Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jos.2023.01.011.

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：Skeletal Radiology  

Objective: The presence of bone marrow edema on magnetic resonance imaging (MRI) in pre-collapse osteonecrosis of the femoral head is suggested to be a sign of occult subchondral fracture; however, to our knowledge, there are no histopathological studies verifying this. This study aimed to histopathologically verify the presence of subchondral fracture at the lateral necrotic boundary in symptomatic pre-collapse osteonecrosis of the femoral head with bone marrow edema on MRI. Materials and methods: Of 149 consecutive necrotic femoral heads resected during total hip arthroplasty at our hospital from January 2019 to June 2024, we included 13 femoral heads that did not show apparent collapse on preoperative radiographs and exhibited bone marrow edema on MRI. Continuous coronal-slice hematoxylin and eosin-stained specimens of each femoral head were examined for the presence of subchondral fracture. Bone microarchitectures around subchondral fractures were measured using micro-computed tomography (CT) images. Results: In all femoral heads, subchondral fractures were histopathologically confirmed at the lateral junction between the reparative and the necrotic zone. On micro-CT, bone volume fraction, trabecular thickness, and bone mineral density of the reparative zone adjacent to the subchondral fracture were all significantly higher than those of the necrotic zone adjacent to the subchondral fracture. Conclusion: Subchondral fracture invariably existed when bone marrow edema was present on MRI during pre-collapse osteonecrosis of the femoral head. When bone marrow edema is observed on MRI, it should be known that subchondral fracture has already occurred, even if femoral head collapse is unclear on radiographs.

DOI： 10.1007/s00256-024-04846-6

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Language：English   Publisher：Journal of Orthopaedic Research  

The reparative zone in femoral head osteonecrosis is pivotal for repair; however, the repair response mechanism remains poorly understood. Although neurotrophic nerve growth factor significantly contributes to bone formation in fatigue fractures and ectopic ossification, the relationship between nerve growth factor and the repair response to osteonecrosis remains unexplored. We aimed to elucidate the role of nerve growth factor in osteonecrosis repair. Twenty-seven wholly resected femoral heads diagnosed with Japanese Investigation Committee Stage 3 femoral head osteonecrosis, excluding those with severe collapse, were analyzed. Histopathological diagnosis confirmed the presence of necrotic, reparative, and viable zones in all examined femoral heads. Quantitative evaluation of immunohistological staining, including nerve growth factor, vascular endothelial growth factor, osteocalcin, CD31, and TUBB3, was conducted in each zone. Additionally, micro-computed tomography was used to measure the trabecular bone microstructure in the reparative zone. Nerve growth factor expression was detected in all 27 femoral heads with osteonecrosis, exhibiting a significantly higher prevalence in the reparative zone than in other regions (p < 0.0001). Nerve growth factor was predominantly distributed on the necrotic side within the reparative zone, rather than the viable side. In the reparative zone, nerve growth factor expression was positively correlated with bone formation parameters derived from micro-computed tomography images. Vascular endothelial growth factor, osteocalcin, CD31(+) vascular endothelial cells, and TUBB3(+) nerve cells also significantly increased in the reparative zone. In conclusion, nerve growth factor expression was consistent across all femoral heads with osteonecrosis and may play a role in reparative reaction to osteonecrotic lesions.

DOI： 10.1002/jor.26055

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Language：English   Publisher：Journal of Orthopaedic Science  

Background: This study assessed the hip survival rate and patient-reported outcome measures (PROMs) of transtrochanteric curved varus osteotomy (CVO) for osteonecrosis of the femoral head (ONFH) compared with those of conservative management. Methods: The CVO group comprised 32 consecutive patients (39 hips) who underwent CVO for ONFH between 2000 and 2011. The conservative group consisted of 36 consecutive patients (37 hips) who were managed conservatively for at least 1 year after collapse and who had ONFH classified by the Japanese Investigation Committee of Health and Welfare as type B or C1, for which CVO is indicated. Kaplan–Meier analysis of hip survival used any ONFH-related therapeutic surgery as the endpoint. PROMs were evaluated for all patients with surviving hips and radiographs available at the latest follow-up. Result: The 10-year hip survival rate in the CVO group was 86.7%, which was significantly higher than the 51.0% 5-year survival rate in the conservative group (p < 0.0001). The Oxford Hip Score and UCLA Activity Score were significantly better in the CVO group without joint space narrowing than in the conservative group, with no significant differences between the CVO group with joint space narrowing and the conservative group. Conclusion: CVO could preserve hip joints more effectively than conservative follow-up after collapse, although the presence of joint space narrowing could reduce satisfaction levels even in patients with long-term hip survival.

DOI： 10.1016/j.jos.2024.03.010

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Language：English   Publisher：Bone and Joint Open  

Aims This study aimed to investigate whether the use of CT-based navigation enhances: 1) the accuracy of cup placement; and 2) the achievement rate of required range of motion (ROM). Additionally, we investigated the impact of using a large femoral head and dual-mobility liner on the achievement rates. Methods This retrospective study analyzed 60 manual and 51 CT-based navigated primary total hip arthroplasties performed at a single facility. Postoperative CT scans and CT-based simulation software were employed to measure the cup orientation and to simulate the ROM. We compared the absolute errors for radiological inclination (RