gait, chair-rising, squatting, and twisting, using a flat panel X-ray detector. These patients received computed tomography scan to generate virtual digitally reconstructed radiographs. The density-based digitally reconstructed radiographs were then compared with the serial X-ray images acquired using image correlations. These 3D-to-2D model-to-image registration techniques determined the 3D positions and orientations of the pelvis and femur during the movement cycle of each activity.
Findings: For gait, chair-rising, and squatting, the maximum hip flexion angles averaged 22, 64, and 68, respectively. The pelvis was tilted anteriorly by an average of around 7 during the full gait cycle. For chair-rising and squatting, the maximum absolute values of anterior/posterior pelvic tilt averaged 8717 and 6718, respectively. Hip flexion showed maximum flexion angle on the way of movement due to further anterior pelvic tilt during both chair-rising and squatting. For twisting, the maximum absolute values of internal/external hip rotation averaged 3713.
Interpretation: Patients with hip osteoarthritis prior to total hip arthroplasty demonstrated the limited ranges of coordinated motion of the pelvis, femur, and hip joint during each activity, especially in deeply flexed and rotated postures. (C) 2015 Elsevier Ltd. All rights reserved.. |
| 316. |
Daisuke Hara, Yasuharu Nakashima, Satoshi Hamai, Hidehiko Higaki, Satoru Ikebe, Takeshi Shimoto, Kensei Yoshimoto, Yukihide Iwamoto, Dynamic Hip Kinematics During the Golf Swing After Total Hip Arthroplasty, AMERICAN JOURNAL OF SPORTS MEDICINE, 10.1177/0363546516637179, 44, 7, 1801-1809, 2016.07, Background: Although most surgeons allow their patients to play golf after total hip arthroplasty (THA), the effect on the implant during the golf swing is still unclear.
Purpose: To evaluate hip kinematics during the golf swing after THA.
Study Design: Descriptive laboratory study.
Methods: Eleven hips in 9 patients who underwent primary THA were analyzed. All patients were right-handed recreational golfers, and these 11 hips included 6 right hips and 5 left hips. Periodic radiographic images of the golf swing were taken using a flat-panel x-ray detector. Movements of the hip joint and components were assessed using 3-dimensional-to-2-dimensional model-to-image registration techniques. Liner-to-neck contact and translation of the femoral head with respect to the acetabular cup (cup-head translation) were examined. Hip kinematics, orientation of components, and maximum cup-head translation were compared between patients with and without liner-to-neck contact.
Results: On average, the golf swing produced approximately 50 degrees of axial rotation in both lead and trail hips. Liner-to-neck contact was observed in 4 hips with elevated rim liners (2 lead hips and 2 trail hips) at maximum external rotation. Neither bone-to-bone nor bone-to-implant contact was observed at any phases of the golf swing in any of the hips. Four hips with liner-to-neck contact had significantly larger maximum external rotation (37.9 degrees 7.0 degrees vs 20.6 degrees 9.9 degrees, respectively; P = .01) and more cup anteversion (26.5 degrees +/- 6.1 degrees vs 10.8 degrees +/- 8.9 degrees, respectively; P = .01) than hips without liner-to-neck contact. No significant differences between hips with and without contact were found for cup inclination (42.0 degrees +/- 2.5 degrees vs 38.1 degrees +/- 5.5 degrees, respectively; P = .22), combined anteversion (45.3 degrees +/- 8.9 degrees vs 51.4 degrees +/- 7.9 degrees, respectively; P = .26), or maximum cup-head translation (1.3 +/- 0.3 mm vs 1.5 +/- 0.4 mm, respectively; P = .61).
Conclusion: In this analysis, the golf swing did not produce excessive hip rotation or cup-head translation in any hips. However, liner-to-neck contact during the golf swing was observed in 36% of the hips, with unknown effects on the long-term results.
Clinical Relevance: Golf is an admissible sport after THA because dynamic hip stability was observed. However, the implant position, especially cup anteversion and the use of elevated rim liners, promoted liner-to-neck contact.. |
| 317. |
Keisuke Komiyama, Yasuharu Nakashima, Masanobu Hirata, Daisuke Hara, Yusuke Kohno, Yukihide Iwamoto, Does High Hip Center Decrease Range of Motion in Total Hip Arthroplasty? A Computer Simulation Study, JOURNAL OF ARTHROPLASTY, 10.1016/j.arth.2016.03.014, 31, 10, 2342-2347, 2016.10, Background: High placement of a cementless acetabular cup is often required to have sufficient bone coverage in hip dysplasia. We examined whether a high hip center decreases the postoperative range of motion (ROM) in total hip arthroplasty.
Methods: Using a computer software, ROM and bone coverage were examined in 32 patients with unilateral osteoarthritis of the hip with Crowe type II or III hip dysplasia. The cup was placed at the anatomic hip center and moved vertically in 5-mm increments. Vertical center of rotation (V-COR) was defined as the distance from the head center to the interteardrop line. The required ROM was defined as flexion >= 110 degrees, internal rotation (IR) at 90 degrees flexion >= 30 degrees, extension >= 30 degrees, and external rotation >= 30 degrees. We determined the V-COR to satisfy the required ROM and cup center-edge angle (Cup-CE) >= 0 degrees.
Results: Only 40.6% of the patients satisfied Cup-CE >= 0 degrees at the anatomic hip center. Bone coverage increased with the peak at 30, 35 mm of V-COR (90.6% satisfied Cup-CE >= 0 degrees) and decreased at >= 40 mm. Higher V-COR resulted in lower range of flexion and IR, but increased the range of extension and external rotation. The cutoff value from the receiver-operating characteristic curve for both flexion and IR was a V-COR of 35 mm.
Conclusion: The higher hip center gained more bone coverage but decreased the range of hip flexion and IR. Acceptable V-COR in hip dysplasia was around 35 mm, about 20 mm above the true hip center, in terms of ROM. (C) 2016 Elsevier Inc. All rights reserved.. |
| 318. |
Kensei Yoshimoto, Yasuharu Nakashima, Takuaki Yamamoto, Jun-ichi Fukushi, Goro Motomura, Masanobu Ohishi, Satoshi Hamai, Yukihide Iwamoto, Dislocation and its recurrence after revision total hip arthroplasty, INTERNATIONAL ORTHOPAEDICS, 10.1007/s00264-015-3020-3, 40, 8, 1625-1630, 2016.08, Purpose Dislocation is a leading cause of failure after revision total hip arthroplasty (THA). This study was conducted to examine the risk factors for dislocation as well as their recurrence after revision THA.
Methods We retrospectively reviewed 178 revision THAs in 162 patients between 1998 and 2013. The mean patient age was 65.2 years at operation and the mean follow-up period was 6.7 years. Multivariate logistic regression was performed to identify risk factors for dislocation, and further comparison was made between patients with single and recurrent dislocations.
Results Sixteen hips in 15 patients (9.0 %) dislocated at a mean of 9.1 months (range, 0-83 months) after revision THA. Multivariate analysis identified advanced age (odds ratio [OR] = 2.94/10 years) and osteonecrosis of the femoral head (OR = 7.71) as the independent risk factors for any dislocations. Risk factors for recurrent dislocations, which were observed in eight hips (50 %), were later dislocations (a parts per thousand yen4 months) and lower BMI.
Conclusion Dislocation is a serious problem after revision THA with multiple risk factors. Although our findings were limited to revision THAs done through posterolateral approach, recognition of these factors is helpful in patient education and surgical planning.. |
| 319. |
Satoshi Hamai, Yasuharu Nakashima, Naohiko Mashima, Takuaki Yamamoto, Tomomi Kamada, Goro Motomura, Hiroshi Imai, Jun-ichi Fukushi, Hiromasa Miura, Yukihide Iwamoto, Comparison of 10-year clinical wear of annealed and remelted highly cross-linked polyethylene: A propensity-matched cohort study, JOURNAL OF THE MECHANICAL BEHAVIOR OF BIOMEDICAL MATERIALS, 10.1016/j.jmbbm.2015.12.022, 59, 99-107, 2016.06, No previous studies comparing the clinical wear rates of the two different kinds of cross linked ultra-high-molecular-weight polyethylene (XLPE), annealed and remelted, are available. We compared the creep and steady wear rates of 36 matched pairs (72 hips in total) adjusting for baseline characteristics with propensity score matching techniques. Zirconia femoral heads with 26-mm diameter were used in all cases. The femoral-head cup penetration was measured digitally on radiographs. Significantly greater creep (p=0.006) was detected in the remelted (0.234 mm) than annealed (0.159 mm) XLPE. However, no significant difference (p=0.19) was found between the steady wear rates (0.003 and 0.008 mm/year, respectively) of the annealed and remelted XLPE. Multiple regression analyses showed that remelted XLPE is significant independent variable (p<0.001) that is positively associated with creep. However, the patient age and body weight, cup size, the liner thickness, cup inclination, follow-up periods, and postoperative Merle d'Aubigne hip score had no significant effects (p>0.05) on the steady wear rates. No patients exhibited above the osteolysis threshold of 0.1 mm/year, progressive radiolucencies, osteolysis, or polyethylene fracture. This propensity-matched cohort study document no significant difference in wear resistant performances of annealed and remelted XLPE over an average period of 10 years. (C) 2015 Elsevier Ltd. All rights reserved.. |
| 320. |
Sachi Hasegawa, Teresa Victoria, Hülya Kayserili, Elaine Zackai, Gen Nishimura, Nobuhiko Haga, Yasuharu Nakashima, Osamu Miyazaki, Hiroshi Kitoh, Characteristic calcaneal ossification: an additional early radiographic finding in infants with fibrodysplasia ossificans progressiva., Pediatric radiology, 10.1007/s00247-016-3662-3, 46, 11, 1568-72, 2016.10, BACKGROUND: We have clinically encountered children with fibrodysplasia ossificans progressiva who had abnormal calcaneal ossification. OBJECTIVE: To evaluate whether calcaneal ossification variants are significant radiographic findings in children with fibrodysplasia ossificans progressiva. MATERIALS AND METHODS: Lateral feet radiographs in nine children who fulfilled the diagnostic criteria of fibrodysplasia ossificans progressiva were reviewed. The studies were obtained during infancy or early childhood. RESULTS: Fourteen lateral foot radiographs of fibrodysplasia ossificans progressiva were available for this study (ages at examination: 1-104 months). Four children ages 2 months to 11 months showed double calcaneal ossification centers; 7 children had plantar calcaneal spurs that decreased in size with age. Overall, eight of nine children with fibrodysplasia ossificans progressiva demonstrated double calcaneal ossifications and/or plantar calcaneal spurs in infancy or childhood. CONCLUSION: Double calcaneal ossification centers in early infancy and plantar calcaneal spurs in childhood are frequently seen in children with fibrodysplasia ossificans progressiva and may be a useful radiologic indicator for early diagnosis.. |
| 321. |
Masanobu Ohishi, Yasuharu Nakashima, Takuaki Yamamoto, Goro Motomura, Jun-ichi Fukushi, Satoshi Hamai, Yusuke Kohno, Yukihide Iwamoto, Cementless total hip arthroplasty for patients previously treated with femoral osteotomy for hip dysplasia: the incidence of periprosthetic fracture, INTERNATIONAL ORTHOPAEDICS, 10.1007/s00264-015-2992-3, 40, 8, 1601-1606, 2016.08, Purpose Femur deformities can make stem fixation difficult in total hip arthroplasty (THA). We report the clinical results of cementless THA using a press-fit stem in patients who had previously undergone femoral osteotomy for hip dysplasia.
Methods The subjects included 66 hips in 64 patients, with the mean follow-up period of 7.3 years. THA was performed at a mean period of 17.1 years after intertrochanteric femoral osteotomy. Valgus osteotomy was performed in 42 hips, and varus osteotomy in 24. Clinical results were evaluated by using the Merle d'Aubigne-Postel score. Implant survival was determined with revision as the end point, and any related complications were investigated.
Results The Merle d'Aubigne-Postel score improved from 9.4 to 16.1 at the final follow-up, without any implant loosening. However, periprosthetic femoral fractures were observed in four hips (6.0 %), one intra-operatively and three within three weeks after THA. Among these cases, three hips previously had varus osteotomy (12.5 %) and one hip had valgus osteotomy (2.3 %). Two hips were revised with full porous stems and circumferential wiring. The five and ten year cumulative survivorship rates were 97 % (range, 88.8-99.3 %) and 97 % (88.8-99.3 %), respectively.
Conclusions Although the use of a press-fit cementless stem yielded acceptable results in most of the patients, perioperative femoral fracture was a major complication especially in the patients previously treated with intertrochanteric varus osteotomy. Careful planning and implant selection could be emphasized for these cases.. |
| 322. |
Daisuke Hara, Yasuharu Nakashima, Taishi Sato, Masanobu Hirata, Masayuki Kanazawa, Yusuke Kohno, Kensei Yoshimoto, Yusuke Yoshihara, Akihiro Nakamura, Yumiko Nakao, Yukihide Iwamoto, Bone bonding strength of diamond-structured porous titanium-alloy implants manufactured using the electron beam-melting technique, MATERIALS SCIENCE & ENGINEERING C-MATERIALS FOR BIOLOGICAL APPLICATIONS, 10.1016/j.msec.2015.11.025, 59, 1047-1052, 2016.02, The present study examined the bone bonding strength of diamond-structured porous titanium-alloy (Porous-Ti-alloy) manufactured using the electron beam-melting technique-in comparison with fiber mesh-coated or rough-surfaced implants. Cylindrical implants with four different pore sizes (500, 640, 800, and 1000 mu m) of Porous-Ti-alloy, titanium fiber mesh (FM), and surfaces roughened by titanium arc spray (Ti-spray) were implanted into the distal femur of rabbits. Bone bonding strength and histological bone ingrowth were evaluated at 4 and 12 weeks after implantation. The bone bonding strength of Porous-Ti-alloy implants (640 pm pore size) increased over time from 541.4 N at 4 weeks to 704.6 N at 12 weeks and was comparable to that of FM and Ti-spray implants at both weeks. No breakage of the porous structure after mechanical testing was found with Porous-Ti-alloy implants. Histological bone ingrowth that increased with implantation time occurred along the inner structure of Porous-Ti-alloy implants. There was no difference in bone ingrowth in Porous-Ti-alloy implants with pore sizes among 500, 640, and 800 pm; however, less bone ingrowth was observed with the 1000 pm pore size. These results indicated Porous-Ti-alloy implants with pore size under 800 pm provided biologically active and mechanically stable surface for implant fixation to bone, and had potential advantages for weight beating orthopedic implants such as acetabular cups. (C) 2015 Elsevier B.V. All rights reserved.. |
| 323. |
中川 亮, 藤田 修平, 本間 大輔, 荒木 一司, 井上 竜也, 加藤 亜矢子, 稲木 公一郎, 和田 千佐, 小野 祥正, 中島 康晴, 北林 一生, ヒストンメチル化酵素EZH1/2二重阻害による骨髄腫幹細胞を標的とした新規治療, 日本癌学会総会記事, 76回, E-2040, 2017.09. |
| 324. |
Clinical usefulness of the 3D highly porous cup. |
| 325. |
Kensei Yoshimoto, Satoshi Hamai, Hidehiko Higaki, Hirotaka Gondoh, Yasuharu Nakashima, Visualization of a cam-type femoroacetabular impingement while squatting using image-matching techniques: a case report, SKELETAL RADIOLOGY, 10.1007/s00256-017-2677-7, 46, 9, 1277-1282, 2017.09, The in vivo assessment of the three-dimensional (3D) kinematics of the hip in patients with femoroacetabular impingement (FAI) under weight-bearing conditions has not been previously reported. We evaluated the pre- and postoperative hip kinematics of a 34-year-old man, with a cam-type FAI while squatting, using image-matching techniques with measurement of the rim-neck distance. Post-osteochondroplasty, the alpha-angle improved from 51.0 degrees to 35.5 degrees and the head-neck offset ratio from 0.04 to 0.23. Coxalgia during squatting disappeared, and the Harris Hip Score improved from 79 to 92 at 1 year post-surgery. Postoperative hip kinematic values (3.8 degrees of posterior pelvic tilt and 101.2 degrees of femoral flexion at 96.8 degrees of maximum hip flexion) were similar to the preoperative values (2.9 degrees of posterior pelvic tilt and 102.7 degrees of femoral flexion at 98.8A degrees of maximum hip flexion). Meanwhile, osteochondroplasty improved the minimum rim-neck distance at maximum hip flexion from 2.0 to 10.4 mm. In vivo 3D visualization of the clearance between the femoral head-neck junction and the acetabulum could assist surgeons in adequately identifying the location of impingement and confirming sufficient resection post-operatively.. |
| 326. |
Umito Kuwashima, Hideki Mizu-uchi, Ken Okazaki, Satoshi Hamai, Yukio Akasaki, Koji Murakami, Yasuharu Nakashima, Three-dimensional analysis of accuracy of patient-matched instrumentation in total knee arthroplasty: Evaluation of intraoperative techniques and postoperative alignment, JOURNAL OF ORTHOPAEDIC SCIENCE, 10.1016/j.jos.2017.08.010, 22, 6, 1077-1083, 2017.11, Background: It is questionable that the accuracies of patient-matched instrumentation (PMI) have been controversial, even though many surgeons follow manufacturers' recommendations. The purpose of this study was to evaluate the accuracy of intraoperative procedures and the postoperative alignment of the femoral side using PMI with 3-dimensional (3D) analysis.
Methods: Eighteen knees that underwent total knee arthroplasty using MRI-based PMI were assessed. Intraoperative alignment and bone resection errors of the femoral side were evaluated with a CT-based navigation system. A conventional adjustable guide was used to compare cartilage data with that derived by PMI intraoperatively. Postoperative alignment was assessed using a 3D coordinate system with a computer-assisted design software. We also measured the postoperative alignments using conventional alignment guides with the 3D evaluation.
Results: Intraoperative coronal alignment with PMI was 90.9 degrees +/- 1.6 degrees. Seventeen knees (94.4%) were within 3 degrees of the optimal alignment. Intraoperative rotational alignment of the femoral guide position of PMI was 0.2 degrees +/- 1.6 degrees compared with the adjustable guide, with 17 knees (94.4%) differing by 3 degrees or less between the two methods. Maximum differences in coronal and rotation alignment before and after bone cutting were 2.0 degrees and 2.8 degrees, respectively. Postoperative coronal and rotational alignments were 89.4 degrees +/- 1.8 degrees and -1.1 degrees +/- 1.3 degrees, respectively. In both alignments, 94.4% of cases were within 3 degrees of the optimal value. The PMI group had less outliers than conventional group in rotational alignment (p = 0.018).
Conclusions: Our 3D analysis provided evidence that PMI system resulted in reasonably satisfactory alignments both intraoperatively and postoperatively. Surgeons should be aware that certain surgical techniques including bone cutting, and the associated errors may affect postoperative alignment despite accurate PMI positioning. (C) 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.. |
| 327. |
Takeshi Utsunomiya, Goro Motomura, Satoshi Ikemura, Satoshi Hamai, Jun-ichi Fukushi, Yasuharu Nakashima, The Results of Total Hip Arthroplasty After Sugioka Transtrochanteric Anterior Rotational Osteotomy for Osteonecrosis, JOURNAL OF ARTHROPLASTY, 10.1016/j.arth.2017.04.034, 32, 9, 2768-2773, 2017.09, Background: Since Sugioka transtrochanteric anterior rotational osteotomy (ARO) for osteonecrosis of the femoral head (ONFH) changes the morphology of the proximal femur, total hip arthroplasty (THA) after previous ARO is considered a technically demanding procedure. The purpose of this study was to compare the clinicoradiologic outcomes of THA after ARO with those of THA without any antecedent surgery for ONFH.
Methods: Twenty-four hips in 20 patients who underwent cementless THA after ARO (postosteotomy group) were retrospectively reviewed and compared with patients who underwent cementless THA without any antecedent surgery for ONFH during the same period (primary group). In the postosteotomy group, the mean duration from ARO to THA was 19.7 years. All patients were followed for at least 5 years (mean, 8.3 years; follow-up rate, 78.5%). A clinical assessment was performed preoperatively and at the latest follow-up using the Harris Hip Score. A radiographic examination was performed at 3 months after THA and at the latest follow-up.
Results: The Harris Hip Score at the latest follow-up in the postosteotomy group was equivalent to that in the primary group, but longer operation time and greater intraoperative blood loss were observed in the postosteotomy group. There were no significant differences in postoperative complications, including dislocation (2 hips in each group). The leg lengthening in the postosteotomy group tended to be longer. No hips showed implant malpositioning, loosening, or required any revision surgery.
Conclusion: The clinicoradiologic outcomes of THA after ARO are considered to be comparable with those of THA without any antecedent surgery for ONFH. (C) 2017 Elsevier Inc. All rights reserved.. |
| 328. |
Yasutaka Tashiro, Tom Gale, Vani Sundaram, Kanto Nagai, James J Irrgang, William Anderst, Yasuharu Nakashima, Scott Tashman, Freddie H Fu, The Graft Bending Angle Can Affect Early Graft Healing After Anterior Cruciate Ligament Reconstruction: In Vivo Analysis With 2 Years' Follow-up., The American journal of sports medicine, 10.1177/0363546517698676, 45, 8, 1829-1836, 2017.07, BACKGROUND: A high graft bending angle (GBA) after anterior cruciate ligament (ACL) reconstruction has been suggested to cause stress on the graft. Nevertheless, evidence about its effect on graft healing in vivo is limited. HYPOTHESIS: The signal intensity on magnetic resonance imaging (MRI) would be higher in the proximal region of the ACL graft, and higher signals would be correlated to a higher GBA. STUDY DESIGN: Descriptive laboratory study. METHODS: Anatomic single-bundle ACL reconstruction was performed on 24 patients (mean age, 20 ± 4 years) using the transportal technique. A quadriceps tendon autograft with a bone plug was harvested. To evaluate graft healing, the signal/noise quotient (SNQ) was measured in 3 regions of interest (ROIs) of the proximal, midsubstance, and distal ACL graft using high-resolution MRI (0.45 × 0.45 × 0.70 mm), with decreased signals suggesting improved healing. Dynamic knee motion was examined during treadmill walking and running to assess the in vivo GBA. The GBA was calculated from the 3-dimensional angle between the graft and femoral tunnel vectors at each motion frame, based on tibiofemoral kinematics determined from dynamic stereo X-ray analysis. Graft healing and GBAs were assessed at 6 and 24 months postoperatively. Repeated-measures analysis of variance was used to compare the SNQ in the 3 ROIs at 2 time points. Pearson correlations were used to analyze the relationship between the SNQ and mean GBA during 0% to 15% of the gait cycle. RESULTS: The SNQ of the ACL graft in the proximal region was significantly higher than in the midsubstance ( P = .022) and distal regions ( P |
| 329. |
Hisakata Yamada, Akihisa Haraguchi, Koji Sakuraba, Ken Okazaki, Jun-Ichi Fukushi, Hideki Mizu-Uchi, Yukio Akasaki, Yukio Esaki, Satoshi Kamura, Kenjiro Fujimura, Masakazu Kondo, Hisaaki Miyahara, Yasuharu Nakashima, Yasunobu Yoshikai, Th1 is the predominant helper T cell subset that produces GM-CSF in the joint of rheumatoid arthritis, RMD Open, 10.1136/rmdopen-2017-000487, 3, 1, e000487, 2017.07. |
| 330. |
Norio Goto, Ken Okazaki, Yukio Akasaki, Kohei Ishihara, Koji Murakami, Kiyoshi Koyano, Yasunori Ayukawa, Noriyuki Yasunami, Tomohiro Masuzaki, Yasuharu Nakashima, Single intra-articular injection of fluvastatin-PLGA microspheres reduces cartilage degradation in rabbits with experimental osteoarthritis, JOURNAL OF ORTHOPAEDIC RESEARCH, 10.1002/jor.23562, 35, 11, 2465-2475, 2017.11, Statins are cholesterol-lowering drugs that inhibit 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, a rate-limiting enzyme of the mevalonate pathway. The anti-inflammatory effect of statins has been reported in recent years. The present study investigated therapeutic effects of the local administration of statin in osteoarthritis (OA). We assessed clinically used statins and selected fluvastatin for further experimentation, as it showed potent anabolic and anti-catabolic effects on human OA chondrocytes. To achieve controlled intra-articular administration of statin, we developed an intra-articular injectable statin using poly(lactic-co-glycolic acid) (PLGA) as a drug delivery system (DDS). The release profile of the statin was evaluated in vitro. Finally, therapeutic effects of fluvastatin-loaded PLGA microspheres (FLU-PLGA) were tested in a rabbit OA model. Rabbit knees were divided into four subgroups: group 1-A, PLGA-treated group; group 1-B, PLGA contralateral saline control group; group 2-A, FLU-PLGA-treated group; and group 2-B, FLU-PLGA contralateral saline control group. Histological analysis 5 weeks after intra-articular injection revealed that OARSI scores were lower in group 2-A. No significant differences in OARSI scores were observed between groups 1-A, 1-B, and 2-B. This study indicates that a single intra-articular injection of fluvastatin-loaded PLGA microspheres could be a novel therapeutic approach for treating patients with OA. (c) 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2465-2475, 2017.. |
| 331. |
Yuma Sakamoto, Takuaki Yamamoto, Noriko Miyake, Naomichi Matsumoto, Aritoshi Iida, Yasuharu Nakashima, Yukihide Iwamoto, Shiro Ikegawa, Screening of the COL2A1 Mutation in Idiopathic Osteonecrosis of the Femoral Head, JOURNAL OF ORTHOPAEDIC RESEARCH, 10.1002/jor.23300, 35, 4, 768-774, 2017.04, Idiopathic osteonecrosis of the femoral head (idiopathic ONFH) is an ischemic disorder resulting in necrosis of the subchondral bone of the femoral head. COL2A1 mutations, including c.3508G>A, have been reported to be involved in its etiology. However, the etiological role of COL2A1 mutations in idiopathic ONFH remains controversial, because the pathology of idiopathic ONFH is ischemic necrosis, not epiphyseal dysplasia usually seen in the diseases caused by COL2A1 mutations. The purpose of this study is to examine whether COL2A1 mutations have causal relation with idiopathic ONFH or not. We recruited 1,451 Japanese patients with idiopathic ONFH, including steroid-, alcohol-, and neither steroid nor alcohol-associated (neither-associated) ONFH. The diagnosis was based on the criteria of the Japanese Research Committee on idiopathic ONFH of the Ministry of Health, Labour and Welfare. By whole-exome sequencing, entire COL2A1 coding regions and flanking introns were analyzed in 49 neither-associated ONFH patients. In addition, the c.3508G>A mutation of COL2A1 was checked in all idiopathic ONFH patients using the invader assay. Whole-exome sequencing did not detect any COL2A1 mutations in the 49 patients. The c.3508G>A mutation was not found in any of the 1,451 patients. In conclusion, COL2A1 is unlikely to cause idiopathic ONFH. Epiphyseal dysplasia of the femoral head caused by COL2A1 mutations may radiographically mimic idiopathic ONFH. COL2A1 mutations should prompt clinical re-evaluation of the patient's phenotype. (C) 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.. |
| 332. |
Kensei Yoshimoto, Yasuharu Nakashima, Shigeo Aota, Ayumi Kaneuji, Kiyokazu Fukui, Kazuo Hirakawa, Nariaki Nakura, Koichi Kinoshita, Masatoshi Naito, Yukihide Iwamoto, Re-dislocation after revision total hip arthroplasty for recurrent dislocation: a multicentre study., International orthopaedics, 10.1007/s00264-016-3127-1, 41, 2, 253-258, 2017.02, PURPOSE: Although most case of dislocations after total hip arthroplasty (THA) can be managed with conservative treatment, recurrent dislocation may require surgical intervention. This multicentre study was conducted to evaluate the re-dislocation rate after revision THA for recurrent dislocation, and to determine the risk factors for re-dislocation. METHODS: We retrospectively reviewed the 88 hips in 88 patients who underwent revision THA for recurrent dislocation at five institutions between 1995 and 2014. The mean patient age at surgery was 68.5 years and the mean follow-up period was 53.1 months. Multivariate logistic regression was performed to identify risk factors for re-dislocation. RESULTS: Sixteen hips in 16 patients (18.2 %) re-dislocated at a mean of 25.5 months (range, 1-83 months) after revision THA. Multivariate analysis identified osteonecrosis of the femoral head (odds ratio [OR] = 5.62 vs. osteoarthritis) and a femoral head size |
| 333. |
Abdul Halim Abdullah, Mitsugu Todo, Yasuharu Nakashima, Prediction of damage formation in hip arthroplasties by finite element analysis using computed tomography images, MEDICAL ENGINEERING & PHYSICS, 10.1016/j.medengphy.2017.03.006, 44, 8-15, 2017.06, Femoral bone fracture is one of the main causes for the failure of hip arthroplasties (HA). Being subjected to abrupt and high impact forces in daily activities may lead to complex loading configuration such as bending and sideway falls. The objective of this study is to predict the risk of femoral bone fractures in total hip arthroplasty (THA) and resurfacing hip arthroplasty (RHA). A computed tomography (CT) based on finite element analysis was conducted to demonstrate damage formation in a three dimensional model of HAs. The inhomogeneous model of femoral bone was constructed from a 79 year old female patient with hip osteoarthritis complication. Two different femoral components were modeled with titanium alloy and cobalt chromium and inserted into the femoral bones to present THA and RHA models respectively. The analysis included six configurations, which exhibited various loading and boundary conditions, including axial compression, torsion, lateral bending, stance and two types of falling configurations. The applied hip loadings were normalized to body weight (BW) and accumulated from 1 BW to 3 BW. Predictions of damage formation in the femoral models were discussed as the resulting tensile failure as well as the compressive yielding and failure elements. The results indicate that loading directions can forecast the pattern and location of fractures at varying magnitudes of loading. Lateral bending configuration experienced the highest damage formation in both THA and RHA models. Femoral neck and trochanteric regions were in a common location in the RHA model in most configurations, while the predicted fracture locations in THA differed as per the Vancouver classification. (C) 2017 IPEM. Published by Elsevier Ltd. All rights reserved.. |
| 334. |
Shoji Baba, Goro Motomura, Junichi Fukushi, Satoshi Ikemura, Kazuhiko Sonoda, Yusuke Kubo, Takeshi Utsunomiya, Hiroyuki Hatanaka, Yasuharu Nakashima, Osteonecrosis of the femoral head associated with pigmented villonodular synovitis, RHEUMATOLOGY INTERNATIONAL, 10.1007/s00296-016-3624-y, 37, 5, 841-845, 2017.05, A 23-year-old Japanese woman with no history of corticosteroid intake or alcohol abuse presented with a 10-month history of left hip pain without any antecedent trauma. An anteroposterior radiograph performed 10 months after the onset of pain showed slight joint space narrowing and bone erosions surrounded by sclerotic lesions in both the acetabular roof and femoral neck. Magnetic resonance images of the left hip showed a feature of osteonecrosis of the femoral head and a mass with villus proliferation extending from the posterior intertrochanteric area to the anteromedial aspect of the femoral neck. In addition, the left quadratus femoris muscle, which is generally located just above the nutrient vessels of the femoral head, was not detected. Based on these findings, the patient was diagnosed with osteonecrosis of the femoral head caused by impairment of the nutrient vessels from invasion of the pigmented villonodular synovitis. She underwent radical synovectomy of the left hip 16 months after the onset of pain, and her hip pain improved after the surgery.. |
| 335. |
Methotrexate-Related Lymphoproliferative Disorder Presenting with Severe Swelling of the Elbow Joint: A Case Report.
Case: A patient with rheumatoid arthritis (RA) who was being treated with methotrexate (MTX) therapy presented with severe swelling of the left elbow. Magnetic resonance imaging showed a tumor-like lesion around the elbow joint. Fluorodeoxyglucose positron emission tomography indicated multiple lesions in the lung and the lymph nodes. An open biopsy of a cervical lymph node was performed, and MTX-related lymphoproliferative disorder (MTX-LPD) was diagnosed. After cessation of the MTX therapy, the elbow swelling regressed, and the patient was in remission of MTX-LPD. Conclusion: MTX-LPD should be considered in the differential diagnosis when a patient with RA develops severe joint swelling while on MTX therapy.. |
| 336. |
Naohide Takeuchi, Takao Mae, Jun-ichi Fukushi, Nobuaki Tsukamoto, Hideki Mizu-uchi, Kenta Momii, Yasuharu Nakashima, Management of Intra-Articular Calcaneal Fractures: Clinical Results of Reduction Technique Using a Bone Spreader, JOURNAL OF FOOT & ANKLE SURGERY, 10.1053/j.jfas.2017.04.026, 56, 5, 1025-1030, 2017.09, The purpose of the present study was to examine the clinical results of surgery for intra-articular calcaneal fractures using a calcaneal locking plate and a bone spreader as a reduction tool. Ten patients with intra-articular calcaneal fractures were treated. An extended lateral approach was used. The reduction of the intra-articular fragments of the posterior facet was temporarily held using a bone spreader and Kirschner wires. Internal fixation was achieved with a locking calcaneal plate. Bohler's angle and Preiss' angle were assessed on the day of injury and the day of the final follow-up examination. The step off and gap of the posterior facet were assessed on the day of injury and the first week after surgery. The functional outcome was evaluated using the American Orthopaedic Foot and Ankle Society ankle hindfoot scale score. The mean Bohler's angle ranged from 2.1 degrees 11.0 degrees to 30.4 degrees +/- 5.0 degrees (p |
| 337. |
Takeyuki Saito, Masamitsu Hara, Hiromi Kumamaru, Kazu Kobayakawa, Kazuya Yokota, Ken Kijima, Shingo Yoshizaki, Katsumi Harimaya, Yoshihiro Matsumoto, Kenichi Kawaguchi, Mitsumasa Hayashida, Yutaka Inagaki, Keiichiro Shiba, Yasuharu Nakashima, Seiji Okada, Macrophage Infiltration Is a Causative Factor for Ligamentum Flavum Hypertrophy through the Activation of Collagen Production in Fibroblasts., The American journal of pathology, 10.1016/j.ajpath.2017.08.020, 187, 12, 2831-2840, 2017.12, Ligamentum flavum (LF) hypertrophy causes lumbar spinal canal stenosis, leading to leg pain and disability in activities of daily living in elderly individuals. Although previous studies have been performed on LF hypertrophy, its pathomechanisms have not been fully elucidated. In this study, we demonstrated that infiltrating macrophages were a causative factor for LF hypertrophy. Induction of macrophages into the mouse LF by applying a microinjury resulted in LF hypertrophy along with collagen accumulation and fibroblasts proliferation at the injured site, which were very similar to the characteristics observed in the severely hypertrophied LF of human. However, we found that macrophage depletion by injecting clodronate-containing liposomes counteracted LF hypertrophy even with microinjury. For identification of fibroblasts in the LF, we used collagen type I α2 linked to green fluorescent protein transgenic mice and selectively isolated green fluorescent protein-positive fibroblasts from the microinjured LF using laser microdissection. A quantitative RT-PCR on laser microdissection samples revealed that the gene expression of collagen markedly increased in the fibroblasts at the injured site with infiltrating macrophages compared with the uninjured location. These results suggested that macrophage infiltration was crucial for LF hypertrophy by stimulating collagen production in fibroblasts, providing better understanding of the pathophysiology of LF hypertrophy.. |
| 338. |
Yusuke Kohno, Yasuharu Nakashima, Toshio Kitano, Taichi Irie, Atsushi Kita, Tomoyuki Nakamura, Hirosuke Endo, Yosuke Fujii, Takayuki Kuroda, Shigeru Mitani, Hiroshi Kitoh, Masaki Matsushita, Tadashi Hattori, Koji Iwata, Yukihide Iwamoto, Is the timing of surgery associated with avascular necrosis after unstable slipped capital femoral epiphysis? A multicenter study., JOURNAL OF ORTHOPAEDIC SCIENCE, 10.1016/j.jos.2016.08.012, 22, 1, 112-115, 2017.01, Background: An unstable slipped capital femoral epiphysis (SCFE) is associated with a high rate of avascular necrosis (AVN). The etiology of AVN seems to be multifactorial, although it is not thoroughly known. The aims of our study were to determine the rate of AVN after an unstable SCFE and to investigate the risk factors for AVN, specifically evaluating the notion of an "unsafe window", during which medical interventions would increase the risk for AVN.
Methods: This retrospective multicenter study included 60 patients with an unstable SCFE diagnosed between 1985 and 2014. Timing of surgery was evaluated for three time periods, from acute onset of symptoms to surgery: period I, 7 days. Multivariate logistic regression analysis was used to identify risk factors for AVN.
Results: Closed reduction and pinning was performed in 43 patients and in situ pinning in 17. Among these cases, 16 patients (27%) developed AVN. The rate of AVN was significantly higher in patients treated by closed reduction and pinning (15/43, 35%) than in thoe treated by in situ pinning (1/17, 5.9%) (p = 0.022). In patients treated by closed reduction and pinning, the incidence of AVN was 2/11 (18%) in period I, 10/13 (77%) in period II and 3/15 (20%) in period III, showing the significantly higher rate in period II (p = 0.002). The surgery provided in period II was identified as an independent risk factor for the development of AVN.
Conclusions: Our rate of AVN was 27% using two classical treatment methods. Time-to-surgery, between 24 h and 7 days, was independently associated with AVN, supporting the possible existence of an "unsafe window" in patients with unstable SCFE treated by closed reduction and pinning. (C) 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.. |
| 339. |
Masamitsu Hara, Kazu Kobayakawa, Yasuyuki Ohkawa, Hiromi Kumamaru, Kazuya Yokota, Takeyuki Saito, Ken Kijima, Shingo Yoshizaki, Katsumi Harimaya, Yasuharu Nakashima, Seiji Okada, Interaction of reactive astrocytes with type I collagen induces astrocytic scar formation through the integrin-N-cadherin pathway after spinal cord injury., Nature medicine, 10.1038/nm.4354, 23, 7, 818-828, 2017.07, Central nervous system (CNS) injury transforms naive astrocytes into reactive astrocytes, which eventually become scar-forming astrocytes that can impair axonal regeneration and functional recovery. This sequential phenotypic change, known as reactive astrogliosis, has long been considered unidirectional and irreversible. However, we report here that reactive astrocytes isolated from injured spinal cord reverted in retrograde to naive astrocytes when transplanted into a naive spinal cord, whereas they formed astrocytic scars when transplanted into injured spinal cord, indicating the environment-dependent plasticity of reactive astrogliosis. We also found that type I collagen was highly expressed in the spinal cord during the scar-forming phase and induced astrocytic scar formation via the integrin-N-cadherin pathway. In a mouse model of spinal cord injury, pharmacological blockade of reactive astrocyte-type I collagen interaction prevented astrocytic scar formation, thereby leading to improved axonal regrowth and better functional outcomes. Our findings reveal environmental cues regulating astrocytic fate decisions, thereby providing a potential therapeutic target for CNS injury.. |
| 340. |
Kazuhiro Shirozu, Keita Takahashi, Mitsumasa Hayashida, Katsuyuki Matsushita, Yasuharu Nakashima, Sumio Hoka, Incidental Cerebral Acute Subdural Hematoma After Transforaminal Lumbar Interbody Fusion: A Case Report., A & A case reports, 10.1213/XAA.0000000000000536, 9, 3, 94-96, 2017.08, We present a 68-year-old woman who developed acute cerebral subdural hematoma (SDH) early after transforaminal lumbar interbody fusion. Four hours postoperatively, the patient complained of headache and nausea. Enhanced cranial computed tomography showed cerebral SDH. Despite no obvious intraoperative dural damage, we suggest that cerebrospinal fluid leakage by incidental dural tear likely caused the SDH. To our knowledge, this is the first report of detected cerebral SDH immediately after spinal surgery in spite of no neurological deficits.. |
| 341. |
Yasuharu Nakashima, Hisaaki Miyahara, Masakazu Kondo, Takaaki Fukuda, Hiroshi Harada, Akihisa Haraguchi, Yasushi Inoue, Takashi Ishinishi, Masayuki Maekawa, Akira Maeyama, Munetoshi Nakashima, Eisuke Shono, Eiichi Suematsu, Takashi Shimauchi, Tomomi Tsuru, Hiroshi Tsukamoto, Shigeru Yoshizawa, Seiji Yoshizawa, Yukihide Iwamoto, Impact of methotrexate dose on efficacy of adalimumab in Japanese patients with rheumatoid arthritis: Results from registered data analyses, MODERN RHEUMATOLOGY, 10.3109/14397595.2016.1170958, 27, 1, 15-21, 2017.01, Objective: Upper limit of methotrexate (MTX) for patients with rheumatoid arthritis (RA) was recently increased from 8 to 16mg/week in Japan. We therefore examined the effect of concomitant MTX dose on the efficacy of adalimumab (ADA) in clinical practice.
Method: Sixty-one consecutive RA patients treated with ADA were followed for minimum 52 weeks and retrospectively compared by MTX dose; patients receiving concomitant MTX of 10mg/week or more (MTX >= 10mg group) and Results: The MTX >= 10mg group consistently showed better improvement in DAS28 and resulted in more patients (52.8%) with DAS28-remission compared with the MTX = 10mg had a significant effect on DAS28 remission with odds ratio of 5.12. ADA retention rate was 72.2% in MTX 10mg group compared with 52.0% in MTX Conclusions: These findings support the critical role of concomitant MTX in the efficacy of ADA, and recommend use of MTX >= 10mg in Japanese RA patients.. |
| 342. |
Suguru Fukushima, Makoto Endo, Yoshihiro Matsumoto, Jun-ichi Fukushi, Tomoya Matsunobu, Ken-ichi Kawaguchi, Nokitaka Setsu, Keiichiro Iida, Nobuhiko Yokoyama, Makoto Nakagawa, Kenichiro Yahiro, Yoshinao Oda, Yukihide Iwamoto, Yasuharu Nakashima, Hypoxia-inducible factor 1 alpha is a poor prognostic factor and potential therapeutic target in malignant peripheral nerve sheath tumor, PLOS ONE, 10.1371/journal.pone.0178064, 12, 5, e0178064, 2017.05, Background
Malignant peripheral nerve sheath tumor (MPNST) is a rare soft tissue sarcoma with poor prognosis. Hypoxia-inducible factor 1 (HIF-1) plays a crucial role in the cellular response to hypoxia and regulates the expression of multiple genes involved in tumor progression in various cancers. However, the importance of the expression of HIF-1 alpha in MPNSTs is unclear.
Methods
The expression of HIF-1 alpha was examined immunohistochemically in 82 MPNST specimens. Cell culture assays of human MPNST cells under normoxic and hypoxic conditions were used to evaluate the impact of anti-HIF-1 alpha-specific siRNA inhibition on cell survival. A screening kit was employed to identify small molecules that inhibited HIF-1 alpha.
Results
The nuclear expression of HIF-1 alpha was positive in 75.6% of MPNST samples (62/82 cases). Positivity for HIF-1a was a significant poor prognostic factor both in univariate (P = 0.048) and multivariate (P Conclusion
Inhibition of HIF-1 alpha signaling is a potential treatment option for MPNSTs.. |
| 343. |
Kazuhiko Sonoda, Goro Motomura, Satoshi Ikemura, Yusuke Kubo, Takuaki Yamamoto, Yasuharu Nakashima, Favorable Clinical and Radiographic Results of Transtrochanteric Anterior Rotational Osteotomy for Collapsed Subchondral Insufficiency Fracture of the Femoral Head in Young Adults., JB & JS open access, 10.2106/JBJS.OA.16.00013, 2, 1, e0013, 2017.03, Background: Subchondral insufficiency fracture of the femoral head (SIF) occurs infrequently in young adults. As the collapsed SIF lesion is usually located at the anterior portion of the femoral head, young adults with SIF are considered to be candidates for transtrochanteric anterior rotational osteotomy, similar to patients with osteonecrosis of the femoral head (ON). In the present study, we assessed the clinical and radiographic results of anterior rotational osteotomy for the treatment of SIF as compared with ON. Methods: We retrospectively reviewed 28 consecutive patients who underwent anterior rotational osteotomy for the treatment of unilateral SIF (7 patients) or unilateral ON (21 patients). The mean duration of follow-up was 3.7 years (range, 2.0 to 6.2 years). Clinical and radiographic assessments were performed with use of the Harris hip score (HHS), sequential radiographs, and single-photon emission computed tomography/computed tomography (SPECT/CT) with 99mTc-hydroxymethylene diphosphonate performed 5 weeks after surgery. Results: The mean HHS (and standard deviation) in the SIF group improved significantly from 51.6 ± 11.7 preoperatively to 91.9 ± 7.1 at 1 year after surgery and to 96.9 ± 3.8 at the time of the latest follow-up (p = 0.0010 and 0.0002, respectively). Similarly, the mean HHS in the ON group improved significantly from 52.4 ± 13.7 preoperatively to 80.7 ± 10.0 at 1 year after surgery and to 88.2 ± 12.6 at the time of the latest follow-up (p 80% was achieved in association with smaller femoral neck-shaft varus angles in the SIF group (10.0° ± 4.2°) as compared with the ON group (15.3° ± 8.2°). Postoperative progression of collapse at the anteriorly rotated subchondral lesion was observed in 5 patients (23.8%) in the ON group but no patients in the SIF group. SPECT/CT images showed that rate of increased tracer uptake at the collapsed lesions in the SIF group was significantly higher than that in the ON group (p |
| 344. |
Y. Kubo, G. Motomura, S. Ikemura, K. Sonoda, T. Yamamoto, Y. Nakashima, Factors influencing progressive collapse of the transposed necrotic lesion after transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head, ORTHOPAEDICS & TRAUMATOLOGY-SURGERY & RESEARCH, 10.1016/j.otsr.2016.10.019, 103, 2, 217-222, 2017.04, Background: Transtrochanteric anterior rotational osteotomy (ARO) for osteonecrosis of the femoral head (ONFH) can preserve for a long-time collapsed femoral head. Progressive collapse of anteriorly-transposed necrotic lesion leads to secondary arthritic changes and clinical failure. Critical factors influencing collapse of the transposed necrotic lesion after ARO remain largely unknown. Therefore, we performed a retrospective study of ARO to determine: (1) if preoperative collapse influences collapse of the transposed necrotic area, (2) if any other factor may influence collapse of the transposed necrotic area.
Hypothesis: We hypothesized the degree of preoperative femoral head collapse influences progressive collapse of the transposed necrotic lesion after ARO.
Materials and methods: We reviewed 47 hips in 42 patients with ONFH treated with ARO between 2000 and 2005 with a mean follow-up of 11.4 years (10-14 years). The occurrence of progressive collapse of the transposed necrotic lesion after ARO was examined using lateral radiographs taken at least once every year after ARO. The following factors were statistically analyzed: age, sex, body mass index, Harris Hip Score (HHS), preoperative level of collapse, extent of the necrotic lesion and postoperative intact ratio (ratio of the transposed intact articular surface of the femoral head).
Results: Progressive collapse of the transposed necrotic lesion (progressive collapse group) was seen in 17 hips (36%) during a mean period of 1.8 years (0.5-3.7 years) after ARO, which has developed within 4 years in all cases. Preoperative level of collapse in the progressive collapse group (4.4 +/- 1.4 mm) was significantly larger than that in the non-progressive collapse group (2.1 +/- 1.0 mm), which was independently associated with progressive collapse of the transposed necrotic lesion in multivariate analysis (P Discussion: The current study suggests that progressive collapse of the transposed necrotic lesion after ARO depends mainly on the preoperative level of collapse (cut-off point=2.98 mm) . (C) 2016 Elsevier Masson SAS. All rights reserved.. |
| 345. |
Kanji Tsuru, Ayami Yoshimoto, Masayuki Kanazawa, Yuki Sugiura, Yasuharu Nakashima, Kunio Ishikawa, Fabrication of Carbonate Apatite Block through a Dissolution-Precipitation Reaction Using Calcium Hydrogen Phosphate Dihydrate Block as a Precursor., Materials (Basel, Switzerland), 10.3390/ma10040374, 10, 4, 2017.03, Carbonate apatite (CO₃Ap) block, which is a bone replacement used to repair defects, was fabricated through a dissolution-precipitation reaction using a calcium hydrogen phosphate dihydrate (DCPD) block as a precursor. When the DCPD block was immersed in NaHCO₃ or Na₂CO₃ solution at 80 °C, DCPD converted to CO₃Ap within 3 days. β-Tricalcium phosphate was formed as an intermediate phase, and it was completely converted to CO₃Ap within 2 weeks when the DCPD block was immersed in Na₂CO₃ solution. Although the crystal structures of the DCPD and CO₃Ap blocks were different, the macroscopic structure was maintained during the compositional transformation through the dissolution-precipitation reaction. CO₃Ap block fabricated in NaHCO₃ or Na₂CO₃ solution contained 12.9 and 15.8 wt % carbonate, respectively. The diametral tensile strength of the CO₃Ap block was 2 MPa, and the porosity was approximately 57% regardless of the carbonate solution. DCPD is a useful precursor for the fabrication of CO₃Ap block.. |
| 346. |
Masayuki Kanazawa, Kanji Tsuru, Naoyuki Fukuda, Yuta Sakemi, Yasuharu Nakashima, Kunio Ishikawa, Evaluation of carbonate apatite blocks fabricated from dicalcium phosphate dihydrate blocks for reconstruction of rabbit femoral and tibial defects., Journal of materials science. Materials in medicine, 10.1007/s10856-017-5896-5, 28, 6, 85-85, 2017.06, This study aimed to evaluate in vivo behavior of a carbonate apatite (CO3Ap) block fabricated by compositional transformation via a dissolution-precipitation reaction using a calcium hydrogen phosphate dihydrate [DCPD: CaHPO4·2H2O] block as a precursor. These blocks were used to reconstruct defects in the femur and tibia of rabbits, using sintered dense hydroxyapatite (HAp) blocks as the control. Both the CO3Ap and HAp blocks showed excellent tissue response and good osteoconductivity. HAp block maintained its structure even after 24 weeks of implantation, so no bone replacement of the implant was observed throughout the post-implantation period in either femoral or tibial bone defects. In contrast, CO3Ap was resorbed with increasing time after implantation and replaced with new bone. The CO3Ap block was resorbed approximately twice as fast at the metaphysis of the proximal tibia than at the epiphysis of the distal femur. The CO3Ap block was resorbed at an approximately linear change over time, with complete resorption was estimated by extrapolation of data at approximately 1-1.5 years. Hence, the CO3Ap block fabricated in this study has potential value as an ideal artificial bone substitute because of its resorption and subsequent replacement by bone.. |
| 347. |
K. Sonoda, G. Motomura, S. Ikemura, Y. Kubo, T. Yamamoto, Y. Nakashima, Effects of intertrochanteric osteotomy plane and preoperative femoral anteversion on the postoperative morphology of the proximal femur in transtrochanteric anterior rotational osteotomy: 3D CT-based simulation study, ORTHOPAEDICS & TRAUMATOLOGY-SURGERY & RESEARCH, 10.1016/j.otsr.2017.06.012, 103, 7, 1005-1010, 2017.11, Background: Transtrochanteric anterior rotational osteotomy (ARO) is joint-preserving surgery for patients with osteonecrosis of the femoral head (ONFH). During ARO, femoral neck-shaft varus angulation by changing intertrochanteric osteotomy plane is often designed to obtain a sufficient postoperative intact ratio. However, the effect of intertrochanteric osteotomy plane on postoperative femoral anteversion has not been well examined. Therefore, we performed a simulation study of ARO to determine how intertrochanteric osteotomy plane and preoperative femoral anteversion affect both femoral neck-shaft varus angle and postoperative femoral anteversion.
Hypothesis: Both femoral neck-shaft varus angle and postoperative femoral anteversion are predicted by intertrochanteric osteotomy plane and preoperative femoral anteversion in ARO.
Materials and methods: Using CT-data obtained from 10 hips in 10 patients with ONFH, ARO was simulated. On anteroposterior view, basic intertrochanteric osteotomy line (AP-view line) was defined as the perpendicular line to the femoral neck axis. On lateral view, basic intertrochanteric osteotomy line( lateral-view line) made through the cut surface of greater trochanter was defined as the perpendicular line to the lateral axis of the femur. By changing either AP-view or lateral-view line, 49 ARO models/hip were produced, in which femoral neck-shaft varus angle and postoperative femoral anteversion were assessed.
Results: With increase in the vertically-inclined degree of AP-view line, both neck-shaft varus angle and postoperative femoral anteversion increased. With increase in the posteriorly-tilted degree of lateral-view line, neck-shaft varus angle increased, whereas postoperative femoral anteversion decreased. The approximation equations based on the multiple regression analyses were as follows: neck-shaft varus angle approximate to vertically-inclined degree of AP-view line x 0.9 + posteriorly-tilted degree of lateral-view line x 0.8 + preoperative femoral anteversion x 0.7; postoperative femoral anteversion approximate to vertically-inclined degree of AP-view line x 1.1 - posteriorly-tilted degree of lateral-view line x 0.8.
Discussion: The postoperative morphology of proximal femur was nearly defined by intertrochanteric osteotomy plane with preoperative femoral anteversion, which is useful for preoperative planning in terms of both achieving a sufficient postoperative intact ratio and maintaining femoral anteversion. (C) 2017 Elsevier Masson SAS. All rights reserved.. |
| 348. |
Naoya Kozono, Takamitsu Okada, Naohide Takeuchi, Takeshi Shimoto, Hidehiko Higaki, Yasuharu Nakashima, Effect of the Optimal Asymmetry on the Strength of Six-Strand Tendon Repair: An Ex Vivo Biomechanical Study., The Journal of hand surgery, 10.1016/j.jhsa.2017.01.015, 42, 4, 250-256, 2017.04, PURPOSE: To evaluate the mechanical properties of a 6-strand core suture repair with asymmetric purchase in the 2 tendon ends, in comparison with a repair with symmetric suture purchases. METHODS: Under cyclic loading of the tendons, we recorded the fatigue strength (Forces × Cycles) of a 6-strand flexor tendon repair with different symmetry in the lengths of suture purchase in 60 porcine tendons. The symmetric repair was made with 3 groups of parallel Kessler repairs of equal suture purchase (10 mm from the cut end) in the 2 tendon stumps. The asymmetric core suture repairs were then made with a Kessler repair of equal suture purchase (10 mm from the cut end) in the 2 tendon stumps, and shifting 2 other Kessler repairs by 1, 2, 3, 4, or 5 mm, respectively, along the longitudinal axis of the tendon in relation to the first (symmetric) Kessler repair. RESULTS: The core repairs with 2 mm or more asymmetry in suture purchases in 2 tendon ends showed significantly greater fatigue strength compared with those with symmetric suture placement. The core repairs with 3 mm or more asymmetry in suture purchases in 2 tendon ends showed significantly smaller gaps compared with those with symmetric suture placement. CONCLUSIONS: The core repairs with 3 mm or more asymmetry in suture purchases in 2 tendon ends generated increased fatigue strength and reduced gap sizes compared with those with symmetric suture placement in an ex vivo porcine model. CLINICAL RELEVANCE: An asymmetric core suture repair with 3 mm or more difference in purchase length may allow for earlier rehabilitation and reduce the risk of postoperative complications.. |
| 349. |
Yusuke Kubo, Goro Motomura, Satoshi Ikemura, Kazuhiko Sonoda, Takuaki Yamamoto, Yasuharu Nakashima, Effect of collapse on the deformity of the femoral head-neck junction in osteonecrosis of the femoral head, ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY, 10.1007/s00402-017-2720-0, 137, 7, 933-938, 2017.07, Introduction The purpose of this study was to morphologically assess the effect of collapse on the deformity of the femoral head-neck junction in patients with nontraumatic osteonecrosis of the femoral head (ONFH).
Materials and methods From January 2005 through March 2016, magnetic resonance (MR) imaging including the oblique view was repeatedly performed before and after collapse in 24 hips of patients with ONFH (16 men, 8 women; mean age 43 years; range 23-68 years), that were the subjects of this study. The interval of MR imaging before and after collapse was 8.0 months (range 1-32 months). In addition, 82 asymptomatic hips in patients without ONFH as identified by MR imaging taken at the same duration were used as controls. The oblique MR image was used to measure the radiological parameters of the femoral head-neck junction, including the alpha-angle and head-neck offset ratio (HNOR).
Results The alpha-angle and HNOR after collapse (58.3 degrees +/- 10.0 degrees and 0.138 +/- 0.033, respectively) indicated significantly decreased anterior femoral head-neck offset compared with those before collapse (46.2 degrees +/- 5.7 degrees and 0.178 +/- 0.018, respectively; p Conclusions This study demonstrated that the decreased femoral head-neck offset observed in patients with ONFH was a consequence of collapse.. |
| 350. |
Taro Mawatari, Koichiro Kawano, Shinkichi Arisumi, Muneyuki Takahashi, Satoshi Ikemura, Satoshi Hamai, Gen Matsui, Takahiro Iguchi, Hiroaki Mitsuyasu, Shinya Kawahara, Yasuharu Nakashima, Effect of Bisphosphonate and Teriparatide on Vertebral Bone Microarchitecture and Strength in Vivo Assessed by Clinical Computed Tomography., JOURNAL OF BONE AND MINERAL RESEARCH, 32, S162-S163, 2017.12. |
| 351. |
Daisuke Hara, Satoshi Hamai, Jun-ichi Fukushi, Ken-ichi Kawaguchi, Goro Motomura, Satoshi Ikemura, Keisuke Komiyama, Yasuharu Nakashima, Does Participation in Sports Affect Osteoarthritic Progression After Periacetabular Osteotomy?, AMERICAN JOURNAL OF SPORTS MEDICINE, 10.1177/0363546517707942, 45, 11, 2468-2475, 2017.09, Background: Periacetabular osteotomy (PAO) is an effective treatment for symptomatic acetabular dysplasia. However, whether postoperative participation in sports leads to progression of the Kellgren-Lawrence (KL) grade of osteoarthritis (OA) in these patients is unclear.
Purpose: To investigate (1) participation in sports before and after PAO and (2) whether postoperative participation in sports leads to progression of the KL grade.
Study Design: Case-control study; Level of evidence, 3.
Methods: The authors retrospectively reviewed data on 161 patients (183 hips) who underwent PAO for symptomatic acetabular dysplasia with preoperative KL grade 1 or 2 between 1998 and 2011. The mean age at the time of surgery was 42.0 +/- 10.9 years (range, 12-64 years), and the mean follow-up duration was 100 months (range, 13-180 months). Data included participation in sports, the University of California, Los Angeles (UCLA) activity scale score, age at the time of surgery, body mass index, follow-up duration, history of treatment for developmental hip dislocations, Merle d'Aubigne-Postel score, Oxford Hip Score, center-edge angle, and KL grade. Univariate and multivariate analyses were applied to determine which factors were associated with progression to KL grade 3 or 4 after PAO.
Results: The number of patients who participated in sports significantly increased from 50 (31.1%) preoperatively to 89 (55.3%) postoperatively. The mean UCLA score significantly increased from 4.7 +/- 2.1 preoperatively to 5.5 +/- 2.0 postoperatively. The KL grade progressed to grade 3 or 4 in 16 hips, including 4 hips that underwent conversion to total hip arthroplasty. No significant differences were found in postoperative participation in sports (89 hips [53.3%] vs 11 hips [68.8%], respectively; P = .24) and the UCLA score (5.6 +/- 2.0 vs 5.1 +/- 2.0, respectively; P = .30) between hips with KL grade 1 or 2 and KL grade 3 or 4. A multivariate analysis revealed that no factors, including postoperative participation in sports, were significantly associated with progression to KL grade 3 or 4.
Conclusion: Postoperative participation in sports after PAO did not significantly and negatively influence progression of the KL grade at midterm follow-up.. |
| 352. |
Kazuhiko Sonoda, Goro Motomura, Satoshi Kawanami, Yukihisa Takayama, Hiroshi Honda, Takuaki Yamamoto, Yasuharu Nakashima, Degeneration of articular cartilage in osteonecrosis of the femoral head begins at the necrotic region after collapse: a preliminary study using T1 rho MRI, SKELETAL RADIOLOGY, 10.1007/s00256-017-2567-z, 46, 4, 463-467, 2017.04, The purpose of this study is to evaluate the role of collapse on the degeneration of articular cartilage in patients with osteonecrosis of the femoral head (ONFH).
Sixteen hips in 12 patients (four men, eight women; mean age, 34.8 years) with a history of systemic corticosteroid treatment were studied using T1 rho magnetic resonance imaging (MRI). Six hips had collapsed ONFH, five had non-collapsed ONFH, and five had no osteonecrosis (controls). Using oblique coronal images, we divided the articular surface of necrotic femoral heads into a region just above the necrotic bone (necrotic zone) and another above the living bone (living zone). T1 rho value was evaluated for each zone.
The mean T1 rho value in the necrotic zone was significantly higher in the collapsed ONFH group (48.4 +/- 2.7 ms) than in the non-collapsed ONFH group (41.0 +/- 0.9 ms). In the collapsed ONFH group, the mean T1 rho value was significantly higher in the necrotic zone (48.4 +/- 2.7 ms) than in the living zone (43.5 +/- 2.5 ms). In the non-collapsed ONFH group, there was no significant difference between the mean T1 rho values of the necrotic and living zones. In the collapsed ONFH group, the mean T1 rho value of the necrotic zone and the interval from pain onset to the MRI examination were positively correlated.
The current T1 rho MRI study suggested that the degeneration of articular cartilage in ONFH begins at the necrotic region after collapse.. |
| 353. |
Masanori Fujii, Tetsuro Nakamura, Toshihiko Hara, Yasuharu Nakashima, Can the hip joint center be estimated from pelvic dimensions in dysplastic hips?, JOURNAL OF ORTHOPAEDIC SCIENCE, 10.1016/j.jos.2017.08.013, 22, 6, 1089-1095, 2017.11, Background: We aimed to determine correlations between the hip joint center position and pelvic dimensions and whether the three-dimensional position of the original hip joint center could be estimated from pelvic landmarks in dysplastic and normal hips.
Methods: We reviewed the pelvic CT scans of 70 patients (70 hips) with hip dysplasia. Seventy-seven normal hips were used as controls. The hip joint center coordinates (Cx, Cy, and Cz) and pelvic dimensions were measured with reference to the anterior pelvic plane coordinate system. Multiple regression formulas were used to estimate the original hip joint center.
Results: The hip center for both dysplastic and normal hip was highly correlated with the distance between the anterior superior iliac spine (ASIS) in the coronal plane (r = 0.76 and 0.84), the distance from the ASIS to the pubic tubercle in the sagittal plane (r = 0.81 and 0.76), and distance from the pubic tubercle to the most posterior point of the ischium on the transverse plane (r = 0.76 and 0.78). The hip joint center could be estimated within a 5-mm error for more than 80% of hips on their respective axes in both dysplastic and normal hips.
Conclusions: The three-dimensional position of the original hip joint center was correlated with pelvic dimensions, and can be estimated with substantial accuracy using pelvic landmarks as references. Although these results are preliminary, this estimation method may be useful for surgeons planning total hip arthroplasties. (C) 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.. |
| 354. |
Yasutaka Tashiro, Ken Okazaki, Koji Murakami, Hirokazu Matsubara, Kanji Osaki, Yukihide Iwamoto, Yasuharu Nakashima, Anterolateral rotatory instability in vivo correlates tunnel position after anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft, World Journal of Orthopaedics, 10.5312/wjo.v8.i12.913, 8, 12, 913-921, 2017.12, AIM To quantitatively assess rotatory and anterior-posterior instability in vivo after anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BTB) autografts, and to clarify the influence of tunnel positions on the knee stability. METHODS Single-bundle ACL reconstruction with BTB autograft was performed on 50 patients with a mean age of 28 years using the trans-tibial (TT) (n = 20) and trans-portal (TP) (n = 30) techniques. Femoral and tibial tunnel positions were identified from the high-resolution 3D-CT bone models two weeks after surgery. Anterolateral rotatory translation was examined using a Slocum anterolateral rotatory instability test in open magnetic resonance imaging (MRI) 1.0-1.5 years after surgery, by measuring anterior tibial translation at the medial and lateral compartments on its sagittal images. Anterior-posterior stability was evaluated with a Kneelax3 arthrometer. RESULTS A total of 40 patients (80%) were finally followed up. Femoral tunnel positions were shallower (P <
0.01) and higher (P <
0.001), and tibial tunnel positions were more posterior (P <
0.05) in the TT group compared with the TP group. Anterolateral rotatory translations in reconstructed knees were significantly correlated with the shallow femoral tunnel positions (R = 0.42, P <
0.01), and the rotatory translations were greater in the TT group (3.2 ± 1.6 mm) than in the TP group (2.0 ± 1.8 mm) (P <
0.05). Side-to-side differences of Kneelax3 arthrometer were 1.5 ± 1.3 mm in the TT, and 1.7 ± 1.6 mm in the TP group (N.S.). Lysholm scores, KOOS subscales and reinjury rate showed no difference between the two groups. CONCLUSION Anterolateral rotatory instability significantly correlated shallow femoral tunnel positions after ACL reconstruction using BTB autografts. Clinical outcomes, rotatory and anterior-posterior stability were overall satisfactory in both techniques, but the TT technique located femoral tunnels in shallower and higher positions, and tibial tunnels in more posterior positions than the TP technique, thus increased the anterolateral rotation. Anatomic ACL reconstruction with BTB autografts may restore knee function and stability.. |
| 355. |
Hamai Satoshi, 吉本 憲生, 福士 純一, 本村 悟朗, 池村 聡, 藤井 政徳, 中島 康晴, 画像マッチング法を用いたスクワット中のcam型およびpincer型大腿骨寛骨臼インピンジメントの可視化 2症例の予備的評価(Visualization of cam- and pincer-type femoroacetabular impingement during squat using image-matching techniques: A preliminary evaluation of two cases), 日本整形外科スポーツ医学会雑誌, 38, 4, 483-483, 2018.08. |
| 356. |
Symposium7-2. |
| 357. |
岡田 貴充, 花田 麻須大, 中島 康晴, ヒストン脱アセチル化酵素阻害剤Suberoylanilide Hidroxamic Acidは骨肉腫細胞株において、二つのプログラム細胞死を選択的に誘導する(The Selective Induction of Programed Cell Death in Osteosarcoma Cells by Histone Deacetylase Inhibitor Suberoylanylide Hydroxamic Acid), 福岡医学雑誌, 109, 4, 79-90, 2018.12, 骨肉腫の治療成績は近年飛躍的に改善されたが、再発・転移例の予後は依然として不良である。再発・転移例は制癌剤や放射線療法に抵抗性を持つことが多く、この問題の克服が骨肉腫の予後向上に重要である。骨肉腫の薬剤耐性には多剤耐性因子であるP-glycoprotein(P-gp)やMRP1の関与が示唆されており、一方放射線耐性機序としてはapoptosis抵抗性の獲得が挙げられる。我々は以前P-gp、MRP1を発現する多剤耐性骨肉腫細胞株MNNG/ADRを樹立したが、この細胞はP-gp、MRP1による制癌剤耐性だけでなく、apoptosis抵抗性により放射線耐性を有しており再発・転移例の良いモデルと考えられた。ヒストン脱アセチル化酵素阻害剤(HDACI)のsuberoylanilide hydroxamic acid(SAHA)は新規抗腫瘍薬として注目されている。薬剤感受性のある骨肉腫細胞株MNNGではSAHAはcleaved-PARPの発現を上昇させ、細胞周期のsub-G1分画を上昇させアポトーシスを誘導して抗腫瘍効果を発揮する。アポトーシス抵抗性を持つ多剤耐性骨肉腫細胞株MNNG/ADRに対してはLC3-IとLC3-IIの発現を誘導し電子顕微鏡でautophagosomeの形成を促進しており、programed cell death type2に分類されるオートファジー細胞死を誘導して抗腫瘍効果を発揮していることが分かった。この事実はSAHAは腫瘍細胞の持つ細胞死に対する抵抗性によって、誘導する細胞死のタイプを選択できる可能性を示唆している。現在の化学療法や放射線療法による抗腫瘍治療は、腫瘍細胞に主としてapoptosisによる細胞死を誘導する。これらの治療に耐性を示す腫瘍細胞は、多剤耐性因子の発現やapoptosis抵抗性を獲得している可能性が考えられる。アポトーシスと異なる細胞死である「オートファジー細胞死」をも誘導するSAHAは、これらの治療抵抗性の腫瘍に対する効果が期待できる。(著者抄録). |
| 358. |
Kimitaka Nakamura, Masanobu Ohishi, Tomoya Matsunobu, Yasuharu Nakashima, Akio Sakamoto, Akira Maekawa, Yoshinao Oda, Yukihide Iwamoto, Tumor-induced osteomalacia caused by a massive phosphaturic mesenchymal tumor of the acetabulum: A case report., Modern rheumatology, 10.3109/14397595.2016.1173322, 28, 5, 906-910, 2018.09, We report a case of tumor-induced osteomalacia (TIO) caused by a massive phosphaturic mesenchymal tumor (PMT) of the acetabulum. A 68-year-old woman presented with progressive bone pain of the rib cage, and polyarthralgia and back pain for 3 years. She was diagnosed with hypophosphatemic osteomalacia because laboratory testing was remarkable for low serum phosphorus and a low level of 1,25(OH)2 vitamin D. Three years later, her hip radiograph revealed an osteolytic lesion of the acetabulum. Magnetic resonance imaging of the acetabulum showed a massive lesion. Laboratory data showed hypophosphatemia and an elevated serum level of fibroblast growth factor 23 (FGF-23). Samples obtained with open biopsy showed a low-grade spindle cell neoplasm with FGF-23 positivity, identified by using immunohistochemical staining, confirming the diagnosis of a PMT mixed connective tissue variant. Curettage of the tumor was performed, and the defects were filled with bone allografts. The hip joint was reconstructed with total hip arthroplasty using a Muller support ring. To our knowledge, this report represents the first documented case of massive PMT of the acetabulum causing TIO.. |
| 359. |
Keiichiro Iida, Yoshihiro Matsumoto, Nokitaka Setsu, Katsumi Harimaya, Kenichi Kawaguchi, Mitsumasa Hayashida, Seiji Okada, Yasuharu Nakashima, The neurological outcome of radiotherapy versus surgery in patients with metastatic spinal cord compression presenting with myelopathy, Archives of Orthopaedic and Trauma Surgery, 10.1007/s00402-017-2817-5, 138, 1, 7-12, 2018.01, © 2017, The Author(s). Purpose: While radiotherapy is generally an acceptable treatment for metastatic spinal cord compression, surgical intervention is controversial due to the invasiveness and diversity of diseases in the patients being considered. The ideal treatment, therefore, depends on the situation, and the most acute treatment possible is necessary in patients presenting with myelopathy. We compared the neurological outcomes between radiotherapy and surgery in patients with metastatic spinal cord compression presenting with myelopathy. Methods: A total 54 patients with metastatic spinal cord compression presenting with myelopathy treated in our institution between 2006 and 2016 were analyzed retrospectively. Twenty patients were selected by radiotherapy alone (radiation group), and 36 patients were selected by decompression and stabilization surgery with or without radiotherapy (surgery group). The neurological outcomes and complications were compared between the two treatment groups. Results: Seven patients initially in the radiation group underwent surgery because of a substantial decline in their motor strength during radiotherapy. One of the remaining 13 patients (8%) in the radiation group and 30 of the 34 patients (88%) in the surgery group showed improvement in their neurological symptoms (P |
| 360. |
Yusuke Kubo, Goro Motomura, Satoshi Ikemura, Kazuhiko Sonoda, Hiroyuki Hatanaka, Takeshi Utsunomiya, Shoji Baba, Yasuharu Nakashima, The effect of the anterior boundary of necrotic lesion on the occurrence of collapse in osteonecrosis of the femoral head, International Orthopaedics, 10.1007/s00264-018-3836-8, 42, 7, 1449-1455, 2018.07, Purpose: The location of the necrotic lesion is one of the important factors for collapse in osteonecrosis of the femoral head (ONFH). The significance of anterior localization has been little studied. This study evaluated the effects of anterior boundary of a necrotic lesion on collapse. Methods: We reviewed the outcomes of 113 consecutive non-collapsed asymptomatic hips in 98 ONFH patients with mean follow-up of 4.7 years (2.0–11.8) after the initial magnetic resonance (MR) imaging. The presence or absence of collapse was investigated using follow-up radiographs. The location of the anterior boundary of a necrotic lesion was assessed using the anterior necrotic angle between the midline of the femoral neck shaft and the line passing from the femoral head centre to the anterior boundary on mid-oblique MR imaging. Multivariate analysis was performed to identify risk factors for collapse, and further analyses were executed according to the lateral boundary of the necrotic lesion. Results: During the follow-up period, collapse was confirmed in 61 hips (54.0%). Multivariate analysis revealed that the anterior necrotic angle was independently associated with collapse as well as the lateral boundary of the necrotic lesion. When the lateral boundary was located at the middle third of weight-bearing portion (32 hips), that was generally categorized as a low risk of collapse, all five cases with anterior necrotic angle ≥ 79° developed collapse, whereas only one of 27 cases (3.7%) with an anterior necrotic angle <
79° developed collapse (p <
0.0001). Conclusions: This study indicates that ONFH patients with anterior localization of a necrotic lesion can develop collapse even if the necrotic lesion is medially located.. |
| 361. |
Naoyuki Fukuda, Masayuki Kanazawa, Kanji Tsuru, Akira Tsuchiya, Sunarso, Riki Toita, Yoshihide Mori, Yasuharu Nakashima, Kunio Ishikawa, Synergistic effect of surface phosphorylation and micro-roughness on enhanced osseointegration ability of poly(ether ether ketone) in the rabbit tibia., Scientific reports, 10.1038/s41598-018-35313-7, 8, 1, 16887-16887, 2018.11, This study was aimed to investigate the osseointegration ability of poly(ether ether ketone) (PEEK) implants with modified surface roughness and/or surface chemistry. The roughened surface was prepared by a sandblast method, and the phosphate groups on the substrates were modified by a two-step chemical reaction. The in vitro osteogenic activity of rat mesenchymal stem cells (MSCs) on the developed substrates was assessed by measuring cell proliferation, alkaline phosphatase activity, osteocalcin expression, and bone-like nodule formation. Surface roughening alone did not improve MSC responses. However, phosphorylation of smooth substrates increased cell responses, which were further elevated in combination with surface roughening. Moreover, in a rabbit tibia implantation model, this combined surface modification significantly enhanced the bone-to-implant contact ratio and corresponding bone-to-implant bonding strength at 4 and 8 weeks post-implantation, whereas modification of surface roughness or surface chemistry alone did not. This study demonstrates that combination of surface roughness and chemical modification on PEEK significantly promotes cell responses and osseointegration ability in a synergistic manner both in vitro and in vivo. Therefore, this is a simple and promising technique for improving the poor osseointegration ability of PEEK-based orthopedic/dental implants.. |
| 362. |
Daisuke Hara, Satoshi Hamai, Keisuke Komiyama, Goro Motomura, Kyohei Shiomoto, Yasuharu Nakashima, Sports Participation in Patients After Total Hip Arthroplasty vs Periacetabular Osteotomy: A Propensity Score-Matched Asian Cohort Study., The Journal of arthroplasty, 10.1016/j.arth.2017.08.035, 33, 2, 423-430, 2018.02, BACKGROUND: No studies have compared sports participation between total hip arthroplasty (THA) and periacetabular osteotomy (PAO) in matched Asian cohorts. We investigated sports participation and activity levels in Asian THA cohort, and compared them between THA and PAO cohorts. METHODS: Multivariate analyses were applied to determine which factors were associated with postoperative sports participation and University of California-Los Angeles (UCLA) activity score in (1) 524 THA patients and (2) 487 acetabular dysplasia patients (295 THA patients and 192 PAO patients). In addition, postoperative sports participation and UCLA score were compared between 62 THA and 62 PAO patients after adjusting for baseline characteristics with propensity score matching. RESULTS: Sports participation and UCLA score significantly increased after THA (P |
| 363. |
Kazuyuki Karasuyama, Goro Motomura, Satoshi Ikemura, Jun-ichi Fukushi, Satoshi Hamai, Kazuhiko Sonoda, Yusuke Kubo, Takuaki Yamamoto, Yasuharu Nakashima, Risk factor analysis for postoperative complications requiring revision surgery after transtrochanteric rotational osteotomy for osteonecrosis of the femoral head, Journal of Orthopaedic Surgery and Research, 10.1186/s13018-018-0714-4, 13, 1, 6-6, 2018.01, Background: This study investigated the risk factors for postoperative complications requiring revision surgery within 3 years after transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head (ONFH). Methods: We reviewed 127 patients (147 hips) who underwent TRO (anterior or posterior rotational osteotomy) for ONFH between January 2002 and December 2014. Two patients were lost to follow-up, and five patients with progression of femoral head collapse requiring a salvage procedure such as total hip arthroplasty within 3 years after TRO were excluded. The better hip in patients treated bilaterally was also excluded (n = 20) to avoid duplication of patient demographics, leaving 120 hips (120 patients) for the analysis. We reviewed the medical records of each patient to screen for postoperative complications that required revision surgery within 3 years after surgery, recording the patient's age, sex, body mass index, surgical side, condition of the contralateral hip, previous alcohol intake, previous alcohol abuse, previous corticosteroid use, perioperative corticosteroid use, smoking status, preoperative stage and type of ONFH, preoperative activity level, and preoperative and final follow-up Japanese Orthopaedic Association scores. Differences between cases with and without complications were analyzed. Results: Eleven (9.2%) cases showed postoperative complications that required revision surgery. The most common complication was deep infection (n = 5), followed by nonunion of the greater trochanter (n = 3), nonunion of the intertrochanteric osteotomy site (n = 2), and femoral head fracture (n = 1). The multivariate analysis showed an independent association between previous alcohol abuse and postoperative complications (odds ratio, 13.5). Conclusion: A correlation might exist between alcohol abuse and complications following a TRO procedure.. |
| 364. |
Koji Murakami, Satoshi Hamai, Ken Okazaki, Satoru Ikebe, Hidehiko Higaki, Takeshi Shimoto, Yasuharu Nakashima, Preoperative tibial mechanical axis orientation and articular surface design influence on the coronal joint line orientation relative to the ground during gait after total knee arthroplasties., Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 10.1007/s00167-018-4899-1, 26, 11, 3368-3376, 2018.11, PURPOSE: Neutral lower limb alignment does not necessarily produce a horizontal joint line after total knee arthroplasty (TKA). The orientation of the pre- and postoperative tibial mechanical axes (TMAs-G), tibial component, and joint line relative to the ground were evaluated. METHODS: The study group included 46 knees, 23 posterior-stabilized (PS) and 23 bicruciate-stabilized (BCS) TKAs. Using whole-leg standing radiographs, the static orientation of the pre- and postoperative TMAs-G and the tibial component as well as the postoperative alignment were measured. Applying image-matching techniques, the dynamic coronal orientation of the tibial component and joint line over the stance phase of gait were analysed. The correlation between static and dynamic orientation of the tibial component and differences in the joint line between the PS and BCS TKAs were evaluated. RESULTS: In standing, the postoperative TMA-G (0.8° ± 2.8°) and tibial component (1.5° ± 2.4°) were laterally tilted with a strong correlation. The preoperative lateral tilt of the TMA-G (7.9° ± 5.1°) was a significant predictor of the postoperative TMA-G. The lateral tilt of the tibial component increased to 5.1° ± 2.4° on dynamic analysis, and was moderately correlated to static orientation. The dynamic orientation of the joint line was smaller for the BCS (1.8° ± 2.4°) compared to the PS (5.5° ± 2.7°) TKA. CONCLUSION: Even with a mechanically well-aligned TKA, a lateral tilt of the tibial component was identified due to the lateral tilt of the postoperative TMA-G and the stance phase of gait. The BCS can better accommodate the residual lateral tilt of the joint line due to the 3° medial inclination of the joint surfaces of the implant. This study increases the awareness of surgeons regarding the possibility of the coronal joint line orientation to influence preoperative TMA-G and be accommodated by articular surface design, even in mechanically aligned TKA. LEVEL OF EVIDENCE: IV.. |
| 365. |
Masamitsu Hara, Kazuya Yokota, Takeyuki Saito, Kazu Kobayakawa, Ken Kijima, Shingo Yoshizaki, Ken Okazaki, Shigeo Yoshida, Yoshihiro Matsumoto, Katsumi Harimaya, Yasuharu Nakashima, Seiji Okada, Periostin Promotes Fibroblast Migration and Inhibits Muscle Repair After Skeletal Muscle Injury, The Journal of bone and joint surgery. American volume, 10.2106/JBJS.17.01230, 100, 16, e108, 2018.08, BACKGROUND: Skeletal muscle injury (SMI) can cause physical disability due to insufficient recovery of the muscle. The development of muscle fibrosis after SMI has been widely regarded as a principal cause of this failure to recover. Periostin (Postn) exacerbates tissue fibrosis in various organs. We investigated whether Postn is involved in the pathophysiology after SMI. METHODS: Partial laceration injuries of the gastrocnemius were created in wild-type (WT) and Postn knockout (Postn) mice. We examined the expression of the Postn gene before and after SMI. Regeneration and fibrosis of skeletal muscle were evaluated by histological analyses, and recovery of muscle strength was measured by physiological testing. Immunohistochemistry was used to examine the number and proliferative potential of infiltrating fibroblasts in injured muscle. A trans-well migration assay was used to assess the migration capability of fibroblasts. Control immunoglobulin G (IgG) or Postn-neutralizing antibody (Postn-nAb) was injected into injured muscle at 7 and 14 days after injury (dpi). We evaluated the effects of Postn-nAb on muscle repair after SMI. RESULTS: The expression of Postn was dramatically upregulated after SMI. Compared with WT mice, Postn mice had improved muscle recovery and attenuated fibrosis as well as a significantly reduced number of infiltrating fibroblasts. The proliferative potential of these fibroblasts in WT and Postn mice was comparable at 14 dpi; however, the migration capability of fibroblasts was significantly enhanced in the presence of Postn (mean, 258%; 95% confidence interval, 183% to 334%). Moreover, the administration of Postn-nAb inhibited fibroblast infiltration and promoted muscle repair after SMI. CONCLUSIONS: Postn exacerbates fibrotic scar formation through the promotion of fibroblast migration into injured muscle after SMI. Treatment with Postn-nAb is effective for attenuating fibrosis and improving muscle recovery after SMI. CLINICAL RELEVANCE: Our findings may provide a potential therapeutic strategy to enhance muscle repair and functional recovery after SMI.. |
| 366. |
Yusuke Kubo, Goro Motomura, Satoshi Ikemura, Hiroyuki Hatanaka, Jun-Ichi Fukushi, Satoshi Hamai, Takuaki Yamamoto, Yasuharu Nakashima, Osteoclast-related markers in the hip joint fluid with subchondral insufficiency fracture of the femoral head., Journal of orthopaedic research : official publication of the Orthopaedic Research Society, 10.1002/jor.24066, 36, 11, 2987-2995, 2018.11, Similar to the radiological findings in rapidly destructive arthrosis of the hip joint (RDA), subchondral insufficiency fracture of the femoral head (SIF) can result in progressive femoral head collapse of unknown etiology. We thus examined the osteoclast activity of hip joint fluid in SIF with progressive collapse in comparison with that in RDA. Twenty-nine hip joint fluid samples were obtained intraoperatively with whole femoral heads from 12 SIF patients and 17 RDA patients. SIF cases were classified into subgroups based on the presence of ≥2 mm collapse on preoperative radiographs: SIF with progressive collapse (n = 5) and SIF without progressive collapse (n = 7). The levels of tartrate-resistant acid phosphatase (TRACP)-5b, interleukin-8, vascular endothelial growth factor (VEGF), and matrix metalloproteinase (MMP)-9 were measured. The number of multinuclear giant cells at the subchondral region was histopathologically assessed using mid-coronal slice of each femoral head specimen. The median levels of all markers and the median number of multinuclear giant cells in SIF with progressive collapse were significantly higher than those in SIF without progressive collapse, while there were no significant differences in SIF with progressive collapse versus RDA. Regression analysis showed that the number of multinuclear giant cells was positively correlated with the level of TRACP-5b in joint fluid. The present study demonstrated the possible association of increased osteoclast activity with the existing condition of progressive collapse in SIF, which was quite similar to the findings in RDA, indicating that increased osteoclast activity may reflect the condition of progressive collapse in SIF as well as RDA. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2987-2995, 2018.. |
| 367. |
Satoshi Hamai, Yusuke Kohno, Daisuke Hara, Kyohei Shiomoto, Mio Akiyama, Jun-Ichi Fukushi, Goro Motomura, Satoshi Ikemura, Masanori Fujii, Yasuharu Nakashima, Minimum 10-Year Clinical Outcomes After Periacetabular Osteotomy for Advanced Osteoarthritis Due to Hip Dysplasia., Orthopedics, 10.3928/01477447-20180806-04, 41, 5, 300-305, 2018.09, The purpose of this study was to examine the minimum 10-year clinical outcomes, including patient-reported and functional outcomes, of periacetabular osteotomy in patients with advanced osteoarthritis. A total of 46 hips in 44 patients with advanced osteoarthritis who underwent periacetabular osteotomy between 1992 and 2006 were retrospectively reviewed. Mean age at surgery was 47.5 years, and mean follow-up was 16.9±4.7 years. Survivorship was determined using the Kaplan-Meier method, and the associated risk factors for the endpoint-conversion to total hip arthroplasty less than 15 years after surgery-were evaluated. The Oxford Hip Score and the University of California, Los Angeles activity score were evaluated at final follow-up. The survival rates at 15 and 20 years after surgery were 80% and 59%, respectively. Multivariate analysis indicated that body mass index greater than 24 kg/m2 (P=.034; odds ratio, 1.72) was significantly associated with the endpoint as an independent risk factor. For 32 hips of 31 patients with preserved native joints at final follow-up, the Oxford Hip Score and the University of California, Los Angeles score averaged 41±5 and 5.2±1.8, respectively, equivalent (P=.28 and P=.215, respectively) to the scores of 14 hips of 13 patients with conversion to total hip arthroplasty (38±8.7 and 5.8±1.4, respectively). The results of this mid-term study may be useful for surgical decision-making among patients with advanced osteoarthritis who want to preserve native hip joints. [Orthopedics. 2018; 41(5):300-305.].. |
| 368. |
Koji Murakami, Satoshi Hamai, Ken Okazaki, Hirotaka Gondo, Yifeng Wang, Satoru Ikebe, Hidehiko Higaki, Takeshi Shimoto, Hideki Mizu-Uchi, Yukio Akasaki, Yasuharu Nakashima, Knee kinematics in bi-cruciate stabilized total knee arthroplasty during squatting and stair-climbing activities., Journal of orthopaedics, 10.1016/j.jor.2018.05.003, 15, 2, 650-654, 2018.06, This study aimed to evaluate clinical outcomes and in vivo kinematics of bi-cruciate stabilized (BCS) total knee arthroplasty (TKA), using image-matching techniques. We analyzed tibiofemoral anteroposterior translation, axial rotation, and anterior/posterior cam-post contact for 22 BCS TKAs during squatting and stair-climbing. The functional activities on the 2011 Knee Society Score were significantly improved from 36 to 71. The tibiofemoral translation and axial rotation during squatting/stair-climbing were 16.1 mm/7.1 mm and 2.5° external/1.1° internal, respectively. Anterior/posterior cam-post contacts were observed during squatting (14%/96%) and stair-climbing (27%/96%). In conclusion, BCS TKA produced physiological sagittal plane kinematics during activities with favorable clinical outcomes.. |
| 369. |
Kensei Yoshimoto, Yasuharu Nakashima, Miyo Wakiyama, Daisuke Hara, Akihiro Nakamura, Mikio Iwamoto, Initial stability of a highly porous titanium cup in an acetabular bone defect model, Journal of Orthopaedic Science, 10.1016/j.jos.2018.03.007, 23, 4, 665-670, 2018.07, Backgrounds: The purpose of this study was to quantify the initial stability of a highly porous titanium cup using an acetabular bone defect model. Methods: The maximum torque of a highly porous titanium cup, with a pore size of 640 μm and porosity of 60%, was measured using rotational and lever-out torque testing and compared to that of a titanium-sprayed cup. The bone models were prepared using a polyurethane foam block and had three levels of bone coverage: 100, 70, and 50%. Results: The highly porous titanium cup demonstrated significantly higher maximum torque than the titanium-sprayed cups in the three levels of bone defects. On rotational torque testing, it was found to be 1.5, 1.3, and 1.3 times stronger than the titanium-sprayed cups with 100, 70 and 50% bone coverage, respectively. Furthermore, it was found to be 2.2, 2.3, and 1.5 times stronger on lever-out testing than the titanium-sprayed cup. No breakage in the porous layers was noted during the testing. Conclusion: This study provides additional evidence of the initial stability of highly porous titanium cup, even in the presence of acetabular bone defects.. |
| 370. |
Murakami K, Hamai S, Okazaki K, Wang Y, Ikebe S, Higaki H, Shimoto T, Mizu-Uchi H, Akasaki Y, Nakashima Y, In vivo kinematics of gait in posterior-stabilized and bicruciate-stabilized total knee arthroplasties using image-matching techniques., International orthopaedics, 10.1007/s00264-018-3921-z, 42, 11, 2573-2581, 2018.11. |
| 371. |
Naoya Kozono, Takamitsu Okada, Naohide Takeuchi, Satoshi Hamai, Hidehiko Higaki, Takeshi Shimoto, Satoru Ikebe, Hirotaka Gondo, Yoshitaka Nakanishi, Takahiro Senju, Yasuharu Nakashima, In vivo dynamic acromiohumeral distance in shoulders with rotator cuff tears., Clinical biomechanics (Bristol, Avon), 10.1016/j.clinbiomech.2018.07.017, 60, 95-99, 2018.12, BACKGROUND: There are no previous studies on the acromiohumeral distance in shoulders with large-to-massive full-thickness rotator cuff tears. In this study, the acromiohumeral distance in rotator cuff tear and healthy shoulders was measured using 3D-to-2D model-to-image registration techniques. METHODS: The dynamic glenohumeral kinematics during scapular plane abduction and axial rotation were analyzed in 11 rotator cuff tear patients and 10 healthy control subjects. Periodic radiographic images of scapular plane abduction and axial rotation were taken using a flat-panel radiograph image detector. Movements of the shoulder joint were assessed using radiographic images and computed tomography-derived digitally reconstructed radiographs. The acromiohumeral distance was defined as the shortest 3D distance between the acromion and the proximal humerus. FINDINGS: For scapular plane abduction, the rotator cuff tear group had significantly smaller acromiohumeral distance than the control group at 15°, 30°, 45°, 60°, 75°, 135°, and 150° of humeral abduction (P |
| 372. |
Hiroshi Otsuka, Kenichi Kohashi, Masato Yoshimoto, Shin Ishihara, Yu Toda, Yuichi Yamada, Hidetaka Yamamoto, Yasuharu Nakashima, Yoshinao Oda, Immunohistochemical evaluation of H3K27 trimethylation in malignant peripheral nerve sheath tumors., Pathology, research and practice, 10.1016/j.prp.2017.12.015, 214, 3, 417-425, 2018.03, The histological definitive diagnosis of malignant peripheral nerve sheath tumor (MPNST) is quite difficult because the morphological features are not specific and no useful immunohistochemical marker has been identified. Loss-of-function mutations in EED or SUZ12, which encode the core subunit of polycomb repressive complex 2 (PRC2), were reported in MPNSTs, and the mutations were shown to cause inactivation of PRC2, leading to loss of trimethylation of histone H3 at lysine 27 (H3K27me3). Immunohistochemistry of H3K27me3 is expected to be a specific marker for MPNSTs. We evaluated immunohistochemical expression of H3K27me3 in MPNSTs with heterologous components and metachronous cases of MPNSTs. Among 145 MPNST samples, 50 (34.5%) showed complete loss of staining, and 45 (31.0%) showed partial loss of staining. Regarding the backgrounds of MPNSTs, 43 patients of neurofibromatosis type 1 (NF-1)-associated MPNST demonstrated 19 (44.2%) complete and 12 (27.9%) partial loss of H3K27me3. Among MPNSTs with heterologous component, almost all of MPNSTs with epithelioid differentiation (8/9 samples, 88.9%) retained H3K27me3, and malignant Triton tumors without epithelioid component lacked H3K27me3 at high rate (91.7%). Five of 20 metachronous MPNST cases showed significantly reduced expression of H3K27me3 between primary and later-occurring tumors, but in some cases increased expression of H3K27me3 in the clinical course (such as complete loss to partial loss) was observed. If the tumors are recurrent or metastatic, H3K27me3 expression should be reduced or at least maintained because loss of H3K27me3 is due to genetic mutation of EED or SUZ12. MPNSTs, especially those associated with NF-1, can occur in heterochronous and multiple patterns, and the identification of increased expression of H3K27me3 during a patient's clinical course can be helpful for determining whether the tumors are heterochronous, multiple or not. As heterochronous and multiple tumors may show lower malignancy compared to recurrent or metastatic tumors, favorable prognosis may be expected when H3K27me3 expression is increased.. |
| 373. |
Yuichi Yamada, Izumi Kinoshita, Kohashi Kenichi, Hidetaka Yamamoto, Takeshi Iwasaki, Hiroshi Otsuka, Masato Yoshimoto, Shin Ishihara, Yu Toda, Yuki Kuma, Nokitaka Setsu, Yuki Koga, Yumi Honda, Takeshi Inoue, Hiroyuki Yanai, Kyoko Yamashita, Ichiro Ito, Mitsuru Takahashi, Shouichi Ohga, Masutaka Furue, Yasuharu Nakashima, Yoshinao Oda, Histopathological and genetic review of phosphaturic mesenchymal tumours, mixed connective tissue variant., Histopathology, 10.1111/his.13377, 72, 3, 460-471, 2018.02, AIMS: Phosphaturic mesenchymal tumour, mixed connective tissue variant (PMT-MCT), is a tumour of uncertain differentiation, characterised by 'smudgy/grungy' calcification and vitamin D-resistant phosphaturic osteomalacia. Fibroblast growth factor (FGF)23 is recognised as a reliable marker of PMT-MCT, but quantitative evaluation has never been performed. We reviewed cases of tumour-associated osteomalacia or histologically definitive PMT-MCT without osteomalacia using histological, immunohistochemical and genetic methods and evaluated the diagnostic significance of these findings. METHODS AND RESULTS: A total of 19 tumours from 14 cases diagnosed previously as PMT-MCT were retrieved, on which immunohistochemical staining, reverse transcription-polymerase chain reaction (RT-PCR) and fluorescence in-situ hybridisation (FISH) analysis were performed. Histologically, fibrous capsule, calcification and giant cell reaction tended to be observed in soft-tissue PMT-MCT, while PMT-MCT of bone and multiple PMT-MCT showed an infiltrative growth pattern. The immunohistochemical results were as follows: the tumour cells were positive for FGF23 (nine of 12, 75%), FGFR1 (11 of 11, 100%), CD56 (12 of 14, 85.7%) and E26 oncogene homologue (ERG) (5 of 13, 38.4%). The sole malignant tumour was positive for p53. FGF23 mRNA was detected in seven of 14 formalin-fixed paraffin-embedded (FFPE) specimens and all five frozen specimens by RT-PCR. The level of FGF23 mRNA, which was determined by real-time PCR, varied among the phosphaturic cases. Two of 17 tumours were positive for FGFR1 gene rearrangement. CONCLUSIONS: It was considered that PMT-MCT is a histopathological entity with or without phosphaturia, with varying levels of FGF23 mRNA, and with or without fibronectin 1 (FN1)-FGFR1 fusion gene. The authors propose that the histology of PMT-MCT differs depending on its location, such as bone or soft tissue, which could complicate the differential diagnosis.. |
| 374. |
Ma Y, Mizu-Uchi H, Okazaki K, Ushio T, Murakami K, Hamai S, Akasaki Y, Nakashima Y, Effects of tibial baseplate shape on rotational alignment in total knee arthroplasty: three-dimensional surgical simulation using osteoarthritis knees., Archives of orthopaedic and trauma surgery, 10.1007/s00402-017-2828-2, 138, 1, 105-114, 2018.01. |
| 375. |
Takeshi Utsunomiya, Goro Motomura, Satoshi Ikemura, Yusuke Kubo, Kazuhiko Sonoda, Hiroyuki Hatanaka, Shoji Baba, Koichiro Kawano, Takuaki Yamamoto, Yasuharu Nakashima, Effects of sclerotic changes on stress concentration in early-stage osteonecrosis: A patient-specific, 3D finite element analysis., Journal of orthopaedic research : official publication of the Orthopaedic Research Society, 10.1002/jor.24124, 36, 12, 3169-3177, 2018.12, Stress distribution remains unclear in early-stage osteonecrosis of the femoral head (ONFH). To clarify this issue, we generated patient-specific finite element models (FEMs) from 51 patients with ONFH. Patients' hips were classified into three groups: ONFH without a sclerotic boundary (Stage 1, n = 6), ONFH with a sclerotic boundary (Stage 2, n = 10), and ONFH with both a sclerotic boundary and |
| 376. |
Kenichi Kawaguchi, Katsumi Harimaya, Yoshihiro Matsumoto, Mitsumasa Hayashida, Seiji Okada, Keiichiro Iida, Go Kato, Kuniyoshi Tsuchiya, Toshio Doi, Yoshinao Oda, Yukihide Iwamoto, Yasuharu Nakashima, Effect of cartilaginous endplates on extruded disc resorption in lumbar disc herniation, PLoS ONE, 10.1371/journal.pone.0195946, 13, 4, e0195946, 2018.04, © 2018 Kawaguchi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Objective The aim of this study was to investigate the clinicopathologic features of lumbar disc herniation (LDH) with endplate degeneration and the association between cartilaginous fragments and inflammatory response to the herniated disc. Summary of background data LDH often involves hyaline cartilage fragments pulled from the vertebral endplates. Modic changes are closely associated with LDH that contains hyaline cartilage, and cartilaginous endplates seem to affect resorption of the herniated disc. Methods A total of 78 patients who underwent microscopic discectomy between 9 and 16 weeks after an occurrence of LDH were reviewed. Modic changes, disc degeneration, high-intensity zone, and vertebral corner defect were evaluated using magnetic resonance imaging (MRI). Histopathological observations of cartilaginous endplates and inflamed granulation tissue in the herniated disc were made. In cases with inflamed granulation tissue, neovascularization and macrophage infiltration were also evaluated using immunohistochemical analysis. Results Modic changes were observed in approximately one-third of the patients (26 cases: type 1, 7; type 2, 17; and type 3, 2). Cartilaginous endplates were observed in 32 cases (41%) and in the majority of cases with Modic changes compared with cases without Modic changes (65%, p = 0.001). Although inflamed granulation tissue was observed in 60 cases (77%), no significant differences were detected in patient age and the composition of the herniated material. Immunohistochemical analysis showed that fewer CD34-positive capillaries and CD68-positive cells were found in cases with cartilaginous fragments compared with those without cartilaginous fragments (p |
| 377. |
Naoya Kozono, Takamitsu Okada, Naohide Takeuchi, Satoshi Hamai, Hidehiko Higaki, Takeshi Shimoto, Satoru Ikebe, Hirotaka Gondo, Yoshitaka Nakanishi, Takahiro Senju, Yasuharu Nakashima, Dynamic kinematics of the glenohumeral joint in shoulders with rotator cuff tears., Journal of orthopaedic surgery and research, 10.1186/s13018-017-0709-6, 13, 1, 9-9, 2018.01, BACKGROUND: No clear trend has emerged from the literature regarding three-dimensional (3D) translations of the humerus relative to the scapula in shoulders with rotator cuff tears (RCTs). The purpose of this study was to evaluate the kinematics of RCT shoulders using 3D-to-two-dimensional (2D) model-to-image registration techniques. METHODS: Dynamic glenohumeral kinematics during scapular plane abduction and axial rotation were analyzed in 11 RCT patients and 10 healthy control subjects. We measured the 3D kinematic parameters of glenohumeral joints using X-ray images and CT-derived digitally reconstructed radiographs. RESULTS: For scapular plane abduction, the humeral head center was positioned significantly more medially in shoulders with RCTs than in controls at 135° of humeral abduction (p = 0.02; RCTs versus controls: - 0.9 ± 1.6 versus 0.3 ± 1.3 mm). There was no significant difference in the superior/inferior translation of the humeral head center (p = 0.99). For axial rotation in adducted position, the humeral head center was positioned significantly more anteriorly in shoulders with RCTs than in controls at - 30° of glenohumeral external rotation (p |
| 378. |
Keisuke Komiyama, Satoshi Hamai, Daisuke Hara, Satoru Ikebe, Hidehiko Higaki, Kensei Yoshimoto, Kyohei Shiomoto, Hirotaka Gondo, Yifeng Wang, Yasuharu Nakashima, Dynamic hip kinematics during squatting before and after total hip arthroplasty., Journal of orthopaedic surgery and research, 10.1186/s13018-018-0873-3, 13, 1, 162-162, 2018.07, BACKGROUND: The difference in in vivo kinematics before and after total hip arthroplasty (THA) for the same subjects and the clearance between the liner and neck during squatting have been unclear. The purpose of the present study was to clarify (1) the changes in the in vivo kinematics between prosthetic hips and osteoarthritis hips of the same subjects and (2) the extent of the liner-to-neck clearance during squatting under weight-bearing conditions. METHODS: This study consisted of 10 patients who underwent unilateral THA for symptomatic osteoarthritis. Using a flat-panel X-ray detector, we obtained continuous radiographs during squatting. We analyzed the hip joint's movements using three-dimensional-to-two-dimensional model-to-image registration techniques. We also quantified the minimum distance at maximum flexion and extension, and the minimum angle at maximum flexion between the liner and stem neck. RESULTS: The maximum hip flexion angles post-THA (80.7° [range, 69.4-98.6°]) changed significantly compared with the pre-THA values (71.7° [range, 55.2°-91.2°]). The pelvic tilt angle (posterior +, anterior-) at the maximum hip flexion post-THA (10.4° [range, - 6.7° to 26.9°]) was significantly smaller than that at pre-THA (16.6° [range, - 3° to 40.3°]). The minimum anterior and posterior liner-to-neck distances averaged 10.9 and 8.0 mm, respectively, which was a significant difference. The minimum liner-to-neck angle at maximum flexion averaged 34.7° (range, 20.7°-46.3°). No liner-to-neck contact occurred in any of the hips. CONCLUSION: THA increased the range of hip joint motion and the pelvis tilted anteriorly more after than before THA, with sufficient liner-to-neck clearance during squatting. These data may be beneficial for advising patients after THA regarding postoperative activity restrictions in daily life.. |
| 379. |
Jun-Ichi Fukushi, Ichiro Kawano, Goro Motomura, Satoshi Hamai, Ken-Ichi Kawaguchi, Yasuharu Nakashima, Does hip center location affect the recovery of abductor moment after total hip arthroplasty?, Orthopaedics & traumatology, surgery & research : OTSR, 10.1016/j.otsr.2018.06.022, 104, 8, 1149-1153, 2018.12, BACKGROUND: In total hip arthroplasty (THA), placing the cup in an anatomic position is not always possible in case of deformities related to developmental dysplasia of the hip (DDH). Thus far, the influence of a hip center on the abductor moment after THA has not been clearly elucidated. Therefore, we performed a retrospective study to assess (1) how abductor muscle moment recovers postoperatively in THA and (2) whether acetabular cup position affects the recovery of abductor moment. HYPOTHESIS: A high hip center affects the recovery of abductor moment of a dysplastic hip after THA. PATIENTS AND METHODS: We evaluated 100 patients, who underwent unilateral primary THA, at 12 months postoperatively. The study included 86 women and 14 men, with a mean age of 65.5±9.9 years (range, 40 to 86 years). Patients with secondary osteoarthritis due to DDH were included (Crowe 1: 76; Crowe 2: 15, Crowe 3:9, and Crowe 4: none). A cementless straight stem was implanted in all hips. Hip abductor moment was measured using a belt-stabilized hand-held dynamometer. The ratio of moment of the affected side to that of the contralateral side was calculated as moment ratio. The horizontal and vertical centers of rotation (H-COR and V-COR) (with respect to the inter teardrop line) and vertical shift (V-shift) (difference in V-COR between the affected hip and the contralateral normal hip) were determined. RESULTS: At 6 and 12 months postoperatively, the abductor moment ratios were 95.1 and 94.7%, respectively. Significant negative correlation was observed between the postoperative abductor moment ratio and V-COR at 6 months postoperatively (r=-0.2436, p=0.0238). Significant delay in the recovery of abductor moment ratio was observed in the groups with higher hip center (V-shift>15mm) (odds ratio=12.7; 95% CI: 2.11-232.1, p=0.0034) at 6 months postoperatively, which was fully recovered at 12 months postoperatively. DISCUSSION: Superior placement of a hip center, more than 15mm above the true hip center, delayed the recovery of abductor muscle moment after THA. LEVEL OF EVIDENCE: III, retrospective comparative study.. |
| 380. |
Hidetaka Yamamoto, Takeshi Iwasaki, Yuichi Yamada, Yoshihiro Matsumoto, Hiroshi Otsuka, Masato Yoshimoto, Kenichi Kohashi, Kenichi Taguchi, Ryohei Yokoyama, Yasuharu Nakashima, Yoshinao Oda, Diagnostic utility of histone H3.3 G34W, G34R, and G34V mutant-specific antibodies for giant cell tumors of bone., Human pathology, 10.1016/j.humpath.2017.11.020, 73, 41-50, 2018.03, Giant cell tumors of bone (GCTBs) are characterized by mononuclear stromal cells and osteoclast-like giant cells; up to 95% have H3F3A gene mutation. The RANKL inhibitor denosumab, when used for the treatment of GCTB, leads to histological changes such as new bone formation and giant cell depletion. Here we assessed the diagnostic utility of immunohistochemical staining with the antibodies against histone H3.3 G34W, G34R and G34V mutant proteins for GCTB and other histologically similar bone and joint lesions. H3.3 G34W, G34R and G34V expressions were detected in mononuclear stromal cells in 47/51 (92%), 1/51 (2%) and 3/51 (6%) cases of primary GCTBs, respectively, in a mutually exclusive manner. All recurrent/metastatic GCTBs (n=14), post-denosumab GCTBs (n=8) and secondary malignant GCTBs (n=2) were positive for H3.3 G34W. The immunohistochemical results were essentially correlated with the H3F3A genotype determined by mutation analysis. In post-denosumab GCTBs, H3.3 G34W expression was seen in immature bone-forming cells. H3.3 G34W, G34R and G34V were negative in 121/122 cases of non-GCTB, including chondroblastoma, osteosarcoma, primary aneurysmal bone cyst and other giant cell-rich lesions. The exception was a single case of undifferentiated high-grade pleomorphic sarcoma that was positive for H3.3 G34W, suggesting the possibility of sarcomatous overgrowth of primary malignant GCTB. Therefore, H3.3 G34W/R/V mutant-specific antibodies are useful surrogate markers for the H3F3A genotype and helpful for the diagnosis of GCTB and its variants. The expression of H3.3 G34W mutant protein in post-denosumab GCTB suggests that neoplastic stromal cells may play a role in new bone formation.. |
| 381. |
Hisakata Yamada, Tatsuhiko Ozawa, Hiroyuki Kishi, Seiji Okada, Yasuharu Nakashima, Atsushi Muraguchi, Yasunobu Yoshikai, Cutting edge: B cells expressing cyclic citrullinated peptide-specific antigen receptor are tolerized in normal conditions, Journal of Immunology, 10.4049/jimmunol.1800826, 201, 12, 3492-3496, 2018.12, © 2018 by The American Association of Immunologists, Inc. Generation of neoantigens by citrullination is implicated in the production of anti-citrullinated protein Abs in rheumatoid arthritis, but citrullination is also a physiological process. To verify whether citrullin-specific B cells are immunologically ignorant or tolerant in normal conditions, transgenic (Tg) mice expressing IgM with the V region of an anti-cyclic citrullinated peptide (CCP) mAb cloned from a rheumatoid arthritis patient were generated. CCP-specific B cells developed in the anti-CCP IgM Tg mice with an alteration of bone marrow B cell fractions, and the number of mature B cells decreased compared with wild-type or the control anti-influenza nucleoprotein-specific IgM Tg mice. In addition, B cells in anti-CCP IgM Tg mice are functionally anergic. Thus, tolerance is induced in CCP-specific B cells in vivo, suggesting that the immune systems are naturally exposed to citrullinated Ags, and anti-CCP Ab production requires additional steps beyond the generation of neoantigens by citrullination.. |
| 382. |
Kenyu Iwasaki, Takuaki Yamamoto, Goro Motomura, Kazuyuki Karasuyama, Kazuhiko Sonoda, Yusuke Kubo, Yasuharu Nakashima, Computed tomography findings of subchondral insufficiency fractures of the femoral head, Journal of Orthopaedics, 10.1016/j.jor.2018.01.044, 15, 1, 173-176, 2018.03, Objectives: The objective of this study was to describe the appearance of Subchondral insufficiency fracture (SIF) by computed tomography (CT). Methods: Images of 52 consecutive patients diagnosed with SIF were retrospectively reviewed. CT was available for five patients (7 cases). Results: Corresponding to a low-intensity band on MR images, a radiolucent or sclerotic band was observed on CT images. Conclusion: The present study is the first to report CT findings of SIF. A radiolucent or sclerotic band was observed on CT images. The results of the present study provide useful information for diagnosis of SIF.. |
| 383. |
Miho Iwamoto, Yasuharu Nakashima, Tomoyuki Nakamura, Yusuke Kohno, Ryosuke Yamaguchi, Kazuyuki Takamura, Clinical outcomes of conservative treatment with a non-weight-bearing abduction brace for Legg–Calvé–Perthes disease, Journal of Orthopaedic Science, 10.1016/j.jos.2017.09.012, 23, 1, 156-160, 2018.01, Background Treatment with a brace is the first choice as conservative treatment via the containment method for Legg–Calvé–Perthes disease (LCPD). The purpose of this study is to evaluate clinical outcomes and influential factors of conservative treatment with the non-weight-bearing abduction brace for LCPD. Methods One hundred thirty hips in 130 patients were examined in this study. The mean age at onset was 7.0 years (3.3–12.4 years) and the mean follow-up period was 8.4 years (4.1–17.6 years). The extent of necrosis and lateral collapse of the femoral head were evaluated using the Catterall classification and the lateral pillar classification, respectively. Radiological outcome was assessed as good (classes I and II), fair (III), and poor (IV), according to the modified Stulberg classification. Results Radiographic outcome at final follow-up was good in 82 hips (63%), fair in 40 hips (31%), and poor in 8 hips (6%). Multinomial logistic regression analysis showed that major influential factors for good outcomes were as follows: age at onset, lateral pillar classification, and Catterall classification. From the receiver operating characteristic curve, the cut-off value for age at onset was 8.4 years old to obtain good outcomes. Hips with Catterall group I and II and lateral pillar group A and B had significantly better results. Conclusion Patients younger than 8.4 years old at onset with lateral pillar group A or B or Catterall group I or II showed good outcomes with a non-weight-bearing abduction brace for LCPD. These results show that alternative treatment, such as surgery, may be another option for patients who are not included in the above groups.. |
| 384. |
Yoshihiro Matsumoto, Kenichi Kawaguchi, Jun-Ichi Fukushi, Makoto Endo, Nokitaka Setsu, Keiichiro Iida, Satoshi Baba, Hirokazu Saiwai, Akinobu Matsushita, Mitsumasa Hayashida, Seiji Okada, Yasuharu Nakashima, Clinical Outcome and Prognostic Factors of Malignant Spinal Dumbbell Tumors., Spine surgery and related research, 10.22603/ssrr.2018-0004, 2, 4, 317-323, 2018.10, Introduction: To investigate the clinical outcome and prognostic factors of malignant spinal dumbbell tumors (m-SDTs). Methods: We retrospectively reviewed the clinical outcome of 22 consecutive cases of m-SDTs and analyzed the prognostic factors associated with worse outcome. Results: Nineteen of the 22 cases were managed with surgery (86%), and gross total resection (GTR) was achieved in four cases (21%). The duration of overall survival (OS) ranged from 3 to 140 months, with a median survival time of 15.3 months. The 5 year OS rate was 55.6%. In multivariate analysis, histological subtype (high-grade malignant peripheral nerve sheath tumor) (hazard ratio [HR] 14.9, p = 0.0191), GTR (HR 0.07, p = 0.0343), and presence of local recurrences (HR 11.2, p = 0.0479) were significant and independent predictors of OS. Conclusions: On the basis of clinical data, we propose that GTR and prevention of local recurrence may improve the clinical outcome of m-SDTs.. |
| 385. |
Akiko Oyamada, Yoshihiro Matsumoto, Yoshifumi Wakata, Atsushi Kimura, Ko Ikuta, Kuniyoshi Tsuchiya, Naohisa Tayama, Shinji Tomari, Hisaaki Miyahara, Takao Mae, Hirokazu Shiraishi, Taichi Saito, Takeshi Arizono, Kozo Kaji, Taro Mawatari, Masami Fujiwara, Riku Sakimura, Kunichika Shin, Kenichi Ninomiya, Kazutoshi Nakaie, Yasuaki Antoku, Shoji Tokunaga, Naoki Nakashima, Yukihide Iwamoto, Yasuharu Nakashima, Characteristics of patients with fragility hip fractures in the northern Kyushu district in Japan: a multicenter prospective registry based on an electronic data capture system., Journal of bone and mineral metabolism, 10.1007/s00774-017-0869-9, 36, 5, 596-604, 2018.09, Osteoporosis has become a worldwide public health problem, in part due to the fact that it increases the risk of fragility hip fractures (FHFs). The epidemiological assessment of FHFs is critical for their prevention; however, datasets for FHFs in Japan remain scarce. This was a multicenter, prospective, observational study in the northern district of Kyushu Island. Inclusion criteria were age > 60 years with a diagnosis of FHF and acquisition of clinical data by an electronic data capture system. Of 1294 registered patients, 1146 enrolled in the study. Nearly one third of patients (31.8%) had a history of previous fragility fractures. The percentage of patients receiving osteoporosis treatment on admission was 21.5%. Almost all patients underwent surgical treatment (99.1%), though fewer than 30% had surgery within 48 h after hospitalization. Bone mineral density (BMD) was evaluated during hospitalization in only 50.4% of patients. The rate of osteoporosis treatment increased from 21.5% on admission to 39.3% during hospitalization. The main reasons that prescribers did not administer osteoporosis treatment during hospitalization were forgetfulness (28.4%) and clinical judgment (13.6%). Age and female ratio were significantly higher in patients with previous FHFs than in those without. There was a significant difference in the rate of osteoporosis treatment or L-spine BMD values in patients with or without previous FHFs on admission. In conclusion, this study confirmed that the evaluation and treatment of osteoporosis and FHFs is still suboptimal in Japan, even in urban districts.. |
| 386. |
Daisuke Shiraishi, Yukio Fujiwara, Hasita Horlad, Yoichi Saito, Toyohisa Iriki, Junko Tsuboki, Pan Cheng, Naomi Nakagata, Hiroshi Mizuta, Hirofumi Bekki, Yasuharu Nakashima, Yoshinao Oda, Motohiro Takeya, Yoshihiro Komohara, CD163 Is Required for Protumoral Activation of Macrophages in Human and Murine Sarcoma., Cancer research, 10.1158/0008-5472.CAN-17-2011, 78, 12, 3255-3266, 2018.06, Recent findings have shown the significance of CD163-positive macrophages in tumor progression, yet there have been few studies on the function of CD163 in macrophages. Here, we uncover the role of CD163 in macrophage activation using CD163-deficient mice and human samples. We detected CD163 in 62 undifferentiated pleomorphic sarcoma samples, in which a high percentage of CD163-positive macrophages was associated with decreased overall survival and higher histologic grade. We observed macrophage-induced tumor cell proliferation in cocultures of human monocyte-derived macrophages and leiomyosarcoma (TYLMS-1) and myxofibrosarcoma (NMFH-1) cell lines, which was abrogated by silencing of CD163. Tumor development of sarcoma (MCA205 and LM8) cells in CD163-deficient mice was significantly abrogated in comparison with wild-type (WT) mice. Coculture with WT peritoneal macrophages significantly increased proliferation of MCA205 cells but decreased in the presence of CD163-deficient macrophages. Production of IL6 and CXCL2 in CD163-deficient macrophages was suppressed in comparison with WT macrophages, and overexpression of CD163 in CD163-deficient macrophages induced production of IL6 and CXCL2. Silencing of IL6 but not CXCL2 abrogated macrophage-induced proliferation of MCA205 cells. Taken together, our results show that CD163 is involved in protumoral activation of macrophages and subsequent development and progression of tumors in mice and humans.Significance: Macrophage CD163-mediated induction of IL6 promotes tumor development and progression in murine and human malignant tumors. Cancer Res; 78(12); 3255-66. ©2018 AACR.. |
| 387. |
Masaru Hada, Hideki Mizu-Uchi, Ken Okazaki, Takao Kaneko, Koji Murakami, Yuan Ma, Satoshi Hamai, Yasuharu Nakashima, Bi-cruciate stabilized total knee arthroplasty can reduce the risk of knee instability associated with posterior tibial slope., Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 10.1007/s00167-017-4718-0, 26, 6, 1709-1716, 2018.06, PURPOSE: The purpose of this study was to evaluate the relationship between posterior tibial slope and knee kinematics in bi-cruciate stabilized (BCS) total knee arthroplasty (TKA), which has not been previously reported. METHODS: This computer simulation study evaluated Journey 2 BCS components (Smith & Nephew, Inc., Memphis, TN, USA) implanted in a female patient to simulate weight-bearing stair climbing. Knee kinematics, patellofemoral contact forces, and quadriceps forces during stair climbing (from 86° to 6° of flexion) were computed in the simulation. Six different posterior tibial slope angles (0°-10°) were simulated to evaluate the effect of posterior tibial slope on knee kinematics and forces. RESULTS: At 65° of knee flexion, no anterior sliding of the tibial component occurred if the posterior tibial slope was less than 10°. Anterior contact between the anterior aspect of the tibial post- and the femoral component was observed if the posterior tibial slope was 6° or more. An increase of 10° in posterior tibial slope (relative to 0°) led to a 4.8% decrease in maximum patellofemoral contact force and a 1.2% decrease in maximum quadriceps force. CONCLUSION: BCS TKA has a wide acceptable range of posterior tibial slope for avoiding knee instability if the posterior tibial slope is less than 10°. Surgeons should prioritize avoiding adverse effects over trying to achieve positive effects such as decreasing patellofemoral contact force and quadriceps force by increasing posterior tibial slope. Our study helps surgeons determine the optimal posterior tibial slope during surgery with BCS TKA; posterior tibial slope should not exceed 10° in routine clinical practice.. |
| 388. |
Seiji Okada, Masamitsu Hara, Kazu Kobayakawa, Yoshihiro Matsumoto, Yasuharu Nakashima, Astrocyte reactivity and astrogliosis after spinal cord injury., Neuroscience research, 10.1016/j.neures.2017.10.004, 126, 39-43, 2018.01, After traumatic injuries of the central nervous system (CNS), including spinal cord injury (SCI), astrocytes surrounding the lesion become reactive and typically undergo hypertrophy and process extension. These reactive astrocytes migrate centripetally to the lesion epicenter and aid in the tissue repair process, however, they eventually become scar-forming astrocytes and form a glial scar which produces axonal growth inhibitors and prevents axonal regeneration. This sequential phenotypic change has long been considered to be unidirectional and irreversible; thus glial scarring is one of the main causes of the limited regenerative capability of the CNS. We recently demonstrated that the process of glial scar formation is regulated by environmental cues, such as fibrotic extracellular matrix material. In this review, we discuss the role and mechanism underlying glial scar formation after SCI as well as plasticity of astrogliosis, which helps to foster axonal regeneration and functional recovery after CNS injury.. |
| 389. |
Tetsuro Ushio, Ken Okazaki, Hideki Mizu-uchi, Satoshi Hamai, Yukio Akasaki, Yasuharu Nakashima, Anterior cruciate ligament reconstruction in a patient who has received systemic steroids for autoimmune disease, Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology, 10.1016/j.asmart.2017.11.003, 11, 12-14, 2018.01, Background An anterior cruciate ligament (ACL) reconstruction has become more common and the surgical morbidity has decreased, it has been performed not only in younger people to play sports but also middle-aged people, with satisfactory results. Therefore, some patients might have comorbidities for which they take medicines. Especially the medicines, such as systemic steroids, might influence the reconstructed ligament strength and durability. Case report A 49-year-old woman who was taking oral steroids for autoimmune hepatitis suffered a spontaneous ACL injury. She complained of unstable symptoms in the knee despite initial conservative treatment. Then, she was treated operatively with autologous hamstring tendon grafts. Three years postoperatively, her knee remained stable with 1.8 mm side-to-side difference on a Kneelax arthrometer and with 1.6 mm on anterior stress radiographs. There was no rerupture or instability. Conclusion The patient who had received systemic steroids for a long time recovered satisfactorily after the operation, with achievement of knee stability and possibility to prevent degenerative change in the knee joint. ACL reconstruction should be considered even in patients with such medication.. |
| 390. |
Yasutaka Tashiro, Gian Andrea Lucidi, Tom Gale, Kanto Nagai, Elmar Herbst, James J Irrgang, Yasuharu Nakashima, William Anderst, Freddie H Fu, Anterior cruciate ligament tibial insertion site is elliptical or triangular shaped in healthy young adults: high-resolution 3-T MRI analysis., Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 10.1007/s00167-017-4607-6, 26, 2, 485-490, 2018.02, PURPOSE: To clarify the morphology of anterior cruciate ligament (ACL) tibial insertion site in healthy young knees using high-resolution 3-T MRI. METHODS: Subjects were 50 ACL-reconstructed patients with a mean age of 21.4 ± 6.8 years. The contralateral healthy knees were scanned using high-resolution 3-T MRI. The tibial insertion sites of the anteromedial (AM) and posterolateral (PL) bundle fibres, and the ACL attachment on the anterior horn of lateral meniscus (AHLM) were segmented from the MR images, and 3D models were reconstructed to evaluate the morphology. The shape of ACL footprint was qualitatively analysed, and the size of AM and PL attachments and AHLM overlapped area was measured digitally. RESULTS: Tibial AM and PL bundles were clearly identified in 42 of 50 knees (84.0%). Morphology of the whole ACL tibial insertion site was elliptical in 23 knees (54.8%) and triangular in 19 knees (45.2%), but not classified as C-shape in any knees. However, the AM bundle attachment was of C-shape in 29 knees (69.0%) and band-like in 13 knees (31.0%). Overlap of ACL on AHLM was found in 26 knees (61.9%), and the size of the overlapped area was 4.8 ± 4.7% of the whole ACL insertion site. CONCLUSION: 3D morphology of the intact ACL tibial insertion site analysed by high-resolution 3-T MRI was elliptical or triangular in healthy young knees. However, the AM bundle insertion site was of C-shape or band-like. A small lateral portion of the ACL was overlapped with the AHLM. As for clinical relevance, these findings should be considered in order to reproduce the native ACL insertion site sufficiently. LEVEL OF EVIDENCE: III.. |
| 391. |
Naoya Kozono, Takamitsu Okada, Naohide Takeuchi, Takeshi Shimoto, Hidehiko Higaki, Yasuharu Nakashima, A Biomechanical Comparison Between Asymmetric Pennington Technique and Conventional Core Suture Techniques: 6-Strand Flexor Tendon Repair., The Journal of hand surgery, 10.1016/j.jhsa.2017.06.104, 43, 1, 79.e1-79.e8-79.e8, 2018.01, PURPOSE: To evaluate the fatigue strength and gap sizes of the asymmetric Pennington technique compared with 2 conventional 6-strand core suture techniques: the triple-looped suture and the Yoshizu #1. METHODS: We recorded the fatigue strength (forces × cycles) and gap sizes of a 6-strand flexor tendon repair with different core suture techniques under cyclic loading in 30 porcine tendons. The asymmetric Pennington technique was performed with a Pennington repair of equal suture purchase in the 2 tendon stumps, with the 2 other Pennington repairs shifted by 3 mm, respectively, along the longitudinal axis of the tendon in relation to the first Pennington repair. The triple-looped suture technique was made with triple Tsuge sutures. The Yoshizu #1 technique was performed with a combined Pennington repair (using a double strand) and Tsuge suture. RESULTS: The asymmetric Pennington technique showed significantly greater fatigue strength and significantly smaller gaps in comparison to the triple-looped suture and Yoshizu #1 techniques. CONCLUSIONS: This study demonstrated that the asymmetric Pennington technique generated increased fatigue strength and reduced gap sizes compared with 2 conventional 6-strand core suture techniques, the triple-looped suture and Yoshizu #1. CLINICAL RELEVANCE: The asymmetric Pennington technique may permit an early active motion rehabilitation protocol similar to the triple-looped suture and Yoshizu #1 techniques.. |
| 392. |
木村 敦, 松本 嘉寛, 若田 好史, 小山田 亜希子, 大石 正信, 藤原 敏史, 土屋 邦喜, 泊 真二, 宮原 寿明, 齊藤 太一, 加治 浩三, 原 俊彦, 馬渡 太郎, 崎村 陸, 進 訓央, 藤原 将己, 徳永 章二, 中島 直樹, 岩本 幸英, 中島 康晴, 大腿骨近位部骨折患者における退院1年後の死亡予測因子についての検討 北部九州での多施設共同後ろ向き研究, 日本骨代謝学会学術集会プログラム抄録集, 37回, 185-185, 2019.09. |
| 393. |
イメージマッチング法を用いた3次元股関節動態解析とメカニカルストレス. |
| 394. |
Hiroyuki Hatanaka, Goro Motomura, Satoshi Ikemura, Yusuke Kubo, Takeshi Utsunomiya, Shoji Baba, Yasuharu Nakashima, Volume of hip synovitis detected on contrast-enhanced magnetic resonance imaging is associated with disease severity after collapse in osteonecrosis of the femoral head., Skeletal radiology, 10.1007/s00256-019-3158-y, 48, 8, 1193-1200, 2019.08, OBJECTIVE: To evaluate the relationship between the volume of hip synovitis detected on contrast-enhanced magnetic resonance imaging (MRI) and the disease stage of osteonecrosis of the femoral head (ONFH). MATERIALS AND METHODS: Sixty-three consecutive hips in 40 ONFH patients were reviewed using contrast-enhanced MRI. Ten unaffected hips in 10 patients with unilateral ONFH were used as controls. Based on the Japanese Investigation Committee system, these hips were classified according to stage and type. The volume and location of hip synovitis were semi-quantitatively measured on contrast-enhanced MRI. Clinicoradiological factors were statistically analyzed to determine the relationship with the volume of hip synovitis. RESULTS: The mean synovial volume was significantly larger in ONFH hips (8,020 ± 6,900 mm3) than in controls (910 ± 1,320 mm3; p = 0.001). The area of synovitis in the anterior portion of the hip joint was double (mean: 2.17 ± 1.77) that in the posterior portion. The volume of synovitis was small in pre-collapse-stage hips (stage 1: 680 ± 690 mm3, stage 2: 1,460 ± 1,200 mm3), but significantly larger in post-collapse-stage hips (stage 3A: 7,820 ± 4,490 mm3, stage 3B: 13,850 ± 7,110 mm3; p |
| 395. |
Mingjian Xu, Goro Motomura, Takeshi Utsunomiya, Satoshi Ikemura, Ryosuke Yamaguchi, Hiroyuki Hatanaka, Shoji Baba, Koichiro Kawano, Yasuharu Nakashima, Traumatic subchondral fracture of the femoral head occurring concurrently with contralateral acetabular fracture., Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 10.1016/j.jos.2019.05.016, 27, 2, 495-499, 2019.06. |
| 396. |
Shingo Yoshizaki, Ken Kijima, Masamitsu Hara, Takeyuki Saito, Tetsuya Tamaru, Masatake Tanaka, Dai-Jiro Konno, Yasuharu Nakashima, Seiji Okada, Tranexamic acid reduces heme cytotoxicity via the TLR4/TNF axis and ameliorates functional recovery after spinal cord injury., Journal of neuroinflammation, 10.1186/s12974-019-1536-y, 16, 1, 160-160, 2019.07, BACKGROUND: Spinal cord injury (SCI) is a catastrophic trauma accompanied by intralesional bleeding and neuroinflammation. Recently, there is increasing interest in tranexamic acid (TXA), an anti-fibrinolytic drug, which can reduce the bleeding volume after physical trauma. However, the efficacy of TXA on the pathology of SCI remains unknown. METHODS: After producing a contusion SCI at the thoracic level of mice, TXA was intraperitoneally administered and the bleeding volume in the lesion area was quantified. Tissue damage was evaluated by immunohistochemical and gene expression analyses. Since heme is one of the degraded products of red blood cells (RBCs) and damage-associated molecular pattern molecules (DAMPs), we examined the influence of heme on the pathology of SCI. Functional recovery was assessed using the open field motor score, a foot print analysis, a grid walk test, and a novel kinematic analysis system. Statistical analyses were performed using Wilcoxon's rank-sum test, Dunnett's test, and an ANOVA with the Tukey-Kramer post-hoc test. RESULTS: After SCI, the intralesional bleeding volume was correlated with the heme content and the demyelinated area at the lesion site, which were significantly reduced by the administration of TXA. In the injured spinal cord, toll-like receptor 4 (TLR4), which is a DAMP receptor, was predominantly expressed in microglial cells. Heme stimulation increased TLR4 and tumor necrosis factor (TNF) expression levels in primary microglial cells in a dose-dependent manner. Similarly to the in vitro experiments, the injection of non-lysed RBCs had little pathological influence on the spinal cord, whereas the injection of lysed RBCs or heme solution significantly upregulated the TLR4 and TNF expression in microglial cells. In TXA-treated SCI mice, the decreased expressions of TLR4 and TNF were observed at the lesion sites, accompanied by a significant reduction in the number of apoptotic cells and better functional recovery in comparison to saline-treated control mice. CONCLUSION: The administration of TXA ameliorated the intralesional cytotoxicity both by reducing the intralesional bleeding volume and preventing heme induction of the TLR4/TNF axis in the SCI lesion. Our findings suggest that TXA treatment may be a therapeutic option for acute-phase SCI.. |
| 397. |
貴島賢, 前田健, 中島康晴, 岡田誠司, 脊髄損傷の治療アップデート 脊髄損傷の予後予測因子-脊髄損傷後の急性期血清亜鉛濃度は運動機能予後を予測する信頼性の高いバイオマーカーである-, 関節外科, 10.1016/j.ebiom.2019.03.003, 41, 3, 659-669, 2019.03. |
| 398. |
Makoto Nakagawa, Fumihiko Nakatani, Hironori Matsunaga, Takahiko Seki, Makoto Endo, Yoko Ogawara, Yukino Machida, Takuo Katsumoto, Kazutsune Yamagata, Ayuna Hattori, Shuhei Fujita, Yukiko Aikawa, Takamasa Ishikawa, Tomoyoshi Soga, Akira Kawai, Hirokazu Chuman, Nobuhiko Yokoyama, Suguru Fukushima, Kenichiro Yahiro, Atsushi Kimura, Eijiro Shimada, Takeshi Hirose, Toshifumi Fujiwara, Nokitaka Setsu, Yoshihiro Matsumoto, Yukihide Iwamoto, Yasuharu Nakashima, Issay Kitabayashi, Selective inhibition of mutant IDH1 by DS-1001b ameliorates aberrant histone modifications and impairs tumor activity in chondrosarcoma., Oncogene, 10.1038/s41388-019-0929-9, 38, 42, 6835-6849, 2019.10, Chondrosarcoma is the second most common malignant bone tumor. It is characterized by low vascularity and an abundant extracellular matrix, which confer these tumors resistance to chemotherapy and radiotherapy. There are currently no effective treatment options for relapsed or dedifferentiated chondrosarcoma, and new targeted therapies need to be identified. Isocitrate dehydrogenase (IDH) mutations, which are detected in ~50% of chondrosarcoma patients, contribute to malignant transformation by catalyzing the production of 2-hydroxyglutarate (2-HG), a competitive inhibitor of α-ketoglutarate-dependent dioxygenases. Mutant IDH inhibitors are therefore potential novel anticancer drugs in IDH mutant tumors. Here, we examined the efficacy of the inhibition of mutant IDH1 as an antitumor approach in chondrosarcoma cells in vitro and in vivo, and investigated the association between the IDH mutation and chondrosarcoma cells. DS-1001b, a novel, orally bioavailable, selective mutant IDH1 inhibitor, impaired the proliferation of chondrosarcoma cells with IDH1 mutations in vitro and in vivo, and decreased 2-HG levels. RNA-seq analysis showed that inhibition of mutant IDH1 promoted chondrocyte differentiation in the conventional chondrosarcoma L835 cell line and caused cell cycle arrest in the dedifferentiated JJ012 cell line. Mutant IDH1-mediated modulation of SOX9 and CDKN1C expression regulated chondrosarcoma tumor progression, and DS-1001b upregulated the expression of these genes via a common mechanism involving the demethylation of H3K9me3. DS-1001b treatment reversed the epigenetic changes caused by aberrant histone modifications. The present data strongly suggest that inhibition of mutant IDH1 is a promising therapeutic approach in chondrosarcoma, particularly for the treatment of relapsed or dedifferentiated chondrosarcoma.. |
| 399. |
Kenta Momii, Satoshi Hamai, Goro Motomura, Kensuke Kubota, Masato Kiyohara, Takuaki Yamamoto, Yasuharu Nakashima, Revascularization of the necrotic femoral head after traumatic open anterior hip dislocation in a child: a case report., Journal of medical case reports, 10.1186/s13256-019-2192-7, 13, 1, 254-254, 2019.08, INTRODUCTION: Avascular necrosis of the femoral capital epiphysis is the most serious complication after traumatic dislocation of the hip in children. This case report discusses the localization and revascularization of the necrotic femoral head following rarely experienced traumatic open anterior hip dislocation in children. CASE PRESENTATION: Our patient was an 11-year-old Japanese boy who had open anterior hip dislocation sustained in a traffic accident. Reduction of the hip joint was performed in an emergency operation, and he was evaluated using serial gadolinium-enhanced magnetic resonance imaging. T1-weighted magnetic resonance images showed two bands with low signal intensity in the femoral capital epiphysis on coronal and oblique axial planes, indicating the existence of avascular osteonecrosis of the femoral head. We observed gadolinium enhancement in the central region of the epiphysis, where the area between the two bands with low signal intensity was located. Serial assessment with enhanced magnetic resonance images during a non-weight-bearing period of 1.5 years after injury showed revascularization starting from the central region and converging toward the peripheral region. Although the patient had leg-length discrepancy due to the early epiphyseal closure, non-weight-bearing treatment for the avascular osteonecrosis of the femoral head achieved a favorable outcome without any hip joint dysfunction, pain, or sign of secondary osteoarthritic change within 4.5 years after injury. CONCLUSION: We confirmed the revascularization process of the necrotic lesion in the femoral capital epiphysis in an 11-year-old boy using serial gadolinium-enhanced magnetic resonance imaging. Conservative non-weight-bearing treatment achieved a favorable outcome.. |
| 400. |
Hirokazu Saiwai, Seiji Okada, Ken ichi Kawaguchi, Takeyuki Saito, Mitsumasa Hayashida, Akinobu Matsushita, Yoshihiro Matsumoto, Yasuharu Nakashima, Prone position surgery for a professional sumo wrestler with thoracic ossification of the posterior longitudinal ligament resulting in intraoperative brachial plexus injury by hypertrophic pectoral muscles, Journal of Clinical Neuroscience, 10.1016/j.jocn.2019.01.047, 63, 227-230, 2019.05, © 2019 Elsevier Ltd Surgery in the prone position is associated with a variety of complications due to the positioning, including the widely recognized peripheral nerve compression injuries and brachial plexus neuropathy. Previous studies have reported that thin body habitus is a predisposing risk factor for the compressive peripheral nerve injuries due to the prone position surgery. However, prone-position-related brachial plexus injury in patients who are overweight due to hypertrophic muscles have never been reported. Here we report a case of a professional sumo wrestler with severe thoracic ossification of the posterior longitudinal ligament (OPLL). Thoracic OPLL was successfully treated by posterior spinal fusion and decompression surgery. Despite a preoperative simulation and intraoperative inspection of the patient's surgical positioning, he suffered from bilateral upper extremity paralysis immediately after the surgery. Postoperative axillary MRI image revealed a high-intensity area on both sides of his pectoral muscles and axillary fossa, which implied that the pectoral muscles between the ribs and chest pad were pushed out toward the axillary fossa, resulting in compressive brachial plexus injury. His upper extremity motor paralysis was fully recovered in 6 months, but he still has mild tingling sensation even after 12 months of his surgery. In conclusion, overweight patients with hypertrophic muscles pose a risk for brachial plexus entrapment injury by pectoral muscles during prone-position surgery, and therefore it would be more effective to use a wide chest pad to reduce the pressure on the pectoral muscles to prevent it from being pushed out toward the axillary fossa.. |
| 401. |
Kazuya Yokota, Takeshi Maeda, Osamu Kawano, Eiji Mori, Tsuneaki Takao, Hiroaki Sakai, Muneaki Masuda, Yuichiro Morishita, Tetsuo Hayashi, Kensuke Kubota, Yasuharu Nakashima, Progression of local kyphosis after conservative treatment for compressive cervical spine fracture with spinal cord injury., Journal of orthopaedic surgery and research, 10.1186/s13018-019-1115-z, 14, 1, 98-98, 2019.04, INTRODUCTION: Compressive-flexion type cervical spine fracture is typically accompanied by apparent dislocation of the facet joints, undesirable cervical alignment, and devastating neurological dysfunction, which provides strong rationale for rendering prompt operative treatment. However, the validity of conservative treatment for compressive-flexion cervical spine injury in cases with preserved congruity of the facet joints has yet to be elucidated. The purpose of this study is to evaluate the long-term outcome of cervical alignment following conservative treatment for compressive-flexion cervical spine injury with preserved congruity of the facet joints. METHODS: A total of 662 patients who experienced spinal cord injury from 2007 to 2017 were included and underwent retrospective review in a single institute. Thirteen patients were identified as receiving conservative therapy following compressive-flexion cervical spine fractures with spinal cord injury. Clinical and radiological results were collected, including vertical fractures of the vertebral column, laminar fractures, progression of local kyphosis, and neurological status. The degree of the local cervical kyphosis was evaluated with two methods: the posterior tangent method and the endplate method. RESULTS: All 13 patients were male, and the mean age at the time of injury was 28.4 years. The mean follow-up period was 3 years. Although none of the patients presented neurological deterioration after the injury, the degree of local kyphosis was increased at the time of final follow-up compared to what was observed at the time of injury. Patient age at the time of injury and concurrent vertical fracture of vertebral body could have been influencing factors for the progression of the kyphosis. While laminar fracture affected the kyphosis at the time of injury, it was not a strong influencing factor of the overall progression of local kyphosis. CONCLUSIONS: The conservative option for the compressive-flexion cervical injury allowed us to treat without exacerbating neurological symptoms as long as the facet joints are preserved. However, in terms of cervical alignment, surgical stabilization may have been desirable for these patients. Notably, the younger patients and the patients with vertical fracture of the cervical vertebral column in this type of injury required closer observation to help prevent the progression of local kyphosis.. |
| 402. |
Satoshi Baba, Yoshihiro Matsumoto, Kenichi Kawaguchi, Keiichiro Iida, Hirokazu Saiwai, Seiji Okada, Akira Matsunobu, Yoshiyuki Shioyama, Yasuharu Nakashima, Post-carbon-ion radiotherapy vertebral pathological fractures in upper cervical primary malignant spinal tumors treated by occipito-cervical fusion, Archives of Orthopaedic and Trauma Surgery, 10.1007/s00402-019-03183-x, 139, 11, 1525-1531, 2019.01, © 2019, Springer-Verlag GmbH Germany, part of Springer Nature. Purpose: To describe the characteristic features of post-carbon-ion radiotherapy (CIRT) vertebral pathological fractures (VPFs) in upper cervical primary malignant spinal tumors (PMSTs) treated by occipito-cervical (OC) fusion. Methods: OC fusion was performed for three consecutive patients with post-CIRT VPFs. The clinical results and imaging findings, including bone single-photon emission computed tomography (SPECT)/CT were prospectively collected. Results: No surgery-related wound complication and surgical site infection were noted. One patient experienced re-fracture and displacement of dens with the loosening of occipital screws and was treated by posterior revision surgery. At the final follow-up, all patients were alive without evidence of disease, and the solid OC fusion was confirmed. Bone SPECT/CT clearly revealed the effect of CIRT on bone turnover in the irradiated field. Conclusion: The OC fusion with autologous bone grafts was a reliable option for the treatment of post-CIRT VPCs in the patients with upper cervical PMSTs. In addition, evaluation of the bone turnover at the irradiated field by bone SPECT/CT would help surgeons select an effective plan of care, such as fusion level and postoperative care.. |
| 403. |
Yoshihiro Komohara, Hiroto Takeya, Nanako Wakigami, Natsuki Kusada, Hirofumi Bekki, Shin Ishihara, Motohiro Takeya, Yasuharu Nakashima, Yoshinao Oda, Positive correlation between the density of macrophages and T-cells in undifferentiated sarcoma., Medical molecular morphology, 10.1007/s00795-018-0201-3, 52, 1, 44-51, 2019.03, Undifferentiated sarcoma (US) is a frequent soft tissue sarcoma. Although the 10-year survival rate is around 60%, advanced US is highly resistant to chemo/radiotherapy. The tumor microenvironment (TME) is closely associated with tumor progression. However, few studies of infiltrated immune cells in US have been published. In this study, we evaluated tumor-associated macrophages (TAMs) and CD8-positive cytotoxic T lymphocytes (CTLs) in 28 cases of US. Iba1, CD163, and CD204 were used as markers for TAMs. The density of CTLs was positively correlated with the density of TAMs. However, a negative correlation was seen between the density of CTLs and the percentage of CD204-positive TAMs. We found no significant association between the density of Iba1-/CD204-/CD8-positive cells and clinicopathological factors. No significant correlation between immune cell infiltration and clinical outcome was observed. Although we found no significant association between immune cells and clinicopathological factors, these findings may provide new insight into the characterization of immune cells in the TME of US.. |
| 404. |
Umito Kuwashima, Ken Okazaki, Kenyu Iwasaki, Yukio Akasaki, Hideya Kawamura, Hideki Mizu-Uchi, Satoshi Hamai, Yasuharu Nakashima, Patient reported outcomes after high tibial osteotomy show comparable results at different ages in the mid-term to long-term follow-up., Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 10.1016/j.jos.2018.12.022, 24, 5, 855-860, 2019.09, BACKGROUND: Few studies have evaluated the impact of age on patient-reported outcomes in the long-term follow-up after high tibial valgus osteotomy (HTO). The purpose of this study is to assess the association between age at surgery and patient-reported clinical outcomes in the mid-term to long-term follow-up of HTO. MATERIALS AND METHODS: We mailed the 2011 Knee Society score (KSS) questionnaires to 234 consecutive patients (295 knees) who had undergone closing-wedge HTO, and 158 patients (202 knees, 68.5%) returned a completed questionnaire. The cohort was divided into two groups depending on the age at the time of surgery, and pairs matched the follow-up period and sex was created. The mean follow-up period was approximately 12 years. KSS scores at the final follow-up were compared between two groups using the Student t test and chi-square test, and the survival rates were calculated using Kaplan-Meier survival curves. RESULTS: The symptom, satisfaction, and expectation scores were not significantly different between the ≤64-year-old patients and ≥65-year-old patients. The functional activities score was significantly lower in older patients than in younger patients. The overall survival rates of HTO were 99.1 ± 0.4% at 5 years, 94.4 ± 1.2% at 10 years, and 84.6 ± 2.7% at 15 years. There was no significant difference in the survival rate after HTO between the two groups divided by the age (p = 0.602). CONCLUSIONS: Pain relief and satisfaction after HTO in older patients were comparable to those in younger patients in the mid-term to long-term follow-up, although the functional activity was affected by age.. |
| 405. |
Kazuya Yokota, Kensuke Kubota, Kazu Kobayakawa, Takeyuki Saito, Masamitsu Hara, Ken Kijima, Takeshi Maeda, Hiroyuki Katoh, Yasuyuki Ohkawa, Yasuharu Nakashima, Seiji Okada, Pathological changes of distal motor neurons after complete spinal cord injury., Molecular brain, 10.1186/s13041-018-0422-3, 12, 1, 4-4, 2019.01, Traumatic spinal cord injury (SCI) causes serious disruption of neuronal circuits that leads to motor functional deficits. Regeneration of disrupted circuits back to their original target is necessary for the restoration of function after SCI, but the pathophysiological condition of the caudal spinal cord has not been sufficiently studied. Here we investigated the histological and biological changes in the distal part of the injured spinal cord, using a mice model of complete thoracic SCI in the chronic stage (3 months after injury). Atrophic changes were widely observed in the injured spinal cord both rostral and caudal to the lesion, but the decrease in area was mainly in the white matter in the rostral spinal cord while both the white and gray matter decreased in the caudal spinal cord. The number of the motor neurons was maintained in the chronic phase of injury, but the number of presynaptic boutons decreased in the lumbar motor neurons caudal to the lesion. Using laser microdissection, to investigate gene expressions in motor neurons caudal to the lesion, we observed a decrease in the expressions of neuronal activity markers. However, we found that the synaptogenic potential of postsynapse molecules was maintained in the motor neurons after SCI with the expression of acetylcholine-related molecules actually higher after SCI. Collectively, our results show that the potential of synaptogenesis is maintained in the motor neurons caudal to the lesion, even though presynaptic input is decreased. Although researches into SCI concentrate their effort on the lesion epicenter, our findings suggest that the area caudal to the lesion could be an original therapeutic target for the chronically injured spinal cord.. |
| 406. |
Toshifumi Fujiwara, Kenjiro Fujimura, Satoshi Hamai, Satoshi Kamura, Yasuharu Nakashima, Hisaaki Miyahara, Mid-term clinical outcome of constrained condylar knee prosthesis for patients with rheumatoid arthritis., Modern rheumatology, 10.1080/14397595.2018.1486954, 29, 4, 596-601, 2019.07, Objectives: This study retrospectively investigated the mid-term outcome of Legacy constrained condylar knee (LCCK) prosthesis in patients with rheumatoid arthritis (RA) having severe varus/valgus deformity, instability, and/or bone loss. Methods: Between January 2000 and December 2015, LCCK prostheses had been performed in 32 knees of 25 patients with RA, and 23 knees of 17 patients of the postoperative follow-up minimum 2 years were analyzed in this study (Primary: 14 knees, Revision: 9 knees). The average of follow-up duration was 6.9 ± 2.7 years, all were female, and the average of age and RA duration at the surgery was 59.0 ± 9.5 years and 26.6 ± 13.5 years, respectively. Clinical result was analyzed by Knee Society Score (KSS) knee and function at preoperative time and final visit. Imaging outcome was investigated by femoral tibial angle (FTA), four component alignment angles, and radiolucent line at pre-/postoperative time. Results: KSS knee/function scores and radiographic FTAs were improved after operation. Radiolucent lines around components were seen in 17 knees (73.9%), of which only one knee (4.3%) has shown aseptic loosening. The seven-year Kaplan-Meier survivorship analysis resulted in 91.7%. Conclusion: LCCK prosthesis in RA patients was achieved to the excellent mid-term clinical and radiographic result.. |
| 407. |
Tetsuro Ushio, Hideki Mizu-Uchi, Ken Okazaki, Kazuki Miyama, Yukio Akasaki, Yuan Ma, Yasuharu Nakashima, Medial soft tissue contracture does not always exist in varus osteoarthritis knees in total knee arthroplasty., Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 10.1007/s00167-018-5276-9, 27, 5, 1642-1650, 2019.05, PURPOSE: To evaluate preoperative soft tissue balance for total knee arthroplasty (TKA), varus/valgus stress radiographs has been used in previous studies. While the joint line of femur and tibia is almost parallel in healthy and postoperative knees, osteoarthritis (OA) knees exhibit articular cartilage wear that causes the joint line tilting even in a non-stress condition. Therefore, the exact angle of the joint line might mislead to understand the joint laxity in OA knees. The purpose of this study was to evaluate soft tissue balance in varus OA knees using preoperative stress radiographs under three different constant loads, taking the articular cartilage wear into consideration. METHODS: One hundred and eighteen varus-deformed OA knees in 102 patients were investigated before primary TKA. Preoperative knee radiographs were obtained in the anteroposterior view with no stress (defined as the neutral condition) and with varus and valgus stresses (5, 10, and 15 kg) in extension. Two different types of joint line angle (JLA), the absolute JLA (an exact angle of joint line) and the relative JLA (the absolute JLA minus the JLA in the neutral condition), were compared for the same load with the paired t test. RESULTS: The absolute JLA was 7.9 ± 1.2°/- 1.5 ± 2.2° under varus/valgus 15 kg stress, 6.7 ± 2.4°/- 0.3 ± 2.1° under varus/valgus 10 kg stress, and 4.7 ± 2.4°/1.1 ± 2.2° under varus/valgus 5 kg stress. Significant differences in the numerical values of the absolute JLA were observed between varus and valgus stresses for each load. The neutral JLA was 3.2 ± 2.0°. The relative JLA was 4.8 ± 2.1°/- 4.7 ± 1.8° under varus/valgus 15 kg stress, 3.5 ± 2.0°/- 3.5 ± 1.8° under varus/valgus 10 kg stress, and 1.5 ± 1.9°/- 2.1 ± 1.8° under varus/valgus 5 kg stress. No significant differences in the numerical values of the relative JLA were observed between varus and valgus stresses for each load. CONCLUSIONS: Consideration of cartilage wear allowed knee laxity to be evaluated more precisely in this study than in previous reports. It was shown that medial soft tissue contracture did not always exist, even in varus OA knees. Regarding clinical relevance, surgeons should be aware that underestimating medial soft tissue laxity due to reliance on the absolute JLA might lead to excessive medial tissue release and result in postoperative instability and lower patient satisfaction. LEVEL OF EVIDENCE: IV.. |
| 408. |
Kazu Kobayakawa, Yasuyuki Ohkawa, Shingo Yoshizaki, Tetsuya Tamaru, Takeyuki Saito, Ken Kijima, Kazuya Yokota, Masamitsu Hara, Kensuke Kubota, Yoshihiro Matsumoto, Katsumi Harimaya, Keiko Ozato, Takahiro Masuda, Makoto Tsuda, Tomohiko Tamura, Kazuhide Inoue, V Reggie Edgerton, Yukihide Iwamoto, Yasuharu Nakashima, Seiji Okada, Macrophage centripetal migration drives spontaneous healing process after spinal cord injury., Science advances, 10.1126/sciadv.aav5086, 5, 5, eaav5086, 2019.05, Traumatic spinal cord injury (SCI) brings numerous inflammatory cells, including macrophages, from the circulating blood to lesions, but pathophysiological impact resulting from spatiotemporal dynamics of macrophages is unknown. Here, we show that macrophages centripetally migrate toward the lesion epicenter after infiltrating into the wide range of spinal cord, depending on the gradient of chemoattractant C5a. However, macrophages lacking interferon regulatory factor 8 (IRF8) cannot migrate toward the epicenter and remain widely scattered in the injured cord with profound axonal loss and little remyelination, resulting in a poor functional outcome after SCI. Time-lapse imaging and P2X/YRs blockade revealed that macrophage migration via IRF8 was caused by purinergic receptors involved in the C5a-directed migration. Conversely, pharmacological promotion of IRF8 activation facilitated macrophage centripetal movement, thereby improving the SCI recovery. Our findings reveal the importance of macrophage centripetal migration via IRF8, providing a novel therapeutic target for central nervous system injury.. |
| 409. |
Yasuo Nakahara, Hiroshi Kitoh, Yasuharu Nakashima, Junya Toguchida, Nobuhiko Haga, Longitudinal study of the activities of daily living and quality of life in Japanese patients with fibrodysplasia ossificans progressiva., Disability and rehabilitation, 10.1080/09638288.2017.1405083, 41, 6, 699-704, 2019.03, PURPOSE: Fibrodysplasia ossificans progressiva is a rare congenital disorder that causes systemic heterotopic ossification, leading to systemic ankyloses and mobility losses. This study aimed to ascertain the natural history of fibrodysplasia ossificans progressiva. METHODS: In addition to the medical history questionnaire, patients aged 16 years and older were asked to complete activities of daily living and quality of life surveys using the Barthel Index, MOS 36-Item Short-Form Health Survey, and Health Assessment Questionnaire. The surveys were conducted over a 4-years period. RESULTS: Of the 15 participating patients, 13 reported swelling during the study period. The Barthel Index and Health Assessment Questionnaire surveys indicated a tendency for questionnaire items related to arm function to reflect early decreases in the activities of daily living. Decreases in activities of daily living functioning were closely related to decreases in the quality of life in physical function domains. Activities of daily living and quality of life were maintained at a similar level to baseline values over the study period (Barthel Index: p = 0.42, MOS 36-Item Short-Form Health Survey: p = 0.43, Health Assessment Questionnaire: p = 0.87). CONCLUSIONS: We obtained longitudinal information relating to natural history on fibrodysplasia ossificans progressiva patients. Implications for rehabilitation Fibrodysplasia ossificans progressiva is a rare congenital disease that causes heterotopic ossification of muscle tissue throughout the body, leading to systemic ankyloses and mobility losses. When the Barthel Index was high and the activities of daily living were relatively stable, the items on the Health Assessment Questionnaire that are related to arm function began to show impairment. Early focus on upper extremity function that includes the use of assistive devices during the period when a patient is still able to perform many activities of daily living is important. Although decreases in activities of daily living functioning were closely related to decreases in the quality of life in the physical function domains, the scores of the domains other than physical function were similar to the national standard score.. |
| 410. |
Masuo Hanada, Hideki Kadota, Sei Yoshida, Naohide Takeuchi, Takamitsu Okada, Yoshihiro Matsumoto, Yasuharu Nakashima, Large-defect Resurfacing: A Comparison of Skin Graft Results Following Sarcoma Resection and Traumatic Injury Repair., Wounds : a compendium of clinical research and practice, 31, 7, 184-192, 2019.07, INTRODUCTION: Soft tissue sarcomas are rare neoplasms, and most plastic surgeons do not commonly resurface large tissue defects after a wide resection of these tumors. OBJECTIVE: The purpose of this study is to elucidate the clinical results of large skin grafts after wide sarcoma resection by comparison with grafts for traumatic skin defects. MATERIALS AND METHODS: A retrospective review was performed of patients who received skin grafts > 50 cm2 after traumatic injury or wide sarcoma resection from 2014 to 2016. Patient medical records were reviewed; graft take rate, graft loss, and days to complete epithelialization were compared between the 2 groups. RESULTS: In the sarcoma group (n = 8), 5 grafts were partially lost; the sarcoma group mean graft take rate of 67.5% ± 30.0% was significantly lower than that of the trauma group (n = 7) at 99.6% ± 1.1%. The mean time to complete epithelialization from the skin graft placement in the sarcoma group was 113.3 ± 66.0 days, which was significantly longer than that of the trauma group (40.3 ± 38.0 days). Wounds located around the shoulder joint in 2 sarcoma group patients did not heal even after 300 days of conservative treatment; 1 required a secondary flap. CONCLUSIONS: The results of skin grafting for resurfacing large defects after sarcoma resection are inferior to those for traumatic injury repair. Skin grafts may fail because the blood supply for the wound bed is impaired during resection. Furthermore, due to the wound bed movement, epithelialization over muscles of the shoulder joint is difficult to achieve, and skin grafts in this region will likely fail.. |
| 411. |
Keiichiro Iida, Katsumi Harimaya, Kiyoshi Tarukado, Osamu Tono, Yoshihiro Matsumoto, Yasuharu Nakashima, Kyphosis Progression after Balloon Kyphoplasty Compared with Conservative Treatment., Asian spine journal, 10.31616/asj.2018.0329, 13, 6, 928-935, 2019.07, Study Design: Retrospective cohort study (level of evidence: 4). Purpose: To demonstrate the effects of balloon kyphoplasty (BKP) on prevention of kyphosis progression. Overview of Literature: Kyphoplasty can correct local kyphosis (fractured vertebra), but its efficacy is attenuated by adjacent fracture and/or disc height reduction with endplate damage. With these attenuating factors incorporated, a comparison between BKP and conservative treatment is necessary to verify the effect of BKP on kyphosis correction. Methods: This study retrospectively analyzed 129 patients treated conservatively and 95 treated with BKP in our institution. The rate of new adjacent fracture occurrence was determined using Kaplan-Meier analysis. We examined the progression of local kyphosis in patients who underwent lateral X-ray after 1 year. Local kyphosis was measured as an angle between higher end plate of the vertebra above and lower end plate of the vertebra below the fractured vertebra. The comparison included 45 patients treated conservatively and 58 treated with BKP. Results: The incidence of new adjacent fracture at 1 year was 7.3% in the conservative treatment group and 23.2% in the BKP group (p |
| 412. |
Jun-Ichi Fukushi, Hidetoshi Tsushima, Yoshihiro Matsumoto, Chikage Mitoma, Masutaka Furue, Hisaaki Miyahara, Yasuharu Nakashima, Influence of dioxin-related compounds on physical function in Yusho incident victims., Heliyon, 10.1016/j.heliyon.2019.e02702, 5, 10, e02702, 2019.10, Purpose: Few studies have examined the influence of dioxin-related compounds on human physical function, and existing results are inconsistent. In 1968, accidental human exposure to rice oil contaminated with dioxin-related compounds resulted in the development of Yusho oil disease in Japan. We aimed to determine whether the degree of exposure to dioxin-related compounds was associated with physical function in Yusho patients. Methods: In 2016, 65 men (average age: 65.7 years) and 77 women (average age: 64.7 years) participated in a nationwide health examination in Fukuoka prefecture. Functional reach, gait speed, hand grip strength, and toe grip strength were evaluated as part of physical function. The serum levels of polychlorinated dibenzo-p-dioxin, polychlorinated dibenzofurans, and non-ortho polychlorinated biphenyls were measured using high-resolution gas chromatography and high-resolution mass spectrometry. We examined the association between physical function tests and serum toxic equivalency (TEQ) values. Results: A 10-fold increase in serum TEQ levels was negatively associated with functional reach (adjusted b = -4.07, p = 0.017) and hand grip strength (adjusted b = -2.20, p = 0.0245) in men. No association was observed between serum TEQ level and physical function in women. Conclusion: Our findings suggest that dioxin-related compounds have a negative influence on physical function in men. However, these findings should be interpreted carefully. Future studies examining additional data on musculoskeletal disorders are warranted.. |
| 413. |
Keisuke Komiyama, Satoshi Hamai, Satoru Ikebe, Kensei Yoshimoto, Hidehiko Higaki, Kyohei Shiomoto, Hirotaka Gondo, Daisuke Hara, Yifeng Wang, Yasuharu Nakashima, In vivo kinematic analysis of replaced hip during stationary cycling and computer simulation of optimal cup positioning against prosthetic impingement., Clinical biomechanics (Bristol, Avon), 10.1016/j.clinbiomech.2019.05.035, 68, 175-181, 2019.08, BACKGROUND: Dynamic hip kinematics during stationary cycling after total hip arthroplasty (THA) have been unclear. Furthermore, no computer simulation of optimal cup position based on in vivo kinematics has yet been assessed. METHODS: This study consisted of 7 patients who underwent unilateral primary THA for symptomatic osteoarthritis. Using a flat-panel X-ray detector, continuous radiographs were obtained during stationary cycling. We analyzed the three-dimensional replaced hip kinematics from the top to the bottom position of the crank using image-matching techniques and quantified minimum liner-to-stem neck distance. Simulation analyses with in vivo kinematics were performed to examine patient-specific optimal cup placement against prosthetic impingement. FINDINGS: During stationary cycling, pelvis showed 27.1° of posterior tilt on average without significant change. Hip flexed by 59.4° and 19.3° on average at the top and bottom positions, respectively. Minimum liner-to-neck distance was 8.8 mm on average at the bottom position. Liner-to-neck, bone-to-bone, or bone-to-component impingement was not observed at any positions in any hips. Simulation analysis of cup placement showed that larger cup anteversion, inclination, and use of elevated liner significantly decreased the minimum distance between posterior liner and stem neck. Cup anteversion of more than 30° with elevated liner could cause posterior liner-to-neck impingement at bottom position. INTERPRETATION: Stationary cycling after THA provides no excessive hip range of motion or liner-to-neck contact. Cup placement and use of elevated liner significantly influence the minimum liner-to-neck distance, in some cases simulating posterior prosthetic impingement.. |
| 414. |
Yuta Sakemi, Keisuke Komiyama, Kensei Yoshimoto, Kyohei Shiomoto, Miho Iwamoto, Yasuharu Nakashima, How does anteroposterior cup placement affect bone coverage and range of motion in primary total hip arthroplasty for hip dysplasia?, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 10.1016/j.jos.2018.08.019, 24, 2, 269-274, 2019.03, BACKGROUND: Due to anterior bone defects, high and/or posterior placement of an acetabular cup is often required to achieve sufficient coverage in patients with hip dysplasia. We examined whether posterior cup placement affected the postoperative range of motion (ROM) in primary total hip arthroplasty (THA). METHODS: Using computer software, bone coverage and ROM were examined in 32 patients with unilateral osteoarthritis of the hip with Crowe type II or III hip dysplasia. We determined the cup position to satisfy cup center-edge (Cup-CE) angle ≥0° and the required ROM. The cup was placed at the anatomic hip center and moved in 2-mm increments anteroposteriorly and 10-mm increments vertically. RESULTS: At vertical anatomic hip center, less than 68.8% hips fulfilled Cup-CE ≥0° regardless of anteroposterior position. Significantly more hips at higher hip center with posterior cup placement achieved Cup-CE ≥0° than hips at vertical anatomic hip center, and 10 mm higher hip center was the most suitable for achieving bone coverage. However, posterior and superior cup placement significantly decreased the flexion and IR due to early bone impingement, whereas ER and extension were not affected. A smoothing spline curve demonstrated that more posterior cup placement than 4.8 mm and 3.6 mm did not satisfy the required ROM at 10 mm and 20 mm higher hip center, respectively. CONCLUSIONS: Posterosuperior cup placement gained more bone coverage but decreased the range of hip flexion and internal rotation. Consequently, posterosuperior cup placement did not satisfy the required ROM.. |
| 415. |
Yoshitaka Nakanishi, Takamitsu Okada, Naohide Takeuchi, Naoya Kozono, Takahiro Senju, Koichi Nakayama, Yasuharu Nakashima, Histological evaluation of tendon formation using a scaffold-free three-dimensional-bioprinted construct of human dermal fibroblasts under in vitro static tensile culture., Regenerative therapy, 10.1016/j.reth.2019.02.002, 11, 47-55, 2019.12, Introduction: Tendon tissue engineering requires scaffold-free techniques for safe and long-term clinical applications and to explore alternative cell sources to tenocytes. Therefore, we histologically assessed tendon formation in a scaffold-free Bio-three-dimensional (3D) construct developed from normal human dermal fibroblasts (NHDFs) using our Bio-3D printer system under tensile culture in vitro. Methods: Scaffold-free ring-like tissues were constructed from 120 multicellular spheroids comprising NHDFs using a bio-3D printer. Ring-like tissues were cultured in vitro under static tensile-loading with or without in-house tensile devices (tension-loaded and tension-free groups), with increases in tensile strength applied weekly to the tensile-loaded group. After a 4 or 8-week culture on the device, we evaluated histological findings according to tendon-maturing score and immunohistological findings of the middle portion of the tissues for both groups (n = 4, respectively). Results: Histology of the tension-loaded group revealed longitudinally aligned collagen fibers with increased collagen deposition and spindle-shaped cells with prolonged culture. By contrast, the tension-free group showed no organized cell arrangement or collagen fiber structure. Additionally, the tension-loaded group showed a significantly improved tendon-maturing score as compared with that for the tension-free group at week 8. Moreover, immunohistochemistry revealed tenascin C distribution with a parallel arrangement in the tensile-loading direction at week 8 in the tension-loaded group, which exhibited stronger scleraxis-staining intensity than that observed in the tension-free group at weeks 4 and 8. Conclusions: The NHDF-generated scaffold-free Bio-3D construct underwent remodeling and formed tendon-like structures under tensile culture in vitro.. |
| 416. |
Yuta Sakemi, Koichiro Hayashi, Akira Tsuchiya, Yasuharu Nakashima, Kunio Ishikawa, Fabrication and Histological Evaluation of Porous Carbonate Apatite Block from Gypsum Block Containing Spherical Phenol Resin as a Porogen., Materials (Basel, Switzerland), 10.3390/ma12233997, 12, 23, 2019.12, The utility of carbonate apatite (CO3Ap) as a bone substitute has been demonstrated. The feasibility of fabricating macroporous CO3Ap was evaluated through a two-step dissolution-precipitation reaction using gypsum as the precursor and spherical phenol resin as the porogen. Porogen-containing gypsum was heated to burn out the porogen and to fabricate macroporous structures. Gypsum transformed into CaCO3 upon immersion in a sodium carbonate solution, while maintaining its macroporous structure. Next, CaCO3 transformed into CO3Ap upon immersion in a Na2HPO4 solution while maintaining its macroporous structure. The utility of the macroporous CO3Ap for histologically reconstructing bone defects was evaluated in rabbit femurs. After 4 weeks, a much larger bone was formed inside the macroporous CO3Ap than that inside non-macroporous CO3Ap and macroporous hydroxyapatite (HAp). A larger amount of bone was observed inside non-macroporous CO3Ap than inside macroporous HAp. The bone defects were completely reconstructed within 12 weeks using macroporous CO3Ap. In conclusion, macroporous CO3Ap has good potential as an ideal bone substitute.. |
| 417. |
Ichiro Kurakazu, Yukio Akasaki, Mitsumasa Hayashida, Hidetoshi Tsushima, Norio Goto, Takuya Sueishi, Masakazu Toya, Masanari Kuwahara, Ken Okazaki, Tomas Duffy, Martin K Lotz, Yasuharu Nakashima, FOXO1 transcription factor regulates chondrogenic differentiation through transforming growth factor β1 signaling., The Journal of biological chemistry, 10.1074/jbc.RA119.009409, 294, 46, 17555-17569, 2019.11, The forkhead box O (FOXO) proteins are transcription factors involved in the differentiation of many cell types. Type II collagen (Col2) Cre-Foxo1-knockout and Col2-Cre-Foxo1,3,4 triple-knockout mice exhibit growth plate malformation. Moreover, recent studies have reported that in some cells, the expressions and activities of FOXOs are promoted by transforming growth factor β1 (TGFβ1), a growth factor playing a key role in chondrogenic differentiation. Here, using a murine chondrogenic cell line (ATDC5), mouse embryos, and human mesenchymal stem cells, we report the mechanisms by which FOXOs affect chondrogenic differentiation. FOXO1 expression increased along with chondrogenic differentiation, and FOXO1 inhibition suppressed chondrogenic differentiation. TGFβ1/SMAD signaling promoted expression and activity of FOXO1. In ATDC5, FOXO1 knockdown suppressed expression of sex-determining region Y box 9 (Sox9), a master regulator of chondrogenic differentiation, resulting in decreased collagen type II α1 (Col2a1) and aggrecan (Acan) expression after TGFβ1 treatment. On the other hand, chemical FOXO1 inhibition suppressed Col2a1 and Acan expression without suppressing Sox9 To investigate the effects of FOXO1 on chondrogenic differentiation independently of SOX9, we examined FOXO1's effects on the cell cycle. FOXO1 inhibition suppressed expression of p21 and cell-cycle arrest in G0/G1 phase. Conversely, FOXO1 overexpression promoted expression of p21 and cell-cycle arrest. FOXO1 inhibition suppressed expression of nascent p21 RNA by TGFβ1, and FOXO1 bound the p21 promoter. p21 inhibition suppressed expression of Col2a1 and Acan during chondrogenic differentiation. These results suggest that FOXO1 is necessary for not only SOX9 expression, but also cell-cycle arrest during chondrogenic differentiation via TGFβ1 signaling.. |
| 418. |
Takamitsu Okada, Hidehiko Yuge, Takeshi Kamitani, Takahiro Senju, Naohide Takeuchi, Koji Sagiyama, Naoya Kozono, Yoshitaka Nakanishi, Hiroshi Honda, Yasuharu Nakashima, Evaluation of humeral head cartilage using magnetic resonance imaging T1 rho mapping for patients with small-to-medium rotator cuff tears: A pilot study., Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 10.1016/j.jos.2018.10.002, 24, 2, 258-262, 2019.03, BACKGROUND: It is unclear whether smaller rotator cuff tears cause cartilage degeneration. This study was designed to detect early humeral head cartilage degeneration in patients with small-to-medium cuff tears using magnetic-resonance-imaging T1 rho mapping. METHODS: Five male and 5 female volunteers without shoulder symptoms (control group) and 5 male and 5 female patients with small-to-medium ( |
| 419. |
Keisuke Komiyama, Satoshi Hamai, Daisuke Hara, Satoru Ikebe, Yifeng Wang, Hirotaka Gondo, Hidehiko Higaki, Yasuharu Nakashima, Dynamic hip kinematics during recreational classical ballet and hula dance after total hip arthroplasty: two case reports., Journal of medical case reports, 10.1186/s13256-018-1942-2, 13, 1, 11-11, 2019.01, BACKGROUND: The in vivo assessment of the three-dimensional kinematics of the hip during dance activities in patients after total hip arthroplasty has not been previously reported. We evaluated the replaced hip kinematics during recreational classical ballet and hula dance using radiographic-based image-matching techniques. CASE PRESENTATION: A 58-year-old Japanese woman (patient 1; height, 157 cm; weight, 74.5 kg) and a 73-year-old Japanese woman (patient 2; height, 153 cm; weight, 48 kg) were still doing classical ballet and hula dance, respectively, after primary total hip arthroplasty. For ballet, there were gradual three-dimensional hip movements with 48° flexion, 36° abduction, and 49° external rotation in développé and 34° flexion, 29° abduction, and 43° external rotation in plié. For hula, there were small three-dimensional hip movements with 31° flexion, 15° adduction, and 11° external rotation in kao and 17° flexion, 11° adduction, and 11° external rotation in kaholo. No liner-to-neck contact was found in any dance activities. CONCLUSION: Both classical ballet and hula dance produced complex ranges of hip movements and activity-dependent kinematics. These kinematic data could be useful for recommending each patient with total hip arthroplasty to continue recreational dance activities.. |
| 420. |
Makoto Nakagawa, Shuhei Fujita, Takuo Katsumoto, Kazutsune Yamagata, Yoko Ogawara, Ayuna Hattori, Yuki Kagiyama, Daisuke Honma, Kazushi Araki, Tatsuya Inoue, Ayako Kato, Koichiro Inaki, Chisa Wada, Yoshimasa Ono, Masahide Yamamoto, Osamu Miura, Yasuharu Nakashima, Issay Kitabayashi, Dual inhibition of enhancer of zeste homolog 1/2 overactivates WNT signaling to deplete cancer stem cells in multiple myeloma., Cancer science, 10.1111/cas.13840, 110, 1, 194-208, 2019.01, Multiple myeloma (MM) is an incurable hematological malignancy caused by accumulation of abnormal clonal plasma cells. Despite the recent development of novel therapies, relapse of MM eventually occurs as a result of a remaining population of drug-resistant myeloma stem cells. Side population (SP) cells show cancer stem cell-like characteristics in MM; thus, targeting these cells is a promising strategy to completely cure this malignancy. Herein, we showed that SP cells expressed higher levels of enhancer of zeste homolog (EZH) 1 and EZH2, which encode the catalytic subunits of Polycomb repressive complex 2 (PRC2), than non-SP cells, suggesting that EZH1 as well as EZH2 contributes to the stemness maintenance of the MM cells and that targeting both EZH1/2 is potentially a significant therapeutic approach for eradicating myeloma stem cells. A novel orally bioavailable EZH1/2 dual inhibitor, OR-S1, effectively eradicated SP cells and had a greater antitumor effect than a selective EZH2 inhibitor in vitro and in vivo, including a unique patient-derived xenograft model. Moreover, long-term continuous dosing of OR-S1 completely cured mice bearing orthotopic xenografts. Additionally, PRC2 directly regulated WNT signaling in MM, and overactivation of this signaling induced by dual inhibition of EZH1/2 eradicated myeloma stem cells and negatively affected tumorigenesis, suggesting that repression of WNT signaling by PRC2 plays an important role in stemness maintenance of MM cells. Our results show the role of EZH1/2 in the maintenance of myeloma stem cells and provide a preclinical rationale for therapeutic application of OR-S1, leading to significant advances in the treatment of MM.. |
| 421. |
Keisuke Komiyama, Jun-Ichi Fukushi, Goro Motomura, Satoshi Hamai, Satoshi Ikemura, Masanori Fujii, Yasuharu Nakashima, Does high hip centre affect dislocation after total hip arthroplasty for developmental dysplasia of the hip?, International orthopaedics, 10.1007/s00264-018-4154-x, 43, 9, 2057-2063, 2019.09, BACKGROUND: To achieve sufficient socket coverage by the native bone, high placement of cementless acetabular cup is often required. We previously reported, using computer simulation, that higher hip centre improved the bone coverage but decreased the range of motion in total hip arthroplasty (THA) for patients with hip dysplasia. However, in a clinical setting, the correlation between the hip centre height and dislocation after primary THA is still unclear. We examined whether a high hip centre affects dislocation after THA. METHODS: A total of 910 patients, with 1079 dysplastic hips, who underwent primary THA were retrospectively reviewed. The age at THA averaged 63.0 years and mean follow-up was 74.3 months. Vertical centre of rotation (V-COR) was defined as the distance from the head centre to the interteardrop line. Uni- and multivariate logistic regression models were applied to identify significant factors affecting dislocation. RESULTS: Ten hips in nine patients (0.9%) had dislocation after THA. In univariate analysis, age at surgery and V-COR were significant risk factors for dislocation. Multivariate analysis identified advanced age at operation (odds ratio [OR] 1.8/5 years), Crowe classification (OR 15.6), V-COR (OR 3.1/5 mm), and femoral head size (OR 11.6) as independent risk factors for dislocation. Receiver operating characteristic curve analysis revealed the cutoff value of the V-COR for dislocation as 23.9 mm. CONCLUSIONS: A higher hip centre with the V-COR > 23.9 mm affected dislocation after THA for DDH. Our results would be useful for reconstruction of the hip centre, particularly with cementless acetabular cups.. |
| 422. |
Tetsuya Tachibana, Masanori Fujii, Kenji Kitamura, Tetsuro Nakamura, Yasuharu Nakashima, Does Acetabular Coverage Vary Between the Supine and Standing Positions in Patients with Hip Dysplasia?, Clinical orthopaedics and related research, 10.1097/CORR.0000000000000898, 477, 11, 2455-2466, 2019.11, BACKGROUND: Although variation in physiologic pelvic tilt may affect acetabular version and coverage, postural change in pelvic tilt in patients with hip dysplasia who are candidates for hip preservation surgery has not been well characterized, and its clinical importance is unknown. QUESTIONS/PURPOSES: The aim of this study was to determine (1) postural changes in sagittal pelvic tilt between the supine and standing positions; (2) postural changes in the acetabular orientation and coverage of the femoral head between the supine and standing positions; and (3) patient demographic and morphologic factors associated with sagittal pelvic tilt. METHODS: Between 2009 and 2016, 102 patients underwent pelvic osteotomy to treat hip dysplasia. All patients had supine and standing AP pelvic radiographs and pelvic CT images taken during their preoperative examination. Ninety-five patients with hip dysplasia (lateral center-edge angle |
| 423. |
Masato Kiyohara, Satoshi Hamai, Daisuke Hara, Daisuke Fujiyoshi, Satoru Harada, Kenichi Kawaguchi, Yasuharu Nakashima, Do component position and muscle strength affect the cup-head translation during gait after total hip arthroplasty?, European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 10.1007/s00590-019-02443-1, 29, 6, 1263-1269, 2019.08, INTRODUCTION: This study examined whether the component position or muscle strength affects the cup-head translation under in vivo weight-bearing conditions after total hip arthroplasty (THA). We hypothesized that there was a correlation between the hip offset or abductor strength and cup-head translation during gait. MATERIALS AND METHODS: We prospectively evaluated 31 patients undergoing unilateral cementless primary THA. The cup height, cup/stem offset, and limb length discrepancy were measured on anterior-posterior bilateral hip radiographic images. The isometric muscle strength of the lower limbs was quantified using a handheld dynamometer. Continuous radiographic images were recorded during gait, and cup-head translation was analysed using a computer-assisted method. RESULTS: The average cup height, cup/stem offset, and limb length discrepancy were - 3.8 ± 5.1 mm, 1.2 ± 5.2 mm/- 0.7 ± 7.7 mm, and - 2.1 ± 5.2 mm, respectively. The average hip abductor/flexor and knee extensor strength were 86% ± 18%/85% ± 17% and 88% ± 17% of the contralateral healthy hip, respectively. The average cup-head translation during swing phase of gait was - 0.003 ± 0.31 mm. Multiple regression analyses found no significant independent predictors of cup-head translation (p > 0.05). CONCLUSIONS: The component position or muscle strength did not significantly influence cup-head translation during gait after well-positioned primary THA.. |
| 424. |
Hiroyuki Hatanaka, Goro Motomura, Satoshi Ikemura, Yusuke Kubo, Takeshi Utsunomiya, Shoji Baba, Koichiro Kawano, Yasuharu Nakashima, Differences in magnetic resonance findings between symptomatic and asymptomatic pre-collapse osteonecrosis of the femoral head., European journal of radiology, 10.1016/j.ejrad.2019.01.002, 112, 1-6, 2019.03, PURPOSE: The purpose of this study was to assess the differences in magnetic resonance (MR) findings between the symptomatic and asymptomatic pre-collapse stage of osteonecrosis of the femoral head (ONFH). MATERIALS AND METHODS: This study reviewed 123 consecutive hips in 91 patients in the pre-collapse stage of ONFH based on plain radiographic findings. These 123 hips were divided into symptomatic and asymptomatic groups according to the pain domain score in the Harris hip score system. Bone marrow edema (BME), synovial fluid effusion, and subchondral fracture were evaluated using MR imaging. Odds ratios (ORs) were calculated between these three parameters and symptoms. The subsequent clinical course after MR examination was also assessed for each hip that could be followed more than 1 year. RESULTS: Forty-six hips (37.4%) were categorized as symptomatic and 77 hips (62.6%) as asymptomatic. The prevalence of BME, synovial fluid effusion, and subchondral fracture were 87.0% (40/46), 80.4% (37/46), and 34.8% (16/46), respectively, in the symptomatic group, and 0%, 28.6% (22/77), and 0%, respectively, in the asymptomatic group, indicating significant differences between the two groups (p |
| 425. |
Makoto Endo, Nokitaka Setsu, Toshifumi Fujiwara, Takeaki Ishii, Makoto Nakagawa, Kenichiro Yahiro, Atsushi Kimura, Eijiro Shimada, Yasuharu Nakashima, Yoshihiro Matsumoto, Diagnosis and Management of Subcutaneous Soft Tissue Sarcoma., Current treatment options in oncology, 10.1007/s11864-019-0656-z, 20, 7, 54-54, 2019.05, OPINION STATEMENT: The proper diagnosis and treatment planning for subcutaneous soft tissue sarcoma is very important. Soft tissue tumors can occur anywhere in the body, but if they occur subcutaneously, patients can easily notice a subcutaneous soft tissue mass. Therefore, it is possible to determine through recording, the growth speed of the mass, which is often difficult to obtain with deep-situated soft tissue masses. Palpation can also provide information about the firmness and mobility of the mass. Thus, history taking and physical examinations are informative for subcutaneous soft tissue tumors, compared to tumors that occur deeply. Because subcutaneous soft tissue tumors are easily recognized, they are often resected, without sufficient imaging analyses or thorough treatment planning. An operation performed based on such an inadequate preoperative plan is called a "whoops surgery." In the case of "whoops surgeries," subsequent radical surgery is required to remove additional areas, including hematomas that result from the initial surgery, that require a wider range of resection and soft tissue reconstruction. Therefore, as with deep-seated soft tissue tumors, it is important to conduct careful imaging examinations and make appropriate preoperative plans for subcutaneous soft tissue tumors. Subcutaneous soft tissue sarcomas often show an invasive pattern, and such tumors require a more careful assessment to prevent local recurrence after surgery. During surgery, it is necessary to remove the entire infiltration area along the fascia. Sometimes, an adequately wide excision is necessary, which is considered the minimum necessary procedure to eradicate the lesion. As noted above, clinicians who see patients with subcutaneous soft tissue tumors are encouraged to have sufficient knowledge and experience regarding the diagnosis and treatment. This article is intended for all doctors who deal with subcutaneous soft tissue tumors and focuses on essential points regarding their diagnosis and management.. |
| 426. |
Tetsuro Ushio, Ken Okazaki, Kanji Osaki, Yukihisa Takayama, Koji Sagiyama, Hideki Mizu-Uchi, Satoshi Hamai, Yukio Akasaki, Hiroshi Honda, Yasuharu Nakashima, Degenerative changes in cartilage likely occur in the medial compartment after anterior cruciate ligament reconstruction., Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 10.1007/s00167-019-05468-5, 27, 11, 3567-3574, 2019.11, PURPOSE: Magnetic resonance imaging with T1ρ mapping is used to quantify the amount of glycosaminoglycan in articular cartilage, which reflects early degenerative changes. The purposes of this study were to evaluate early degenerative changes in knees after anterior cruciate ligament (ACL) reconstruction by comparing T1ρ values before and 2 years after surgery and investigate whether surgical factors and clinical outcomes are related to differences in T1ρ values. METHODS: Fifty patients who underwent unilateral primary ACL reconstruction were evaluated using T1ρ mapping before and 2 years after surgery. Three regions of interest (ROIs) were defined in the cartilage associated with the medial (M) and lateral (L) weight-bearing areas of the femoral condyle (FC) (anterior: MFC1 and LFC1, middle: MFC2 and LFC2, and posterior: MFC3 and LFC3). Two ROIs associated with the tibial plateau (T) were defined (anterior: MT1 and LT1, and posterior: MT2 and LT2). T1ρ values within the ROIs were measured before and 2 years after surgery and compared using the paired t test. Correlations between the difference in T1ρ values at these two time points and patient characteristics, presence of a cartilaginous lesion, graft type, and postoperative anteroposterior laxity were also evaluated using Pearson's and Spearman's correlation coefficients. RESULTS: There was a significant increase in T1ρ before versus 2 years after surgery in the MT1, MT2, LFC1, and LT1 areas, and a significant decrease in the LFC3 and LT2 areas. There was a significant correlation between postoperative anterior-posterior laxity and a postoperative increase in T1ρ values in the MFC3 (r = 0.37, P = 0.013) and MT2 (r = 0.35, P = 0.021) areas. Increases in T1ρ values in the MFC2 area were negatively correlated with KOOS symptoms (ρ = - 0.349, P = 0.027) and quality of life (ρ = - 0.374, P = 0.017) subscale scores. CONCLUSION: Early degenerative changes in medial articular cartilage were observed with T1ρ mapping at 2 years after ACL reconstruction. Postoperative anterior-posterior laxity is correlated with an increase in T1ρ values in the posteromedial femur and tibia. An increase in T1ρ values in the central medial femoral condyle was associated with knee symptoms. LEVEL OF EVIDENCE: III.. |
| 427. |
Umito Kuwashima, Ryohei Takeuchi, Hiroyuki Ishikawa, Mikio Shioda, Yasuharu Nakashima, Steffen Schröter, Comparison of torsional changes in the tibia following a lateral closed or medial open wedge high tibial osteotomy., The Knee, 10.1016/j.knee.2019.01.009, 26, 2, 374-381, 2019.03, OBJECTIVE: The aim of this study is to evaluate, by computed tomography (CT), whether different torsional changes occur in the tibia following a lateral closed wedge high tibial osteotomy (CWHTO) versus a medial open wedge high tibial osteotomy (OWHTO) procedure. It was hypothesized that the distal fragment of the tibia would show greater internal rotation after CWHTO. METHODS: Thirty knees from 25 patients who underwent HTO were enrolled. Fifteen knees of 14 patients who underwent CWHTO and 15 knees of 11 patients who received OWHTO were match-paired. CT scans were taken before and three weeks after surgery. Rotational changes in the distal fragment of the tibia were assessed by measuring the tibial torsion angle (TTA). RESULTS: The mean TTA in the CWHTO group pre-operatively and postoperatively was +23.9° ± 7.8° and + 18.2° ± 7.0°, respectively. Internal rotation of the distal fragment of the tibia after CWHTO was -5.7 ± 3.3° (P 0.05). CONCLUSIONS: The distal fragment of the tibia rotated internally after CWHTO but not after OWHTO. LEVEL OF EVIDENCE: Level III: case-control study.. |
| 428. |
Yuichi Yamada, Kenichi Kohashi, Izumi Kinoshita, Hidetaka Yamamoto, Takeshi Iwasaki, Masato Yoshimoto, Shin Ishihara, Yu Toda, Yoshihiro Itou, Yutaka Koga, Mikiko Hashisako, Yui Nozaki, Daisuke Kiyozawa, Daichi Kitahara, Takeshi Inoue, Munenori Mukai, Yumi Honda, Gouji Toyokawa, Kenji Tsuchihashi, Yoshifumi Matsushita, Fumiyoshi Fushimi, Kenichi Taguchi, Sadafumi Tamiya, Yumi Oshiro, Masutaka Furue, Yasuharu Nakashima, Satoshi Suzuki, Toru Iwaki, Yoshinao Oda, Clinicopathological review of solitary fibrous tumors: dedifferentiation is a major cause of patient death., Virchows Archiv : an international journal of pathology, 10.1007/s00428-019-02622-9, 475, 4, 467-477, 2019.10, Solitary fibrous tumor (SFT) is a soft-tissue neoplasm of intermediate malignant potential, presenting a wide histopathological spectrum. Poorer prognosis of hemangiopericytoma of the central nervous system (CNS), hypoglycemic SFT, and dedifferentiation are well-known characters of SFT, but their clinical significance were not demonstrated enough by large-sized study. Here, the clinicopathological features of SFTs are reviewed and the relationship between genetics and clinicopathological features is examined using 145 SFT cases. All cases were STAT6 IHC-positive and/or NAB2-STAT6 fusion gene-positive. Tumor location was classified into three categories: 30 pleuropulmonary, 96 non-pleuropulmonary/non-central nervous system (CNS), and 18 CNS tumors. The tumor developed recurrence in 21 of 93 available cases (22.5%), metastasis in 11 of 93 (11.8%), and tumor death in 9 of 93 (9.6%). Hypoglycemia occurred in 2 primary tumors and 1 metastatic tumor among 63 reviewable cases, and dedifferentiation occurred in 10 cases (6.8%) including 6 primary tumors, 2 recurrent tumors, and 2 metastatic tumors. Recurrence was positively associated with CNS location (p = 0.0109) and hypoglycemia (p = 0.001); metastasis was positively associated with CNS location (p = 0.0231), hypoglycemia (p |
| 429. |
Yoshihiro Matsumoto, Akira Matsunobu, Kenichi Kawaguchi, Mistumasa Hayashida, Keiichiro Iida, Hirokazu Saiwai, Seiji Okada, Makoto Endo, Nokitaka Setsu, Toshifumi Fujiwara, Shingo Baba, Satoshi Nomoto, Yasuharu Nakashima, Clinical results of carbon-ion radiotherapy with separation surgery for primary spine/paraspinal sarcomas., International journal of clinical oncology, 10.1007/s10147-019-01505-y, 24, 11, 1490-1497, 2019.11, PURPOSE: To evaluate the clinical outcome of combination of carbon-ion radiotherapy with separation surgery (CIRT-SS) in patients with primary spinal/paraspinal sarcoma (PSPS) and epidural spinal cord compression (ESCC). METHODS: CIRT-SS was performed in 11 consecutive patients. Patients treated in the primary and salvage settings were categorized into Group A (n = 8) and Group B (n = 3), respectively. Clinical results and imaging findings were collected, with a particular focus on ESCC grade, treatment-associated adverse events (AEs), and the locoregional control (LRC) rate and overall survival (OS). RESULTS: The median follow-up period from the start of CIRT-SS was 25 months (7-57 months). ESCC was improved by SS in all cases. No patients exhibited radiation-induced myelopathy (RIM), but three developed Grade 3 vertebral compression fracture (VCF) during follow-up. Locoregional recurrences were observed in four patients [Group A: 1 (12.5%), Group B: 3 (100%)]. Over the entire follow-up period, three patients developed distant metastases and two patients died. The 2-year LRC rate and OS were 70% and 80%, respectively. CONCLUSION: CIRT-SS in the primary setting achieved acceptable LRC and OS without RIM in patients with PSPS and with ESCC. VCF was the most frequent AE associated with CIRT-SS.. |
| 430. |
Yuan Ma, Hideki Mizu-Uchi, Tetsuro Ushio, Satoshi Hamai, Yukio Akasaki, Koji Murakami, Yasuharu Nakashima, Bony landmarks with tibial cutting surface are useful to avoid rotational mismatch in total knee arthroplasty., Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 10.1007/s00167-018-5052-x, 27, 5, 1570-1579, 2019.05, PURPOSE: The purpose of this study was to define various anteroposterior axes of the tibial component as references and to evaluate their accuracy and variability using virtual surgery. It was hypothesized that (1) Akagi's Line could result in high accuracy and low variability in varus osteoarthritic knees; (2) anteroposterior axes defined by using the tibial bony cutting surface as a landmark might be good substitutes for Akagi's Line; and (3) extra-articular bony landmarks might influence the variability of the anteroposterior axis. METHODS: Three-dimensional bone models were reconstructed from the preoperative computed tomography data of 111 osteoarthritic knees with varus deformities. Seven different anteroposterior axes of the tibial component were defined: Akagi's Line, Axis MED, Axis 1/6MED, Axis 1/3MED, Axis of Oval Shape, Axis of Anterior Crest, and Axis Second Metatarsus. The rotational mismatch angle was measured between the tibial anteroposterior axis and the line perpendicular to the transepicondylar axis projected on the cutting surface (positive value: external rotation of the tibial anteroposterior axis). RESULTS: The average rotational mismatch angles (referring to the projected anatomical/surgical epicondylar axes) were - 2.7° ± 5.8°/1.0° ± 6.0° (Akagi's Line), - 4.2° ± 7.7°/- 0.5° ± 7.8°, 2.9° ± 7.2°/6.6° ± 7.2°, 9.8° ± 7.0°/13.5° ± 6.8° (Axis MED, Axis 1/6MED, Axis 1/3MED), - 5.1° ± 7.9°/- 1.4° ± 7.8° (Axis of Oval Shape), and 19.3 ± 9.5°/23.0° ± 9.6°, - 2.0° ± 11.3°/1.7° ± 11.4° (Axis Anterior Crest, Axis Second Metatarsus), respectively. CONCLUSIONS: Akagi's Line provided the best accuracy and least variability in varus osteoarthritic knees. Axis 1/6MED and Axis MED are good substitutes for Akagi's Line due to the difficulty of identifying the attachment site of the posterior cruciate ligament after the proximal tibia has been cut. Extra-articular bony landmarks should not be used for alignment due to their high variability. This study will aid surgeons in choosing the proper anteroposterior axis of the tibial component to reduce rotational mismatch and thus achieve good clinical knee outcomes. LEVELS OF EVIDENCE: III.. |
| 431. |
Takahiro Senju, Takamitsu Okada, Naohide Takeuchi, Naoya Kozono, Yoshitaka Nakanishi, Hidehiko Higaki, Takeshi Shimoto, Yasuharu Nakashima, Biomechanical analysis of four different medial row configurations of suture bridge rotator cuff repair., Clinical biomechanics (Bristol, Avon), 10.1016/j.clinbiomech.2019.07.015, 69, 191-196, 2019.10, BACKGROUND: Rotator cuff tendon rupture after suture bridge repair occasionally occurs at the medial row, with remnant tendon tissue remaining at the footprint. While concentrated medial row stress is suspected to be involved in such tears, the optimal suture bridge technique remains controversial. METHODS: This study aimed to investigate the construct strength provided by suture bridge techniques having four different medial row configurations using artificial materials (n = 10 per group): Group 1, four-hole (two stitches per hole) knotless suture bridge; Group 2, eight-hole (one stitch per hole) parallel knotless suture bridge; Group 3, eight-hole non-parallel knotless suture bridge; and Group 4, eight-hole knot-tying suture bridge. Each construct underwent cyclic loading from 5 to 30 N for 20 cycles, followed by tensile testing to failure. The ultimate failure load and linear stiffness were measured. FINDINGS: Group 2 had the highest ultimate failure load (mean 160.54 N, SD 6.40) [Group 4 (mean 150.21 N, SD 9.76, p = 0.0138), Group 3 (mean 138.80 N, SD 7.18, p |
| 432. |
Norio Goto, Ken Okazaki, Takenori Akiyama, Yukio Akasaki, Hideki Mizu-Uchi, Satoshi Hamai, Shunsuke Nakamura, Yasuharu Nakashima, Alignment factors affecting the medial meniscus extrusion increases the risk of osteoarthritis development., Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 10.1007/s00167-018-5286-7, 27, 8, 2617-2623, 2019.08, PURPOSE: Varus alignment is known as one of the major causes of medial compartment osteoarthritis (OA). Medial meniscus extrusion also plays a critical role in the in the development of OA. However, studies on the exact relationship between alignment parameters and medial meniscus extrusion are limited. Therefore, this study aimed to investigate this relationship in patients with knee OA. METHODS: Based on a retrospective analysis of the outpatient magnetic resonance imaging (MRI) database, 190 knees were identified to be examined using weight-bearing, whole-leg radiographs and MRIs within 3 months from the first consultation. Subsequently, various parameters of lower leg alignment were measured, which affected the knee varus in radiographs. Finally, a statistical analysis was performed to assess the relationships between the OA grade, distance of medial meniscus extrusion (MME), and alignment parameters; hip-knee-ankle angle (HKAA), percentage of mechanical axis (% MA), medial proximal tibial angle (MPTA), and joint line convergence angle (JLCA). The subjects were divided according to the presence or absence of MME (Group A: MME distance below 3 mm, Group B: MME distance 3 mm and above) to assess the differences in each alignment parameter correlated with MME distance between the groups. RESULTS: MME distance significantly increased with OA grade progression. HKAA, % MA, MPTA, and JLCA significantly correlated with medial meniscus extrusion distance (r = - 0.21, - 0.23, - 0.16, 0.3, respectively). Multiple regression analysis of each significant alignment combined with age, sex, and body mass index revealed that HKAA, % MA, MPTA, and JLCA were significant independent factors of MME distance (P = 0.008, 0.0026, 0.011, 0.0001, respectively). These significant findings were reinforced in group B. In contrast, the correlation between alignment parameters and medial meniscus extrusion distance was not significant in group A. CONCLUSION: Varus alignment factors are related to MME distance especially in extruded meniscus knees, as the OA grade progressed. Therefore, the coexistence of varus alignment and MME can be the risk factors for OA progression. As the low MPTA was an independent alignment factor for generating varus alignment, patients with osteoarthritis of the knee with both, low MPTA and MME could be the appropriate candidates for early intervention by high tibial osteotomy. LEVEL OF EVIDENCE: III.. |
| 433. |
Representative animal models of osteonecrosis of the femoral head for the development of treatment strategy. |
| 434. |
Late onset paralysis with bone sand after lumbar interbody fusion : report of two cases. |
| 435. |
Lower extremity pain after spinal cord compression involves STAT3-dependent reactive astrocytes and interleukin-6. |
| 436. |
市ヶ谷 憲, 花田 麻須大, 門田 英輝, 吉田 聖, 薛 宇孝, 遠藤 誠, 松本 嘉寛, 中島 康晴, 悪性軟部腫瘍切除後の適切な創閉鎖 再発症例での皮弁の必要性(Appropriate Wound Closure after Malignant Soft Tissue Tumor Excision: Need for Flap Surgery in Recurrent Tumors), 福岡医学雑誌, 111, 2, 86-91, 2020.06, 近年、悪性骨軟部腫瘍の集学的治療の進歩により再発症例においても患肢温存が可能になってきている。創閉鎖の成否は深部感染の予防の鍵を握っている。今回我々は、146人の軟部腫瘍広範切除後患者の再建法と臨床成績を調査した。初回適切切除は103例、初回不適切切除は15例、再発は28例であった。直接縫合が行えた107症例のうち105例は二次縫合以外の追加手術なしで上皮化したが、2例で追加再手術を要した。適切切除症例では80%で直接縫合が行えたのに対して、不適切切除症例では33%しか直接縫合が行えず、40%で皮弁を要した。再発例で再建を要する場合は全て皮弁術であった。不適切切除症例は皮膚再建の準備が必要である。再発症例は皮弁による再建を準備すべきである。(著者抄録). |
| 437. |
寛骨臼移動術の特徴とそのメリット. |
| 438. |
THA後のスポーツ動作解析. |
| 439. |
Goro Motomura, Takuaki Yamamoto, Yusuke Kubo, Takeshi Utsunomiya, Satoshi Hamai, Satoshi Ikemura, Masanori Fujii, Yasuharu Nakashima, Transtrochanteric Anterior Rotational Osteotomy Combined with Re-Sphericalization of the Collapsed Femoral Head Using Calcium Phosphate Cement Filling., Surgical technology international, 36, 347-350, 2020.05, INTRODUCTION: Transtrochanteric anterior rotational osteotomy (ARO) is an established joint-preserving surgery for collapsed osteonecrosis of the femoral head (ONFH) in which the collapsed necrotic lesion is rotated anteriorly. Recently, preoperative collapse of more than 2.98mm was reported to be the most influential factor for progressive collapse of the anteriorly transposed necrotic lesion after ARO, the main cause of secondary osteoarthritic changes and clinical failure. We attempted to prevent progressive collapse with re-sphericalization of the collapsed femoral head using calcium phosphate cement (CPC) filling in conjunction with ARO. MATERIALS AND METHODS: Between May 2015 and April 2018, five consecutive hips with ONFH, femoral head collapse of ³3mm, and one-third or more of the posterior region of the femoral head intact, were prospectively recruited for re-sphericalization with ARO. This report describes intraoperative surgical techniques focusing on re-sphericalization of the collapsed femoral head using CPC and short-term effects of this additional procedure on progressive collapse of the transposed necrotic lesion, defined as ³2mm progression on lateral radiographs. RESULTS: After anterior rotation of the proximal fragment, followed by fixation of the transtrochanteric osteotomy site, a 5mm fenestration was made in the collapsed region of the anterior femoral head cartilage, through which the collapsed surface was carefully lifted with an elevatrium. Subsequently, CPC paste was injected into the lifted subchondral space with a small needle. After CPC paste injection, the femoral head was maintained at 40°C for 10 minutes to promote solidification of the CPC paste. With the re-sphericalization method, the mean level of collapse decreased from 4.1mm before surgery to 2.0mm after surgery. Subsequently, progressive collapse of the transposed necrotic lesion was confirmed in two hips. One of these hips had a deep infection that required complete curettage of CPC three weeks after the initial surgery. All hip joints have been preserved without conversion to prosthesis during a mean follow up of 2.1 years. CONCLUSION: A joint-preserving procedure for ONFH with severe collapse remains a challenging problem for surgeons. When ARO is indicated based on one-third or more of the posterior region of the femoral head being intact, the current re-sphericalization method could be worth considering as an additional procedure in cases with severe collapse.. |
| 440. |
Shingo Yoshizaki, Kazuya Yokota, Kensuke Kubota, Takeyuki Saito, Masatake Tanaka, Dai-Jiro Konno, Takeshi Maeda, Yoshihiro Matsumoto, Yasuharu Nakashima, Seiji Okada, The beneficial aspects of spasticity in relation to ambulatory ability in mice with spinal cord injury., Spinal cord, 10.1038/s41393-019-0395-9, 58, 5, 537-543, 2020.05, STUDY DESIGN: Experimental study with mice. OBJECTIVES: Spasticity is a common complication after spinal cord injury (SCI) and has detrimental aspects, such as persistent pain and involuntary muscle spasms. This study aimed to assess the influence of antispastic therapy on locomotor function after SCI. SETTING: University-based laboratory in Fukuoka, Japan. METHODS: A mouse model of spasticity was developed by producing incomplete SCI at the 9th thoracic level. At 8 weeks after SCI, an antispastic drug, baclofen, was intraperitoneally administered to six injured and two sham-operated mice. The severity of spasticity was evaluated by the modified Ashworth scoring (MAS) system, and locomotor function was evaluated by the Basso-Beattie-Bresnahan (BBB) scale/Basso mouse score (BMS). RESULTS: The administration of baclofen significantly improved spasticity in the SCI mice and the mean MAS decreased to from 6.2 to 2.8. However, at the same time, it significantly exacerbated the locomotor dysfunction of the SCI mice and the mean BMS decreased from 4.7 to 2.3. The time-course of the changes in locomotor function coincided with the time-course of the spasticity score. We also confirmed that the administration of baclofen was not associated with any changes in either locomotor function or spasticity of the sham-operated control mice. CONCLUSIONS: Our results suggest that spasticity has a certain beneficial effect on ambulation ability. It is important to note that antispastic treatments may be associated with a risk of impairing the preserved function of chronic SCI patients.. |
| 441. |
Hirokazu Saiwai, Seiji Okada, Mitsumasa Hayashida, Katsumi Harimaya, Yoshihiro Matsumoto, Ken Ichi Kawaguchi, Kazu Kobayakawa, Takeshi Maeda, Hideki Ohta, Kenzo Shirasawa, Kuniyoshi Tsuchiya, Kazumasa Terada, Kouzo Kaji, Takeshi Arizono, Taichi Saito, Masami Fujiwara, Yukihide Iwamoto, Yasuharu Nakashima, Surgery-related predictable risk factors influencing postoperative clinical outcomes for thoracic myelopathy caused by ossification of the posterior longitudinal ligament: A multicenter retrospective study, Journal of Neurosurgery: Spine, 10.3171/2019.10.SPINE19831, 32, 5, 703-709, 2020.05, © AANS 2020, OBJECTIVE Compression of the spinal cord by thoracic ossification of the posterior longitudinal ligament (T-OPLL) often causes severe thoracic myelopathy. Although surgery is the most effective treatment for T-OPLL, problems associated with surgical intervention require resolution because surgical outcomes are not always favorable, and a small number of patients experience deterioration of their neurological status after surgery. The aim of the present study was to examine the surgery-related risk factors contributing to poor clinical outcomes for myelopathy caused by T-OPLL. METHODS Data were extracted from the records of 55 patients with thoracic myelopathy due to T-OPLL at institutions in the Fukuoka Spine Group. The mean follow-up period was 5.3 years. Surgical outcomes were assessed using the Japanese Orthopaedic Association (JOA) scale. To investigate the definitive factors associated with surgical outcomes, univariate and multivariate regression analyses were performed with several patient-related and surgery-related factors, including preoperative comorbidities, radiological findings, JOA score, surgical methods, surgical outcomes, and complications. RESULTS Neurological status improved in 33 patients (60.0%) and deteriorated in 10 patients (18.2%) after surgery. The use of instrumentation was significantly associated with an improved outcome. In the comparison of surgical approaches, posterior decompression and fusion resulted in a significantly higher neurological recovery rate than did anterior decompression via a posterior approach and fusion or decompression alone. It was also found that postoperative neurological status was significantly poorer when there were fewer instrumented spinal levels than decompression levels. CSF leakage was a predictable risk factor for deterioration following surgery. CONCLUSIONS It is important to identify preventable risk factors for poor surgical outcomes for T-OPLL. The findings of the present study suggest that intraoperative CSF leakage and a lower number of instrumented spinal fusion levels than decompression levels were exacerbating factors for the neurological improvement in T-OPLL surgery.. |
| 442. |
Yasuharu Nakashima, Masakazu Kondo, Eisuke Shono, Takashi Ishinishi, Hiroshi Tsukamoto, Koji Kuroda, Akira Maeyama, Hiroshi Harada, Masayuki Maekawa, Takashi Shimauchi, Ryuji Nagamine, Hiroshi Jojima, Seiji Yoshizawa, Tomomi Tsuru, Takeshi Otsuka, Hisaaki Miyahara, Eiichi Suematsu, Ken Wada, Shigeru Yoshizawa, Yasushi Inoue, Takaaki Fukuda, Satoshi Ikemura, Akihisa Haraguchi, Suppression of joint destruction with subcutaneous tocilizumab for Japanese patients with rheumatoid arthritis in clinical practice., Modern rheumatology, 10.1080/14397595.2019.1676369, 30, 5, 807-815, 2020.09, Objectives: To investigate the efficacy of suppressing joint destruction with subcutaneous tocilizumab (TCZ-SC) for Japanese rheumatoid arthritis (RA) patients in the real-world clinical setting.Methods: This 1-year prospective, multicenter study included 110 RA patients in whom TCZ-SC was newly initiated. Primary endpoint was the change from baseline in vdH-modified total Sharp score (mTSS) at week 52. Structural remission was defined as yearly mTSS of 0.5 or less. Disease activity was evaluated using the disease activity score (DAS28-ESR) and clinical disease activity index (CDAI).Results: At baseline, the patients' mean age was 58.6 years, and the mean disease duration was 10.6 years. The proportion of patients who were naïve for biologics was 44.5%, and 64.5% concomitantly received methotrexate. The yearly mTSS showed significant improvement from 9.41 before TCZ-SC initiation to -0.15 after 52 weeks. The structural remission rate was 76.1%. After 52 weeks, the DAS28-ESR and CDAI remission rates were 52% and 21%, respectively. Although the previous usage of biologics and baseline disease activity significantly affected the clinical remission, no factors with significant effects on structural remission were identified.Conclusion: These findings support the efficacy of TCZ-SC in suppressing disease activity as well as joint destruction over a 1-year period.. |
| 443. |
Ryosuke Yamaguchi, Tomoyuki Nakamura, Takuaki Yamamoto, Kazuyuki Takamura, Haruhisa Yanagida, Toru Yamaguchi, Yasuharu Nakashima, Subchondral fracture of the femoral head in children: Differential diagnosis of pediatric hip pain, JOURNAL OF ORTHOPAEDIC SURGERY, 10.1177/2309499020937862, 28, 2, 2020.05, This report describes clinical and radiographic characteristics of two pediatric patients with a presumptive diagnosis of subchondral fracture of the femoral head made based on their clinical course and imaging findings. An 8-year-old boy and an 8-year-old girl had subchondral fracture in the femoral head without osteonecrosis, which was verified by contrast-enhanced magnetic resonance imaging. Although complete disappearance of the fracture line was confirmed in the boy, the girl had a residual femoral head deformity after conservative treatment. Subchondral fracture of the femoral head should be included in the differential diagnosis of pediatric hip pain.. |
| 444. |
Toshifumi Fujiwara, Toshihiro Ebihara, Kazuki Kitade, Nokitaka Setsu, Makoto Endo, Keiichiro Iida, Yoshihiro Matsumoto, Tomoya Matsunobu, Yoshinao Oda, Yukihide Iwamoto, Yasuharu Nakashima, Risk Factors of Periprosthetic Infection in Patients with Tumor Prostheses Following Resection for Musculoskeletal Tumor of the Lower Limb., Journal of clinical medicine, 10.3390/jcm9103133, 9, 10, 1-12, 2020.09, Tumor prostheses for the lower limb following resection of musculoskeletal tumors is useful limb salvage management; however, as compared with routine total joint replacement, an increased incidence of deep periprosthetic infection of tumor prosthesis has been observed. The risk factors for periprosthetic infection of tumor prosthesis remain unclear. This study examines the risk factors and outcomes of periprosthetic infection. This was a retrospective observational study including 121 patients (67 males and 54 females) who underwent tumor prosthesis of the lower limb after resection of musculoskeletal tumors between 1 January 2000 and 30 November 2018. Among a total of 121 tumor prostheses, 7 were total femurs, 47 were proximal femurs, 47 were distal femurs, and 20 were proximal tibias. The incidence of postoperative infection and its risk factors were analyzed. Forty-five patients (37%) had osteosarcoma, 36 patients (30%) had bone metastasis, and 10 patients (8%) had soft-tissue tumors invading the bone. The mean operating time was 229 min, and the mean follow-up duration was 5.9 years. Deep periprosthetic infection was noted in 14 patients (12%). In the multivariate analysis, the risk factors for postoperative infection were identified as being male (hazard ratio [HR], 11.2316; p = 0.0100), soft-tissue tumor (HR, 52.2443; p = 0.0003), long operation (HR, 1.0056; p = 0.0184), and radiotherapy (HR, 6.5683; p = 0.0476). The incidence of periprosthetic infection in our institution was similar to that of previous reports. Patients undergoing tumor prosthesis of the lower limb who were male, had a soft-tissue tumor, were predicted to have a long operation, and who underwent radiation, had an increased possibility of postoperative infection.. |
| 445. |
Masato Yoshimoto, Yuichi Yamada, Shin Ishihara, Kenichi Kohashi, Yu Toda, Yoshihiro Ito, Yosuke Susuki, Izumi Kinoshita, Hidetaka Yamamoto, Yasuharu Nakashima, Yoshinao Oda, Retroperitoneal Myxofibrosarcoma: A Controversial Entity., Pathology, research and practice, 10.1016/j.prp.2020.152969, 216, 6, 152969-152969, 2020.06. |
| 446. |
Nobuaki Tsukamoto, Takao Mae, Akihisa Yamashita, Takahiro Hamada, Tatsuhiko Miura, Takahiro Iguchi, Masami Tokunaga, Toshihiro Onizuka, Kenta Momii, Eiji Sadashima, Yasuharu Nakashima, Refracture of pediatric both-bone diaphyseal forearm fracture following intramedullary fixation with Kirschner wires is likely to occur in the presence of immature radiographic healing., European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 10.1007/s00590-020-02689-0, 30, 7, 1231-1241, 2020.10, PURPOSE: Refracture of pediatric both-bone diaphyseal forearm fractures (PBDFFs) may occur, even if the fractures are treated with intramedullary nailing. The purpose of this study was to investigate the risk of refracture of PBDFFs treated with intramedullary Kirschner wires (K-wires), which are commonly used in our clinic. METHODS: The present multicenter retrospective study included 60 consecutive patients with 60 PBDFFs who were treated with intramedullary K-wires at 5 hospitals between 2007 and 2016. The age of the patients at the time of the primary fracture ranged from 2 to 15 years. The characteristics of the primary fractures and treatment course were evaluated. RESULTS: Refracture occurred in 6 patients (10.0%). Three of the patients were young girls; the other 3 were adolescent boys. Refractures were caused by falling or during sports activity. The duration from primary fracture to refracture ranged from 46 to 277 days, and in 5 of the 6 patients refractures occurred within 6 months. Although we were unable to identify factors significantly contributing to refracture (e.g. fracture type or treatment procedures), radiographs at the latest visit before refracture demonstrated findings of immature healing in five of six patients. Both K-wires and external immobilization had been removed before complete fracture healing in a large proportion of patients with refracture (80.0%). CONCLUSIONS: Refracture of PBDFF may occur several months after treatment with intramedullary K-wires if the primary fracture shows immature healing. Physicians should pay special attention when judging radiographic fracture healing, even when the fracture is deemed to have clinically healed.. |
| 447. |
Shoji Baba, Goro Motomura, Satoshi Ikemura, Yusuke Kubo, Takeshi Utsunomiya, Hiroyuki Hatanaka, Koichiro Kawano, Yasuharu Nakashima, Quantitative evaluation of bone-resorptive lesion volume in osteonecrosis of the femoral head using micro-computed tomography., Joint bone spine, 10.1016/j.jbspin.2019.09.004, 87, 1, 75-80, 2020.01, Objectives To quantify the volume of bone-resorptive lesions in post-collapse osteonecrosis of the femoral head (ONFH) using micro-computed tomography (micro-CT) and assess their characteristics in post-collapse ONFH. Methods We investigated 35 femoral heads resected from 35 patients with ONFH (20 men and 15 women; mean age, 47.2 years). On each of seven coronal high-resolution micro-CT slices of the femoral head, the bone-resorptive areas were extracted using bone microstructure measurement software. Next, the total bone-resorptive volume ratio, defined as the ratio of all bone-resorptive cross-sectional areas to all femoral head cross-sectional areas in all seven slices, was calculated. Associations between total bone-resorptive volume ratio and sex, age, ONFH-associated factors, patient workload levels, ONFH stage, ONFH type, necrotic volume on magnetic resonance imaging, and duration from the onset of pain to surgery were analyzed. Lesion location and the association between bone-resorptive lesion and collapse were also evaluated. Results The mean total bone-resorptive volume ratio was 7.0±6.0%, which varied significantly by ONFH stage (ARCO collapse quantitation 3A, 3.5±2.1%; 3B, 6.8±3.0%; and 3C, 13.6±8.8%). ONFH stage was independently associated with total bone-resorptive volume ratio (P |
| 448. |
Mingjian Xu, Goro Motomura, Satoshi Ikemura, Ryosuke Yamaguchi, Takeshi Utsunomiya, Shoji Baba, Koichiro Kawano, Yasuharu Nakashima, Proximal femoral morphology after transtrochanteric posterior rotational osteotomy for osteonecrosis of the femoral head: A three-dimensional simulation study., Orthopaedics & traumatology, surgery & research : OTSR, 10.1016/j.otsr.2020.07.003, 106, 8, 1569-1574, 2020.12, BACKGROUND: Transtrochanteric posterior rotational osteotomy (PRO) is one of the joint-preserving surgeries for osteonecrosis of the femoral head. In general, postoperative femoral neck-shaft varus realignment is planned to obtain a sufficient intact articular surface of the femoral head in the weight-bearing portion. Unlike anterior rotational osteotomy, PRO allows for more than 90° rotation of the femoral head, resulting in more complicated morphology. However, little is known about the potential risk of postoperative femoral retroversion after PRO. This simulation study aims: 1) to assess whether postoperative femoral neck-shaft varus realignment can coexist with preserved femoral anteversion after PRO, 2) and whether postoperative proximal femoral morphology could be predicted with approximation equations. HYPOTHESIS: High degree (>90°) PRO is favourable for femoral neck-shaft varus realignment, but unfavourable for maintaining postoperative femoral anteversion. MATERIALS AND METHODS: PRO was simulated by using CT data from 10 hips in 10 healthy volunteers. During simulation, the intertrochanteric osteotomy plane was determined three-dimensionally based on anteroposterior-view line (the osteotomy line on anteroposterior view) and lateral-view line (the osteotomy line on lateral view). By changing either the angle of anteroposterior-view line or lateral-view line, we simulated 90°, 110°, 130° and 150° PRO. To clarify the effects of various posterior rotation angles on postoperative proximal femoral morphology, we made simplified PRO models through changing only the posterior rotation angle. RESULTS: In the 90°, 110°, 130° and 150° PRO models, the vertically inclined angle of anteroposterior-view line showed a significant positive correlation with femoral neck-shaft varus realignment (90° PRO, r=0.90; 110° PRO, r=0.95; 130° PRO, r=0.97; 150° PRO, r=0.99), while a significant negative correlation with postoperative femoral anteversion angle (90° PRO, r=-0.97; 110° PRO, r=-0.95; 130° PRO, r=-0.92; 150° PRO, r=-0.7). Likewise, the posteriorly tilted angle of lateral-view line showed a significant negative correlation with both femoral neck-shaft varus realignment (90° PRO, r=-0.81; 110° PRO, r=-0.81; 130° PRO, r=-0.79; 150° PRO, r=-0.72) and postoperative femoral anteversion angle (90° PRO, r=-0.90; 110° PRO, r=-0.89; 130° PRO, r=-0.92; 150° PRO, r=-0.88). In the simplified PRO models, the posterior rotation angle showed a significant positive correlation with femoral neck-shaft varus realignment (r=0.33), while a significant negative correlation with postoperative femoral anteversion angle (r=-0.76). The approximation equations for predicting the proximal femoral morphology after PRO were validated. DISCUSSIONS: It was confirmed that high-degree PRO (>90°) is favourable for femoral neck-shaft varus realignment, but works against preserving femoral anteversion. With the approximation equations developed in the current study, surgeons could examine the feasibility of PRO based on postoperative femoral anteversion. In terms of hip joint function and subsequent total hip arthroplasty, excessive deformities including femoral retroversion and severe varus deformity could be avoided. LEVEL OF EVIDENCE: IV; case series without control group.. |
| 449. |
Toshifumi Fujiwara, Kentaro Tokuda, Kenta Momii, Kyohei Shiomoto, Hidetoshi Tsushima, Yukio Akasaki, Satoshi Ikemura, Jun-Ichi Fukushi, Jun Maki, Noriyuki Kaku, Tomohiko Akahoshi, Tomoaki Taguchi, Yasuharu Nakashima, Prognostic factors for the short-term mortality of patients with rheumatoid arthritis admitted to intensive care units., BMC rheumatology, 10.1186/s41927-020-00164-1, 4, 1, 64-64, 2020.12, BACKGROUND: Patients with rheumatoid arthritis (RA) have high mortality risk and are frequently treated in intensive care units (ICUs). METHODS: This was a retrospective observational study. This study included 67 patients (20 males, 47 females) with RA who were admitted at the ICU of our institution for ≥48 h between January 2008 and December 2017. We analyzed the 30-day mortality of these patients and the investigated prognostic factors in RA patients admitted to our ICU. RESULTS: Upon admission, the median age was 70 (range, 33-96) years, and RA duration was 10 (range, 0-61) years. The 5-year survival after ICU admission was 47%, and 30-day, 90-day, and 1-year mortality rates were 22, 27, and 37%, respectively. The major reasons for ICU admission were cardiovascular complications (24%) and infection (40%) and the most common ICU treatments were mechanical ventilation (69%), renal replacement (25%), and vasopressor (78%). In the 30-day mortality group, infection led to a fatal outcome in most cases (67%), and nonsurvival was associated with a significantly higher glucocorticoid dose, updated Charlson's comorbidity index (CCI), and acute physiology and chronic health evaluation (APACHE) II score. Laboratory data obtained at ICU admission showed that lower platelet number and total protein and higher creatinine and prothrombin time international normalized ratio (PT-INR) indicated significantly poorer prognosis. The multivariate Cox proportional hazard model revealed that nonuse of csDMARDs, high updated CCI, increased APACHE II score, and prolonged PT-INR were associated with a higher risk of mortality after ICU admission. CONCLUSION: Our study demonstrated that the nonuse of csDMARDs, high updated CCI, elevated APACHE II score, and coagulation abnormalities predicted poorer prognosis in RA patients admitted to the ICU.. |
| 450. |
Masaru Hada, Hideki Mizu-Uchi, Ken Okazaki, Koji Murakami, Takao Kaneko, Hidehiko Higaki, Yasuharu Nakashima, Posterior tibial slope and anterior post-cam contact can change knee kinematics in extension in bi-cruciate stabilized total knee arthroplasty., Bone & joint research, 10.1302/2046-3758.911.BJR-2020-0076.R2, 9, 11, 761-767, 2020.11, AIMS: This study aims to investigate the effects of posterior tibial slope (PTS) on knee kinematics involved in the post-cam mechanism in bi-cruciate stabilized (BCS) total knee arthroplasty (TKA) using computer simulation. METHODS: In total, 11 different PTS (0° to 10°) values were simulated to evaluate the effect of PTS on anterior post-cam contact conditions and knee kinematics in BCS TKA during weight-bearing stair climbing (from 86° to 6° of knee flexion). Knee kinematics were expressed as the lowest points of the medial and lateral femoral condyles on the surface of the tibial insert, and the anteroposterior translation of the femoral component relative to the tibial insert. RESULTS: Anterior post-cam contact in BCS TKA was observed with the knee near full extension if PTS was 6° or more. BCS TKA showed a bicondylar roll forward movement from 86° to mid-flexion, and two different patterns from mid-flexion to knee extension: screw home movement without anterior post-cam contact and bicondylar roll forward movement after anterior post-cam contact. Knee kinematics in the simulation showed similar trends to the clinical in vivo data and were almost within the range of inter-specimen variability. CONCLUSION: Postoperative knee kinematics in BCS TKA differed according to PTS and anterior post-cam contact; in particular, anterior post-cam contact changed knee kinematics, which may affect the patient's perception of the knee during activities. Cite this article: Bone Joint Res 2020;9(11):761-767.. |
| 451. |
Yukio Akasaki, Hideki Mizu-Uchi, Satoshi Hamai, Hidetoshi Tsushima, Shinya Kawahara, Tomohiro Horikawa, Yasuharu Nakashima, Patient-specific prediction of joint line convergence angle after high tibial osteotomy using a whole-leg radiograph standing on lateral-wedge insole., Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 10.1007/s00167-019-05821-8, 28, 10, 3200-3206, 2020.10, PURPOSE: To assess the usefulness of a whole-leg radiograph standing on lateral-wedge insole (LWI) for predicting the change in joint line convergence angle (JLCA) before vs. after high tibial osteotomy (HTO). METHODS: Forty knees with medial osteoarthritis underwent open-wedge HTO. Pre-operatively, all patients had whole-leg radiographs taken in three different conditions: supine, standing, and standing on LWI inclined at 20°. A standing whole-leg radiograph was also obtained post-operatively. Radiological measurements including JLCA and percentage of mechanical axis (%MA) were compared. Using pre-operative radiographs, correction angles were calculated with the target %MA at 62.5%. Correlations between the difference in calculated correction angle among the three pre-operative conditions and the change in JLCA before vs. after HTO were assessed. RESULTS: In the pre-operative standing conditions, the mean JLCA of 3.8° was significantly decreased to 3.2° using LWI, which did not differ from post-operative JLCA of 3.1°. Mean %MA significantly shifted laterally from 20.6 to 24.8% using LWI, and was strongly correlated with the change in JLCA (coefficient, 0.83). Calculated correction angles differed significantly among the three pre-operative conditions. The difference in calculated correction angle between standing with and without LWI was strongly correlated to the change in standing JLCA before vs. after HTO (coefficient, 0.73). CONCLUSION: Larger differences in calculated correction angles between pre-operative radiographs standing with and without LWI predicted larger changes in JLCA after HTO. Whole-leg radiograph standing on LWI is a promising modality for correct pre-operative planning considering patient-specific changes in JLCA before vs. after HTO. LEVEL OF EVIDENCE: IV.. |
| 452. |
Yu Toda, Kenichi Kohashi, Yuichi Yamada, Masato Yoshimoto, Shin Ishihara, Yoshihiro Ito, Takeshi Iwasaki, Hidetaka Yamamoto, Yoshihiro Matsumoto, Yasuharu Nakashima, Masaaki Mawatari, Yoshinao Oda, PD-L1 and IDO1 expression and tumor-infiltrating lymphocytes in osteosarcoma patients: comparative study of primary and metastatic lesions., Journal of cancer research and clinical oncology, 10.1007/s00432-020-03242-6, 146, 10, 2607-2620, 2020.10, PURPOSE: Programmed death ligand 1 (PD-L1) and indoleamine 2,3-dioxygenase 1 (IDO1) are immunosuppressive proteins known to be associated with poor prognosis in various cancers. However, their expression and clinical relevance in osteosarcoma remain unknown. In this study, the relationships of PD-L1 and IDO1 expression with clinicopathological features and prognosis were explored. METHODS: The expression of PD-L1, IDO1, CD3, CD4, and CD8 in 112 formalin-fixed, paraffin-embedded tumor tissues collected by biopsy or surgical resection from 56 osteosarcoma patients was evaluated immunohistochemically. Moreover, four osteosarcoma cell lines were evaluated for the effects of IFNγ on PD-L1 and IDO1 mRNA expression by real-time reverse-transcription polymerase chain reaction. RESULTS: In pre-neoadjuvant chemotherapy (NAC) primary specimens, 10 cases (17%) showed PD-L1 expression and 12 (21%) showed IDO1 expression. Six of ten cases (60%) with PD-L1 positivity co-expressed IDO1. In post-NAC metastatic lesions, the frequency of immunoexpression of PD-L1 and IDO1 was increased compared with that in pre-NAC specimens. PD-L1 and/or IDO1 expression was not associated with poor prognosis. PD-L1 immunoexpression was significantly associated with the infiltration of CD3+ T cells, CD4+ T cells, and CD8+ T cells; while, IDO1 immunoexpression was significantly associated with the infiltration of CD3+ T cells and CD4+ T cells. In all osteosarcoma cell lines, PD-L1 and IDO1 expression was upregulated by stimulation with IFNγ. CONCLUSION: Our results suggest that the PD-L1 and IDO1 immune checkpoint inhibitors may provide clinical benefit in osteosarcoma patients with metastatic lesions after conventional chemotherapy.. |
| 453. |
Tetsuya Tachibana, Masanori Fujii, Kenji Kitamura, Satoshi Ikemura, Satoshi Hamai, Goro Motomura, Jun-Ichi Fukushi, Yasuharu Nakashima, Modified lateralized head sign: An accurate marker in diagnosing adult hip dysplasia., Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 10.1016/j.jos.2019.05.015, 25, 3, 460-465, 2020.05, BACKGROUND: Although lateralized head sign (LHS) is considered indicative of structural instability, it lacks reproducibility, and its usefulness in diagnosing adult hip dysplasia is unknown. In this study, we proposed a modified LHS and aimed to determine its reliability and accuracy in diagnosing adult hip dysplasia. METHODS: We reviewed anteroposterior pelvic radiographs of 94 patients (134 hips) with hip dysplasia. As controls, 133 normal hips were evaluated. We defined the modified lateralization distance (LD) as the horizontal distance between the medial aspect of the femoral head to the acetabular fossa. The sensitivity, specificity, and cutoff value of modified LD in diagnosing hip dysplasia were calculated using receiver operating characteristic curve analysis. RESULTS: The sensitivity and specificity of the modified LD (79% and 87%, respectively) were higher than those of the conventional LD (63% and 80%, respectively). Diagnostic accuracy was further improved when patients were divided on the basis of sex. The sensitivity and specificity of the modified LD in men were 89% and 97%, respectively, with a cutoff value of 12 mm, while in women, they were 80% and 96%, respectively, with a cutoff value of 9.7 mm. Therefore, we defined the modified LHS as presentation with a modified LD ≥ 12 mm in men and ≥10 mm in women. Between three observers, the kappa value for intraobserver reliability was ≥0.9, while that for interobserver reliability was >0.8. The mean sensitivity and specificity of the modified LHS in diagnosing hip dysplasia were 85% and 99%, respectively. CONCLUSIONS: Modified LHS-a horizontal distance between the medial aspect of the femoral head and the acetabular fossa ≥12 mm in men and ≥10 mm in women-is a clinically useful marker in detecting lateral femoral head subluxation indicative of hip dysplasia or structural hip instability.. |
| 454. |
Teruaki Ono, Yuta Kohro, Keita Kohno, Hidetoshi Tozaki-Saitoh, Yasuharu Nakashima, Makoto Tsuda, Mechanical pain of the lower extremity after compression of the upper spinal cord involves signal transducer and activator of transcription 3-dependent reactive astrocytes and interleukin-6., Brain, behavior, and immunity, 10.1016/j.bbi.2020.07.025, 89, 389-399, 2020.10, Chronic pain is one of the main symptoms of spinal disorders such as spinal canal stenosis. A major cause of this pain is related to compression of the spinal cord, and chronic pain can develop at the level of the compressed spinal segment. However, in many patients chronic pain arises in an area that does not correspond to the compressed segment, and the underlying mechanism involved remains unknown. This was investigated in the present study using a mouse model of spinal cord compression in which mechanical pain of the hindpaws develops after compression of the first lumbar segment (L1) of the spinal cord. Compression induced the activation of astrocytes in the L1 spinal dorsal horn (SDH)-but not the L4 SDH that corresponds to the hindpaws-and activated signal transducer and activator of transcription 3 (STAT3). Suppressing reactive astrocytes by expressing a dominant negative form of STAT3 (dnSTAT3) in the compressed SDH prevented mechanical pain. Expression of interleukin (IL)-6 was also upregulated in the compressed SDH, and it was inhibited by astrocytic expression of dnSTAT3. Intrathecal administration of a neutralizing anti-IL-6 antibody reversed the compression-induced mechanical pain. These results suggest that astrocytic STAT3 and IL-6 in the compressed SDH are involved in remote mechanical pain observed in the lower extremity, and may provide a target for treating chronic pain associated with spinal cord compression such as spinal canal stenosis.. |
| 455. |
Koichiro Kawano, Goro Motomura, Satoshi Ikemura, Yusuke Kubo, Junichi Fukushi, Satoshi Hamai, Masanori Fujii, Yasuharu Nakashima, Long-term hip survival and factors influencing patient-reported outcomes after transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head: A minimum 10-year follow-up case series., Modern rheumatology, 10.1080/14397595.2018.1558917, 30, 1, 184-190, 2020.01, Objectives: This retrospective study aimed to assess long-term hip survival after transtrochanteric anterior rotational osteotomy (ARO) for osteonecrosis of the femoral head (ONFH) and identify factors influencing patient-reported outcome measures (PROMs) in patients with preserved joints.Methods: Altogether, 95 consecutive hips in 85 ONFH patients who underwent ARO during 2000-2007 (86.7% follow-up) were studied. Controls were 35 patients with 41 hips with ONFH managed conservatively for >1 year after collapse. We analyzed hip survival using the Kaplan-Meier method, with the endpoint defined as any therapeutic surgery related to ONFH. We also evaluated PROMs for both groups in patients with surviving hips and available radiographs at the final follow-up.Results: The 10-year hip survival rate after ARO was 85.4%, which was significantly higher than the 5-year rate in the control group (50.4%). Multiple regression analyses showed that the presence of osteoarthritic change after ARO was significantly associated with poor scores for both the Oxford Hip Score and the Short Form-12 Health Survey Physical Component Summary.Conclusions: ARO could effectively preserve hip joints with post-collapse ONFH, although the presence of osteoarthritic change could lead to lower satisfaction even among patients with long-term hip survival after ARO.. |
| 456. |
Miho Iwamoto, Masanori Fujii, Keisuke Komiyama, Yuta Sakemi, Kyohei Shiomoto, Kenji Kitamura, Ryosuke Yamaguchi, Yasuharu Nakashima, Is lateral acetabular rotation sufficient to correct anterolateral deficiency in periacetabular reorientation osteotomy? A CT-Based simulation study., Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 10.1016/j.jos.2019.12.014, 25, 6, 1008-1014, 2020.11, BACKGROUND: Residual acetabular deficiency after periacetabular reorientation osteotomy can result in suboptimal outcome. The optimal algorithm of acetabular fragment correction to achieve normal anterolateral acetabular coverage is not well characterized. The aim of this study was to determine the prevalence of residual anterolateral deficiency after lateral acetabular rotation and to evaluate the ability of additional sagittal and axial rotation of the acetabulum to normalize the acetabular coverage in periacetabular osteotomy. METHODS: We performed computed tomography-based simulated periacetabular osteotomy on 85 patients (85 hips) with hip dysplasia. The acetabular fragment was rotated laterally to achieve a lateral center-edge angle (CEA) of 30°. For hips with residual anterolateral deficiency, which were identified based on the reference interval of the anterior CEA, the acetabulum was further rotated in the sagittal or axial direction in 5-degree increments from 5° to 20°, and the ability of these two manoeuvres to restore a normal anterior CEA was assessed. RESULTS: After lateral acetabular rotation, 16 hips (19%) had residual anterolateral deficiency, 67 hips (79%) had normal acetabular coverage, and 2 hips (2.4%) had acetabular overcoverage. A preoperative anterior CEA |
| 457. |
Shoji Baba, Goro Motomura, Satoshi Ikemura, Ryosuke Yamaguchi, Takeshi Utsunomiya, Hiroyuki Hatanaka, Koichiro Kawano, Mingjian Xu, Yasuharu Nakashima, Is bone mineral density lower in the necrotic lesion in pre-collapse osteonecrosis of the femoral head?, Journal of orthopaedic research : official publication of the Orthopaedic Research Society, 10.1002/jor.24674, 38, 11, 2434-2442, 2020.11, The purpose of this study was to clarify whether bone mineral density (BMD) of the necrotic lesion in precollapse osteonecrosis of the femoral head (ONFH) is reduced according to Hounsfield unit (HU) values on computed tomography (CT). The superior one-third of the femoral head in the coronal section was set as the region of interest (ROI) for the measurement of HU values. First, HU values of 101 control participants were assessed to identify relevant confounding factors. Next, the relationship between HU values and BMD on dual-energy X-ray absorptiometry (DXA) was verified. Then the mean HU value of the ROI in patients with pre-collapse ONFH was compared with that in propensity score-matched control participants. Finally, the HU values of the lateral boundary in the patients with and without subsequent collapse were compared. Multivariable analysis showed that both age and BMI were significantly correlated with the HU value, which showed a strong correlation with the BMD of the femoral neck on DXA (r = 0.92). In 25 ONFH patients and 25 propensity-matched control participants, no significant difference was found in the HU value of the ROI (p = .54). The mean HU value of the lateral boundary in patients with subsequent collapse was found to be significantly higher than that in patients without subsequent collapse (p |
| 458. |
Kyohei Shiomoto, Satoshi Hamai, Daisuke Hara, Hidehiko Higaki, Hirotaka Gondo, Yifeng Wang, Satoru Ikebe, Kensei Yoshimoto, Keisuke Komiyama, Satoru Harada, Yasuharu Nakashima, In vivo kinematics, component alignment and hardware variables influence on the liner-to-neck clearance during chair-rising after total hip arthroplasty., Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 10.1016/j.jos.2019.05.012, 25, 3, 452-459, 2020.05, BACKGROUND: There is an interest in quantifying dynamic hip kinematics before and after total hip arthroplasty (THA) during chair-rising: one of daily life activities. METHODS: The study consisted of 21 patients who underwent unilateral total hip arthroplasty for symptomatic osteoarthritis. We obtained continuous radiographs using a flat-panel X-ray detector while the participants rose from chair. We assessed the pre and postoperative hip joint's movements using three-dimensional-to-two-dimensional model-to-image registration techniques. We also measured minimum liner-to-neck distances at maximum hip flexion and extension as anterior and posterior liner-to-neck distances, respectively. Multivariate analyses were applied to determine which factors were associated with liner-to-neck distances. RESULTS: The cup inclination, cup anteversion, and stem anteversion averaged 37.4°, 23.1°, and 30.1°, respectively. Significantly larger maximum hip flexion angle (72°) was found during chair-rising after THA compared to that before THA (63°, P |
| 459. |
Kyohei Shiomoto, Satoshi Hamai, Goro Motomura, Satoshi Ikemura, Masanori Fujii, Yasuharu Nakashima, Influencing Factors for Joint Perception After Total Hip Arthroplasty: Asian Cohort Study., The Journal of arthroplasty, 10.1016/j.arth.2019.12.039, 35, 5, 1307-1314, 2020.05, BACKGROUND: Perceiving replaced joints as natural is one of the best scenario after total hip arthroplasty (THA). We investigated the distribution of and influencing factors for patient's joint perception after THA in Asian cohort, which is not well known. METHODS: We mailed a questionnaire to Asian patients who had undergone THA in our institution between 2012 and 2016, and this study included 318 Asian patients. The questionnaire assessed patient's joint perception, Oxford Hip Score (OHS), Short Form-12 Health Survey (SF-12) physical, mental, and role component summaries, and satisfaction score. Leg length discrepancy and global femoral offset before and after THA were measured using radiographs. The patients were divided into 2 groups with patient's joint perception: natural and artificial perception groups. OHS, SF-12, satisfaction, leg length discrepancy, and global femoral offset were compared between natural and artificial perception groups, and which factors significantly influenced joint perception were determined. RESULTS: Of the 318 patients, 165 patients (51.8%) perceived their replaced joint as a natural joint. OHS, SF-12 physical and role component summaries, and satisfaction score in natural perception group were significantly higher than those in artificial perception group, without significant difference in SF-12 mental component summary. Multivariate analysis showed that less of usual pain, easier to get in or out of a car, and osteoarthritis in the contralateral hip were positively associated with natural joint perception after THA. CONCLUSION: This study indicated to surgeons that pain relief and improvement in getting in or out of a car after THA could lead to even better patient's joint perception.. |
| 460. |
居石卓也, 赤崎幸穂, 倉員市郎, 遠矢政和, 桑原正成, 内田泰輔, 津嶋秀俊, 中島康晴, G protein-coupled receptor kinase(GRK)-5の阻害は,NFκB経路を制御することにより軟骨の変性を抑制する, 日本軟骨代謝学会プログラム・抄録集, 10.1002/art.41152, 72, 4, 620-631, 2020.04. |
| 461. |
Izumi Kinoshita, Yuichi Yamada, Kenichi Kohashi, Hidetaka Yamamoto, Takeshi Iwasaki, Shin Ishihara, Y U Toda, Yoshihiro Ito, Yousuke Susuki, Kengo Kawaguchi, Toshio Ichiki, Yuki Sato, Masutaka Furue, Yasuharu Nakashima, Yoshinao Oda, Frequent MN1 Gene Mutations in Malignant Peripheral Nerve Sheath Tumor., Anticancer research, 10.21873/anticanres.14642, 40, 11, 6221-6228, 2020.11, BACKGROUND/AIM: Malignant peripheral nerve sheath tumor (MPNST) is a rare soft-tissue tumor, and its diagnosis is usually made histopathologically. The effectiveness of chemotherapy and radiotherapy has not been established. We elucidated prognostic factors, diagnostic markers, and therapeutic targets. MATERIALS AND METHODS: Cases of MPNST were studied using next-generation sequencing. A total of 24 tumor samples, 11 from von Recklinghausen's disease-associated MPNST (vRH-MPNST), 11 from sporadic non-vRH MPNST, and two neurofibroma (NF) cases were retrieved, on which next-generation sequencing and survival analysis were performed. RESULTS: We identified NF1 gene mutations, including three mutations in two NFs, and 10 mutations in eight MPNSTs (five vRH-MPNSTs and three sporadic MPNSTs). Meningioma 1 (MN1) gene alteration was detected in six cases of vRH-MPNST. It is considered that MN1 gene alteration is related to the tumorigenesis of vRH-MPNST. CONCLUSION: MN1 gene mutation was detected in more than half of our cases, it may have potential for use as a therapeutic target in vRH-MPNST.. |
| 462. |
Nobuhiko Haga, Yasuharu Nakashima, Hiroshi Kitoh, Junji Kamizono, Takenobu Katagiri, Hideto Saijo, Sho Tsukamoto, Yusuke Shinoda, Ryoko Sawada, Yasuo Nakahara, Fibrodysplasia ossificans progressiva: Review and research activities in Japan., Pediatrics international : official journal of the Japan Pediatric Society, 10.1111/ped.14065, 62, 1, 3-13, 2020.01, Fibrodysplasia ossificans progressiva (FOP) is a rare genetic skeletal disorder manifesting progressive heterotopic ossification (HO) and congenital malformation of the great toes. Since 2007, we have conducted research on FOP. Here, we review the findings on FOP published to date, including the results of our research. Epidemiological studies in Japan have indicated that FOP has nearly the same prevalence in Japan as in the rest of the world. Basic research on its pathoetiology has progressed rapidly since the identification of the causal gene in 2006. Clinical and radiological findings have been thoroughly researched, including early radiological signs, and diagnostic criteria were established, designating FOP as an intractable disease in Japan. In patients with FOP, the progression of HO is associated with numerous disabilities, often manifesting in vicious cycles that can lead to early mortality. Through cross-sectional and short-term longitudinal studies, we have explored patient education, quality of life, and activities of daily living among Japanese patients. The management of FOP requires education of patients and caregivers, the use of medications to settle inflammation and flare-ups, instructions to ensure proper oral care, and other compensatory approaches that aid in rehabilitation. An avoidance of medical intervention, which may cause HO to progress, is also important. The advent of new drugs to prevent HO could have clinical benefit.. |
| 463. |
Kenji Tsuchihashi, Hitoshi Kusaba, Tomoyasu Yoshihiro, Toshifumi Fujiwara, Nokitaka Setsu, Makoto Endo, Yoshihiro Matsumoto, Takashi Imajima, Yudai Shinohara, Mamoru Ito, Satoru Yamaga, Kenro Tanoue, Kohei Arimizu, Hirofumi Ohmura, Fumiyasu Hanamura, Kyoko Yamaguchi, Taichi Isobe, Hiroshi Ariyama, Yasuharu Nakashima, Koichi Akashi, Eishi Baba, Eribulin as a first-line treatment for soft tissue sarcoma patients with contraindications for doxorubicin., Scientific reports, 10.1038/s41598-020-77898-y, 10, 1, 20896-20896, 2020.12, Doxorubicin is a first-line therapy for patients with unresectable advanced soft tissue sarcoma (STS). However, because of cardiotoxicities, it is not used for patients with cardiac problems. Eribulin has exhibited efficacy for advanced STS in second- or later-line treatments. In the present study, we retrospectively analyzed the efficacy and safety of first-line eribulin therapy for patients with advanced STS unable to receive doxorubicin. Six of 28 patients who received eribulin as any line treatment received eribulin as a first-line treatment. The reasons for avoiding doxorubicin were as follows: cardiac problems for four patients and advanced age for two. Median progression-free survival (PFS) of the patients who received eribulin as first-line and, second or later-line therapy were 9.7 months (95% CI: 1.0-not reached) and 3.9 months (95% CI: 2.7-5.9), which were not significantly different. The reasons for discontinuation of eribulin were disease progression and adverse events (2 fatigue and 1 neuropathy) for three patients each. No treatment-related cardiotoxicity was observed. The findings of this study indicated that eribulin exhibits meaningful efficacy for the patients with contraindications for doxorubicin as a first-line treatment without cardiac adverse events. However, appropriate safety management is necessary because older patients are typically among those intolerable of doxorubicin.. |
| 464. |
Yusuke Kubo, Goro Motomura, Satoshi Ikemura, Hiroyuki Hatanaka, Takeshi Utsunomiya, Satoshi Hamai, Masanori Fujii, Jun-Ichi Fukushi, Yasuharu Nakashima, Effects of anterior boundary of the necrotic lesion on the progressive collapse after varus osteotomy for osteonecrosis of the femoral head., Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 10.1016/j.jos.2019.02.014, 25, 1, 145-151, 2020.01, BACKGROUND: Anterior localization of the necrotic lesion was recently proposed as an important factor for the occurrence of collapse even in medially located osteonecrosis of the femoral head (ONFH). We examined the effects of the anterior boundary of the necrotic lesion on progressive collapse after varus osteotomy for ONFH. METHODS: We reviewed the outcomes of 31 hips in 27 patients with ONFH treated by transtrochanteric curved varus osteotomy (CVO) from 2000 to 2012 with a mean follow-up of 10.5 years. The occurrence of progressive collapse of the anterior necrotic lesion was defined as the presence of ≥2 mm collapse using follow-up lateral radiographs. Postoperative osteoarthritic change was defined as ≥1 mm progression of joint space narrowing on follow-up radiographs. The location of the anterior boundary of the necrotic lesion was assessed using the anterior necrotic angle (the angle between the midline of the femoral neck shaft and the line passing from the femoral head center to the anterior boundary of the necrotic lesion on a mid-slice oblique magnetic resonance image). RESULTS: All hips had a postoperative intact ratio of ≥34% (percentage of the transposed intact articular surface of the femoral head to the weight-bearing area of the acetabulum after femoral osteotomy). Progressive collapse of the anterior necrotic lesion was seen in five hips (16%) during a mean of 2.2 years after CVO. Of these, four hips (80%) proceeded to develop osteoarthritic change at an average of 4.3 years after the collapse. Multivariate analysis revealed that the anterior necrotic angle was independently associated with progressive collapse of the anterior necrotic lesion as well as the postoperative intact ratio. CONCLUSIONS: This study suggests that hips with anterior localization of the necrotic lesion have a possible risk of progressive collapse of the anterior necrotic lesion after CVO, which can frequently lead to subsequent osteoarthritic change.. |
| 465. |
Kenji Kitamura, Masanori Fujii, Takeshi Utsunomiya, Miho Iwamoto, Satoshi Ikemura, Satoshi Hamai, Goro Motomura, Mitsugu Todo, Yasuharu Nakashima, Effect of sagittal pelvic tilt on joint stress distribution in hip dysplasia: A finite element analysis., Clinical biomechanics (Bristol, Avon), 10.1016/j.clinbiomech.2020.02.011, 74, 34-41, 2020.04, BACKGROUND: Physiologic pelvic tilt can change acetabular orientation and coverage in patients with hip dysplasia. In this study, we aimed to clarify the impact of change in sagittal pelvic tilt on joint stress distribution in dysplastic hips. METHODS: We developed patient-specific finite element models of 21 dysplastic hips and 21 normal hips. The joint contact area, contact pressure, and equivalent stress of the acetabular cartilage were assessed at three pelvic tilt positions relative to the functional pelvic plane: 10° anterior tilt, no tilt, and 10° posterior tilt. FINDINGS: The mean contact area was 0.6-0.7 times smaller, the mean maximum contact pressure was 1.8-1.9 times higher, and the mean maximum equivalent stress was 1.3-2.8 times higher in dysplastic hips than in normal hips at all three pelvic positions. As the pelvis tilted from 10° anterior to 10° posterior, the mean contact area decreased, and the mean maximum contact pressure and median maximum equivalent stress increased. The latter two changes were more significant in dysplastic hips than in normal hips (total increment was 1.3 MPa vs. 0.4 MPa, P = 0.001, and 3.6 MPa vs. 0.4 MPa, P |
| 466. |
Hiroyuki Hatanaka, Goro Motomura, Satoshi Ikemura, Kazuhiko Sonoda, Yusuke Kubo, Takeshi Utsunomiya, Yasuharu Nakashima, Takuaki Yamamoto, Effect of a Specific Questionnaire Sheet on Subclassification of Osteonecrosis of the Femoral Head., Medical science monitor : international medical journal of experimental and clinical research, 10.12659/MSM.921327, 26, e921327, 2020.05, BACKGROUND This study examined whether use of a specific questionnaire sheet for nontraumatic osteonecrosis of the femoral head (ONFH) could affect the subclassification of ONFH compared with a conventional medical interview. MATERIAL AND METHODS Study participants consisted of 400 patients with ONFH who visited our hospital between February 2011 and March 2015. Data on history of systemic steroid therapy and habitual alcohol intake were obtained during a conventional medical interview at the first visit and were re-evaluated using a specific questionnaire sheet at another visit. Patients were subclassified into 4 groups: steroid-associated, alcohol-associated, steroid/alcohol-associated, or idiopathic ONFH. RESULTS Use of the specific questionnaire sheet resulted in a 4.0% increase in the proportion of patients with a history of systemic steroid therapy, from 57.3% (n=229) to 61.3% (n=245), and a 14.3% increase for history of habitual alcohol intake, from 35.0% (n=140) to 49.3% (n=197). The proportion of patients with steroid/alcohol-associated ONFH increased from 2.5% (n=10) to 17.8% (n=71), while the proportion in the other 3 groups decreased: steroid-associated ONFH from 54.8% (n=219) to 43.5% (n=174); alcohol-associated ONFH from 32.5% (n=130) to 31.5% (n=126); and idiopathic ONFH from 10.2% (n=41) to 7.2% (n=29). Ninety-six patients (24.0%) were classified into a different subgroup based on the specific questionnaire sheet. CONCLUSIONS The use of a specific questionnaire sheet can change the distribution of ONFH subclassifications compared with use of a conventional medical history interview. Use of a specific questionnaire sheet can allow for more detailed self-reporting regarding potential causative factors for nontraumatic ONFH, especially habitual alcohol intake.. |
| 467. |
Kensei Yoshimoto, Satoshi Hamai, Hidehiko Higaki, Hirotaka Gondoh, Kyohei Shiomoto, Satoru Ikebe, Daisuke Hara, Keisuke Komiyama, Yasuharu Nakashima, Dynamic hip kinematics before and after periacetabular osteotomy in patients with dysplasia., Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 10.1016/j.jos.2019.03.019, 25, 2, 247-254, 2020.03, BACKGROUND: We prospectively analyzed the hip kinematics in patients with developmental dysplasia of the hip (DDH) before and after periacetabular osteotomy (PAO) and in healthy subjects while squatting to determine the influence of coverage of the femoral head on hip kinematics. METHODS: 14 hips in 14 patients with DDH and 10 hips in 10 volunteers were included. Continuous radiographs while squatting and computed tomography images were obtained to assess the in vivo kinematics of the hip and the rim-neck distance using density-based 3D-to-2D model-to-image registration techniques. RESULTS: The maximum hip flexion angles were 100.4° and 94.9° before and after PAO (p = 0.0863), respectively. The maximum hip flexion angles after PAO did not significantly differ from those of normal hips (102.2°; p = 0.2552). The hip abduction angles at maximum hip flexion were 31.7° and 26.2° before and after PAO (p = 0.1256), respectively. The rim-neck distance decreased from averaged 12.2 mm-8.9 mm (p = 0.0044) after PAO. The lateral center edge angle (LCEA) and anterior center edge angle (ACEA) significantly improved 14.7°-42.4° and 50.4°-54.0° after PAO (p |
| 468. |
Kensei Yoshimoto, Jun-ichi Fukushi, Hidetoshi Tsushima, Satoshi Kamura, Hisa-aki Miyahara, Hideki Mizu-uchi, Yukio Akasaki, Yasuharu Nakashima, Does Preparation of the Subtalar Joint for Primary Union Affect Clinical Outcome in Patients Undergoing Intramedullary Nail for Rheumatoid Arthritis of the Hindfoot and Ankle?, JOURNAL OF FOOT & ANKLE SURGERY, 10.1053/j.jfas.2019.08.038, 59, 5, 984-987, 2020.09, This study aimed to evaluate whether preparation of the subtalar joint affects the clinical outcomes after tibiotalocalcaneal arthrodesis using an intramedullary nail with fins for rheumatoid ankle/hindfoot deformity. Fifty-three joints in 51 patients who underwent tibiotalocalcaneal arthrodesis using an intramedullary nail with fins for rheumatoid arthritis at 2 institutions were included. Ten patients were male and 41 were female, with a mean age at surgery and follow-up period of 61.3 years and 71.6 months, respectively. Radiographic bone union was evaluated at the most recent visit. Univariate and multivariable analyses were performed to determine the risk factors associated with nonunion. The mean postoperative Japanese Society for Surgery of the Foot ankle/hindfoot scale was 65.3 (range, 5-84). The tibiotalar nonunion rate was 0%, whereas the subtalar nonunion rate was 43.3% (23 joints). Revision surgery was performed in 5, all of which were due to painful subtalar nonunion. Absence of subtalar curettage and earlier postoperative weightbearing were significantly associated with subtalar nonunion (p = .0451 and p = .0438, respectively). Subtalar nonunion after tibiotalocalcaneal arthrodesis for rheumatoid hindfoot is associated with higher revision rate. To decrease the risk of subtalar nonunion after tibiotalocalcaneal arthrodesis with an intramedullary nail in rheumatoid patients, curettage for the subtalar joint should be performed, and full weightbearing should be delayed until at least 26 days postoperatively. (C) 2020 by the American College of Foot and Ankle Surgeons. All rights reserved.. |
| 469. |
Yusuke Kubo, Goro Motomura, Takeshi Utsunomiya, Masanori Fujii, Satoshi Ikemura, Kazuhiko Sonoda, Yasuharu Nakashima, Distribution of Femoral Head Subchondral Fracture Site Relates to Contact Pressures, Age, and Acetabular Structure., AJR. American journal of roentgenology, 10.2214/AJR.19.21895, 215, 2, 448-457, 2020.08, OBJECTIVE. Nontraumatic subchondral fracture of the femoral head (FH) is often seen in elderly patients with osteoporosis and acetabular dysplasia. Although this injury can also occur in young people, even those without osteoporosis, it remains unclear who is at risk. We examined the acetabular structure and sites of subchondral fracture of the FH in young patients compared with those in middle-aged and older patients. MATERIALS AND METHODS. Forty-eight hips with nontraumatic subchondral fracture of the FH were divided into two groups according to patient age: young ( |
| 470. |
Shinya Kawahara, Toshihiko Hara, Taishi Sato, Kazuki Kitade, Takeshi Shimoto, Tetsuro Nakamura, Taro Mawatari, Hidehiko Higaki, Yasuharu Nakashima, Digitalized analyses of intraoperative acetabular component position using image-matching technique in total hip arthroplasty., Bone & joint research, 10.1302/2046-3758.97.BJR-2019-0260.R2, 9, 7, 360-367, 2020.07, Aims: Appropriate acetabular component placement has been proposed for prevention of postoperative dislocation in total hip arthroplasty (THA). Manual placements often cause outliers in spite of attempts to insert the component within the intended safe zone; therefore, some surgeons routinely evaluate intraoperative pelvic radiographs to exclude excessive acetabular component malposition. However, their evaluation is often ambiguous in case of the tilted or rotated pelvic position. The purpose of this study was to develop the computational analysis to digitalize the acetabular component orientation regardless of the pelvic tilt or rotation. Methods: Intraoperative pelvic radiographs of 50 patients who underwent THA were collected retrospectively. The 3D pelvic bone model and the acetabular component were image-matched to the intraoperative pelvic radiograph. The radiological anteversion (RA) and radiological inclination (RI) of the acetabular component were calculated and those measurement errors from the postoperative CT data were compared relative to those of the 2D measurements. In addition, the intra- and interobserver differences of the image-matching analysis were evaluated. Results: Mean measurement errors of the image-matching analyses were significantly small (2.5° (SD 1.4°) and 0.1° (SD 0.9°) in the RA and RI, respectively) relative to those of the 2D measurements. Intra- and interobserver differences were similarly small from the clinical perspective. Conclusion: We have developed a computational analysis of acetabular component orientation using an image-matching technique with small measurement errors compared to visual evaluations regardless of the pelvic tilt or rotation.Cite this article: Bone Joint Res 2020;9(7):360-367.. |
| 471. |
Koichiro Kawano, Goro Motomura, Satoshi Ikemura, Ryosuke Yamaguchi, Shoji Baba, Mingjian Xu, Yasuharu Nakashima, Differences in the microarchitectural features of the lateral collapsed lesion between osteonecrosis and subchondral insufficiency fracture of the femoral head., Bone, 10.1016/j.bone.2020.115585, 141, 115585-115585, 2020.12, BACKGROUND: Like osteonecrosis of the femoral head (ONFH), subchondral insufficiency fracture of the femoral head (SIF) causes femoral head collapse. However, little is known about the differences between the two diseases regarding the morphological features of the collapsed lesion. We tested the hypothesis that the morphological features of the lateral collapsed lesion would differ between ONFH and SIF. METHODS: Twenty femoral heads histopathologically diagnosed as ONFH (n = 10) or SIF (n = 10) were used in this study. In the lateral collapsed lesion of each femoral head, cubic regions of interest (ROIs) were selected within the collapsed subchondral area and the nearby non-collapsed subchondral area. Micro-CT-based microarchitectural parameters were compared between the ROIs in each disease. Additionally, correlations between histopathological and microarchitectural features were evaluated. RESULTS: In ONFH, bone volume fraction, trabecular thickness, and bone mineral density in the collapsed area were all significantly lower than those in the nearby non-collapsed area where thickened bone trabeculae accompanied by appositional bone formation were invariably seen. On the other hand, in SIF there were no significant differences between the ROIs in any of these microarchitectural parameters. Histopathologically, varying degrees of callus formation overlying the fracture of the subchondral plate were seen around the lateral collapsed lesion. CONCLUSION: The morphological features of the lateral collapsed lesion were inconsistent between ONFH and SIF, suggesting different pathomechanisms of femoral head collapse.. |
| 472. |
Kanako Yakushiji, Kimie Fujita, Satomi Tanaka, Rumi Tanaka, Jun-Ichi Fukushi, Goro Motomura, Satoshi Hamai, Satoshi Ikemura, Masanori Fujii, Yasuharu Nakashima, Cross-cultural adaptation, reliability and validity of the Japanese version of the Hospital for Special Surgery Hip Replacement Expectations Survey., Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 10.1016/j.jos.2019.07.006, 25, 4, 599-605, 2020.07, BACKGROUND: The Hospital for Special Surgery Hip Replacement Expectations Survey (HSS-THRES) is used in many countries to determine patient expectations before surgery. This study aimed to assess the reliability and validity of the Japanese version of HSS-THRES. METHODS: A total of 134 patients scheduled for total hip arthroplasty (THA) underwent a self-administered preoperative survey questionnaire. Patient's expectation and quality of life (QOL) were measured using the Japanese version of HSS-THRES, overall expectations for THA, Oxford hip score (OHS), and EuroQol-5D (EQ-5D). Some patients completed the Japanese version of HSS-THRES and the overall expectations for THA after a ten-day interval. Cross-cultural adaptation was validated by an expert committee comprising health professionals, a methodologist, language experts, and orthopedic specialists. The internal consistency was evaluated by the Cronbach α coefficient. The test-retest reliability was examined using the intraclass coefficient correlation (ICC) and the Bland and Altman analysis. To test the construct validity, nine priori hypotheses were tested by correlation analysis between the Japanese version of HSS-THRES and two QOL scales, and by examining the association with demographic variables. RESULTS: A total of 116 patients completed four scales. Patients were predominantly female (75.9%), with an average age of 62.2 ± 11.7. In the cross-cultural adaptation, all patients responded to the questionnaire without problems. The Japanese version of HSS-THRES showed good internal consistency (Cronbach α: 0.9). ICC was 0.94 and Bland-Altman analysis indicated no bias. The correlation between Japanese HSS-THRES and overall expectations for THA was high (r = 0.67). Similarly, the correlation with the OHS was higher than that with EQ-5D. A total of 77.8% of the hypotheses were confirmed. CONCLUSIONS: The Japanese version of HSS-THRES showed good cultural acceptability, high reliability, and validity to evaluate preoperative expectations for THA patients.. |
| 473. |
Masato Yoshimoto, Yuichi Yamada, Shin Ishihara, Kenichi Kohashi, Yu Toda, Yoshihiro Ito, Hidetaka Yamamoto, Masutaka Furue, Yasuharu Nakashima, Yoshinao Oda, Comparative Study of Myxofibrosarcoma With Undifferentiated Pleomorphic Sarcoma: Histopathologic and Clinicopathologic Review., The American journal of surgical pathology, 10.1097/PAS.0000000000001389, 44, 1, 87-97, 2020.01, Myxofibrosarcoma (MFS) is a malignant fibroblastic/myofibroblastic neoplasm with the prominent myxoid area. It has the clinical features of frequent local recurrence and occasional distant metastasis. Morphologically, MFS is occasionally difficult to distinguish from undifferentiated pleomorphic sarcoma (UPS), especially in the case of high-grade MFS. Here, we reviewed clinical and histologic data of 162 MFS cases and 43 UPS cases. MFS was distinguished from UPS with the criterion of 10% myxoid area as a cutoff value. Overall, 52 MFS (34.4%) and 9 UPS (20.9%) cases showed local recurrence, 18 MFS (12.2%) and 19 UPS (44.2%) cases developed distant metastasis, and 13 MFS (9.5%) and 14 UPS (32.6%) cases resulted in tumor-related death. Statistically, MFS had a better prognosis than UPS. Moreover, MFS with less myxoid area had a tendency to present a poorer prognosis. FNCLCC grade was a statistically significant prognostic factor (distant metastasis: P=0.0021, tumor-related death: P=0.0021). Cellularity and nuclear atypia had only a statistical tendency for associations with a poorer prognosis. The overall survival rate of MFS after transformation into a UPS-like condition ( |
| 474. |
Taro Mawatari, Satoshi Ikemura, Gen Matsui, Takahiro Iguchi, Hiroaki Mitsuyasu, Shinya Kawahara, Masayuki Maehara, Ryoichi Muraoka, Yukihide Iwamoto, Yasuharu Nakashima, Assessment of baseline bone turnover marker levels and response to risedronate treatment: Data from a Japanese phase III trial., Bone reports, 10.1016/j.bonr.2020.100275, 12, 100275-100275, 2020.06, Background: Risedronate increases bone mineral density (BMD) and reduces fracture risk, but treatment response may depend on the baseline state of bone turnover. Data regarding the selection of therapeutic drugs or the prediction of therapeutic effects with baseline levels of bone turnover markers (BTMs) as a reference are insufficient. We hypothesized that when the baseline levels of BTMs are higher, baseline BMD might be lower, changes in BMD at 12 months after risedronate treatment might be higher, and the reduction of fracture incidence might be greater. This study aimed to analyze the data of a phase III clinical trial of risedronate from Japan to investigate the relationships between baseline BTM levels and (1) baseline BMD, (2) changes in BMD at 12 months after the start of treatment, and (3) the incidence of new vertebral fractures. Methods: This post-hoc analysis included 788 postmenopausal women with osteoporosis whose baseline BTM levels as well as baseline and endpoint BMDs were measured. Relationships between baseline BTM levels and BMD at baseline and 12 months after risedronate treatment and new vertebral fractures were examined. One-way analysis of variance, two-tailed Student's t-test, and Fisher's exact test were used to analyze the data. Results: Baseline BMD showed a significant upward trend when baseline BTM levels were lower in the analysis by tertiles. New vertebral fractures tended to occur in patients with prevalent vertebral fractures, but the relationship between new fractures and BTM levels was not statistically significant. Regardless of BTM types, BMD percentage increments (%) and increments (g/cm2) with the 12-month treatment were high when pretreatment BTM levels were high (P 5.0% increase in BMD was observed even if baseline BTM levels were within the normal range. A new vertebral fracture occurred in only six patients (0.77%), and there was not enough statistical power to clarify the relationship between baseline BTM levels and fracture risk reduction. Conclusions: When pretreatment BTM levels increased, baseline BMD tended to be lower and the increase in BMD with 12-month risedronate treatment was higher. However, BMD could still be increased even if the baseline BTM levels are within the normal range. Combined with available evidence, baseline BTMs may not have an important role in deciding the optimal therapy. To elucidate the relationship between baseline BTM levels and long-term fracture risk, it will be necessary to conduct more large-scale studies with a longer follow-up period in severe osteoporotic patients with a high fracture risk. Mini abstract: We evaluated the significance of baseline bone turnover markers in the response to risedronate treatment. The increase in the bone mineral density (BMD) with the 12-month treatment may be higher when the state of bone turnover at baseline is higher, and BMD could still be increased even if the baseline bone turnover is within the normal range.. |
| 475. |
Kazuya Yokota, Osamu Kawano, Hironari Kaneyama, Takeshi Maeda, Yasuharu Nakashima, Acute spinal subdural hematoma: A case report of spontaneous recovery from paraplegia., Medicine, 10.1097/MD.0000000000020032, 99, 19, e20032, 2020.05, RATIONALE: Spontaneous spinal subdural hematoma (SSDH) is a rare disease that can cause severe permanent neurological dysfunction. Here we present a case of spontaneous SSDH, in which a series of magnetic resonance images (MRIs) taken through the course of the disease facilitated understanding of the resolution process of the hematoma and the diagnosis of SSDH. PATIENT CONCERNS: A 59-year-old male presented with sudden severe back pain and rapid onset of paraplegia. This symptom had continued developing while he was transferred to the emergency department. Initial physical examination showed flaccid paralysis of both lower limbs with areflexia and loss of all sensation below T6 bilaterally. MRI images showed an anterior subdural hematoma from C7 to T7 with spinal cord compression. DIAGNOSIS: Based on MRI findings, the diagnosis was SSDH. INTERVENTIONS: We chose conservative treatment of 1-week bed rest and intensive rehabilitation for the patient due to the presence of sacral sparing and the slight motor recovery at 24 hours after the onset. OUTCOMES: Frequent MRI images demonstrated that the spinal cord compression was surprisingly mitigated only 2 days and mostly absorbed 4 days after the onset. The patient's motor function was recovered completely and he was discharged after 8 weeks of hospitalization. LESSONS: Our chronological MRI findings provide crucial information for diagnosing SSDH and also suggest that spinal surgeons should consider the potential option of a conservative approach for treating SSDH. Although prompt selection of a therapeutic strategy for SSDH could be challenging, the surgeons could observe the course of the patient's neurological status for a few days to detect signs of spontaneous recovery.. |
| 476. |
Kenichiro Yahiro, Yoshihiro Matsumoto, Hisakata Yamada, Makoto Endo, Nokitaka Setsu, Toshifumi Fujiwara, Makoto Nakagawa, Atsushi Kimura, Eijiro Shimada, Seiji Okada, Yoshinao Oda, Yasuharu Nakashima, Activation of TLR4 signaling inhibits progression of osteosarcoma by stimulating CD8-positive cytotoxic lymphocytes., Cancer immunology, immunotherapy : CII, 10.1007/s00262-020-02508-9, 69, 5, 745-758, 2020.02, BACKGROUND: Osteosarcoma (OS) is the most common malignant bone tumor and the prognosis of advanced cases is still poor. Recently, there have been several reports suggesting the relationship between innate immunity and OS, but the detailed mechanism is unknown. We demonstrate the relationship between OS and Toll-like receptor 4 (TLR4) which is one of the most important factors in innate immunity. METHODS: We established a syngenic mouse tumor model using C3H/HeN, C3H/HeJ mouse and a highly metastatic OS cell line, LM8. TLR4 activation with lipopolysaccharide (LPS) was performed on both mice and its influence on the progression of OS was evaluated. We also performed CD8 + cells depletion to examine the influence on TLR4 activation effects. RESULTS: Tumor volume of C3H/HeN mice was significantly smaller and overall survival of C3H/HeN mice was significantly longer than C3H/HeJ mice. We found more CD8+ cells infiltrating in lung metastases of C3H/HeN mice and depletion of CD8+ cells canceled the antitumor effects of LPS. CONCLUSION: TLR4 activation by LPS increased CD8+ cells infiltrating into lung metastases and suppressed OS progression in the mouse model. TLR4 activation may suppress the progression of OS via stimulating CD8+ cells and can be expected as a novel treatment for OS.. |
| 477. |
Yusuke Kohno, Yasuharu Nakashima, Masanori Fujii, Kyohei Shiomoto, Miho Iwamoto, Acetabular retroversion in dysplastic hips is associated with decreased 3D femoral head coverage independently from lateral center-edge angle., Archives of orthopaedic and trauma surgery, 10.1007/s00402-019-03277-6, 140, 7, 869-875, 2020.07, INTRODUCTION: The clinical significance of acetabular retroversion in non-dysplastic hips can be explained as pincer-type femoroacetabular impingement (FAI), whereas that in dysplastic hips is not clarified because FAI normally poses little problems for dysplastic hips. We aimed to evaluate three-dimensional (3D) femoral head coverage in dysplastic hips with and without acetabular retroversion and to elucidate the role of acetabular retroversion on the 3D femoral head coverage. MATERIALS AND METHODS: We retrospectively investigated 93 hips in 93 patients (9 males and 84 females) that underwent periacetabular osteotomy for hip dysplasia. Dysplastic hips were divided into anteversion and retroversion groups according to their cranial anteversion, which was measured on the axial section 5 mm caudal to the acetabular roof. The 3D femoral head coverage was provided as a percentage of the acetabulum-covered surface area of the upper femoral hemisphere using a 3D preoperative planning software for total hip arthroplasty. RESULTS: Of the 93 dysplastic hips, 15 hips (16%) were assigned to the retroversion group, which had significantly younger age at surgery (31.9 years versus 39.2 years; p = 0.033). The lateral center-edge angles were comparable between the groups (13.8° versus 12.9°; p = 0.68); however, the hips in the retroversion group had a trend of smaller 3D femoral head coverage than those in the anteversion group (59% versus 63%; p = 0.058). Multivariate analysis using two-way analysis of covariance showed that lateral center-edge angle (partial regression coefficient = 0.83; t value = 17.3; p |
| 478. |
Hisakata Yamada, Tomomi Tsuru, Takeshi Otsuka, Masayuki Maekawa, Hiroshi Harada, Takaaki Fukuda, Hiroshi Tsukamoto, Akira Maeyama, Shigeru Yoshizawa, Ken Wada, Yasuharu Nakashima, Eisuke Shono, Seiji Yoshizawa, Hiroshi Jojima, Masakazu Kondo, Abatacept reduces disease activity of rheumatoid arthritis independently of modulating anti-citrullinated peptide antibody production., Immunological medicine, 10.1080/25785826.2020.1718833, 43, 2, 87-91, 2020.06, Abatacept may exert its clinical effect on rheumatoid arthritis (RA) by suppressing anti-cyclic citrullinated peptide (CCP) antibody production. This study was undertaken to test this hypothesis by examining the changes of disease activity of RA and anti-CCP antibody levels over time after starting abatacept. Sixty Japanese RA patients who started abatacept were included in this multicenter, prospective observational study. Simple Disease Activity Index (SDAI) and anti-CCP antibody levels were evaluated at 12, 24, and 52 weeks. The mean SDAI score significantly decreased within 12 weeks after starting abatacept and was maintained thereafter. On the contrary, the mean anti-CCP antibody levels did not change until 52 weeks. At the individual level, there were substantial changes of anti-CCP antibody levels, but these were not correlated with the changes of disease activity at any time points. Thus, abatacept reduces the disease activity of RA independently of modulating anti-CCP antibody production.. |
| 479. |
Clinical Outcome of Extensor Tendon Ruptures in Rheumatoid Hands. |
| 480. |
Post carbon-ion radiotherapy pathological vertebral compression fracture in primary malignant spine/paraspinal tumor : lone term follow up and risk factors. |
| 481. |
A case of reccurent hip pain after hip arthroscopy treated with transposition osteotomy of the acetabulum. |
| 482. |
Current location and future path of immunotherapy for bone and soft tissue sarcoma. |
| 483. |
Overview, current status and controversial issues of ceiling system: Our experience in the Kyushu University orthopaedic surgery training program. |
| 484. |
Relationship between dynamic knee joint stiffness and muscle contraction in gait loading response of knee osteoarthritis patients.. |
| 485. |
Medications for bone metastases. |
| 486. |
Kinematic analysis of the hip joint using image-matching techniques. |
| 487. |
Kenta Momii, Yuji Shono, Kanji Osaki, Yoshinori Nakanishi, Takeshi Iyonaga, Masaaki Nishihara, Tomohiko Akahoshi, Yasuharu Nakashima, Use of venovenous extracorporeal membrane oxygenation for perioperative management of acute respiratory distress syndrome caused by fat embolism syndrome: A case report and literature review., Medicine, 10.1097/MD.0000000000024929, 100, 8, e24929, 2021.02, INTRODUCTION: Fat embolism syndrome (FES) is a known complication of long bone fracture and can affect multiple organs. The organ most commonly affected with FES is the lung. Severe cases of FES from long bone fracture can cause acute respiratory distress syndrome (ARDS). Although the treatment of ARDS remains challenging, it is reported that a lung protection strategy and prone positioning are effective. In addition, early fixation is reported to be beneficial in respiratory failure due to FES, though it may exacerbate respiratory failure during the perioperative period. We report the use of venovenous extracorporeal membrane oxygenation (VV-ECMO) for the successful perioperative management of a patient diagnosed with ARDS due to FES. PATIENT CONCERNS: A 24-year-old man injured in a traffic accident was brought to our emergency department due to shock and consciousness disorder. DIAGNOSIS: After examining the patient, we noted bilateral pneumothorax, liver and spleen injuries, and multiple long bone fractures. Four days after admission, he was diagnosed with FES due to a prolonged consciousness disorder, progressive hypoxia with diffuse lung damage, and cutaneous and mucosal petechiae. INTERVENTION: As respiratory failure progressed, VV-ECMO was initiated on the 6th day. To improve the respiratory failure caused by ARDS, prone position therapy was necessary. Thus, we performed osteosynthesis on the 9th day under ECMO. Prone position therapy was started after surgery. OUTCOMES: Subsequently, his respiratory condition and chest radiographs improved steadily. VV-ECMO was discontinued on the 17th day and the ventilator was removed on the 28th day. His consciousness levels improved without residual central nervous system complications. CONCLUSION: Our study reveals the successful improvement of FES-induced ARDS by osteosynthesis and prone positioning under VV-ECMO. This strategy prioritizes supportive treatment over pharmacologic interventions.. |
| 488. |
Satoru Harada, Satoshi Hamai, Kyohei Shiomoto, Daisuke Hara, Goro Motomura, Satoshi Ikemura, Masanori Fujii, Yasuharu Nakashima, Wear analysis of the first-generation cross-linked polyethylene at minimum 10 years follow-up after THA: no significant effect of sports participation., Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs, 10.1007/s10047-021-01297-x, 25, 2, 140-147, 2021.10, The impact of sports on long-term wear of highly cross-linked polyethylene (XLPE) after total hip arthroplasty (THA) is not fully understood. We investigated (1) the wear performance of the first-generation XLPE, and (2) whether sports participation influences the steady wear rate of XLPE. The femoral head penetration into the cup was measured digitally on radiographs of hips undergoing THA with XLPE. We retrospectively reviewed data that included age, gender, body mass index, follow-up period, preoperative diagnosis, types of XLPE, ball diameter, head material, inclination of the cup, physical function score, and sports participation. Statistical analyses were applied to determine whether sports affect the wear of XLPE and which factors were associated with the steady wear rate. Creep and steady wear rate were found to be 0.18 mm and 0.005 mm/year, respectively. Sports participation, regardless of impact, provided no significant difference in the steady wear rate. Multiple regression analysis demonstrated that sports did not increase the steady wear rate. Our findings showed excellent wear performance of the first-generation XLPE at a minimum of ten years after THA, without significant effect of sports participation on the liner wear.. |
| 489. |
Ewing-like sarcoma (Undifferentiated small round cell sarcomas of bone and soft tissue). |
| 490. |
Yu Toda, Kenichi Kohashi, Hidetaka Yamamoto, Shin Ishihara, Yoshihiro Ito, Yosuke Susuki, Kengo Kawaguchi, Daisuke Kiyozawa, Dai Takamatsu, Izumi Kinoshita, Yuichi Yamada, Junki Maehara, Atsushi Kimura, Sadafumi Tamiya, Kenichi Taguchi, Tomoya Matsunobu, Yoshihiro Matsumoto, Yasuharu Nakashima, Masaaki Mawatari, Yoshinao Oda, Tumor microenvironment in giant cell tumor of bone: evaluation of PD-L1 expression and SIRPα infiltration after denosumab treatment., Scientific reports, 10.1038/s41598-021-94022-w, 11, 1, 14821-14821, 2021.07, Giant cell tumor of bone (GCTB) is an intermediate malignant bone tumor that is locally aggressive and rarely metastasizes. Denosumab, which is a receptor activator of nuclear factor kappa B ligand (RANKL) inhibitor, can be used to treat GCTB. We focused on potential immunotherapy for GCTB and investigated the tumor microenvironment of GCTB. Programmed death-ligand 1 (PD-L1) and indoleamine 2,3-dioxygenase 1 (IDO1) expression and signal-regulatory protein alpha (SIRPα), forkhead box P3 (FOXP3), and cluster of differentiation 8 (CD8) infiltration were assessed by immunohistochemical studies of 137 tumor tissues from 96 patients. Of the naive primary specimens, 28% exhibited PD-L1 expression and 39% exhibited IDO1 expression. There was significantly more SIRPα+, FOXP3+, and CD8+ cell infiltration in PD-L1- and IDO1-positive tumors than in PD-L1- and IDO1-negative tumors. The frequency of PD-L1 expression and SIRPα+ cell infiltration in recurrent lesions treated with denosumab was significantly higher than in primary lesions and recurrent lesions not treated with denosumab. PD-L1 expression and higher SIRPα+ cell infiltration were significantly correlated with shorter recurrence-free survival. PD-L1 and SIRPα immune checkpoint inhibitors may provide clinical benefit in GCTB patients with recurrent lesions after denosumab therapy.. |
| 491. |
Yu Soejima, Yukio Akasaki, Satoshi Hamai, Hidetoshi Tsushima, Shinya Kawahara, Yasuharu Nakashima, Transverse osteotomy closer to tibial plateau is associated with larger postoperative change in valgus laxity after open-wedge high tibial osteotomy., Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 10.1007/s00167-021-06810-6, 2021.12, PURPOSE: To identify the factors impacting changes in valgus laxity between before and after open-wedge high tibial osteotomy (OW-HTO) using quantitative valgus stress radiographs. METHODS: A total of 40 knees from 38 patients who underwent OW-HTO were assessed. The study population comprised 14 men and 24 women, with a mean age of 61.5 years. Valgus stress radiographs before and 1 year after OW-HTO were performed using a Telos device. The difference between pre- and postoperative joint line convergence angle (JLCA) was expressed as ΔJLCA (post-pre). As indicators of the proximal detachment of superficial medial collateral ligament (sMCL) on radiographs, two distances were defined: the distance from the level of the osteotomy starting point to the tangent line of the proximal tibial plateau (Distance A), or to the medial edge of the proximal tibial plateau (Distance B). Correlations between ΔJLCA and radiographic parameters or KOOS sub-scores were assessed using Spearman's rank correlation coefficient analysis. Receiver operator curves were generated to evaluate the predictive strength of the significant factor for an increase in ΔJLCA > 1°. RESULTS: Pre-operative OA severity consisted of Kellgren-Lawrence grade 2 (n = 18), 3 (n = 16), and 4 (n = 6). The average ΔJLCA (post-pre) was 0.5°, and ranged from - 1.4° to + 3.0°. The maximum systemic measurement error and limits of agreement were 0.07° and 0.20°, respectively. There were significant correlations between ΔJLCA and Distance A (36.9 ± 3.9 mm, R = - 0.46, p = 0.002), between ΔJLCA and Distance B (39.9 ± 4.0 mm, R = - 0.49, p = 0.001). The cut-off value for Distance A was determined to be 35 mm below the tibial plateau; the AUC was 0.804, with a sensitivity of 0.75 and a specificity of 0.82. Distance B correlated strongly with Distance A (R = 0.96, p |
| 492. |
Keisuke Komiyama, Satoshi Hamai, Goro Motomura, Satoshi Ikemura, Masanori Fujii, Shinya Kawahara, Yasuharu Nakashima, Total hip arthroplasty after periacetabular osteotomy versus primary total hip arthroplasty: a propensity-matched cohort study., Archives of orthopaedic and trauma surgery, 10.1007/s00402-021-03817-z, 141, 8, 1411-1417, 2021.08, BACKGROUND: Controversy still exist regarding the outcomes of total hip arthroplasty (THA) after periacetabular osteotomy (PAO). The purpose of this study was to compare the clinical and radiologic outcomes of THA after PAO with primary THA based on balanced baseline characteristics with propensity score matching. METHODS: Using propensity score matching, 1:2 matched cohort to facilitate comparison between patients who underwent primary cementless THA with or without previous PAO. Then, we compared the operative time, blood loss, complications, postoperative clinical score, cup size, position, and alignment of acetabular cup, and degree of bony coverage on cup between the two groups. RESULTS: Thirty-five patients with 37 hips who underwent THA after PAO were successfully matched to 70 patients with 74 hips who underwent primary THA. The operative time and blood loss in THA after PAO were significantly longer and larger than those in primary THA (P 0.05). For THA after PAO, the cup size and bony coverage were larger (P = 0.0014 and |
| 493. |
中島 康晴, ウィズ・ポストコロナ時代の日本整形外科学会のあり方, 日本整形外科学会雑誌 = The Journal of the Japanese Orthopaedic Association, 10.1016/j.jos.2021.11.007, 27, 1, 1-2, 2021.12. |
| 494. |
Shin Ishihara, Takeshi Iwasaki, Kenichi Kohashi, Yuichi Yamada, Yu Toda, Yoshihiro Ito, Yousuke Susuki, Kengo Kawaguchi, Dai Takamatsu, Shinichiro Kawatoko, Daisuke Kiyozawa, Taro Mori, Izumi Kinoshita, Hidetaka Yamamoto, Toshifumi Fujiwara, Nokitaka Setsu, Makoto Endo, Yoshihiro Matsumoto, Yasuharu Nakashima, Yoshinao Oda, The association between the expression of PD-L1 and CMTM6 in undifferentiated pleomorphic sarcoma., Journal of cancer research and clinical oncology, 10.1007/s00432-021-03616-4, 147, 7, 2003-2011, 2021.07, BACKGROUND: Undifferentiated pleomorphic sarcoma (UPS) is a sarcoma with a poor prognosis. A clinical trial, SARC028, revealed that treatment with anti-PD-1 drugs was effective against UPS. Studies have reported that UPS expresses PD-L1, sometimes strongly (≥ 50%). However, the mechanism of PD-L1 expression in UPS has remained unclear. CKLF-like MARVEL transmembrane domain containing 6 (CMTM6) was identified as a novel regulator of PD-L1 expression. The positive relationship between PD-L1 and CMTM6 has been reported in several studies. The aim of this study was thus to examine CMTM6 expression in UPS and evaluate the relationship between PD-L1 and CMTM6 in this disease. MATERIALS AND METHODS: Fifty-one primary UPS samples were subjected to CMTM6 and PD-L1 immunostaining. CMTM6 expression was assessed using proportion and intensity scores. CMTM6 gene copy number was also evaluated using a real-time PCR-based copy number assay. We also analyzed the mRNA expression and copy number variation of PD-L1 and CMTM6 in The Cancer Genome Atlas (TCGA) data. RESULTS: TCGA data indicated that the mRNAs encoded by genes located around 3p22 were coexpressed with CMTM6 mRNA in UPS. Both proportion and intensity scores of CMTM6 positively correlated with strong PD-L1 expression (≥ 50%) (both p = 0.023). CMTM6 copy number gain increased CMTM6 expression. Patients with UPS with a high CMTM6 intensity score had a worse prognosis for overall survival. CONCLUSIONS: UPS showed variation in CMTM6 copy number and CMTM6 expression. CMTM6 expression was significantly correlated with PD-L1 expression, especially with strong PD-L1 expression.. |
| 495. |
Hideki Mizu-Uchi, Hidehiko Kido, Tomonao Chikama, Kenta Kamo, Satoshi Kido, Yasuharu Nakashima, The Adjustment of the Rotational Alignment of the Distal End of the Extramedullary Guide to the Anteroposterior Axis of the Proximal Tibia in Total Knee Arthroplasty., The journal of knee surgery, 10.1055/s-0040-1722660, 2021.01, The optimal placement within 3 degrees in coronal alignment was reportedly achieved in only 60 to 80% of patients when using an extramedullary alignment guide for the tibial side in total knee arthroplasty (TKA). This probably occurs because the extramedullary alignment guide is easily affected by the position of the ankle joint which is difficult to define by tibial torsion. Rotational direction of distal end of the extramedullary guide should be aligned to the anteroposterior (AP) axis of the proximal tibia to acquire optimal coronal alignment in the computer simulation studies; however, its efficacy has not been proven in a clinical setting. The distal end of the guide can be overly displaced from the ideal position when using a conventional guide system despite the alignment of the AP axis to the proximal tibia. This study investigated the effect of displacement of the distal end of extramedullary guide relative to the tibial coronal alignment while adjusting the rotational alignment of the distal end to the AP axis of the proximal tibia in TKA. A total of 50 TKAs performed in 50 varus osteoarthritic knees using an image-free navigation system were included in this study. The rotational alignment of the proximal side of the guide was adjusted to the AP axis of the proximal tibia. The position of the distal end of the guide was aligned to the center of the ankle joint as viewed from the proximal AP axis (ideal position) and as determined by the navigation system. The tibial intraoperative coronal alignments were recorded as the distal end was moved from the ideal position at 3-mm intervals. The intraoperative alignments were 0.5, 0.9, and 1.4 degrees in valgus alignment with 3-, 6-, and 9-mm medial displacements, respectively. The intraoperative alignments were 0.7, 1.2, and 1.7 degrees in varus alignment with 3-, 6-, and 9-mm lateral displacements, respectively. In conclusion, the acceptable tibial coronal alignment (within 2 degrees from the optimal alignment) can be achieved, although some displacement of the distal end from the ideal position can occur after the rotational alignment of the distal end of the guide is adjusted to the AP axis of the proximal tibia.. |
| 496. |
Satoru Harada, Satoshi Hamai, Hirotaka Gondo, Hidehiko Higaki, Satoru Ikebe, Yasuharu Nakashima, Squatting after total hip arthroplasty: Patient-reported outcomes and in vivo three-dimensional kinematic study., The Journal of arthroplasty, 10.1016/j.arth.2021.12.028, 37, 4, 734-741, 2021.12, BACKGROUND: Squatting is an important function for many daily activities, but has not been well documented after total hip arthroplasty (THA). This study investigated the participation rate of squatting and in vivo kinematics during squatting. METHODS: A survey questionnaire about squatting was mailed to patients who underwent primary THA and 328 patients returned acceptable responses. Additionally, 32 hips were evaluated for dynamic three-dimensional kinematics of squatting using density-based image-matching techniques. Multivariate analyses were applied to determine which factors were associated with anterior liner-to-neck distance at maximum hip flexion. RESULTS: Patients who could easily squat significantly increased this ability postoperatively (23.5% vs. 46%, P |
| 497. |
Naohide Takeuchi, Naoya Kozono, Akihiro Nishii, Koumei Matsuura, Eiichi Ishitani, Toshihiro Onizuka, Yoshihisa Zaitsu, Takamitsu Okada, Yasuhiro Mizuki, Takehiro Kimura, Hidehiko Yuge, Taiki Uchimura, Kunio Iura, Tatsuya Mori, Koki Ueda, Go Miake, Takahiro Senju, Kenji Takagishi, Yasuharu Nakashima, Stump classification was correlated with retear in the suture-bridge and double-row repair techniques for arthroscopic rotator cuff repair., Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 10.1007/s00167-020-06415-5, 29, 8, 2587-2594, 2021.08, PURPOSE: The Stump classification is significantly correlated with a retear after arthroscopic rotator cuff repair. However, no study has evaluated whether or not the stump classification is correlated with retear in the suture-bridge or double-row repair techniques. The aim of this study was to evaluate the relationship between a retear and the stump classification in the suture-bridge and double-row repair techniques. METHODS: Among 389 patients who underwent arthroscopic repairs of full-thickness rotator cuff tears using suture-bridge or double-row repair techniques, 326 patients (median age 67.0 years; range 25-85) were included. There were 51 small, 172 medium, 83 large, and 20 massive tears. Two hundred forty patients were treated with the suture-bridge technique, and 86 patients were treated with the double-row technique. The following variables were analyzed: age, sex, the Cofield classification, anteroposterior and mediolateral tear size on preoperative MRI, global fatty degeneration index, and the stump classification. Cuff integrity was evaluated on magnetic resonance imaging at 6 months after surgery. The patients were divided into the intact and retear groups and the relationship between the variables and retear was evaluated by multivariate logistic regression analysis. RESULTS: The overall retear rate was 10.1%. In the multivariate logistic regression analysis, the independent predictors of a retear were the stump classification type 3 (Odds ratio: 4.71, p = 0.0246), global fatty degeneration index (Odds ratio: 3.87, p = 0.0030), and anteroposterior tear size (Odds ratio: 1.07, p = 0.0077) in the suture bridge technique. In the double-row technique, the independent predictors of retear were stump classification type 3 (Odds ratio: 7.82, p = 0.0348), and age (Odds ratio: 1.22, p = 0.0163). CONCLUSION: The stump classification was significantly correlated with retear in the suture-bridge and double-row repair technique. Stump classification type 3 was indicated to be an important risk factor for predicting retear. LEVEL OF EVIDENCE: III.. |
| 498. |
Yoshihiro Matsumoto, Hirokazu Saiwai, Keiichiro Iida, Seiji Okada, Makoto Endo, Nokitaka Setsu, Toshifumi Fujiwara, Kenichi Kawaguchi, Yasuharu Nakashima, Shape Factor of the Spinal Cord: A Possible Predictor of Surgical Outcome for Intradural Extramedullary Spinal Tumors in the Thoracic Spine., Global spine journal, 10.1177/2192568220982571, 12, 7, 2192568220982571-2192568220982571, 2021.01, STUDY DESIGN: Retrospective diagnostic analysis. OBJECTIVES: To establish a new predictor of surgical outcome after surgery for intradural extramedullary spinal tumor (IDEMT) in the thoracic spine, we introduced shape factor (SF), a mathematical description of the morphology of the spinal cord. SF was calculated by dividing object area by the square of perimeter. MATERIALS AND METHODS: Forty-three consecutive patients with IDEMT, detected by magnetic resonance imaging at the thoracic level with myelopathic signs, were included. Preoperative transverse cross-sectional area (CSA) and perimeter of the spinal cord (perimeter) at the level of maximal compression were measured. SF was calculated as 4π × CSA/(perimeter)2. The association between clinicoradiological factors and surgical outcome of IDEMT was statistically analyzed. RESULTS: Mean CSA, perimeter, and SF were 27.8 ± 15.8 mm2, 28.8 ± 6.1 mm, and 0.385 ± 0.14, respectively. A histogram distribution revealed that perimeter and SF, but not CSA, fit the normal distribution. The patients were subdivided into 2 groups according to postoperative modified Japanese Orthopedic Association Score (mJOA). [group F (favorable): n = 32, mJOA ≥ 9; group UF (unfavorable): n = 11, mJOA |
| 499. |
Shoji Baba, Goro Motomura, Satoshi Ikemura, Ryosuke Yamaguchi, Satoshi Hamai, Masanori Fujii, Koichiro Kawano, Yasuharu Nakashima, Risk factors for radiological changes after bipolar hemiarthroplasty for osteonecrosis of the femoral head., Modern rheumatology, 10.1080/14397595.2020.1775959, 31, 3, 725-732, 2021.05, OBJECTIVES: This study aimed to report the mid-term radiological outcomes of patients with bipolar hemiarthroplasty (BHA) for stage 3 osteonecrosis of the femoral head (ONFH), and to identify the risk factors for postoperative radiological changes. METHODS: We retrospectively investigated 62 patients (38 men and 24 women; mean age, 50.1 years) aged |
| 500. |
Kenta Momii, Toshifumi Fujiwara, Takao Mae, Masami Tokunaga, Takeshi Iwasaki, Kyohei Shiomoto, Kensuke Kubota, Toshihiro Onizuka, Tatsuhiko Miura, Takahiro Hamada, Tetsuro Nakamura, Takashi Itokawa, Takahiro Iguchi, Akihisa Yamashita, Naoshi Kikuchi, Kazutoshi Nakaie, Yoshihiro Matsumoto, Yasuharu Nakashima, Risk factors for excessive postoperative sliding of femoral trochanteric fracture in elderly patients: A retrospective multicenter study., Injury, 10.1016/j.injury.2021.07.039, 52, 11, 3369-3376, 2021.08, INTRODUCTION: The application of a load on the internal fixation of a trochanteric fracture exerts a moment along the lag screw, causing the proximal bone fragment to slide along the lag screw, allowing contact between the proximal and distal bone fragments, which promotes healing. However, excessive sliding is related to poor postoperative outcomes. We aimed to identify the risk factors for excessive sliding. MATERIALS AND METHODS: We conducted a multicenter retrospective study including 115 trochanteric fractures sustained through low-energy trauma in 19 male and 96 female patients aged 60 years or older (mean age: 82.9 years) between September 2013 and December 2014. We measured the postoperative sliding distance after osteosynthesis using a sliding hip screw or intramedullary nailing, and classified participants with ≥8 mm of sliding into the excessive sliding group (ESG) and with |
| 501. |
Yuta Sakemi, Koichiro Hayashi, Akira Tsuchiya, Yasuharu Nakashima, Kunio Ishikawa, Reconstruction of critical-size segmental defects in rat femurs using carbonate apatite honeycomb scaffolds., Journal of biomedical materials research. Part A, 10.1002/jbm.a.37157, 109, 9, 1613-1622, 2021.09, Critical-size segmental defects are formidable challenges in orthopedic surgery. Various scaffolds have been developed to facilitate bone reconstruction within such defects. Many previously studied scaffolds achieved effective outcomes with a combination of high cost, high-risk growth factors or stem cells. Herein, we developed honeycomb scaffolds (HCSs) comprising carbonate apatite (CO3 Ap) containing 8% carbonate, identical to human bone composition. The CO3 Ap HCSs were white-columned blocks harboring regularly arranged macropore channels of a size and wall thickness of 156 ± 5 μm and 102 ± 10 μm, respectively. The compressive strengths of the HCSs parallel and perpendicular to the macropore channel direction were 51.0 ± 11.8 and 15.6 ± 2.2 MPa, respectively. The HCSs were grafted into critical-sized segmental defects in rat femurs. The HCSs bore high-load stresses without any observed breakage. Two-weeks post-implantation, calluses formed around the HCSs and immature bone formed in the HCS interior. The calluses and immature bone matured until 8 weeks via endochondral ossification. At 12 weeks post-implantation, large parts of the HCSs were gradually replaced by newly formed bone. The bone reconstruction efficacy of the CO3 Ap HCSs alone was comparable to that of protein and cell scaffolds, while achieving a lower cost and increased safety.. |
| 502. |
Yu Toda, Yuichi Yamada, Kenichi Kohashi, Shin Ishihara, Yoshihiro Ito, Yosuke Susuki, Kengo Kawaguchi, Izumi Kinoshita, Daisuke Kiyozawa, Taro Mori, Yusuke Kuboyama, Yuki Tateishi, Hidetaka Yamamoto, Toshifumi Fujiwara, Nokitaka Setsu, Makoto Endo, Yoshihiro Matsumoto, Yasuharu Nakashima, Masaaki Mawatari, Yoshinao Oda, Prognostic implication of desmoplastic stroma in synovial sarcoma: A histological review., Pathology, research and practice, 10.1016/j.prp.2021.153668, 228, 153668-153668, 2021.12, Synovial sarcoma (SS) is a malignant soft tissue neoplasm harboring SS18-SSX fusion gene and is histologically characterized by spindle cells and epithelial components. Some investigations have demonstrated that desmoplastic reaction (DR) is an independent prognostic factor of cancers. However, it remains unknown whether DR is of predictive value for the prognosis of synovial sarcoma patients. Here, we reviewed the clinical and histological findings of 88 patients with SS. We defined DR as hyalinized collagenous structures and classified the degree of DR as follows: none, mild, moderate, and severe. Overall, 23 SS cases (24%) showed moderate or severe DR histologically. Statistically, the cases with moderate or severe degree of DR showed poorer prognosis than those with no or mild DR (local recurrence: P = 0.0059, distant metastasis: P = 0.0002, tumor death: P = 0.0382). The findings of the study suggest that the DR of synovial sarcoma could be an important prognostic factor.. |
| 503. |
Masanori Fujii, Yasuharu Nakashima, Kenji Kitamura, Goro Motomura, Satoshi Hamai, Satoshi Ikemura, Yasuo Noguchi, Preoperative Rather Than Postoperative Intra-Articular Cartilage Degeneration Affects Long-Term Survivorship of Periacetabular Osteotomy., Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 10.1016/j.arthro.2021.01.060, 37, 7, 2112-2122, 2021.07, PURPOSE: To determine whether intra-articular lesions changed in short-term follow-up after periacetabular osteotomy (PAO) and whether the intra-articular lesion changes impacted the long-term survivorship of PAO. METHODS: We reviewed patients with hip dysplasia who underwent PAO with arthroscopic observation between 1990 and 2001. Patients who underwent second-look arthroscopy were included. The correlations between the intra-articular lesion changes and the long-term outcome of PAO were analyzed for patients with >10 years of follow-up. The possible risk factors included demographic factors (age, sex, and body mass index), radiographic factors (Tönnis grade, lateral center-edge angle, Tönnis angle, acetabular head index, crossover sign, posterior wall sign, and joint congruity), and arthroscopic findings (full-thickness lesions at the time of PAO and lesions changes at the time of second-look arthroscopy). RESULTS: A total of 64 patients (72 hips) were studied. Second-look arthroscopy was performed at a median of 1.4 years after PAO. Intra-articular lesions were observed in 93% in the acetabulum, 81% in the femoral head, and 97% in the labrum, respectively. These lesions unchanged in 74% in the acetabulum, 76% in the femoral head, and 79% in the labrum, respectively. Cartilage repair was observed in the acetabulum and the femoral head in 24% and 17% of hips, respectively. Labral repair occurred in 10%. Intra-articular lesion changes were not a predictor of failure. Multivariate analysis identified International Cartilage Repair Society grade 4 lesion in the femoral head as an independent risk factor for failure. CONCLUSIONS: Our results suggest that PAO prevents further deterioration in mild cartilage lesions and results in cartilage repair in some cases with advanced cartilage degenerations in the short term. However, these postoperative changes were not associated with long-term survivorship. Thus, appropriate surgical indications based on the preoperative intra-articular cartilage degeneration is paramount to achieving long-term success in PAO. LEVEL OF EVIDENCE: Level IV, therapeutic study.. |
| 504. |
Kimitaka Nakamura, Daigo Yoshida, Takanori Honda, Jun Hata, Mao Shibata, Yoichiro Hirakawa, Yoshihiko Furuta, Hiro Kishimoto, Tomoyuki Ohara, Takanari Kitazono, Yasuharu Nakashima, Toshiharu Ninomiya, Prevalence and Mortality of Sarcopenia in a Community-dwelling Older Japanese Population: The Hisayama Study., Journal of epidemiology, 10.2188/jea.JE20190289, 31, 5, 320-327, 2021.05, BACKGROUND: The prevalence of sarcopenia defined using the Asian Working Group for Sarcopenia (AWGS) criteria in Asian communities has not been fully addressed. Moreover, few studies have addressed the influence of sarcopenia on mortality. METHODS: A total of 1,371 and 1,597 residents aged 65 years or older participated in health surveys in 2012 and 2017. Sarcopenia was determined using the AWGS definition. Factors associated with the presence of sarcopenia were assessed using a logistic regression model in participants in the 2012 survey. Subjects in the 2012 survey were followed-up prospectively for a median of 4.3 years. Mortality risk for subjects with sarcopenia was examined using the Cox proportional hazards model. RESULTS: The crude prevalence of sarcopenia was 7.4% and 6.6% in participants at the 2012 and 2017 surveys, respectively; there was no significant difference between surveys (P = 0.44). The prevalence of sarcopenia increased significantly with age in both sexes (both P for trend |
| 505. |
Koji Ohta, Jun-Ichi Fukushi, Satoshi Ikemura, Satoshi Kamura, Hisa-Aki Miyahara, Yasuharu Nakashima, Preoperative Japanese Society for the Surgery of the Foot Lesser toe score and erythrocyte sedimentation rate influence wound healing following rheumatoid forefoot surgery., Modern rheumatology, 10.1080/14397595.2020.1775960, 31, 2, 380-385, 2021.03, OBJECTIVES: Delayed wound healing is one of the most common complications following forefoot surgery in patients with rheumatoid arthritis. We aimed to identify the risk factors for delayed wound healing following rheumatoid forefoot surgery. METHODS: Consecutive patients who underwent primary rheumatoid forefoot surgery (86 feet; 53 patients) between April 2008 and February 2019 were retrospectively evaluated. Clinical data, including smoking history, duration of the disease, presence of diabetes mellitus, medication, white blood cell count, erythrocyte sedimentation rate (ESR), C-reactive protein, the surgical procedure performed, and the Japanese Society for Surgery of the Foot (JSSF) scores, were collected. RESULTS: Delayed wound healing was identified in 20 of 86 (23.3%) feet. In univariate analysis, participants showing delayed healing were older at the time of surgery (p = .04), their ESR was higher (p = .0006), and their total (p = .019) and pain (p = .016) scores on the JSSF Lesser toe scale were lower than those showing normal healing. In multivariable analysis, both the total preoperative JSSF Lesser toe scale score (p = .0239) and ESR (p = .0126) remained significant risk factors for delayed wound healing. CONCLUSIONS: After rheumatoid forefoot surgery, surgeons should pay more attention to wound care in patients with lower preoperative JSSF Lesser toe score and high ESR.. |
| 506. |
Masaya Kanahori, Yoshihiro Matsumoto, Toshifumi Fujiwara, Atsushi Kimura, Tomoko Tsutsui, Shinkichi Arisumi, Akiko Oyamada, Masanobu Ohishi, Ko Ikuta, Kuniyoshi Tsuchiya, Naohisa Tayama, Shinji Tomari, Hisaaki Miyahara, Takao Mae, Toshihiko Hara, Taichi Saito, Takeshi Arizono, Kozo Kaji, Taro Mawatari, Masami Fujiwara, Minoru Takasaki, Kunichika Shin, Kenichi Ninomiya, Kazutoshi Nakaie, Yasuaki Antoku, Yukihide Iwamoto, Yasuharu Nakashima, Predictive factors of non-treatment and non-persistence to osteoporosis medication after fragility hip fractures at 3 years after discharge: a multicentre, prospective cohort study in the northern Kyushu district of Japan., Archives of osteoporosis, 10.1007/s11657-021-00988-5, 16, 1, 132-132, 2021.09, We examined osteoporosis medication use and factors affecting persistence in 497 patients with fragility hip fractures. Only 25.5% of patients received continuous medication for 3 years, and 44.1% of patients received no treatment. Low Barthel index at discharge was a risk factor for both non-treatment and non-persistence to osteoporosis medication. PURPOSE: Fragility hip fractures (FHF) caused by osteoporosis decrease the quality of life and worsen life expectancy. Use of osteoporosis medication may be an efficient method in the prevention of secondary FHF. However, previous studies have reported low rates of osteoporosis medication and persistence after FHF. This study aimed to evaluate osteoporosis medication use and factors affecting persistence in patients with FHF in the northern Kyushu area of Japan. METHODS: A total of 497 FHF patients aged ≥ 60 years with a 3-year follow-up were included. We prospectively collected data from questionnaires sent every 6 months regarding compliance with osteoporosis medication. We compared baseline characteristics among three groups: no treatment (NT), no persistence (NP), and persistence (P), and conducted multivariable regression models to determine covariates associated with non-treatment (NT vs. NP/P) and non-persistence (NP vs. P). RESULTS: There were 219 (44.1%), 151 (30.4%), and 127 (25.5%) patients in the NT, NP, and P groups, respectively. Factors associated with non-treatment were male sex, chronic kidney disease, no previous osteoporosis treatment, and low Barthel index (BI) at discharge. The only factor associated with non-persistence was a low BI at discharge. Factors associated with a low BI at discharge were male sex, older age, trochanteric fracture, and surgical delay. CONCLUSION: Low BI at discharge is a risk factor for both non-treatment and non-persistence to osteoporosis medication. Therefore, appropriate interventions to improve BI may result in persistence to osteoporosis medication.. |
| 507. |
Masanori Fujii, Kenji Kitamura, Satoshi Ikemura, Satoshi Hamai, Goro Motomura, Yasuharu Nakashima, Pneumatic femoral broaching decreases post-operative subsidence of a cementless taper-wedge stem., International orthopaedics, 10.1007/s00264-021-05196-x, 46, 2, 233-240, 2021.08, PURPOSE: Stem subsidence is a known cause of early failure in cementless total hip arthroplasty (THA). The aim of this study was to determine the usefulness of pneumatic femoral broaching in preventing post-operative subsidence of a proximally porous-coated, taper-wedge stem. METHODS: We reviewed 169 cases of primary THA with a single taper-wedge stem. Eighty THAs performed using pneumatic broaching were compared with 89 THAs performed using manual broaching in terms of postoperative canal fill ratio (CFR) at three levels, stem subsidence at one year post-operation, and stem fixation at latest follow-up (median, 24 months). RESULTS: The median CFRs were higher in the pneumatic group than in the manual group at all levels (p |
| 508. |
Shin Ishihara, Kenichi Kohashi, Yusuke Kuboyama, Yasuharu Nakashima, Yoshinao Oda, Parosteal osteosarcoma with a manifestation of subperiosteal low-grade central osteosarcoma., Skeletal radiology, 10.1007/s00256-021-03747-2, 50, 9, 1903-1907, 2021.09, We report the peculiar case of a parosteal osteosarcoma arising beneath the periosteum in a 12-year-old boy. He complained of difficulty in left knee flexion. Plain radiography showed a uniformly dense mineralized mass in the bone cortex and parosteal ossified nodules at the metaphysis and diaphysis of the left distal femur. Periosteal reaction was not evident. Uniquely, plain radiography had a smooth outline and revealed gradually thickening mass toward the center. Histologically, the tumor showed a proliferation of spindle-shaped cells with parallel-oriented dense bone trabeculae and hyaline cartilaginous tissue disclosing mild atypia. The periosteum was inverted along the polypoid mass, but there was no periosteum at the top. Immunohistochemically, the spindle cells, including those at the top of the polypoid mass, and cartilaginous cells were positive for MDM2 and CDK4. MDM2 gene amplification was detected in these cells by fluorescence in situ hybridization. Despite the peculiar feature of plain radiography, the lesion was diagnosed as parosteal osteosarcoma. This case report presents a case of parosteal osteosarcoma arising beneath the periosteum, although it is postulated to arise in the outer layer of the periosteum. The unique radiographic findings in this case suggest an association of parosteal osteosarcoma with vigorous bone growth before closure of the growth plate.. |
| 509. |
Shin Ishihara, Yuichi Yamada, Takeshi Iwasaki, Masato Yoshimoto, Yu Toda, Kenichi Kohashi, Hidetaka Yamamoto, Yoshihiro Matsumoto, Yasuharu Nakashima, Yoshinao Oda, PD‑L1 and IDO‑1 expression in undifferentiated pleomorphic sarcoma: The associations with tumor infiltrating lymphocytes, dMMR and HLA class I., Oncology reports, 10.3892/or.2020.7837, 45, 1, 379-389, 2021.01, The prognosis of undifferentiated pleomorphic sarcoma (UPS) is generally unfavorable. Recently, clinical trials such as SARC028 demonstrated the utility of cancer immunotherapy for soft tissue sarcomas. The aim of the present study was to assess the expression of PD‑L1 and IDO‑1 as prognostic factors and therapeutic targets. A total of 52 primary UPS cases were retrieved and two UPS cell lines were utilized for supplementary analysis. Immunohistochemical staining of anti‑PD‑L1 (28‑8), IDO‑1, CD8, CD4, CD3, HLA class I, MSH2, MSH6, MLH1 and PMS2 was carried out. Immunohistochemically, 19 of 52 (36.5%) cases showed PD‑L1 expression at least focally (≥1%) and 5 of 52 (9.62%) showed strong PD‑L1 expression (≥50%). Overall, 25 of 52 (48.1%) cases expressed IDO‑1 (≥1%). Two tumors were evaluated as having deficient mismatch repair and six tumors as having the loss of HLA class I. PD‑L1 expression (≥1%) was significantly related to the infiltration of CD8‑ and CD3‑positive lymphocytes, but strong PD‑L1 expression (≥50%) did not present a significant relationship with tumor‑infiltrating lymphocytes. IDO‑1 expression was also associated with CD8‑, CD4‑, and CD3‑positive lymphocytes. In vitro, both PD‑L1 and IDO‑1 were induced by IFN‑γ stimulation. In survival analysis, strong PD‑L1 expression (≥50%) was a significant poor prognostic factor, while IDO‑1 expression (≥1%) was a favorable one. In conclusion, UPS was shown to frequently express PD‑L1 and IDO‑1. It was suggested that PD‑L1 expression (≥50%) and IDO‑1 expression are poor and favorable prognostic factors of UPS patients, respectively.. |
| 510. |
Izumi Kinoshita, Kenichi Kohashi, Hidetaka Yamamoto, Yuichi Yamada, Takeshi Inoue, Koichi Higaki, Norihiro Teramoto, Yumi Oshiro, Yasuharu Nakashima, Yoshinao Oda, Myxoepithelioid tumour with chordoid features: a clinicopathological, immunohistochemical and genetic study of 14 cases of SMARCB1/INI1-deficient soft-tissue neoplasm., Histopathology, 10.1111/his.14393, 79, 4, 629-641, 2021.10, AIMS: Complete loss of SMARCB1/INI1 in soft-tissue tumours such as malignant rhabdoid tumour, epithelioid sarcoma, myoepithelial tumour of soft tissue and extraskeletal myxoid chondrosarcoma is often associated with high-grade malignancy and poor prognosis. The diagnosis is sometimes challenging, owing to histological similarities, so careful differential diagnosis is required. Therefore, soft-tissue tumours with complete SMARCB1/INI1 loss could potentially include an unknown entity. METHODS AND RESULTS: We analysed 160 cases of SMARCB1/INI1-deficient soft-tissue tumour, and found 14 cases that were not classifiable into already existing categories and had common clinical and histological features. These involved two male and 12 female patients, ranging in age from 20 years to 61 years. The tumours were located in the the puboinguinal region (n = 13) and pelvic cavity (n = 1). Histologically, the tumours showed relatively uniform epithelioid to spindle-shaped cells with myxoid stroma. All tumours showed immunoreactivity for brachyury, epithelial membrane antigen, and progesterone receptor, and 12 of 14 cases did so for oestrogen receptor. Variable positive staining for α-smooth muscle actin, S100 and glial fibrillary acidic protein (GFAP) was seen. NR4A3 and EWSR1 gene rearrangements were not detected in 13 and 11 examined cases, respectively. Clinical follow-up data for the 14 patients showed that 13 were alive without disease and one had been lost to follow-up; four patients developed local recurrence and/or metastases. CONCLUSION: The designation 'myxoepithelioid tumour with choroid features' (METC) was proposed as a tumour with intermediate malignancy controllable with appropriate treatment, including the entity of myoepithelioma-like tumour of the vulvar region. METC represents a novel and independent subset that is histologically, biologically and clinically distinct from already existing SMARCB1/INI1-deficient soft-tissue tumours.. |
| 511. |
Kimitaka Nakamura, Daigo Yoshida, Takanori Honda, Jun Hata, Mao Shibata, Yoichiro Hirakawa, Yoshihiko Furuta, Hiro Kishimoto, Tomoyuki Ohara, Sanmei Chen, Takanari Kitazono, Yasuharu Nakashima, Toshiharu Ninomiya, Midlife and late-life diabetes and sarcopenia in a general older Japanese population: The Hisayama Study., Journal of diabetes investigation, 10.1111/jdi.13550, 12, 10, 1899-1907, 2021.03, AIMS/INTRODUCTION: To investigate the association between midlife or late-life diabetes and the development of sarcopenia in an older Japanese population. MATERIALS AND METHODS: A total of 824 Japanese residents aged 65 to 84 years without sarcopenia were followed up from 2012 to 2017. Sarcopenia was determined following the Asian Working Group for Sarcopenia definition. The time of diabetes diagnosis was classified as midlife or late-life diabetes by the age at first diagnosis of diabetes ( 15 years. The odds ratios of incident sarcopenia according to the diabetic status were estimated using a logistic regression analysis. RESULTS: During follow-up, 47 subjects developed sarcopenia. The multivariable-adjusted odds ratio for incident sarcopenia was significantly greater in subjects with diabetes at baseline than in those without it (odds ratio 2.51, 95% confidence interval 1.26-5.00). Subjects with midlife diabetes had a significantly greater risk of incident sarcopenia, whereas no significant association between late-life diabetes and incident sarcopenia was observed. With a longer duration of diabetes, the risk of incident sarcopenia increased significantly (P for trend = 0.002). CONCLUSIONS: The present study suggests that midlife diabetes and a longer duration of diabetes are significant risk factors for incident sarcopenia in the older population. Preventing diabetes in midlife may reduce the risk of the development of sarcopenia in later life.. |
| 512. |
Shingo Yoshizaki, Tetsuya Tamaru, Masamitsu Hara, Ken Kijima, Masatake Tanaka, Dai-Jiro Konno, Yoshihiro Matsumoto, Yasuharu Nakashima, Seiji Okada, Microglial inflammation after chronic spinal cord injury is enhanced by reactive astrocytes via the fibronectin/β1 integrin pathway., Journal of neuroinflammation, 10.1186/s12974-020-02059-x, 18, 1, 12-12, 2021.01, BACKGROUND: After spinal cord injury (SCI), glial scarring is mainly formed around the lesion and inhibits axon regeneration. Recently, we reported that anti-β1 integrin antibody (β1Ab) had a therapeutic effect on astrocytes by preventing the induction of glial scar formation. However, the cellular components within the glial scar are not only astrocytes but also microglia, and whether or not β1Ab treatment has any influence on microglia within the glial scar remains unclear. METHODS: To evaluate the effects of β1Ab treatment on microglia within the glial scar after SCI, we applied thoracic contusion SCI to C57BL/6N mice, administered β1Ab in the sub-acute phase, and analyzed the injured spinal cords with immunohistochemistry in the chronic phase. To examine the gene expression in microglia and glial scars, we selectively collected microglia with fluorescence-activated cell sorting and isolated the glial scars using laser-captured microdissection (LMD). To examine the interaction between microglia and astrocytes within the glial scar, we stimulated BV-2 microglia with conditioned medium of reactive astrocytes (RACM) in vitro, and the gene expression of TNFα (pro-inflammatory M1 marker) was analyzed via quantitative polymerase chain reaction. We also isolated both naïve astrocytes (NAs) and reactive astrocytes (RAs) with LMD and examined their expression of the ligands for β1 integrin receptors. Statistical analyses were performed using Wilcoxon's rank-sum test. RESULTS: After performing β1Ab treatment, the microglia were scattered within the glial scar and the expression of TNFα in both the microglia and the glial scar were significantly suppressed after SCI. This in vivo alteration was attributed to fibronectin, a ligand of β1 integrin receptors. Furthermore, the microglial expression of TNFα was shown to be regulated by RACM as well as fibronectin in vitro. We also confirmed that fibronectin was secreted by RAs both in vitro and in vivo. These results highlighted the interaction mediated by fibronectin between RAs and microglia within the glial scar. CONCLUSION: Microglial inflammation was enhanced by RAs via the fibronectin/β1 integrin pathway within the glial scar after SCI. Our results suggested that β1Ab administration had therapeutic potential for ameliorating both glial scar formation and persistent neuroinflammation in the chronic phase after SCI.. |
| 513. |
Shinya Kawahara, Taro Mawatari, Gen Matsui, Hideki Mizu-Uchi, Satoshi Hamai, Yukio Akasaki, Hidetoshi Tsushima, Yasuharu Nakashima, Malrotation of whole-leg radiograph less than 10 degrees does not influence preoperative planning in open-wedge high tibial osteotomy., Journal of orthopaedic research : official publication of the Orthopaedic Research Society, 10.1002/jor.24845, 39, 7, 1505-1511, 2021.07, Coronal whole-leg radiography is generally used for preoperative open-wedge high tibial osteotomy (OWHTO) planning. Nevertheless, malrotational whole-leg radiographs could affect the planning, and the effects could possibly be strengthened by the knee flexed position. Consecutive 51 varus osteoarthritis knees that underwent OWHTO were included. The digitally reconstructed radiography (DRR) images parallel to the surgical epicondylar axis (neutral rotation; NR), 5° and 10° external rotation (ER) or internal rotation (IR), were reconstructed from preoperative CT. Preoperative weight-bearing line percentage (WBL%), medial proximal tibial angle (MPTA), planned opening angle, and planned postoperative MPTA were measured with OWHTO planning in each DRR image. Correlations among the measured differences relative to NR images and knee flexion angle were investigated. As the DRR image shifted from ER to IR, the differences in preoperative WBL% and MPTA gradually increased, whereas those in the opening angle gradually decreased, although all differences in the opening angle were within 0.5° on an average. Opening angle differences remarkably correlated with knee flexion angle, and knees with >10° flexion contracture had >1° difference in 10° ER or IR images. Planned postoperative MPTA had relatively high consistency regardless of whole-leg malrotation. The opening angle measurement using malrotated radiographs less than 10° would be clinically reliable in cases without knee flexion contracture. Nevertheless, extreme care should be taken in cases with >10° knee flexion contracture. The MPTA after medial opening would be a consistent and reliable parameter in whole-leg alignment evaluation.. |
| 514. |
Prognostic factors of MPNST with complete loss of H3K27me3 and H3K27me2. |
| 515. |
Hirokazu Saiwai, Seiji Okada, Mitsumasa Hayashida, Katsumi Harimaya, Yoshihiro Matsumoto, Ken-Ichi Kawaguchi, Kei-Ichiro Iida, Kazu Kobayakawa, Kazuya Yokota, Takeshi Maeda, Kuniyoshi Tsuchiya, Takeshi Arizono, Taichi Saito, Kazutoshi Nakaie, Yukihide Iwamoto, Yasuharu Nakashima, Long-term outcomes of spinal meningioma resection with outer layer of dura preservation technique., Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 10.1016/j.jocn.2020.11.026, 83, 68-70, 2021.01, Spinal meningioma is a common benign intradural spinal tumor. It has been reported that the local recurrence rate after surgical resection increases with longer follow-up duration. Simpson grade 1 resection could reduce the risk of recurrence, but this procedure needs dural reconstruction, which would cause cerebrospinal fluid (CSF) leakage or iatrogenic spinal cord injury. Saito et al. reported dura preservation technique to reduce the risk of CSF leakage, in which the meningioma together with the inner layer of the dura is removed and the outer layer is preserved for simple dural closure. The long-term outcomes with this technique have never been investigated. In this study, we retrospectively analyzed the data of 38 surgically treated patients (dura preservation technique, 12 patients; Simpson grade 2 resection, 26 patients) to assess the long-term recurrence rate (mean, 121.5 months; range, 60-228 months). The local recurrence rate in the dura preservation group was 8.3% (1 of 12 cases), which was similar to that in Simpson grade 2 resection group (2 of 26 cases [7.7%]). Although this case series did not indicate the significant difference in the recurrence rates between the dura preservation group and Simpson grade 2 group, we consider that this technique still has advantages for surgically less invasiveness in terms of dural reconstruction which is necessary for Simpson grade 1 and higher possibility of complete resection of tumors compared with Simpson grade 2 resection.. |
| 516. |
Katsumi Harimaya, Yoshihiro Matsumoto, Kenichi Kawaguchi, Hirokazu Saiwai, Keiichiro Iida, Yasuharu Nakashima, Long-term outcome after en bloc resection and reconstruction of the spinal column and posterior chest wall in the treatment of malignant tumors., Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 10.1016/j.jos.2021.03.017, 27, 4, 899-905, 2021.05, BACKGROUND: Malignant tumors occurring around both the spinal column and posterior chest wall are uncommon. Surgical resection of chest wall tumors adjacent to the spinal column is still challenging due to the surrounding anatomical structures. The purpose of the present study was to evaluate the long-term outcomes of surgical management in malignant tumors involving the spinal column and posterior chest wall. METHODS: Between 1999 and 2007, 10 consecutive patients underwent en bloc resection combined with the posterior chest wall in the treatment of malignant tumors around the spinal column. There were 6 males and 4 females with a mean age at the surgery of 40.9 years old (range, 14-62 years old). The mean postoperative follow-up period was 159.7 months (range, 84-245 months). The clinical history, physical examination, laboratory data, radiological findings, and operative findings for each patient were retrospectively reviewed. RESULTS: All surgeries were performed via a combined anterior and posterior approach. The mean numbers of partially resected vertebrae and ribs were 3.1 and 4.1, respectively. Lower or upper lobectomy was performed in four patients, and the diaphragm was partially resected in two patients. The surgical margin was wide in seven patients and marginal in two patients. Although five patients had postoperative respiratory problem, all patients improved immediately without life-threatening complications. There were no patients with respiratory insufficiency after surgery. One patient with osteosarcoma died of lung metastases 99 months after surgery. At the final follow-up, only one patient had local recurrence, five had been continuously disease-free, and three were alive with no evidence of disease. CONCLUSIONS: En bloc resection and reconstruction in selected patients with malignant tumors involving both the spinal column and posterior chest wall demonstrated good long-term results for local control and the respiratory function.. |
| 517. |
Masanori Fujii, Tetsuro Nakamura, Toshihiko Hara, Yasuharu Nakashima, Is Ranawat triangle method accurate in estimating hip joint center in Japanese population?, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 10.1016/j.jos.2020.03.007, 26, 2, 219-224, 2021.03, BACKGROUND: Little information has been available regarding the usefulness of Ranawat triangle method in estimating anatomical hip joint center in the Japanese population. In this study, we aimed to determine the accuracy of the method in estimating hip joint center. METHODS: Using digitally reconstructed radiographs of 123 normal hips (123 patients), we measured the hip joint center coordinates (Cx, Cy) with reference to the ipsilateral lowest point of the teardrop, the pelvic width, and the pelvic height. Using these measurement values, we performed the following analyses: (1) the relationship of hip joint center location with pelvic dimensions; (2) accuracy of Ranawat method in estimating hip joint center; (3) alternative methods to estimate hip joint center using pelvic height. RESULTS: The mean Cx and Cy were 32 ± 3.0 mm and 13 ± 2.1 mm, respectively. Pelvic height was positively correlated with Cx (r = 0.51, p |
| 518. |
Kenji Kitamura, Masanori Fujii, Miho Iwamoto, Satoshi Ikemura, Satoshi Hamai, Goro Motomura, Yasuharu Nakashima, Is Anterior Rotation of the Acetabulum Necessary to Normalize Joint Contact Pressure in Periacetabular Osteotomy? A Finite-element Analysis Study., Clinical orthopaedics and related research, 10.1097/CORR.0000000000001893, 480, 1, 67-78, 2021.07, BACKGROUND: Inappropriate sagittal plane correction can result in an increased risk of osteoarthritis progression after periacetabular osteotomy (PAO). Individual and postural variations in sagittal pelvic tilt, along with acetabular deformity, affect joint contact mechanics in dysplastic hips and may impact the direction and degree of acetabular correction. Finite-element analyses that account for physiologic pelvic tilt may provide valuable insight into the effect of PAO on the contact mechanics of dysplastic hips, which may lead to improved acetabular correction during PAO. QUESTIONS/PURPOSES: We performed virtual PAO using finite-element models with reference to the standing pelvic position to clarify (1) whether lateral rotation of the acetabulum normalizes the joint contact pressure, (2) risk factors for abnormal contact pressure after lateral rotation of the acetabulum, and (3) whether additional anterior rotation of the acetabulum further reduces contact pressure. METHODS: Between 2016 and 2020, 85 patients (92 hips) underwent PAO to treat hip dysplasia. Eighty-two patients with hip dysplasia (lateral center-edge angle |
| 519. |
Daisuke Hara, Satoshi Hamai, Kyle R Miller, Goro Motomura, Kensei Yoshimoto, Keisuke Komiyama, Kyohei Shiomoto, Satoshi Ikemura, Yasuharu Nakashima, Scott A Banks, How does transtrochanteric anterior rotational osteotomy change the dynamic three-dimensional intact ratio in hips with osteonecrosis of the femoral head?, Clinical biomechanics (Bristol, Avon), 10.1016/j.clinbiomech.2021.105284, 82, 105284-105284, 2021.02, BACKGROUND: The intact ratio (the ratio of the intact area of the femoral head) on a two-dimensional anteroposterior radiograph is associated with the prognosis of hips with osteonecrosis of the femoral head after transtrochanteric anterior rotational osteotomy. However, changes of the three-dimensional intact ratio during dynamic weight-bearing activity and correlation of the three-dimensional intact ratio with clinical scores are still unknown. METHODS: Kinematics of eight hips with osteonecrosis of the femoral head that underwent anterior rotational osteotomy were analyzed using image-matching techniques during chair-rising and squatting preoperatively and postoperatively. Two types of dynamic three-dimensional intact ratios were examined, including the lunate covered area (IRLC) and in vivo peak contact force vector intersected area (IRFV). The static three-dimensional intact ratio in each octant of the femoral head was also examined. FINDINGS: The mean Harris hip score significantly improved from 67 preoperatively to 90 postoperatively. During chair-rising rising/squatting, the mean IRLC and IRFV significantly increased from 42%/41% and 7%/4% preoperatively, to 66%/65% and 79%/77% postoperatively, respectively. IRLC significantly changed during the motion whereas substantial postoperative IRFV was maintained throughout the motion. Additionally, Harris hip score and the static three-dimensional intact ratio in the superolateral regions had significant positive correlations with both IRLC and IRFV. INTERPRETATION: Hip kinematics affected IRLC but not IRFV, which suggests that substantial intact bone occupies the region in which peak contact forces are applied during deep hip flexion. Additionally, improving intact ratio in the superolateral region led to improvements in both IRLC and IRFV with favorable clinical scores.. |
| 520. |
Keigo Shibahara, Koichiro Hayashi, Yasuharu Nakashima, Kunio Ishikawa, Honeycomb Scaffold-Guided Bone Reconstruction of Critical-Sized Defects in Rabbit Ulnar Shafts, ACS Applied Bio Materials, 10.1021/acsabm.1c00533, 4, 9, 6821-6831, 2021.09, Reconstruction of critical-sized defects (CSDs) in bone shafts remains a major challenge in orthopedics. Honeycomb (HC) scaffolds are considered promising as their uniaxial channels bridge the amputation stumps of bones and promote the ingrowth of bone and blood vessels (BV) into the scaffolds. In this study, the ability of the HC scaffolds, composed of the bone mineral or carbonate apatite (CAp), was evaluated by reconstructing 10, 15, and 20 mm segmental defects in the rabbit ulnar shaft. Radiographic and μ-computed tomography evaluations showed that bony calluses were formed around the scaffolds at 4 weeks post-surgery in all defects, whereas no callus bridged in the ulna without scaffolds. At 12 weeks post-surgery, the scaffolds were connected to the host bone in 10 and 15 mm defects, while a slight gap remained between the scaffold and host bone in the 20 mm defect. New bone formation and scaffold resorption progressed over 12 weeks. Histological evaluations showed that mature bones (MB) and BV were already formed at the edges of the scaffolds at 4 weeks post-surgery in 10, 15, and 20 mm defects. In the central region of the scaffold, in the 10 mm defect, MB and BV were formed at 4 weeks post-surgery. In the 15 mm defect, although BV were formed, a few MB were formed. It is concluded that CAp HC scaffolds have good potential value for the reconstruction of CSDs.. |
| 521. |
Yuichi Yamada, Kenichi Kohashi, Izumi Kinoshita, Hidetaka Yamamoto, Takeshi Iwasaki, Masato Yoshimoto, Shin Ishihara, Yu Toda, Yoshihiro Ito, Yuki Kuma, Yui Yamada-Nozaki, Yutaka Koga, Mikiko Hashisako, Daisuke Kiyozawa, Daichi Kitahara, Fumiya Narutomi, Yusuke Kuboyama, Takahito Nakamura, Takeshi Inoue, Munenori Mukai, Yumi Honda, Gouji Toyokawa, Kenji Tsuchihashi, Fumiyoshi Fushimi, Kenichi Taguchi, Kenichi Nishiyama, Sadafumi Tamiya, Yumi Oshiro, Masutaka Furue, Yasuharu Nakashima, Satoshi Suzuki, Toru Iwaki, Yoshinao Oda, Histological background of dedifferentiated solitary fibrous tumour., Journal of clinical pathology, 10.1136/jclinpath-2020-207311, 75, 6, 397-403, 2021.05, AIMS: Dedifferentiation is a histological phenomenon characterised by abrupt transition of histology to a sarcomatous component with high-grade malignant potential in solitary fibrous tumour (SFT). The authors histologically reviewed SFT cases to reveal the histological background of dedifferentiated SFTs. METHODS: Clinicopathological and histopathological findings of 145 SFT cases were reviewed. Immunohistochemical staining and genetic analysis were also performed. RESULTS: The non-dedifferentiated components showed a cellular component in 45 of 145 (31%), high mitotic rate (≥4/10 high-powered field) in 12 of 145 (8.2%) tumours, necrosis in 7 of 145 (4.8%) tumours, multinodular growth pattern in 39 of 132 (29.5%) available tumours and intratumoural fibrous septa in 37 of 131 (28.2%). Immunohistochemically, the non-dedifferentiated components were positive for CD34 in 128 of 141 (90.7%), bcl-2 in 101 of 133 (75.9%), nuclear pattern of β-catenin in 64 of 127 (50.3%) and p16 in 22 of 140 (15.7%). Loss of Rb protein expression was detected in 17 of 110 (15.4%) cases. Statistically, cellular component, multinodular structure, p16 overexpression and Rb protein loss were significantly associated with dedifferentiation. Moreover, cellular component and multinodular structure were significantly associated with p16 overexpression and Rb protein loss. All the non-deddifferentiated components showed wild type of p53 expression. The dedifferentiated components of all 10 dedifferentiated tumours presented positivity for p16 in 9 of 10 (90%) and mutational type of p53 in 5 of 10 (50%). Loss of Rb protein expression was detected in 6 of 10 (60%). CONCLUSIONS: The authors propose that cellular or multinodular transformation may be associated with dedifferentiation. They also suggest that cellular and multinodular transformation may be associated with p16 overexpression and Rb downregulation.. |
| 522. |
Shin Ishihara, Hidetaka Yamamoto, Takeshi Iwasaki, Yu Toda, Takeo Yamamoto, Masato Yoshimoto, Yoshihiro Ito, Yousuke Susuki, Kengo Kawaguchi, Izumi Kinoshita, Yuichi Yamada, Kenichi Kohashi, Toshifumi Fujiwara, Nokitaka Setsu, Makoto Endo, Yoshihiro Matsumoto, Yuko Kakuda, Yasuharu Nakashima, Yoshinao Oda, Histological and immunohistochemical features and genetic alterations in the malignant progression of giant cell tumor of bone: a possible association with TP53 mutation and loss of H3K27 trimethylation., Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc, 10.1038/s41379-021-00972-x, 35, 5, 640-648, 2021.11, In rare cases, giant cell tumor of bone (GCTB) can undergo primary or secondary malignant transformation to malignant giant cell tumor of bone (MGCTB), but the details of the molecular alterations are still unclear. The present study aimed to elucidate the clinicopathologic and molecular features of MGCTBs based on immunohistochemistry, fluorescence in situ hybridization (FISH) and next generation sequencing (NGS) of nine MGCTBs (five primary and four secondary). Seven (78%) of 9 MGCTBs were immunohistochemically positive for H3.3 G34W. In two (22%) patients, although GCTB components were focally or diffusely positive for H3.3 G34W, their malignant components were entirely negative for H3.3 G34W, which was associated with heterozygous loss of H3F3A by FISH. NGS on four MGCTBs revealed pathogenic mutations in TP53 (n = 3), EZH2 (n = 1) and several other genes. Immunohistochemical analysis of the nine MGCTBs confirmed the p53 nuclear accumulation (n = 5) and loss of H3K27me3 expression (n = 3) and showed that they were mutually exclusive. In addition, four (80%) of five cases of pleomorphic or epithelioid cell-predominant MGCTBs were positive for p53, while three (75%) of four cases of spindle cell-predominant MGCTBs were negative for trimethylation at lysine 27 of histone 3 (H3K27me3). The results suggested that p53 alteration and dysfunction of histone methylation as evidenced by H3K27me3 loss may play an important role in the malignant progression of GCTB, and might contribute to the phenotype-genotype correlation in MGCTB. The combined histologic, immunohistochemical and molecular information may be helpful in part for the diagnosis of challenging cases.. |
| 523. |
Elucidation of Risk Factors of Hepatitis B Virus Reactivation in Rheumatoid Arthritis Patients at Kyushu University Hospital. |
| 524. |
Tetsuro Ushio, Satoshi Hamai, Ken Okazaki, Hirotaka Gondo, Satoru Ikebe, Hidehiko Higaki, Yasuharu Nakashima, Gradual-radius femoral component with s-curve post-cam provides stable kinematics at mid-flexion after total knee arthroplasty., Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 10.1016/j.jos.2021.02.015, 27, 3, 665-671, 2021.04, BACKGROUND: Mid-flexion instability is the one of the reasons for patient dissatisfaction after total knee arthroplasty (TKA). The purposes of this study were to evaluate in vivo knee kinematics and clinical outcomes using a novel TKA design with a gradual femoral radius component and s-curve post-cam, which are intended to prevent the instability initiated by sudden reductions in the femoral radius observed with conventional components. METHODS: We used radiographic-based, image-matching techniques to analyze femorotibial anteroposterior translation, axial rotation, and anterior/posterior cam-post contact during two dynamic movements, squatting and stair climbing, in 20 knees that had undergone posterior-stabilized fixed-bearing TKA with an improved sagittal profiles of the femoral component and post-cam mechanism. We also evaluated patient-reported outcomes assessed by the 2011 Knee Society Score (KSS 2011). RESULTS: Squatting and stair climbing produced a similar trend in anteroposterior translation and a relatively small standard deviation at mid-flexion. Although the rotation angles varied widely during squatting and stair climbing, the femoral component was consistently externally rotated. Anterior/posterior cam-post contact during squatting and stair climbing were observed in 0/17 knees and 0/0 knees, respectively. The "Symptoms", "Satisfaction", and "Functional activities" subscales of the KSS 2011 were significantly (P |
| 525. |
Masakazu Toya, Yukio Akasaki, Takuya Sueishi, Ichiro Kurakazu, Masanari Kuwahara, Taisuke Uchida, Tomoaki Tsutsui, Hidetoshi Tsushima, Hisakata Yamada, Martin K Lotz, Yasuharu Nakashima, G protein-coupled receptor kinase 5 deletion suppresses synovial inflammation in a murine model of collagen antibody-induced arthritis., Scientific reports, 10.1038/s41598-021-90020-0, 11, 1, 10481-10481, 2021.05, G protein-coupled receptor kinase 5 (GRK5) regulates inflammatory responses via the nuclear factor-kappa B (NF-κB) pathway. This study investigated the functional involvement of GRK5 in the pathogenesis of inflammatory arthritis. Immunohistochemically, rheumatoid arthritis (RA) synovium had a significantly higher proportion of GRK5-positive cells in the synovial lining layer than healthy control synovium. Gene expression and NF-κB activation in lipopolysaccharide-stimulated human SW982 synovial cells were significantly suppressed by silencing of the GRK5 gene. Similarly, GRK5 kinase activity inhibition in human primary RA synovial cells attenuated gene expressions of inflammatory factors. In a murine model of collagen antibody-induced arthritis, arthritis scores and serum IL6 production of GRK5 knockout (GRK5-/-) mice were significantly lower than those of wild-type mice. Histologically, the degree of synovitis and cartilage degeneration in GRK5-/- mice was significantly lower than in wild-type mice. In in vitro analyses using activated murine macrophages and fibroblast-like synoviocytes, gene expression of inflammatory factors and p65 nuclear translocation were significantly lower in GRK5-/- mice compared to wild-type mice. In conclusion, our results suggested that GRK5 is deeply involved in the pathogenesis of inflammatory arthritis, therefore, GRK5 inhibition could be a potential therapeutic target for types of inflammatory arthritis such as RA.. |
| 526. |
Takeshi Hirose, Masachika Ikegami, Makoto Endo, Yoshihiro Matsumoto, Yasuharu Nakashima, Hiroyuki Mano, Shinji Kohsaka, Extensive functional evaluation of exon 20 insertion mutations of EGFR., Lung cancer (Amsterdam, Netherlands), 10.1016/j.lungcan.2020.12.023, 152, 135-142, 2021.02, OBJECTIVES: Exon 20 insertion mutations of epidermal growth factor receptor (EGFR) have been identified as oncogenic mutations in general; however, the functional relevance of each remains largely uninvestigated. Herein, we comprehensively assessed the functional significance of insertion mutations of EGFR exon 20. MATERIALS AND METHODS: The transforming potential and drug sensitivities of 25 EGFR recurrent mutants, including twenty-one exon 20 insertions, were evaluated using the mixed-all-nominated-in-one method. RESULTS: The sensitivity of EGFR exon 20 insertions to EGFR tyrosine kinase inhibitors (TKIs) was generally lower than that of the L858R mutation or exon 19 deletions. The results were also confirmed through an in vivo drug test. All of the exon 20 insertions were resistant to gefitinib and afatinib, whereas several mutants were sensitive to osimertinib. EGFR exon 20 insertions exhibited relatively good responses to poziotinib and mobocertinib. CONCLUSIONS: EGFR exon 20 insertions were shown to have different degrees of sensitivity to EGFR TKIs. This extensive assessment of EGFR exon 20 insertions may provide a fundamental database for aiding in a customized mode of therapy for cancers having insertional mutations within exon 20 of EGFR, although the clinical impact of preclinical data should be validated by clinical evidence in the future.. |
| 527. |
Kazuhiro Hata, Kazu Kobayakawa, Hirokazu Saiwai, Tetsuya Tamaru, Hirotaka Iura, Yohei Haruta, Gentarou Ono, Kazuki Kitade, Takeshi Maeda, Yasuharu Nakashima, Seiji Okada, Epidural Fat Tissue is More Effective for Scar Prevention Than Conventional Subcutaneous Fat Grafting After Laminectomy in a Mouse Model., Spine, 10.1097/BRS.0000000000004281, 47, 11, E485-E493, 2021.11, STUDY DESIGN: Basic science study. OBJECTIVE: The aim of this study was to examine whether epidural fat tissue (EFT) transplantation can prevent epidural adhesion after laminectomy more efficiently than subcutaneous fat tissue (SFT) transplantation. SUMMARY OF BACKGROUND DATA: Epidural adhesion is almost inevitable after laminectomy. Although many materials have been used to prevent adhesion, none has been widely accepted. As EFT is an ectopic fat tissue located on the dura mater and there is no adhesion between EFT and the dura mater, we focused on the efficacy of EFT for adhesion prevention. METHODS: We examined the differences in histology and gene expression between EFT and SFT of mice. We performed laminectomy at the 10th thoracic level and immediately transplanted EFT or SFT to the dura mater in mice. At six weeks after transplantation, we performed histological and gene expression analyses and evaluated the adhesion tenacity. In addition, we examined the characteristic differences between human EFT and SFT. RESULTS: The adipocytes of EFT were significantly smaller than those of SFT in mice and humans. The gene expression of inflammatory cytokine and fibrosis-related factors was significantly higher in SFT than in EFT. At six weeks after transplantation, the percentage of the remaining fat area over the dura mater was significantly greater in the EFT group than in SFT group, and the adhesion tenacity score was significantly lower in the EFT group than that in the SFT group. An RNA sequencing analysis revealed 1921 differentially expressed genes (DEGs) between human EFT and SFT, and a Gene Ontology term associated with the inflammatory response was most highly enriched in SFT. CONCLUSIONS: EFT has different molecular and histological profiles from SFT and EFT grafting is more effective for epidural adhesion prevention than conventional SFT transplantation after laminectomy in a mouse model.Level of Evidence: N/A.. |
| 528. |
Masato Kiyohara, Satoshi Hamai, Ken Okazaki, Daisuke Fujiyoshi, Hideki Mizu-Uchi, Yasuharu Nakashima, Evaluation of the balance function before and after total knee arthroplasty using Berg balance scale., Archives of orthopaedic and trauma surgery, 10.1007/s00402-021-04233-z, 2021.10, INTRODUCTION: The purpose of this study was to evaluate balance function before and after total knee arthroplasty (TKA) using Berg balance scale (BBS). The study also aimed to identify factors associated with balance impairment. MATERIALS AND METHODS: Ninety-three knees in 90 patients were prospectively evaluated using their BBS scores, passive knee extension/flexion angles, Visual analogue scale for pain scores, hip-knee-ankle angles, and knee extensor/flexor muscle strengths before and after TKA. A total BBS score of less than 45 indicates an enhanced risk of multiple falls. Multivariate logistic regression models were performed to elucidate factors associated with post-operative BBS score. RESULTS: A significant difference in mean pre- and post-operative BBS scores were noted (49.3 ± 6.4 vs. 52.2 ± 4.7) (p |
| 529. |
Yu Toda, Yoshihiro Matsumoto, Tadatsugu Morimoto, Masaaki Mawatari, Yoshinao Oda, Yasuharu Nakashima, En Bloc Resection for a Malignant Spine Tumor After Balloon Kyphoplasty: Histological Findings of a Retrieved Vertebral Body: A Case Report., JBJS case connector, 10.2106/JBJS.CC.20.00114, 11, 1, 2021.02, CASE: A 45-year-old woman with severe back pain underwent percutaneous curettage and balloon kyphoplasty (BKP) of a lesion believed to be aneurysmal bone cyst. Three months after BKP, local recurrence was observed, and the histological diagnosis was revised to malignant tumor. Thus, we performed a total en bloc spondylectomy, and the L3 vertebral body was resected. She was reconstructed by titanium expandable cage, rod, and pedicle screws. We observed viable tumor cells and foreign body reaction adjacent to the polymethylmethacrylate cement, carrying no bone necrosis. CONCLUSIONS: The long-term durability and safety of BKP for metastatic spine disease should be further clarified.. |
| 530. |
Umito Kuwashima, Kenyu Iwasaki, Ichiro Kurakazu, Yukio Akasaki, Yasuharu Nakashima, Masafumi Itoh, Junya Itou, Ken Okazaki, Effect of osteoarthritis severity on survival and clinical outcomes after high tibial osteotomy., The Knee, 10.1016/j.knee.2021.02.031, 29, 441-447, 2021.03, BACKGROUND: This study aimed to evaluate the effect of osteoarthritis severity on clinical outcomes using the 2011 Knee Society Score (KSS2011) and survival rates after closed wedge high tibial osteotomy (CWHTO). METHODS: In this retrospective study, KSS2011 questionnaires were mailed to patients who had undergone CWHTO between January 1991 and December 2011. The completed questionnaires returned by the patients were analyzed. Preoperative osteoarthritis severity was evaluated by Kellgren-Lawrence (K-L) grade. KSS2011 was compared between the K-L grade groups. To determine the effect of K-L grade for revision surgery, Kaplan-Meier survival curves were created using the need for total knee arthroplasty (TKA) as the endpoint to estimate the probability of failure. RESULTS: There were 16, 81, and 47 knees with preoperative K-L 2, 3, and 4, respectively. Among the KSS2011 sub-scores, the symptom score showed significant differences between the groups (p = 0.006). However, no significant difference was found regarding satisfaction, expectation, and functional activity scores. No significant difference in the symptom score was found between the K-L 2 and 3 groups (p > 0.05). Eighteen knees were treated with TKA at a mean of 9 years after CWHTO. Using the Kaplan-Meier survival estimates, the K-L 4 group showed a significantly higher rate of total knee arthroplasty conversion than the K-L 2 and 3 groups (p |
| 531. |
Kyohei Shiomoto, Akira Babazono, Yumi Harano, Takako Fujita, Peng Jiang, Sung-A Kim, Yasuharu Nakashima, Effect of body mass index on vertebral and hip fractures in older people and differences according to sex: a retrospective Japanese cohort study., BMJ open, 10.1136/bmjopen-2021-049157, 11, 11, e049157, 2021.11, OBJECTIVES: The purpose of this study was to investigate the incidence of vertebral and hip fractures in the older people and to clarify the relationship between these fractures and body mass index (BMI) along with the impact of sex differences.DesignThis was a retrospective cohort study.SettingWe used administrative claims data between April 2010 and March 2018. PARTICIPANTS: Older people aged ≥75 years who underwent health examinations in 2010 and were living in the Fukuoka Prefecture, Japan were included in the study. A total of 24 691 participants were included; the mean age was 79.4±4.3 years, 10 853 males and 13 838 females, and an the mean duration of observation was 6.9±1.6 years. PRIMARY AND SECONDARY OUTCOME MEASURES: We estimated the incidence of vertebral and hip fractures by BMI category (underweight: |
| 532. |
Eijiro Shimada, Makoto Endo, Yoshihiro Matsumoto, Kenji Tsuchihashi, Mamoru Ito, Hitoshi Kusaba, Akira Nabeshima, Tomoya Nawata, Akira Maekawa, Tomoya Matsunobu, Nokitaka Setsu, Toshifumi Fujiwara, Keiichiro Iida, Makoto Nakagawa, Takeshi Hirose, Masaya Kanahori, Ryunosuke Oyama, Taichi Isobe, Hiroshi Ariyama, Kenichi Kohashi, Hidetaka Yamamoto, Yoshinao Oda, Yukihide Iwamoto, Koichi Akashi, Eishi Baba, Yasuharu Nakashima, Does the Use of Peripheral Immune-Related Markers Indicate Whether to Administer Pazopanib, Trabectedin, or Eribulin to Advanced Soft Tissue Sarcoma Patients?, Journal of clinical medicine, 10.3390/jcm10214972, 10, 21, 2021.10, Pazopanib, trabectedin, and eribulin are administered for the treatment of soft tissue sarcomas (STSs); however, there is little consensus on which agent should be preferentially used in a clinical setting. This study assessed whether peripheral immune-related markers served as a useful reference when selecting pazopanib, trabectedin, or eribulin. This study included 63 patients who were administered pazopanib, trabectedin, or eribulin for advanced STSs between March 2015 and December 2020. Patients were divided into three groups based on the first drug administered among these three drugs. Differences in overall survival (OS) or progression-free survival (PFS) among the three groups were analyzed. OS showed no significant differences among the drugs administered first. For patients with low neutrophil-to-lymphocyte ratio (NLR), the OS of patients administered pazopanib as the first choice was shorter than the others (hazard ratio [HR] = 9.53, 95% confidence interval [CI] = 1.94-18.13, p = 0.0018). In the low platelet-to-lymphocyte ratio (PLR) subgroup, the OS of the patients administered eribulin for the first choice was longer than that of the others (HR = 0.32, 95%CI = 0.10-0.98, p = 0.046). Therefore, NLR and PLR might be used as prognostic indicators to dictate whether STS patients receive pazopanib, trabectedin, or eribulin.. |
| 533. |
Kenji Kitamura, Masanori Fujii, Satoshi Ikemura, Satoshi Hamai, Goro Motomura, Yasuharu Nakashima, Does Patient-specific Functional Pelvic Tilt Affect Joint Contact Pressure in Hip Dysplasia? A Finite-element Analysis Study., Clinical orthopaedics and related research, 10.1097/CORR.0000000000001737, 479, 8, 1712-1724, 2021.08, BACKGROUND: Although individual and postural variations in the physiologic pelvic tilt affect the acetabular orientation and coverage in patients with hip dysplasia, their effect on the mechanical environment in the hip has not been fully understood. Individual-specific, finite-element analyses that account for physiologic pelvic tilt may provide valuable insight into the contact mechanics of dysplastic hips, which can lead to further understanding of the pathogenesis and improved treatment of this patient population. QUESTION/PURPOSE: We used finite-element analysis to ask whether there are differences between patients with hip dysplasia and patients without dysplasia in terms of (1) physiologic pelvic tilt, (2) the pelvic position and joint contact pressure, and (3) the morphologic factors associated with joint contact pressure. METHODS: Between 2016 and 2019, 82 patients underwent pelvic osteotomy to treat hip dysplasia. Seventy patients with hip dysplasia (lateral center-edge angle ≥ 0° and 0.99), the difference in the maximum contact pressure varied from -3.3 MPa to 2.9 MPa, reflecting the wide range of APP angles (mean 3° ± 6° [-11° to 14°]) when standing. The maximum joint contact pressure in the standing position was negatively correlated with the standing APP angle (r = -0.46; p = 0.008) in patients with hip dysplasia. CONCLUSION: Based on our findings that individual and postural variations in the physiologic pelvic tilt affect joint contact pressure in the hip, future studies on the pathogenesis of hip dysplasia and joint preservation surgery should not only include the supine or standard pelvic position, but also they need to incorporate the effect of the patient-specific pelvic tilt in the standing position on the biomechanical environment of the hip. CLINICAL RELEVANCE: We recommend assessing postural change in sagittal pelvic tilt when diagnosing hip dysplasia and planning preservation hip surgery because assessment in a supine or standard pelvic position may overlook alterations in the hip's contact mechanics in the weightbearing positions. Further studies are needed to elucidate the effect of patient-specific functional pelvic tilt on the degeneration process of dysplastic hips, the acetabular reorientation maneuver, and the clinical result of joint preservation surgery.. |
| 534. |
Rumi Tanaka, Kimie Fujita, Kiyoko Makimoto, Kanako Yakushiji, Satomi Tanaka, Goro Motomura, Masanori Fujii, Satoshi Ikemura, Yasuharu Nakashima, Development and evaluation of the sedentary behavior and light-intensity physical activity questionnaire., Journal of physical therapy science, 10.1589/jpts.33.125, 33, 2, 125-131, 2021.02, [Purpose] To describe our newly developed Sedentary Behavior and Light-Intensity Physical Activity Questionnaire and examine its reliability and validity. [Participants and Methods] We identified and selected self-reported items through a literature review and interviews with 11 inactive individuals. Thirty-one individuals with lower limb prostheses and an expert panel assessed the content validity of the integrated items and identified 17 items. Patients who had undergone lower limb surgeries were regarded as inactive individuals, and 112 patients completed the questionnaire twice for test-retest reliability and wore an accelerometer for criterion validity. The ethics committee of Kyushu University approved this study (2019-126 and 2019-273). [Results] Item analysis was revised to the Sedentary Behavior and Light-Intensity Physical Activity Questionnaire-10 (six light-intensity physical activity and four sedentary behavior items) because of the floor effect. The test-retest correlation coefficient showed high reliability. Moderate to weak correlation coefficient was observed between the questionnaire and accelerometer (light-intensity physical activity: 0.43 and sedentary behavior: 0.20), and the Bland-Altman plots indicated no bias. [Conclusion] The Sedentary Behavior and Light-Intensity Physical Activity Questionnaire-10 had acceptable validity and reliability among inactive individuals and it could be used for studying light-intensity physical activity.. |
| 535. |
Goro Motomura, Satoshi Hamai, Satoshi Ikemura, Masanori Fujii, Shinya Kawahara, Soichiro Yoshino, Yasuharu Nakashima, Contemporary indications for first-time revision surgery after primary cementless total hip arthroplasty with emphasis on early failures., Journal of orthopaedic surgery and research, 10.1186/s13018-021-02298-5, 16, 1, 140-140, 2021.02, BACKGROUND: To clarify contemporary indications for first-time revision surgery after primary cementless total hip arthroplasty (THA) for addressing potential issues with cementless THA. METHODS: Data for 101 consecutive hips in 94 patients who underwent primary cementless THA at our institution and subsequently underwent first-time revision surgery were retrospectively reviewed. Baseline characteristics, indications for first-time revision surgery, and time from the primary THA to first-time revision surgery were evaluated. RESULTS: The overall mean time to first-time revision surgery was 10.3 years (range, 0-33 years). The indications for first-time revision surgery were polyethylene wear and osteolysis in 33 hips, aseptic loosening in 25 hips, infection in 17 hips, periprosthetic fracture in 13 hips, instability in 8 hips, and component failure (liner dissociation or stem fracture) in 5 hips. Thirty-seven hips (37%) had undergone first-time revision surgery within 5 years of primary THA, of which the most common indications were infection and periprosthetic fracture. CONCLUSION: The current results suggested that reducing the number of early failures seems to be essential form improving THA outcomes.. |
| 536. |
Kyohei Shiomoto, Satoshi Hamai, Satoru Ikebe, Hidehiko Higaki, Daisuke Hara, Hirotaka Gondo, Keisuke Komiyama, Kensei Yoshimoto, Satoru Harada, Yasuharu Nakashima, Computer simulation based on in vivo kinematics of a replaced hip during chair-rising for elucidating target cup and stem positioning with a safety range of hip rotation., Clinical biomechanics (Bristol, Avon), 10.1016/j.clinbiomech.2021.105537, 91, 105537-105537, 2021.11, Background After total hip arthroplasty, dislocation can occur when a patient unexpectedly assumes internal/external limb positions, even during chair-rising, which is a frequently activity of daily life. Therefore, determining the target cup position to avoid impingement in unexpected limb positions using in vivo data of daily life activities is critical. Methods A computer simulation was performed on 21 total hip arthroplasty patients using patient-specific component placements and hip kinematics obtained during chair-rising analysis using image-matching techniques. The liner-to-neck distance and impingement were evaluated by simulating the change in internal/external rotation angle at maximum hip flexion/extension from 0 to 90°. The cutoff values of cup anteversion and combined anteversion at 60° of internal/external rotation were determined. Findings The anterior/posterior liner-to-neck distances were negatively correlated with internal/external rotation angles (r = -0.82 and -0.78, respectively) and decreased by 1.7 and 1.8 mm for every 15° increase, respectively. Three cases (14%) of anterior/posterior impingement were observed at 60° of internal/external rotation angle, respectively. The cutoff values for cup anteversion and combined anteversion to avoid impingement at 60° of internal/external rotation angle were 12°-25°/38°-62°, respectively. The stem anteversion, adjustable by cup anteversion to meet both the target cup anteversion and combined anteversion, was 13°-50°. Interpretation Simulated unintentional internal or external hip rotation, even during chair-rising, caused impingement and posed a dislocation risk. If the stem anteversion is excessively small or large in meeting the target combined anteversion, adjustments to stem anteversion could be recommended in addition to adjustments in cup anteversion.. |
| 537. |
Masato Kiyohara, Satoshi Hamai, Hirotaka Gondo, Hidehiko Higaki, Satoru Ikebe, Ken Okazaki, Yasuharu Nakashima, Comparison of in vivo knee kinematics before and after bicruciate-stabilized total knee arthroplasty during squatting., BMC musculoskeletal disorders, 10.1186/s12891-021-04669-9, 22, 1, 772-772, 2021.09, BACKGROUND: No studies have directly evaluated kinematic changes during squatting before and after bicruciate-stabilized total knee arthroplasty (BCS-TKA) with the dual cam-post mechanism and asymmetric surfaces. This study investigated the effect of BCS-TKA on changes to pre- and postoperative skeletal knee kinematics, to identify factors associated with postoperative skeletal kinematic parameters. METHODS: Seventeen knees in 17 patients were prospectively recruited before primary TKA for advanced medial knee osteoarthritis. Subjects underwent BCS-TKA and were evaluated more than 1 year postoperatively. In vivo dynamic skeletal knee kinematics were evaluated using periodic radiographic images collected during squatting to quantify the tibiofemoral functional extension/flexion angle, anteroposterior (AP) translation, and axial rotation angle using image-matching techniques. Rotational alignments of femoral and tibial components were measured postoperatively using computed tomography images. RESULTS: The pre- and postoperative tibiofemoral functional extension/flexion angles during squatting were 12.2° ± 6.7°/100.1° ± 16.8° and 9.6° ± 8.6°/109.4° ± 16.8°, respectively, with a significant difference in flexion angle (p |
| 538. |
Yoshihiro Ito, Kenichi Kohashi, Makoto Endo, Masato Yoshimoto, Shin Ishihara, Yu Toda, Yosuke Susuki, Kengo Kawaguchi, Hiroshi Furukawa, Yuki Tateishi, Yuichi Yamada, Izumi Kinoshita, Taro Mori, Hidetaka Yamamoto, Yasuharu Nakashima, Yoshinao Oda, Clinicopathological and prognostic significance of H3K27 methylation status in malignant peripheral nerve sheath tumor: correlation with skeletal muscle differentiation., Virchows Archiv : an international journal of pathology, 10.1007/s00428-021-03189-0, 479, 6, 1233-1244, 2021.08, Malignant peripheral nerve sheath tumor (MPNST) is a very aggressive peripheral nerve sheath-derived sarcoma, which is one of the most difficult tumors to diagnose due to its wide spectrum of histological findings and lack of specific immunohistochemical markers. Recently, it has been reported that losses of expression of H3K27me3 and H3K27me2 caused by PRC2 dysfunction may be useful diagnostic markers for MPNST, but there is no consensus on their clinicopathological significance. Here, we investigated the relationship between loss of H3K27 methylation and various parameters and clarified the clinicopathological significance of such loss. We analyzed the clinicopathological and immunohistochemical features in 84 MPNST cases. Complete losses of H3K27me3 and H3K27me2 were observed in 37 (44%) and 29 (35%) cases, respectively. Losses of H3K27me3 and H3K27me2 were significantly correlated with myogenic immunopositivity (H3K27me3 vs. desmin, P = 0.0051; H3K27me3 vs. myogenin, P = 0.0009; H3K27me2 vs. myogenin, P = 0.042). Meanwhile, there were significant correlations between preservation of immunohistochemical neurogenic markers and intact H3K27me3 and H3K27me2 (H3K27me3 vs. S-100 protein, P = 0.0019; H3K27me3 vs. SOX10, P = 0.014; H3K27me2 vs. S-100 protein, P = 0.0011; H3K27me2 vs. SOX10, P = 0.0087). In multivariate analysis, local recurrence, distant metastasis, high FNCLCC grade, and loss of SOX10 expression were independent prognostic factors for overall survival. H3K27me3 and H3K27me2 expression was retained in all 26 cases of rhabdomyosarcoma non-alveolar subtype. In conclusion, we suggest that H3K27me3 and H3K27me2 immunonegativity is useful but not definitive for diagnosing MPNST. Complete loss of H3K27 methylation may be involved in aggressive transdifferentiation from neural differentiation to skeletal muscle differentiation in MPNST.. |
| 539. |
Taro Mori, Yuichi Yamada, Izumi Kinoshita, Kenichi Kohashi, Hidetaka Yamamoto, Yoshihiro Ito, Yosuke Susuki, Kengo Kawaguchi, Yasuharu Nakashima, Yoshinao Oda, Clinicopathological and histopathological review of dedifferentiated liposarcoma: a comprehensive study of 123 primary tumours., Histopathology, 10.1111/his.14588, 80, 3, 538-557, 2021.10, AIMS: Dedifferentiated liposarcoma (DDLS) has varying histopathological features, but their significance for the biological behaviour of this disease has not been fully clarified. The aim of this study was to elucidate the prognostic factors for DDLS by clinicopathologically reviewing a large case series. METHODS AND RESULTS: We clinicopathologically reviewed 123 cases of primary de-novo DDLS without preoperative treatment, including 81 in the internal trunk (internal DDLS) and 42 in peripheral sites (peripheral DDLS). Univariate and multivariate analyses of their features were also performed for all cases, the internal DDLS group, and the peripheral DDLS group. The results showed that, in all three groups, distant metastasis was significantly associated with shorter overall survival (OS) (univariate analysis, P |
| 540. |
Eijiro Shimada, Yoshihiro Matsumoto, Makoto Endo, Nokitaka Setsu, Toshifumi Fujiwara, Kenichiro Yahiro, Atsushi Kimura, Yasuharu Nakashima, Clinical benefits of vessel sealing system (LigaSure™) during surgery for soft tissue sarcoma: a propensity score matching analysis., Japanese journal of clinical oncology, 10.1093/jjco/hyab083, 51, 8, 1242-1247, 2021.08, BACKGROUND: Soft tissue sarcomas arise in the deep sites of the buttocks and lower extremities. Since a tourniquet is not applied during surgery for soft tissue sarcomas at such sites, excessive intraoperative blood loss may occur. Various devices, including LigaSure™ (Medtronic, Dublin, Ireland), are used as electrothermal bipolar vessel sealers. However, its clinical relevance in soft tissue sarcomas surgery remains unclear. This study aimed to assess the effectiveness of LigaSure™ in soft tissue sarcomas surgery. METHODS: This study included 168 patients who underwent surgeries for soft tissue sarcomas in the deep sites in the buttocks and lower extremities between January 2004 and March 2018. The primary outcome was intraoperative blood loss, and secondary outcomes were surgery duration, wound complications, perioperative haemoglobin concentrations and intraoperative blood transfusion. To reduce selection biases, propensity score matching was applied. We defined the matched cases wherein LigaSure™ was used as the 'using group' and the other matched cases as the 'non-using group'. Outcomes were compared between both groups. RESULTS: From each group, 35 cases were selected using propensity score matching. The intraoperative blood loss was significantly smaller statistically in the using group (181.5 ± 240.4 ml vs. 394.7 ± 547.3 ml, respectively; P = 0.041). The duration of operation was longer in the using group (189.9 ± 97.6 min vs. 140.6 ± 75.7 min, respectively; P = 0.007). There were no significant differences in other outcomes. CONCLUSION: By using LigaSure™ for soft tissue sarcomas occurring in the buttocks and lower extremities, we observed a trade-off between reduced intraoperative blood loss and longer operative time.. |
| 541. |
Katsumi Harimaya, Yoshihiro Matsumoto, Kenichi Kawaguchi, Seiji Okada, Hirokazu Saiwai, Akinobu Matsushita, Keiichiro Iida, Hiromi Kumamaru, Takeyuki Saito, Yasuharu Nakashima, Clinical features of multiple spinal schwannomas without vestibular schwannomas., Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 10.1016/j.jos.2021.02.014, 27, 3, 563-568, 2021.04, BACKGROUND: Multiple spinal cord tumors in a single patient are very rare and most often seen in cases of neurofibromatosis and associated disorders. Schwannomatosis, which is characterized by the development of multiple schwannomas without vestibular schwannomas, has been newly defined as a distinct form of neurofibromatosis. The purpose of the present study was to describe and review the clinical and radiological features and the management of patients with multiple spinal schwannomas without vestibular schwannomas. METHODS: Between 1986 and 2016, 19 patients with multiple spinal schwannomas without vestibular schwannoma were diagnosed and treated. Of the 19 patients, 13 were males, and 6 were females. The mean age at the first surgery for spinal schwannoma was 45.2 years old. The mean follow-up period was 123.4 months. The clinical features and radiological findings of the patients with multiple spinal schwannomas were retrospectively reviewed. RESULTS: Among the 19 patients, there were more than 140 spinal schwannomas. The most common area of spinal schwannoma was the thoracolumbar-lumbar region. Initial symptoms and chief complaints caused by spinal schwannomas were primarily pain in the trunk or extremities in 17 (89.5%) of 19 patients. More than 60 spinal schwannomas were surgically resected. Multiple spinal surgeries were required in six patients. In all 19 patients, surgical treatment has provided successful relief of symptoms and neurological recovery. CONCLUSIONS: Surgical treatment was safe and effective in patients with multiple spinal schwannomas without vestibular schwannomas. After surgery, we recommend that all patients be followed with magnetic resonance imaging to monitor for asymptomatic tumors or detect new tumors early.. |
| 542. |
Yasuharu Nakashima, CORR Insights®: What Mid-term Patient-reported Outcome Measure Scores, Reoperations, and Complications Are Associated with Concurrent Hip Arthroscopy and Periacetabular Osteotomy to Treat Dysplasia with Associated Intraarticular Abnormalities?, Clinical orthopaedics and related research, 10.1097/CORR.0000000000001649, 479, 5, 1078-1080, 2021.05. |
| 543. |
Yuanjun Teng, Hideki Mizu-Uchi, Yayi Xia, Yukio Akasaki, Takenori Akiyama, Shinya Kawahara, Yasuharu Nakashima, Axial But Not Sagittal Hinge Axis Affects Posterior Tibial Slope in Medial Open-Wedge High Tibial Osteotomy: A 3-Dimensional Surgical Simulation Study., Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 10.1016/j.arthro.2021.01.063, 37, 7, 2191-2201, 2021.07, PURPOSE: The purpose of this 3-dimensional (3D) surgical simulation study was to investigate the effects of axial and sagittal hinge axes (hinge axes in the axial and sagittal planes) on medial and lateral posterior tibial slope (PTS) in medial open-wedge high tibial osteotomy (OWHTO), and evaluate the quantitative relationship between hinge axis and PTS change. METHODS: Preoperative computed tomography data from patients with varus knee deformity were collected. A standard hinge axis (0°) and 12 different hinge axes (6 axial hinge axes and 6 sagittal hinge axes: ±10°, ±20°, and ±30°) were defined in a 3D surgical simulation of OWHTO using a bone model. The differences between before and after simulation surgery in medial and lateral PTS, medial proximal tibial angle, opening gap, and opening wedge angle were measured. RESULTS: In total, 93 varus knees in 93 patients were included for study. Compared with the standard hinge axis, axial hinge axis significantly affected medial and lateral PTS (P .05). Every 10° change in axial hinge axis with a mean coronal valgus correction of 10° might result in approximately 1.6° of alteration in PTS. Stepwise regression analysis showed that axial hinge axis is the most significant factors affecting PTS (β coefficient = 0.78, P |
| 544. |
Kenta Takakura, Yukio Akasaki, Taku Kuramoto, Yasuhiro Onizuka, Akiko Hattori, Satoshi Hamai, Hidetoshi Tsushima, Shinya Kawahara, Yasuharu Nakashima, Toyoyuki Kato, Angular accuracy of plain radiographic measurements in leg alignment: Teleoroentgenogram versus orthoroentgenogram., Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 10.1016/j.jos.2021.02.011, 27, 3, 642-647, 2021.04, BACKGROUND: The purpose of the present study was to evaluate the accuracy of the measurements associated with leg alignment on a teleoroentgenogram and an orthoroentgenogram. METHODS: The models being irradiated were manufactured and represented 10° varus and 15° varus leg alignment, in which the true values of hip-knee-ankle angle (HKAA), mechanical axis (MA) length, and percentage of MA (%MA) were already known. HKAA, MA length, and %MA were measured in various radiographic conditions of the teleoroentgenogram and orthoroentgenogram. Then, the differences between the radiographic measurement values and the corresponding true values were analyzed. RESULTS: Regarding HKAA, the teleoroentgenogram provided accurate angular measurements with minimal differences between the measurement and true value in both the 10° and 15° varus models, irrespective of the radiographic condition. In the orthoroentgenogram, the modified method measured accurate HKAA; however, the standard method showed significant angular measurement errors with a 0.6° and 1.0° difference from the true value in the 10° and 15° varus models, respectively. This angular measurement error of HKAA in the standard orthoroentgenogram became significantly larger with object-to-image distance. Regarding MA length, the orthoroentgenogram exhibited accurate length measurements. In contrast, the teleoroentgenogram showed a significant length measurement error for the MA length. Regarding %MA, significant differences from the true values of 2.0% and 2.4% were observed in the modified orthoroentgenograms of the 10° and 15° varus models, respectively. The teleoroentgenogram and standard orthoroentgenogram reproduced the accurate measurement value of %MA in the 10° and 15° varus models. CONCLUSION: A teleoroentgenogram is a reliable modality for accurate angular measurements such as HKAA and %MA. An orthoroentgenogram has the potential to measure both HKAA and length accurately if the radiographic condition was modified; however, measurement error in %MA may occur.. |
| 545. |
Takahide Sakuragi, Hisakata Yamada, Akihisa Haraguchi, Kazuhiro Kai, Jun-Ichi Fukushi, Satoshi Ikemura, Yukio Akasaki, Toshifumi Fujiwara, Hidetoshi Tsushima, Tomoko Tsutsui, Masakazu Kondo, Yasunobu Yoshikai, Seiji Okada, Yasuharu Nakashima, Autoreactivity of Peripheral Helper T Cells in the Joints of Rheumatoid Arthritis., Journal of immunology (Baltimore, Md. : 1950), 10.4049/jimmunol.2000783, 206, 9, 2045-2051, 2021.05, Autoreactive CD4 T cells are thought to play pivotal roles in the pathogenesis of rheumatoid arthritis (RA). Recently, a subset of CD4 T cells that express high levels of programmed death-1 (PD-1) but are distinct from follicular helper T cells have been identified in the joints of RA patients and named peripheral helper T (Tph) cells. Because PD-1 is expressed on T cells chronically stimulated with the Ags, we tested a hypothesis that Tph cells are the pathogenic autoreactive CD4 T cells in RA. We found that human Tph cells in RA joints produce proinflammatory effector cytokines, including IFN-γ, TNF-α, and GM-CSF, in addition to B cell-helping cytokines, such as IL-21 and CXCL13. Flow cytometric analysis showed different bias of TCR Vβ usage between PD-1high Tph cells and PD-1low/neg CD4 T cells, including Th1 cells, in the joint or memory CD4 T cells in the peripheral blood, whereas there was little difference between the latter two subsets. In line with this, deep sequencing of TCR demonstrated an overlap of expanded clones between peripheral blood memory CD4 T cells and PD-1low/neg CD4 T cells but not Tph cells in the joint. Interestingly, Tph cells preferentially exhibited autologous MLR in vitro, which required recognition of self-MHC class II and was pronounced by blocking PD-1 signaling. Taken together, these results suggest that Tph cells are the pathogenic autoreactive CD4 T cells in RA, which expand locally in the joints and are regulated by PD-1 signaling.. |
| 546. |
Yuri Matsubara, Yosikazu Nakamura, Naoto Tamura, Hideto Kameda, Kotaro Otomo, Mitsumasa Kishimoto, Yuho Kadono, Shigeyoshi Tsuji, Tatsuya Atsumi, Hiroaki Matsuno, Michiaki Takagi, Shigeto Kobayashi, Keishi Fujio, Norihiro Nishimoto, Nami Okamoto, Ayako Nakajima, Kiyoshi Matsui, Masahiro Yamamura, Yasuharu Nakashima, Atsushi Kawakami, Masaaki Mori, Tetsuya Tomita, A Nationwide Questionnaire Survey on the Prevalence of Ankylosing Spondylitis and Non-Radiographic Axial Spondyloarthritis in Japan., Modern rheumatology, 10.1093/mr/roab096, 32, 5, 960-967, 2021.11, OBJECTIVE: This nationwide study aimed to reveal the prevalence of ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-ax SpA), and the positive rate of human leukocyte antigen (HLA) among these patients in Japan. METHODS: The first survey was conducted in 2221 randomly selected facilities (26.3%) in September, 2018, where the patients with AS/nr-ax SpA were taken care of from January to December, 2017. We estimated the total number of these patients using response and extraction rate. A second survey was conducted in 117 facilities (49.8%) to assess for HLA-B 27 positivity rate and clinical features. RESULTS: The estimated total number of the patients with AS and nr-ax SpA were 3200 (95% confidence interval [CI]: 2400-3900) and 800 (530-1100), suggesting that the prevalence of AS and nr-ax SpA in general population were 2.6/100,000 (0.0026%) and 0.6/100,000 (0.0006%), respectively. Although 55.5 % (76/137) of patients with AS were HLA-B27 positive, those whose age of onset was estimated to be over 50 years tended to undergo less HLA-B27 testing. CONCLUSION: This study revealed the lower prevalence of AS/nr-ax SpA in Japan, compared to those in other countries. Further studies are required to reveal the association of HLA-B27 with the clinical features.. |
| 547. |
Takahito Negishi, Akira Matsunobu, Makoto Endo, Ryouhei Yokoyama, Shuhei Kusano, Nobuki Furubayashi, Kenichi Taguchi, Yoshiyuki Shioyama, Keiichiro Iida, Toshifumi Fujiwara, Nokitaka Setsu, Yoshihiro Matsumoto, Yasuharu Nakashima, Kenichi Kohashi, Hidetaka Yamamoto, Yoshinao Oda, Motonobu Nakamura, An Analysis of 20 Cases of Radiation-Associated Sarcoma, Including 4 Cases Treated by Carbon Ion Radiotherapy., Oncology, 10.1159/000521504, 100, 3, 148-154, 2021.12, Introduction Radiation-associated sarcoma (RAS) is one of the most life-threatening complications associated with the treatment of malignant neoplasms. Because all RAS patients have a history of radiotherapy, there have been no effective treatment options when RAS is not completely resected. Methods We retrospectively reviewed 20 RAS patients, including 4 unresectable cases treated by carbon ion radiotherapy (CIRT). Results The primary diseases targeted by radiotherapy included malignant lymphoma (n=4), cervical cancer (n=3), pharyngeal cancer (n=3), breast cancer (n=2), lung cancer (n=1), rectal cancer (n=1), maxillary cancer (n=1), synovial sarcoma (n=1), and benign neoplasms (n=4). The histological diagnoses of RAS included osteosarcoma (n=8), leiomyosarcoma (n=3), undifferentiated pleomorphic sarcoma (n=3), rhabdomyosarcoma (n=1), angiosarcoma (n=1), malignant peripheral nerve sheath tumor (n=1), spindle cell sarcoma NOS (n=1), and sarcoma not further specified (n=2). The median survival time from the diagnosis of RAS was 26 months. Eleven patients underwent surgery. Five of these patients achieved a continuous disease free status or showed no evidence disease. Four patients underwent CIRT. One of these patients with leiomyosarcoma achieved a continuous disease free status, and the other patient with osteosarcoma achieved a partial response. On the other hand, 2 patients experienced Grade 3 toxicities that required surgical treatment. Conclusion RAS originates from various types of diseases that are treated by radiotherapy and shows diverse pathological features. Complete resection achieves a good prognosis. CIRT can be an effective and feasible option for unresectable RAS.. |
| 548. |
Yu Matsushita, Masuo Hanada, Yoshihiro Matsumoto, Hideki Kadota, Yasuharu Nakashima, A Double-Barreled Fibular Graft for the Reconstruction of Both Forearm Bones and Humeroradial Joint after a Tumor Resection., The journal of hand surgery Asian-Pacific volume, 10.1142/S2424835521720152, 26, 3, 455-459, 2021.09, A double-barreled fibular graft was used to reconstruct both forearm bones and the humeroradial joint after tumor resection. The patient had a tumor of radius that invaded the ulna and extensor groups. After a wide tumor resection, vascularized fibular autograft and soft tissue reconstruction was performed. A fibular graft were placed as a double barrel in the proximal ulnar and radial defects including the radial head and fixed using two locking plates. Simultaneously, reconstruction of the humeroradial joint and wrist dorsiflexion was performed. Two years postoperatively, the patient is satisfied with his elbow function while performing activities of daily living. Although amputation was one of the options considered during the preoperative planning in this case, the affected limb could be preserved by grafting a double-barreled fibula and tendon transfer, which could maintain the function of his upper left limb.. |
| 549. |
Satoshi Ikemura, Goro Motomura, Koichiro Kawano, Satoshi Hamai, Masanori Fujii, Yasuharu Nakashima, The Discrepancy in the Posterior Boundary of Necrotic Lesion Between Axial and Oblique Axial Slices of MRI in Patients with Osteonecrosis of the Femoral Head., The Journal of bone and joint surgery. American volume, 10.2106/JBJS.20.00493, 104, Suppl 2, 33-39, 2022.02, BACKGROUND: Little is known concerning differences in assessment of anteroposterior osteonecrotic lesion of the femoral head (ONFH) between the axial plane parallel to the body axis (axial) and the axial plane parallel to the femoral neck axis (oblique axial) using magnetic resonance imaging (MRI). This study aimed to compare the posterior boundary of necrotic lesions between the axial and oblique axial planes on MRI. METHODS: This study retrospectively reviewed 120 consecutive hips in 71 patients (47 males and 24 females; mean age, 42 years) with ONFH, for which both axial and oblique axial MRI slices were available. The posterior boundaries of the necrotic lesions were calculated as the ratio of posterior intact circumference to anteroposterior circumference of the femoral head using mid-axial and mid-oblique axial MRI slices. The necrotic angles, calculated using the modified Kerboul method, were compared between cases with progression and nonprogression of collapse. RESULTS: The mean posterior intact ratio in the axial slice was 49.2% (range, 8.6 to 85.1%), while that in the oblique axial slice was 33.5% (7.5 to 79.2%). The posterior intact ratio in the oblique axial slice significantly decreased compared to that in the axial slice (p |
| 550. |
Eiji Tashiro, Naohide Takeuchi, Naoya Kozono, Akira Nabeshima, Ei Teshima, Yasuharu Nakashima, Risk of penetration of the baseplate peg in reverse total shoulder arthroplasty for an Asian population., International orthopaedics, 10.1007/s00264-022-05328-x, 46, 5, 1063-1071, 2022.02, PURPOSE: Baseplate positioning may affect clinical outcome after reverse total shoulder arthroplasty (RTSA). The aim of this study was to evaluate the risk of penetration of the baseplate peg in RTSA. METHODS: Forty-four patients with rotator cuff arthropathy or massive rotator cuff tears were included. Using their computed tomography data, ten insertion patterns of the baseplate pegs were simulated. First, in the axial plane, the baseplate was placed perpendicular to the Friedman axis (Friedman placement) and parallel to the glenoid surface (glenoid placement). Second, each of these placements were classified into the following groups: The baseplate peg was placed 2 mm anterior to the long axis of the glenoid (group A2), 1 mm anterior (group A1), on the long axis (group C0), 1 mm posterior (group P1), and 2 mm posterior (group P2). Cases in which the baseplate peg was within the scapular neck were defined as non-penetration, and the non-penetration rates among each group were evaluated and compared between sexes, and their relationship with patient height was evaluated. RESULTS: In both the Friedman and glenoid placements, the non-penetration rate was significantly higher in groups A2 (68.2% and 70.5%) and A1 (65.9% and 65.9%) compared with groups P1 (18.2% and 29.5%) and P2 (9.1% and 13.6%; p |
| 551. |
Eijiro Shimada, Yoshihiro Matsumoto, Makoto Nakagawa, Yosuke Susuki, Makoto Endo, Nokitaka Setsu, Toshifumi Fujiwara, Keiichiro Iida, Akira Nabeshima, Kenichiro Yahiro, Atsushi Kimura, Takeshi Hirose, Masaya Kanahori, Ryunosuke Oyama, Yoshinao Oda, Yasuharu Nakashima, Methylation-mediated silencing of protein kinase C zeta induces apoptosis avoidance through ATM/CHK2 inactivation in dedifferentiated chondrosarcoma., British journal of cancer, 10.1038/s41416-021-01695-1, 126, 9, 1289-1300, 2022.01, BACKGROUND: Dedifferentiated chondrosarcoma (DDCS) is an aggressive bone tumour with a poor prognosis and no effective treatment. Because changes in DNA methylation play critical roles in DDCS, we explored the roles that DNA methylation plays in oncogenesis to potentially identify an effective epigenetic treatment. METHODS: We identified genes downregulated in DDCS vs. conventional chondrosarcoma (CCS) due to DNA methylation using in silico analysis. The results were validated in DDCS clinical samples, and the molecular functions of the genes of interest were investigated in multiple chondrosarcoma cell lines (NDCS-1, SW1353, and OUMS-27). The therapeutic effect of decitabine, a DNA methyltransferase inhibitor, was evaluated in vitro and in vivo. RESULTS: PRKCZ was specifically downregulated by DNA methylation in DDCS. Overexpression of PRKCZ decreased the proliferation of NDCS-1 and SW1353 cells. PRKCZ directly bound to and activated ATM, which was followed by phosphorylation of CHK2 and subsequent apoptosis. Decitabine increased PRKCZ expression through de-methylating the promoter region of PRKCZ, which activated the ATM/CHK2 pathway and inhibited cell proliferation by inducing apoptosis. CONCLUSIONS: Increased DNA methylation and reduced expression of PRKCZ prevents apoptosis via inactivation of the ATM/CHK2 pathway in DDCS. Decitabine-induced expression of PRKCZ represents a promising therapy for DDCS.. |
| 552. |
Satoru Harada, Satoshi Hamai, Goro Motomura, Satoshi Ikemura, Masanori Fujii, Shinya Kawahara, Taishi Sato, Daisuke Hara, Yasuharu Nakashima, Evaluation of optimal implant alignment in total hip arthroplasty based on postoperative range of motion simulation., Clinical biomechanics (Bristol, Avon), 10.1016/j.clinbiomech.2021.105555, 92, 105555-105555, 2022.01, BACKGROUND: Dislocation after total hip arthroplasty is a frequent cause of revision surgery. This study was performed to determine the optimal implant alignment in total hip arthroplasty by simulating the postoperative range of motion. METHODS: All operations were performed via posterolateral approach using combined anteversion of the stem and cup technique. Maximum range of motion without implant impingement was simulated in 79 replaced hips using postoperative computed tomography and the achievement of the required range of motion defined by previous studies was assessed. Optimal cup and stem alignment for impingement-free range of motion were statistically determined using the receiver operator coefficient curve. FINDINGS: Cup inclination and anteversion, stem anteversion, and combined anteversion were 37.6°, 20.1°, 26.2°, and 46.3°, respectively. Maximum range of motion in flexion, extension, internal rotation at 90° of flexion, and external rotation were 131.8°, 42.3°, 56.4°, and 64.5°, respectively. Flexion >110°, extension >30°, internal rotation >30° at 90° of flexion, and external rotation >30° were fulfilled by 96%, 86%, 92%, and 96% of all replaced hips, respectively. Optimal implant alignment for impingement-free range of motion was 34°-43° of cup inclination, 18°-26° of cup anteversion, 17°-29° of stem anteversion, and 35°-56° of combined anteversion. Both cup and stem anteversion showed significant relationship with postoperative range of motion. INTERPRETATION: Surgeons could gain valuable insights into optimal cup and stem alignment to perform postoperative range of motion simulations.. |
| 553. |
Keigo Shibahara, Satoshi Hamai, Yukio Akasaki, Yasuharu Nakashima, Histological evaluation of the low-density region around beta-tricalcium phosphate scaffolds used in opening wedge high tibial osteotomy: A report of two cases., Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 10.1016/j.jos.2021.12.012, 2022.01. |
| 554. |
Goro Motomura, Naohiko Mashima, Hiroshi Imai, Akihiro Sudo, Masahiro Hasegawa, Harumoto Yamada, Mitsuhiro Morita, Naoto Mitsugi, Ryosuke Nakanishi, Yasuharu Nakashima, Effects of porous tantalum on periprosthetic bone remodeling around metaphyseal filling femoral stem: a multicenter, prospective, randomized controlled study., Scientific reports, 10.1038/s41598-022-04936-2, 12, 1, 914-914, 2022.01, Periprosthetic bone loss due to adaptive bone remodeling is an important unresolved issue in cementless total hip arthroplasty (THA). The use of porous tantalum on the proximal surface of the femoral stem is expected to decrease postoperative bone loss around the prosthesis through early fixation. We conducted a multicenter randomized controlled study to determine if porous tantalum could reduce periprosthetic bone loss after THA. From October 2012 to September 2014, 118 patients (mean age, 61.5 years; 107 females and 11 males) were prospectively enrolled and were randomly allocated at a ratio of 1:1 to either a metaphyseal filling stem with a proximal porous tantalum coating (Trabecular Metal) or a conventional metaphyseal filling stem with fiber mesh coating (VerSys). Patients underwent dual-energy x-ray absorptiometry scans within 1 week after surgery (baseline) and at 6, 12, and 24 months after surgery to assess periprosthetic bone mineral density (BMD) in the 7 Gruen zones. In addition, the Japanese Orthopaedic Association hip score was assessed before surgery and at 6, 12, and 24 months after surgery. In the proximal periprosthetic region (zones 1 and 7), the Trabecular Metal group had significantly smaller reductions in BMD than the VerSys group throughout the study period. In the VerSys group, significant reductions in BMD compared to baseline were seen at each measurement point in all regions, except in zone 6 at 24 months. In the Trabecular Metal group, no significant reductions in BMD relative to baseline were seen in zones 1, 5, or 6 throughout the study period. Both groups demonstrated similar improvement in Japanese Orthopaedic Association hip scores over the study period. This study demonstrated that a proximally coated stem with porous tantalum has superior results over a conventional stem with titanium fiber mesh in terms of periprosthetic bone remodeling.. |
| 555. |
Kenji Kitamura, Masanori Fujii, Miho Iwamoto, Satoshi Ikemura, Satoshi Hamai, Goro Motomura, Yasuharu Nakashima, Effect of coronal plane acetabular correction on joint contact pressure in Periacetabular osteotomy: a finite-element analysis., BMC musculoskeletal disorders, 10.1186/s12891-022-05005-5, 23, 1, 48-48, 2022.01, BACKGROUND: The ideal acetabular position for optimizing hip joint biomechanics in periacetabular osteotomy (PAO) remains unclear. We aimed to determine the relationship between acetabular correction in the coronal plane and joint contact pressure (CP) and identify morphological factors associated with residual abnormal CP after correction. METHODS: Using CT images from 44 patients with hip dysplasia, we performed three patterns of virtual PAOs on patient-specific 3D hip models; the acetabulum was rotated laterally to the lateral center-edge angles (LCEA) of 30°, 35°, and 40°. Finite-element analysis was used to calculate the CP of the acetabular cartilage during a single-leg stance. RESULTS: Coronal correction to the LCEA of 30° decreased the median maximum CP 0.5-fold compared to preoperatively (p 53.2%), coronal plane correction alone may not normalize CP. Further studies are needed to clarify the effectiveness of multiplanar correction, including in the sagittal and axial planes, in optimizing the hip joint's contact mechanics.. |
| 556. |
Masanari Kuwahara, Yukio Akasaki, Ichiro Kurakazu, Takuya Sueishi, Masakazu Toya, Taisuke Uchida, Tomoaki Tsutsui, Ryota Hirose, Hidetoshi Tsushima, Takeshi Teramura, Yasuharu Nakashima, C10orf10/DEPP activates mitochondrial autophagy and maintains chondrocyte viability in the pathogenesis of osteoarthritis., FASEB journal : official publication of the Federation of American Societies for Experimental Biology, 10.1096/fj.202100896R, 36, 2, e22145, 2022.02, Osteoarthritis (OA), the most prevalent joint disease, is characterized by the progressive loss of articular cartilage. Autophagy, a lysosomal degradation pathway, maintains cellular homeostasis, and autophagic dysfunction in chondrocytes is a hallmark of OA pathogenesis. However, the cause of autophagic dysfunction in OA chondrocytes remains incompletely understood. Recent studies have reported that decidual protein induced by progesterone (C10orf10/DEPP) positively regulates autophagic functions. In this study, we found that DEPP was involved in mitochondrial autophagic functions of chondrocytes, as well as in OA pathogenesis. DEPP expression decreased in human OA chondrocytes in the absence or presence of pro-inflammatory cytokines, and was induced by starvation, hydrogen peroxide (H2 O2 ), and hypoxia (cobalt chloride). For functional studies, DEPP knockdown decreased autophagic flux induced by H2 O2 , whereas DEPP overexpression increased autophagic flux and maintained cell viability following H2 O2 treatment. DEPP was downregulated by knockdown of forkhead box class O (FOXO) transcription factors and modulated the autophagic function regulated by FOXO3. In an OA mouse model by destabilization of the medial meniscus, DEPP-knockout mice exacerbated the progression of cartilage degradation with TUNEL-positive cells, and chondrocytes isolated from knockout mice were decreased autophagic flux and increased cell death following H2 O2 treatment. Subcellular fractionation analysis revealed that mitochondria-located DEPP activated mitochondrial autophagy via BCL2 interacting protein 3. Taken together, our data demonstrate that DEPP is a major stress-inducible gene involved in the activation of mitochondrial autophagy in chondrocytes, and maintains chondrocyte viability during OA pathogenesis. DEPP represents a potential therapeutic target for enhancing autophagy in patients with OA.. |
| 557. |
Takanori Yamashita, Yoshifumi Wakata, Satoshi Hamai, Yasuharu Nakashima, Yukihide Iwamoto, Brendan Flanagan, Naoki Nakashima, Sachio Hirokawa, Construction of dominant factor presumption model for postoperative hospital days from operation records, 3rd IIAI International Conference on Advanced Applied Informatics, IIAI-AAI 2014
Proceedings - 2014 IIAI 3rd International Conference on Advanced Applied Informatics, IIAI-AAI 2014, 10.1109/IIAI-AAI.2014.16, 19-24, 2014.09, The secondary use of clinical text data to improve the quality and the efficiency of medical care is gaining much attention. However, there are few previous researches that have given feedback to clinical situations. The present paper analyzes the words that appear in operation records to predict the postoperative length of stay. SVM (support vector machine) and feature selection are applied to predict if a stay is longer than the standard length of 25 days. It was confirmed that with less than 20 feature words we can predict if a stay is longer or not with almost the optimal prediction performance.. |
| 558. |
Takanori Yamashita, Yoshifumi Wakata, Naoki Nakashima, Sachio Hirokawa, Satoshi Hamai, Yasuharu Nakashima, Yukihide Iwamoto, Extraction of determinants of postoperative length of stay from operation records, 2014 IEEE Workshop on Electronics, Computer and Applications, IWECA 2014
Proceedings - 2014 IEEE Workshop on Electronics, Computer and Applications, IWECA 2014, 10.1109/IWECA.2014.6845748, 822-827, 2014, Secondary use of clinical text data are gaining much attention in improving the quality and the efficiency of medical treatment. Although there is some case studies of medical-examination text data, there are not many examples fed back to the medical-examination spot. The present paper analyses the operation records of total hip arthroplasty. We extracted feature words that characterize the two peaks which appeared in distribution of postoperative hospital days using SVM (support vector machine) and FS (feature selection). The models gained by optimal FS attained 60% accuracy as prediction performance. We applied logistic regression analysis to estimate postoperative length of stay from the extracted feature words. Most words were not statistically significant except two words.. |
| 559. |
Taishi Sato, Yasuharu Nakashima, Mio Akiyama, Takuaki Yamamoto, Taro Mawatari, Takashi Itokawa, Masanobu Ohishi, Goro Motomura, Masanobu Hirata, Yukihide Iwamoto, Comparison of polyethylene wear between highly crosslinked and annealed UHMWPE and conventional UHMWPE against ceramic heads in total hip arthroplasty, 24th Symposium and Annual Meeting of International Society for Ceramics in Medicine, ISCM 2012
Bioceramics 24, 10.4028/www.scientific.net/KEM.529-530.279, 279-284, 2013.01, The purpose of this study was to examine the effects of ceramic femoral head material on the wear of annealed, crosslinked ultra-high molecular weight polyethylene (UHMWPE) (XLPE) in total hip arthroplasty compared to non-crosslinked conventional UHMWPE (CPE). XLPE was fabricated by crosslinking with 60 kGy irradiation and annealing. Femoral heads made from zirconia and alumina ceramics, and cobalt-chrome (CoCr) of 22 mm or 26 mm diameter were used. In this study, the femoral head penetration into the cup was measured digitally on radiographs of 70 hips with XLPE and 50 hips with CPE. The average follow-up periods were 6.1 and 12.7 years, respectively. The steady wear rate of XLPE was significantly lower than those of CPE (0.002 versus 0.08 mm/year, respectively). Zirconia displayed increased wear rates compared to alumina in CPE; however, there was no difference among head materials in XLPE (0.0028, 0.011 and 0.009 mm/year for zirconia, alumina and CoCr, respectively). Neither head size or implantation period impacted XLPE wear. In contrast to CPE, XLPE displayed low wear rates surpassing the effects of varying femoral head material, size, implantation period and patient demographics.. |
| 560. |
Takanori Yamashita, Brendan Flanagan, Yoshifumi Wakata, Satoshi Hamai, Yasuharu Nakashima, Yukihide Iwamoto, Naoki Nakashima, Sachio Hirokawa, Visualization of key factor relation in clinical pathway, 19th International Conference on Knowledge Based and Intelligent Information and Engineering Systems, KES 2015
Procedia Computer Science, 10.1016/j.procs.2015.08.139, 60, 1, 342-351, 2015, The secondary use of medical data to improve medical care is gaining much attention. We have analyzed electronic clinical pathways for improving the medical process. The analysis of clinical pathways so far has used statistics analysis models, however as issue remains that the order, and multistory spatial and time relations of the each factor could not be analyzed. We constructed an Outcome tree system that shows the greatest significant relation for each factor. The Hip replacement arthroplasty clinical pathway was analyzed by the system, and the outcome variance of the clinical pathway was visualized. The results indicate the path of patient's who have a long hospitalization stay and extracted four critical indicators.. |
| 561. |
Takanori Yamashita, Yoshifumi Wakata, Satoshi Hamai, Yasuharu Nakashima, Yukihide Iwamoto, Brendan Franagan, Naoki Nakashima, Sachio Hirokawa, Temporal Relation Extraction in Outcome Variances of Clinical Pathways, 15th World Congress on Health and Biomedical Informatics, MEDINFO 2015
MEDINFO 2015
eHealth-Enabled Health - Proceedings of the 15th World Congress on Health and Biomedical Informatics, 10.3233/978-1-61499-564-7-1077, 1077, 2015, Recently the clinical pathway has progressed with digitalization and the analysis of activity. There are many previous studies on the clinical pathway but not many feed directly into medical practice. We constructed a mind map system that applies the spanning tree. This system can visualize temporal relations in outcome variances, and indicate outcomes that affect long-term hospitalization.. |
| 562. |
Kazuhiro Shirozu, Keita Takahashi, Mitsumasa Hayashida, Katsuyuki Matsushita, Yasuharu Nakashima, Sumio Hoka, Incidental cerebral acute subdural hematoma after transforaminal lumbar interbody fusion
A case report, 100 Selected Case Reports from Anesthesia and Analgesia, 10.1213/XAA.0000000000000536, 2018.01, We present a 68-year-old woman who developed acute cerebral subdural hematoma (SDH) early after transforaminal lumbar interbody fusion. Four hours postoperatively, the patient complained of headache and nausea. Enhanced cranial computed tomography showed cerebral SDH. Despite no obvious intraoperative dural damage, we suggest that cerebrospinal fluid leakage by incidental dural tear likely caused the SDH. To our knowledge, this is the first report of detected cerebral SDH immediately after spinal surgery in spite of no neurological deficits.. |
| 563. |
Ryosuke Yamaguchi, Tomoyuki Nakamura, Takuaki Yamamoto, Kazuyuki Takamura, Haruhisa Yanagida, Toru Yamaguchi, Yasuharu Nakashima, Subchondral fracture of the femoral head in children
Differential diagnosis of pediatric hip pain, Journal of Orthopaedic Surgery, 10.1177/2309499020937862, 28, 2, 2020, This report describes clinical and radiographic characteristics of two pediatric patients with a presumptive diagnosis of subchondral fracture of the femoral head made based on their clinical course and imaging findings. An 8-year-old boy and an 8-year-old girl had subchondral fracture in the femoral head without osteonecrosis, which was verified by contrast-enhanced magnetic resonance imaging. Although complete disappearance of the fracture line was confirmed in the boy, the girl had a residual femoral head deformity after conservative treatment. Subchondral fracture of the femoral head should be included in the differential diagnosis of pediatric hip pain.. |
| 564. |
Shoji Baba, Goro Motomura, Satoshi Ikemura, Ryosuke Yamaguchi, Satoshi Hamai, Masanori Fujii, Koichiro Kawano, Yasuharu Nakashima, Risk factors for radiological changes after bipolar hemiarthroplasty for osteonecrosis of the femoral head, Modern Rheumatology, 10.1080/14397595.2020.1775959, 1-8, 2020, Objectives: This study aimed to report the mid-term radiological outcomes of patients with bipolar hemiarthroplasty (BHA) for stage 3 osteonecrosis of the femoral head (ONFH), and to identify the risk factors for postoperative radiological changes. Methods: We retrospectively investigated 62 patients (38 men and 24 women; mean age, 50.1 years) aged |
| 565. |
Koji Ohta, Jun ichi Fukushi, Satoshi Ikemura, Satoshi Kamura, Hisa aki Miyahara, Yasuharu Nakashima, Preoperative Japanese Society for the Surgery of the Foot Lesser toe score and erythrocyte sedimentation rate influence wound healing following rheumatoid forefoot surgery, Modern Rheumatology, 10.1080/14397595.2020.1775960, 2020, Objectives: Delayed wound healing is one of the most common complications following forefoot surgery in patients with rheumatoid arthritis. We aimed to identify the risk factors for delayed wound healing following rheumatoid forefoot surgery. Methods: Consecutive patients who underwent primary rheumatoid forefoot surgery (86 feet; 53 patients) between April 2008 and February 2019 were retrospectively evaluated. Clinical data, including smoking history, duration of the disease, presence of diabetes mellitus, medication, white blood cell count, erythrocyte sedimentation rate (ESR), C-reactive protein, the surgical procedure performed, and the Japanese Society for Surgery of the Foot (JSSF) scores, were collected. Results: Delayed wound healing was identified in 20 of 86 (23.3%) feet. In univariate analysis, participants showing delayed healing were older at the time of surgery (p =.04), their ESR was higher (p =.0006), and their total (p =.019) and pain (p =.016) scores on the JSSF Lesser toe scale were lower than those showing normal healing. In multivariable analysis, both the total preoperative JSSF Lesser toe scale score (p =.0239) and ESR (p =.0126) remained significant risk factors for delayed wound healing. Conclusions: After rheumatoid forefoot surgery, surgeons should pay more attention to wound care in patients with lower preoperative JSSF Lesser toe score and high ESR.. |
| 566. |
Teruaki Ono, Yuta Kohro, Keita Kohno, Hidetoshi Tozaki-Saitoh, Yasuharu Nakashima, Makoto Tsuda, Mechanical pain of the lower extremity after compression of the upper spinal cord involves signal transducer and activator of transcription 3-dependent reactive astrocytes and interleukin-6, Brain, Behavior, and Immunity, 10.1016/j.bbi.2020.07.025, 2020, Chronic pain is one of the main symptoms of spinal disorders such as spinal canal stenosis. A major cause of this pain is related to compression of the spinal cord, and chronic pain can develop at the level of the compressed spinal segment. However, in many patients chronic pain arises in an area that does not correspond to the compressed segment, and the underlying mechanism involved remains unknown. This was investigated in the present study using a mouse model of spinal cord compression in which mechanical pain of the hindpaws develops after compression of the first lumbar segment (L1) of the spinal cord. Compression induced the activation of astrocytes in the L1 spinal dorsal horn (SDH)—but not the L4 SDH that corresponds to the hindpaws—and activated signal transducer and activator of transcription 3 (STAT3). Suppressing reactive astrocytes by expressing a dominant negative form of STAT3 (dnSTAT3) in the compressed SDH prevented mechanical pain. Expression of interleukin (IL)-6 was also upregulated in the compressed SDH, and it was inhibited by astrocytic expression of dnSTAT3. Intrathecal administration of a neutralizing anti-IL-6 antibody reversed the compression-induced mechanical pain. These results suggest that astrocytic STAT3 and IL-6 in the compressed SDH are involved in remote mechanical pain observed in the lower extremity, and may provide a target for treating chronic pain associated with spinal cord compression such as spinal canal stenosis.. |
| 567. |
Goro Motomura, Satoshi Hamai, Satoshi Ikemura, Takuaki Yamamoto, Yusuke Kubo, Masanori Fujii, Takeshi Utsunomiya, Yasuharu Nakashima, Transtrochanteric anterior rotational osteoto-my combined with re-sphericalization of the collapsed femoral head using calcium phosphate cement filling, Surgical technology international, 36, 1-4, 2020.05, Introduction: Transtrochanteric anterior rotational osteotomy (ARO) is an established joint-preserving surgery for collapsed osteonecrosis of the femoral head (ONFH) in which the collapsed necrotic lesion is rotated ante-riorly. Recently, preoperative collapse of more than 2.98mm was reported to be the most influential factor for progressive collapse of the anteriorly transposed necrotic lesion after ARO, the main cause of secondary osteoarthritic changes and clinical failure. We attempted to prevent progressive collapse with re-sphericalization of the collapsed femoral head using calcium phosphate cement (CPC) filling in conjunction with ARO. Materials and Methods: Between May 2015 and April 2018, five consecutive hips with ONFH, femoral head collapse of ≥3mm, and one-third or more of the posterior region of the femoral head intact, were prospectively recruited for re-sphericalization with ARO. This report describes intraoperative surgical techniques focusing on re-sphericalization of the collapsed femoral head using CPC and short-term effects of this additional procedure on progressive collapse of the transposed necrotic lesion, defined as ≥2mm progression on lateral radiographs. Results: After anterior rotation of the proximal fragment, followed by fixation of the transtrochanteric osteotomy site, a 5mm fenestration was made in the collapsed region of the anterior femoral head cartilage, through which the collapsed surface was carefully lifted with an elevatrium. Subsequently, CPC paste was injected into the lifted subchondral space with a small needle. After CPC paste injection, the femoral head was maintained at 40°C for 10 minutes to promote solidification of the CPC paste. With the re-sphericalization method, the mean level of collapse decreased from 4.1mm before surgery to 2.0mm after surgery. Subsequently, progressive collapse of the transposed necrotic lesion was confirmed in two hips. One of these hips had a deep infection that required complete curettage of CPC three weeks after the initial surgery. All hip joints have been preserved without conversion to prosthesis during a mean follow up of 2.1 years. Conclusion: A joint-preserving procedure for ONFH with severe collapse remains a challenging problem for surgeons. When ARO is indicated based on one-third or more of the posterior region of the femoral head being intact, the current re-sphericalization method could be worth considering as an additional procedure in cases with severe collapse.. |
| 568. |
Hiroyuki Hatanaka, Goro Motomura, Satoshi Ikemura, Kazuhiko Sonoda, Yusuke Kubo, Takeshi Utsunomiya, Yasuharu Nakashima, Takuaki Yamamoto, Effect of a specific questionnaire sheet on subclassification of osteonecrosis of the femoral head, Medical Science Monitor, 10.12659/MSM.921327, 26, 2020.05, Background: This study examined whether use of a specific questionnaire sheet for nontraumatic osteonecrosis of the femoral head (ONFH) could affect the subclassification of ONFH compared with a conventional medical interview. Material/Methods: Study participants consisted of 400 patients with ONFH who visited our hospital between February 2011 and March 2015. Data on history of systemic steroid therapy and habitual alcohol intake were obtained during a conventional medical interview at the first visit and were re-evaluated using a specific questionnaire sheet at another visit. Patients were subclassified into 4 groups: steroid-associated, alcohol-associated, steroid/alcohol- associated, or idiopathic ONFH. Results: Use of the specific questionnaire sheet resulted in a 4.0% increase in the proportion of patients with a history of systemic steroid therapy, from 57.3% (n=229) to 61.3% (n=245), and a 14.3% increase for history of habitual alcohol intake, from 35.0% (n=140) to 49.3% (n=197). The proportion of patients with steroid/alcohol-associated ONFH increased from 2.5% (n=10) to 17.8% (n=71), while the proportion in the other 3 groups decreased: steroid-associated ONFH from 54.8% (n=219) to 43.5% (n=174); alcohol-associated ONFH from 32.5% (n=130) to 31.5% (n=126); and idiopathic ONFH from 10.2% (n=41) to 7.2% (n=29). Ninety-six patients (24.0%) were classified into a different subgroup based on the specific questionnaire sheet. Conclusions: The use of a specific questionnaire sheet can change the distribution of ONFH subclassifications compared with use of a conventional medical history interview. Use of a specific questionnaire sheet can allow for more detailed self-reporting regarding potential causative factors for nontraumatic ONFH, especially habitual alcohol intake.. |
| 569. |
Kimitaka Nakamura, Daigo Yoshida, Takanori Honda, Jun Hata, Mao Shibata, Yoichiro Hirakawa, Yoshihiko Furuta, Hiro Kishimoto, Tomoyuki Ohara, Takanari Kitazono, Yasuharu Nakashima, Toshiharu Ninomiya, Prevalence and mortality of sarcopenia in a community-dwelling older Japanese population
the Hisayama Study, Journal of epidemiology, 10.2188/jea.JE20190289, 2020.06, BACKGROUND: The prevalence of sarcopenia defined by the Asian Working Group for Sarcopenia (AWGS) definition in Asian communities has not been fully addressed. Moreover, few studies have addressed the influence of sarcopenia on mortality.
METHODS: A total of 1,371 and 1,597 residents aged 65 years or older participated in health surveys in 2012 and 2017. Sarcopenia was determined by the AWGS definition. Factors associated with the presence of sarcopenia were assessed using a logistic regression model in participants in the 2012 survey. Subjects in the 2012 survey were followed-up prospectively for a median of 4.3 years. Mortality risk for subjects with sarcopenia was examined using the Cox proportional hazards model.
RESULTS: The crude prevalence of sarcopenia was 7.4% and 6.6% in participants at the 2012 and 2017 surveys, respectively; there was no significant difference between surveys (p = 0.44). The prevalence of sarcopenia increased significantly with age in both sexes (both p for trend CONCLUSIONS: Approximately 7% of older subjects had sarcopenia in a community-dwelling older Japanese population. Moreover, subjects with sarcopenia had an increased mortality risk. Our findings suggest that a public health strategy for sarcopenia is needed to extend healthy life expectancy.. |
| 570. |
Shinya Kawahara, T. Hara, Taishi Sato, K. Kitade, Y. Nakashima, T. Shimoto, T. Nakamura, T. Mawatari, H. Higaki, Digitalized analyses of intraoperative acetabular component position using image-matching technique in total hip arthroplasty, Bone and Joint Research, 10.1302/2046-3758.97.BJR-2019-0260.R2, 9, 7, 360-367, 2020.07, Aims: Appropriate acetabular component placement has been proposed for prevention of postoperative dislocation in total hip arthroplasty (THA). Manual placements often cause outliers in spite of attempts to insert the component within the intended safe zone; therefore, some surgeons routinely evaluate intraoperative pelvic radiographs to exclude excessive acetabular component malposition. However, their evaluation is often ambiguous in case of the tilted or rotated pelvic position. The purpose of this study was to develop the computational analysis to digitalize the acetabular component orientation regardless of the pelvic tilt or rotation. Methods: Intraoperative pelvic radiographs of 50 patients who underwent THA were collected retrospectively. The 3D pelvic bone model and the acetabular component were image-matched to the intraoperative pelvic radiograph. The radiological anteversion (RA) and radiological inclination (RI) of the acetabular component were calculated and those measurement errors from the postoperative CT data were compared relative to those of the 2D measurements. In addition, the intra- and interobserver differences of the image-matching analysis were evaluated. Results: Mean measurement errors of the image-matching analyses were significantly small (2.5° (SD 1.4°) and 0.1° (SD 0.9°) in the RA and RI, respectively) relative to those of the 2D measurements. Intra- and interobserver differences were similarly small from the clinical perspective. Conclusion: We have developed a computational analysis of acetabular component orientation using an image-matching technique with small measurement errors compared to visual evaluations regardless of the pelvic tilt or rotation.. |
| 571. |
Kanako Yakushiji, Kimie Fujita, Satomi Tanaka, Rumi Tanaka, Jun ichi Fukushi, Goro Motomura, Satoshi Hamai, Satoshi Ikemura, Masanori Fujii, Yasuharu Nakashima, Cross-cultural adaptation, reliability and validity of the Japanese version of the Hospital for Special Surgery Hip Replacement Expectations Survey, Journal of Orthopaedic Science, 10.1016/j.jos.2019.07.006, 25, 4, 599-605, 2020.07, Background: The Hospital for Special Surgery Hip Replacement Expectations Survey (HSS-THRES) is used in many countries to determine patient expectations before surgery. This study aimed to assess the reliability and validity of the Japanese version of HSS-THRES. Methods: A total of 134 patients scheduled for total hip arthroplasty (THA) underwent a self-administered preoperative survey questionnaire. Patient's expectation and quality of life (QOL) were measured using the Japanese version of HSS-THRES, overall expectations for THA, Oxford hip score (OHS), and EuroQol-5D (EQ-5D). Some patients completed the Japanese version of HSS-THRES and the overall expectations for THA after a ten-day interval. Cross-cultural adaptation was validated by an expert committee comprising health professionals, a methodologist, language experts, and orthopedic specialists. The internal consistency was evaluated by the Cronbach α coefficient. The test-retest reliability was examined using the intraclass coefficient correlation (ICC) and the Bland and Altman analysis. To test the construct validity, nine priori hypotheses were tested by correlation analysis between the Japanese version of HSS-THRES and two QOL scales, and by examining the association with demographic variables. Results: A total of 116 patients completed four scales. Patients were predominantly female (75.9%), with an average age of 62.2 ± 11.7. In the cross-cultural adaptation, all patients responded to the questionnaire without problems. The Japanese version of HSS-THRES showed good internal consistency (Cronbach α: 0.9). ICC was 0.94 and Bland–Altman analysis indicated no bias. The correlation between Japanese HSS-THRES and overall expectations for THA was high (r = 0.67). Similarly, the correlation with the OHS was higher than that with EQ-5D. A total of 77.8% of the hypotheses were confirmed. Conclusions: The Japanese version of HSS-THRES showed good cultural acceptability, high reliability, and validity to evaluate preoperative expectations for THA patients.. |
| 572. |
Kensei Yoshimoto, Jun ichi Fukushi, Hidetoshi Tsushima, Satoshi Kamura, Hisa aki Miyahara, Hideki Mizu-uchi, Yukio Akasaki, Yasuharu Nakashima, Does Preparation of the Subtalar Joint for Primary Union Affect Clinical Outcome in Patients Undergoing Intramedullary Nail for Rheumatoid Arthritis of the Hindfoot and Ankle?, Journal of Foot and Ankle Surgery, 10.1053/j.jfas.2019.08.038, 59, 5, 984-987, 2020.09, This study aimed to evaluate whether preparation of the subtalar joint affects the clinical outcomes after tibiotalocalcaneal arthrodesis using an intramedullary nail with fins for rheumatoid ankle/hindfoot deformity. Fifty-three joints in 51 patients who underwent tibiotalocalcaneal arthrodesis using an intramedullary nail with fins for rheumatoid arthritis at 2 institutions were included. Ten patients were male and 41 were female, with a mean age at surgery and follow-up period of 61.3 years and 71.6 months, respectively. Radiographic bone union was evaluated at the most recent visit. Univariate and multivariable analyses were performed to determine the risk factors associated with nonunion. The mean postoperative Japanese Society for Surgery of the Foot ankle/hindfoot scale was 65.3 (range, 5–84). The tibiotalar nonunion rate was 0%, whereas the subtalar nonunion rate was 43.3% (23 joints). Revision surgery was performed in 5, all of which were due to painful subtalar nonunion. Absence of subtalar curettage and earlier postoperative weightbearing were significantly associated with subtalar nonunion (p =.0451 and p =.0438, respectively). Subtalar nonunion after tibiotalocalcaneal arthrodesis for rheumatoid hindfoot is associated with higher revision rate. To decrease the risk of subtalar nonunion after tibiotalocalcaneal arthrodesis with an intramedullary nail in rheumatoid patients, curettage for the subtalar joint should be performed, and full weightbearing should be delayed until at least 26 days postoperatively.. |
| 573. |
Koichiro Kawano, Goro Motomura, Satoshi Ikemura, Ryosuke Yamaguchi, Shoji Baba, Mingjian Xu, Yasuharu Nakashima, Differences in the microarchitectural features of the lateral collapsed lesion between osteonecrosis and subchondral insufficiency fracture of the femoral head, Bone, 10.1016/j.bone.2020.115585, 141, 2020.12, Background: Like osteonecrosis of the femoral head (ONFH), subchondral insufficiency fracture of the femoral head (SIF) causes femoral head collapse. However, little is known about the differences between the two diseases regarding the morphological features of the collapsed lesion. We tested the hypothesis that the morphological features of the lateral collapsed lesion would differ between ONFH and SIF. Methods: Twenty femoral heads histopathologically diagnosed as ONFH (n = 10) or SIF (n = 10) were used in this study. In the lateral collapsed lesion of each femoral head, cubic regions of interest (ROIs) were selected within the collapsed subchondral area and the nearby non-collapsed subchondral area. Micro-CT-based microarchitectural parameters were compared between the ROIs in each disease. Additionally, correlations between histopathological and microarchitectural features were evaluated. Results: In ONFH, bone volume fraction, trabecular thickness, and bone mineral density in the collapsed area were all significantly lower than those in the nearby non-collapsed area where thickened bone trabeculae accompanied by appositional bone formation were invariably seen. On the other hand, in SIF there were no significant differences between the ROIs in any of these microarchitectural parameters. Histopathologically, varying degrees of callus formation overlying the fracture of the subchondral plate were seen around the lateral collapsed lesion. Conclusion: The morphological features of the lateral collapsed lesion were inconsistent between ONFH and SIF, suggesting different pathomechanisms of femoral head collapse.. |
| 574. |
Fukuda N, Kanazawa M, Tsuru K, Tsuchiya A, Sunarso, Toita R, Mori Y, Nakashima Y, Ishikawa K, Synergistic effect of surface phosphorylation and micro-roughness on enhanced osseointegration ability of poly(ether ether ketone) in the rabbit tibia., Sci Rep, 8, 1, 16887, 2019.06. |
| 575. |
Fujii M, Nakamura T, Hara T, Nakashima Y, Can the hip joint center be estimated from pelvic dimensions in dysplastic hips?, J Orthop Sc, 22, 6, 1089-1095, 2017.06. |
| 576. |
Kuwashima U, Mizu-Uchi H, Okazaki K, Hamai S, Akasaki Y, Murakami K, Nakashima Y, Three-dimensional analysis of accuracy of patient-matched instrumentation in total knee arthroplasty: Evaluation of intraoperative techniques and postoperative alignmen, J Orthop Sci, 22, 6, 1077-1083, 2017.06. |
| 577. |
Yamada Y, Kinoshita I, Kohashi K, Yamamoto H, Iwasaki T, Otsuka H, Yoshimoto M, Ishihara S, Toda Y, Kuma Y, Setsu N, Koga Y, Honda Y, Inoue T, Yanai H, Yamashita K, Ito I, Takahashi M, Ohga S, Furue M, Nakashima Y, Oda Y, Histopathological and Genetic Review of Phosphaturic Mesenchymal Tumours, Mixed Connective Tissue Variant, Histopathology, 72, 3, 460-471, 2018.06. |
| 578. |
Matsumoto Y, Shinoto M, Endo M, Setsu N, Iida K, Fukushi JI, Kawaguchi K, Okada S,
Bekki H, Imai R, Kamada T, Shioyama Y, Nakashima Y
, Evaluation of Risk Factors for Vertebral Compression Fracture after Carbon-Ion Radiotherapy for Primary Spinal and Paraspinal Sarcoma, Biomed Res Int, 9467402, 2017.06. |
| 579. |
Takeuchi N, Mae T, Fukushi JI, Tsukamoto N, Mizu-Uchi H, Momii K, Nakashima Y, Management of Intra-Articular Calcaneal Fractures: Clinical Results of Reduction
Technique Using a Bone Spreader
, J Foot Ankle Surg, 56, 5, 1025-1030, 2018.06. |
| 580. |
Matsumoto Y, Baba S, Endo M, Setsu N, Iida K, Fukushi JI, Kawaguchi K, Okada S,
Bekki H, Isoda T, Kitamura Y, Honda H, Nakashima Y
, Metabolic Tumor Volume by 18F-FDG PET/CT Can Predict the Clinical Outcome of Primary Malignant Spine/Spinal Tumors, Biomed Res Int, 8132676, 2017.06. |
| 581. |
Kozono N, Okada T, Takeuchi N, Shimoto T, Higaki H, Nakashima Y, A Biomechanical Comparison Between Asymmetric Pennington Technique and Conventional Core Suture Techniques: 6-Strand Flexor Tendon Repair, J Hand Surg Am, 43, 1, e1-79-e8, 2018.06. |
| 582. |
Tsuru K, Yoshimoto A, Kanazawa M, Sugiura Y, Nakashima Y, Ishikawa K, Fabrication of Carbonate Apatite Block through a Dissolution-Precipitation Reaction Using Calcium Hydrogen Phosphate Dihydrate Block as a Precursor, Materials (Basel), 31, 10(4), 2017.06. |
| 583. |
Hara M, Kobayakawa K, Ohkawa Y, Kumamaru H, Yokota K, Saito T, Kijima K,
YoshizakiS, Harimaya K, Nakashima Y, Okada S
, Interaction of reactive astrocytes with type I collagen induces astrocytic scar formation
through the integrin-N-cadherin pathway after spinal cord injury
, Nat Med, 23, 7, 818-828, 2017.06. |
| 584. |
Hara D, Hamai S, Fukushi JI, Kawaguchi KI, Motomura G, Ikemura S, Komiyama K, Nakashima Y, Does Participation in Sports Affect Osteoarthritic Progression After Periacetabular Osteotomy?, Am J Sports Med, 45, 11, 2468-2475, 2017.06. |
| 585. |
Kubo Y, Motomura G, Ikemura S, Sonoda K, Yamamoto T, Nakashima Y, Effect of collapse on the deformity of the femoral head-neck junction in osteonecrosis of the femoral head, Arch Orthop Trauma Surg, 137, 7, 933-938, 2017.06. |
| 586. |
Utsunomiya T, Motomura G, Ikemura S, Hamai S, Fukushi JI, Nakashima Y, The Results of Total Hip Arthroplasty After Sugioka Transtrochanteric Anterior Rotational Osteotomy for Osteonecrosis, J Arthroplasty, 32, 9, 2768-2773, 2017.06. |
| 587. |
Kanazawa M, Tsuru K, Fukuda N, Sakemi Y, Nakashima Y, Ishikawa K, Evaluation of carbonate apatite blocks fabricated from dicalcium phosphate dihydrate blocks for reconstruction of rabbit femoral and tibial defects., J Mater Sci Mater Med, 28, 6, 85, 2017.06. |
| 588. |
67. Fujii M, Nakashima Y, Nakamura T, Ito Y, Hara T, Minimum Lateral Bone Coverage Required for Securing Fixation of Cementless Acetabular Components in Hip Dysplasia, Biomed Res Int, 4937151, 2017.06. |
| 589. |
Goto N, Okazaki K, Akasaki Y, Ishihara K, Murakami K, Koyano K, Ayukawa Y, Yasunami N, Masuzaki T, Nakashima Y, Single intra-articular injection of fluvastatin-PLGA microspheres reduces cartilage degradation in rabbits with experimental osteoarthritis, J Orthop Res, 10.1002/jor.23562. 2017 , 2017.06. |
| 590. |
Kozono N, Okada T, Takeuchi N, Shimoto T, Higaki H, Nakashima Y, Effect of the Optimal Asymmetry on the Strength of Six-Strand Tendon Repair: An Ex Vivo Biomechanical Study, J Hand Surg Am, 42, 4, 250-256, 2017.06. |
| 591. |
Sonoda K, Motomura G, Kawanami S, Takayama Y, Honda H, Yamamoto T, Nakashima Y, Degeneration of articular cartilage in osteonecrosis of the femoral head begins at the necrotic region after collapse: a preliminary study using T1 rho MRI
, Skeletal Radiol, 46, 4, 463-467, 2017.06. |
| 592. |
Saito T, Yokota K, Kobayakawa K, Hara M, Kubota K, Harimaya K, Kawaguchi K, Hayashida M, Matsumoto Y, Doi T, Shiba K, Nakashima Y, Okada S, Experimental Mouse Model of Lumbar Ligamentum Flavum Hypertrophy, PLoS One, 12, 1, e0169717, 2017.06. |
| 593. |
Hara D, Hamai S, Komiyama K, Motomura G, Shiomoto K, Nakashima Y, Sports Participation in Patients After Total Hip Arthroplasty vs Periacetabular Osteotomy: A Propensity Score-Matched Asian Cohort Study, 33, 2, 423-430, 2018.02. |
| 594. |
Iwamoto M, Nakashima Y, Nakamura T, Kohno Y, Yamaguchi R, Takamura K, Clinical outcomes of conservative treatment with a non-weight-bearing abduction brace for Legg-Calvé-Perthes disease., J Orthop Sci, 23, 1, 156-160, 2018.01. |
| 595. |
Oyamada A, Matsumoto Y, Wakata Y, Kimura A, Ikuta K, Tsuchiya K, Tayama N,
Tomari S, Miyahara H, Mae T, Shiraishi H, Saito T, Arizono T, Kaji K, Mawatari T, Fujiwara M, Sakimura R, Shin K, Ninomiya K, Nakaie K, Antoku Y, Tokunaga S, Nakashima N, Iwamoto Y, Nakashima Y
, Characteristics of patients with fragility hip fractures in the northern Kyushu district in Japan: a multicenter prospective registry based on an electronic data capture system., J Bone Miner Metab, doi: 10.1007/s00774-017-0869-9. 2017, 2017.06. |
| 596. |
Iida K, Matsumoto Y, Setsu N, Harimaya K, Kawaguchi K, Hayashida M, Okada S, Nakashima Y, The neurological outcome of radiotherapy versus surgery in patients with metastatic spinal cord compression presenting with myelopathy., Arch Orthop Trauma Surg, 138, 1, 7-12, 2019.01, PURPOSE:
While radiotherapy is generally an acceptable treatment for metastatic spinal cord compression, surgical intervention is controversial due to the invasiveness and diversity of diseases in the patients being considered. The ideal treatment, therefore, depends on the situation, and the most acute treatment possible is necessary in patients presenting with myelopathy. We compared the neurological outcomes between radiotherapy and surgery in patients with metastatic spinal cord compression presenting with myelopathy.
METHODS:
A total 54 patients with metastatic spinal cord compression presenting with myelopathy treated in our institution between 2006 and 2016 were analyzed retrospectively. Twenty patients were selected by radiotherapy alone (radiation group), and 36 patients were selected by decompression and stabilization surgery with or without radiotherapy (surgery group). The neurological outcomes and complications were compared between the two treatment groups.
RESULTS:
Seven patients initially in the radiation group underwent surgery because of a substantial decline in their motor strength during radiotherapy. One of the remaining 13 patients (8%) in the radiation group and 30 of the 34 patients (88%) in the surgery group showed improvement in their neurological symptoms (P
CONCLUSIONS:
Surgical decompression and stabilization may be required to improve the neurological function in patients with metastatic spinal cord compression presenting with myelopathy. However, the high rate of complications associated with surgery should be taken into consideration.. |
| 597. |
Yasuharu Nakashima, Re-dislocation after revision total hip arthroplasty for recurrent dislocation: a multicentre study., Int Orthop, 41, 2, 253-258, 2017.02. |
| 598. |
Yasuharu Nakashima, Impact of methotrexate dose on efficacy of adalimumab in Japanese patients with rheumatoid arthritis: Results from registered data analyses., Mod Rheumatol, 27, 1, 15-21, 2017.01. |
| 599. |
Yasuharu Nakashima, Is the timing of surgery associated with avascular necrosis after unstable slipped capital femoral epiphysis? A multicenter study., J Orthop Sci, 22, 1, 112-115, 2017.01. |
| 600. |
Yasuharu Nakashima, Minimum 10-year results of cementless total hip arthroplasty in patients with rheumatoid arthritis., Mod Rheumatol, 15, 1-7, 2016.12. |
| 601. |
Yasuharu Nakashima, Transtrochanteric rotational osteotomy for avascular necrosis of the femoral head after unstable slipped capital femoral epiphysis: 10-year clinical results., J Orthop Sci, 21, 6, 831-835, 2016.11. |
| 602. |
Yasuharu Nakashima, Does High Hip Center Decrease Range of Motion in Total Hip Arthroplasty? A Computer Simulation Study., J Arthroplasty, 31, 10, 2342-2347, 2016.10. |
| 603. |
Yasuharu Nakashima, High prevalence of cam deformity in dysplastic hips: A three-dimensional CT study., J Orthop Res, 34, 9, 1613-1619, 2016.09. |
| 604. |
Yasuharu Nakashima, Quantification of pelvic tilt and rotation by width/height ratio of obturator foramina on anteroposterior radiographs., Hip Int, ２６, 5, 462-467, 2016.09. |
| 605. |
Yasuharu Nakashima, Cementless total hip arthroplasty for patients previously treated with femoral osteotomy for hip dysplasia: the incidence of periprosthetic fracture., Int Orthop, 40, 8, 1601-1606, 2016.08. |
| 606. |
Yasuharu Nakashima, Dislocation and its recurrence after revision total hip arthroplasty., Int Orthop, 40, 8, 1625-1630, 2016.08. |
| 607. |
Yasuharu Nakashima, Factors Associated With Severity of Intra-articular Lesions in Patients With Severe Hip Dysplasia., Arthroscopy, 32, 8, 1581-1589, 2016.08. |
| 608. |
Yasuharu Nakashima, Dynamic Hip Kinematics During the Golf Swing After Total Hip Arthroplasty., Am J Sports Med, 44, 7, 1801-1809, 2016.07. |
| 609. |
Yasuharu Nakashima, The Absence of Hydroxyapatite Coating on Cementless Acetabular Components Does Not Affect Long-Term Survivorship in Total Hip Arthroplasty., J Arthroplasty, 31, 6, 1228-1232, 2016.06. |
| 610. |
Yasuharu Nakashima, Comparison of 10-year clinical wear of annealed and remelted highly cross-linked polyethylene: A propensity-matched cohort study., J Mech Behav Biomed Mater, 59, 99-107, 2016.06. |
| 611. |
Yasuharu Nakashima, Is a Stem Version on the Crosstable Lateral Radiograph Accurate in Total Hip Arthroplasty?, J Arthroplasty, 31, 6, 1356-1360, 2016.06. |
| 612. |
Yasuharu Nakashima, Late Anterior Dislocation Due to Posterior Pelvic Tilt in Total Hip Arthroplasty., Open Orthop, 22, 10, 206-212, 2016.06. |
| 613. |
Yasuharu Nakashima, Impact of methotrexate dose on efficacy of adalimumab in Japanese patients with rheumatoid arthritis: results from prospectively registered data analyses., Mod Rheumatol, 2016.05. |
| 614. |
Yasuharu Nakashima, Delayed diagnosis of ankylosing spondylitis in a Japanese population., Mod Rheumatol, 2016.05. |
| 615. |
Yasuharu Nakashima, A novel type II collagen gene mutation in a family with spondyloepiphyseal dysplasia showing wide intra-familial phenotypic diversity, Human Genome Variation, 2016.05. |
| 616. |
Yasuharu Nakashima, Tumor-induced osteomalacia caused by a massive phosphaturic mesenchymal tumor of the acetabulum: A case report., Mod Rheumatol, 4, 1-5, 2016.05. |
| 617. |
Yasuharu Nakashima, Outcome of Joint-Preserving Arthroplasty for Rheumatoid Forefoot Deformities.
, Foot Ankle Int, 37, 3, 262-268, 2016.03. |
| 618. |
Yasuharu Nakashima, Effects of dioxin-related compounds on bone mineral density in patients affected by the Yusho incident., Chemosphere, 145, 25-33, 2016.02. |
| 619. |
Yasuharu Nakashima, Bone bonding strength of diamond-structured porous titanium-alloy implants manufactured using the electron beam-melting technique., Clin Biomech (Bristol, Avon), 32, 1047-1052, 2016.02. |
| 620. |
Yasuharu Nakashima, Optimal anterior femoral offset for functional range of motion in total hip arthroplasty-a computer simulation study, INTERNATIONAL ORTHOPAEDICS, 10.1007/s00264-014-2538-0, 39, 4, 645-651, 2015.04. |
| 621. |
Yasuharu Nakashima, Mid-Term Clinical and Radiographic Outcomes of Porous Tantalum Modular Acetabular Components for Hip Dysplasia, JOURNAL OF ARTHROPLASTY, 10.1016/j.arth.2014.11.007, 30, 4, 607-610, 2015.04. |
| 622. |
Yasuharu Nakashima, Successful In Vitro Culture of Rheumatoid Arthritis Synovial Tissue Explants at the Air-Liquid Interface, ARTHRITIS & RHEUMATOLOGY, 10.1002/art.39019, 67, 4, 887-892, 2015.04. |
| 623. |
Yasuharu Nakashima, Ischio-pubic stress fracture after peri-acetabular osteotomy in patients with hip dysplasia, INTERNATIONAL ORTHOPAEDICS, 10.1007/s00264-014-2375-1, 38, 10, 2051-2056, 2014.10. |
| 624. |
Yasuharu Nakashima, Remission in patients with active rheumatoid arthritis by tocilizumab treatment in routine clinical practice: results from 3 years of prospectively registered data, MODERN RHEUMATOLOGY, 10.3109/14397595.2013.854069, 24, 2, 258-264, 2014.03. |
| 625. |
Yasuharu Nakashima, Scintigraphic assessments of the reparative process in osteonecrosis of the femoral head using SPECT/CT with Tc-99m hydroxymethylene diphosphonate, NUCLEAR MEDICINE COMMUNICATIONS, 10.1097/MNM.0000000000000166, 35, 10, 1047-1051, 2014.10. |
| 626. |
Yasuharu Nakashima, Combined anteversion technique reduced the dislocation in cementless total hip arthroplasty, INTERNATIONAL ORTHOPAEDICS, 10.1007/s00264-013-2091-2, 38, 1, 27-32, 2014.01. |
| 627. |
Yasuharu Nakashima, Results at a minimum of 10 years of follow-up for AMS and PerFix HA-coated cementless total hip arthroplasty: impact of cross-linked polyethylene on implant longevity, JOURNAL OF ORTHOPAEDIC SCIENCE, 10.1007/s00776-013-0456-4, 18, 6, 962-68, 2013.11. |
| 628. |
Yasuharu Nakashima, Effects of posterior pelvic tilt on anterior instability in total hip arthroplasty: A parametric experimental modeling evaluation, CLINICAL BIOMECHANICS, 10.1016/j.clinbiomech.2012.12.011, 28, 2, 178-181, 2013.02. |
| 629. |
Hamasaki M, Yasuharu Nakashima, Era Takumi, Pathogenic mutation of ALK2 inhibits induced pluripotent stem cell reprogramming and maintenance: mechanisms of reprogramming and strategy for drug identification., 30, 11, 2437-2449, 2012.10. |
| 630. |
153) Nakashima Y, Mashima N, Imai H, Mitsugi N, Taki N, Mochida Y, Owan I, Arakaki K, Yamamoto T,
Mawatari T, Motomura G, Ohishi M, Doi T, Kanazawa M, Iwamoto Y.
, Clinical and radiographic evaluation of total hip arthroplasties using porous tantalum modular acetabular components: 5-year follow-up of clinical trial., Mod Rheumatol, Epub ahead of print 2012, 2012.07. |
| 631. |
Kawahara S, Yasuharu Nakashima, Yukihide Iwamoto, High prevalence of acetabular retroversion in both affected and unaffected hips after Legg-Calvé-Perthes disease, 17, 3, 226-232, 2012.06. |
| 632. |
Masanori Fujii, Yasuharu Nakashima, Yukihide Iwamoto, Acetabular Tilt Correlates with Acetabular Version and Coverage in Hip Dysplasia, 470, 2827-2835, 2012.06. |
| 633. |
Yasuharu Nakashima, Taishi Sato, Yukihide Iwamoto, Wear resistant performance of highly crosslinked and annealed ultra-high molecular weight polyethylene against ceramic femoral heads in total hip arthroplasty, 30, 2031-2037, 2012.06, The purpose of this study was to examine the effects of ceramic femoral head material, size, and implantation periods on the wear of annealed, cross-linked ultra-high molecular weight polyethylene (UHMWPE) (XLPE) in total hip arthroplasty compared to non-cross-linked conventional UHMWPE (CPE). XLPE was fabricated by cross-linking with 60 kGy irradiation and annealing. Femoral heads made from zirconia and alumina ceramics and cobalt-chrome (CoCr) of 22 or 26 mm diameter were used. In this retrospective cohort study, the femoral head penetration into the cup was measured digitally on radiographs of 367 hips with XLPE and 64 hips with CPE. The average follow-up periods were 6.3 and 11.9 years, respectively. Both XLPE creep and wear rates were significantly lower than those of CPE (0.19 mm vs. 0.44 mm, 0.0001 mm/year vs. 0.09 mm/year, respectively). Zirconia displayed increased wear rates compared to alumina in CPE; however, there was no difference among head materials in XLPE (0.0008, 0.00007, and -0.009 mm/year for zirconia, alumina, and CoCr, respectively). Neither head size or implantation period impacted XLPE wear. In contrast to CPE, XLPE displayed low wear rates surpassing the effects of varying femoral head material, size, implantation period, and patient demographics. Further follow-up is required to determine the long-term clinical performance of the annealed XLPE.. |
| 634. |
Akiyama Mio, Yasuharu Nakashima, Yukihide Iwamoto, Femoral anteversion is correlated with acetabular version and coverage in Asian women with anterior and global deficient subgroups of hip dysplasia: a CT study , 41, 11, 1411-1418, 2012.03. |
| 635. |
Yasuharu Nakashima, Pelvic Deformity Influences Acetabular Version and Coverage in Hip Dysplasia, CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, 10.1007/s11999-010-1746-1, 469, 6, 1735-1742, 2011.06. |
| 636. |
Yasuharu Nakashima, Preferential Accumulation of Activated Th1 Cells Not Only in Rheumatoid Arthritis But Also in Osteoarthritis Joints, JOURNAL OF RHEUMATOLOGY, 10.3899/jrheum.101355, 38, 8, 1569-1575, 2011.08. |
| 637. |
Yasuharu Nakashima, Clinical Features of Pustulotic Arthro-Osteitis, ARTHRITIS AND RHEUMATISM, 63, 10, S207-S207, 2011.10. |
| 638. |
Yasuharu Nakashima, Transtrochanteric rotational osteotomy for the late onset Legg-Calve-Perthes disease, J Pediatr Orthop, 31, 2, 223-228, 2011.06. |
| 639. |
Fujii M, Nakashima Y, Jingushi S, Yamamoto T, Noguchi Y, Suenaga E, Iwamoto Y., Intraarticular findings in symptomatic developmental dysplasia of the hip., J Pediatr Orthop. 2009 Jan-Feb;29(1):9-13, J Pediatr Orthop. 2009 Jan-Feb;29(1):9-13, 2009.01. |
| 640. |
Fujii M, Nakashima Y, Yamamoto T, Mawatari T, Motomura G, Matsushita A, Matsuda S, Jingushi S, Iwamoto Y, Acetabular retroversion in developmental dysplasia of the hip, J Bone Joint Surg Am, 2010.03. |
| 641. |
Kaibara N, Yamada H, Shuto T, Nakashima Y, Okazaki K, Miyahara H, Esaki Y, Hirata G, Iwamoto Y, Comparative histopathological analysis between tenosynovitis and joint synovitis in rheumatoid arthritis., Histopathology 52(7):856-864, 2008, Histopathology 52(7):856-864, 2008, 2009.05. |
| 642. |
Matsushita A, Nakashima Y, Fujii M, Sato T, Iwamoto Y, Modular Necks Improve the Range of Hip Motion in Cases with Excessively Anteverted or Retroverted Femurs in THA, Clin Orthop Relat Res, 2010.03. |
| 643. |
Matsushita A, Nakashima Y, Jingushi S, Yamamoto T, Iwamoto Y, Effects of femoral offset and head size on the safe range of motion in THA, Journal of Arthoroplasty, 2008.10. |
| 644. |
Mawatari T, Miura H, Hamai S, Shuto T, Nakashima Y, Okazaki K, Kinukawa N, Sakai S, Hoffmann PF, Iwamoto Y, Keaveny TM, Vertebral strength changes in rheumatoid arthritis patients treated with alendronate, as assessed by finite element analysis of clinical computed tomography scans: a prospective randomized clinical trial., Arthritis Rheum 58(11):3340-3349, 2008, Arthritis Rheum 58(11):3340-3349, 2008, 2009.05. |
| 645. |
Nakashima Y, Kondo M, Harada H, Horiuchi T, Ishinishi T, Jojima H, Kuroda K, Miyahara H, Nagamine R, Nakashima H, Otsuka T, Saikawa I, Shono E, Suematsu E, Tsuru T, Wada K, Iwamoto Y, Clinical evaluation of tocilizumab for patients with active rheumatoid arthritis refractory to anti-TNF biologics: tocilizumab in combination with methotrexate., Mod Rheumatol, 2010.03. |
| 646. |
Yamada H, Nakashima Y, Okazaki K, Mawatari T, Fukushi JI, Kaibara N, Hori A, Iwamoto Y, Yoshikai Y, Th1 but not Th17 cells predominate in the joints of patients with rheumatoid arthritis., Ann Rheum Dis 67(9):1299-1304, 2008, Ann Rheum Dis 67(9):1299-1304, 2008, 2008.09. |
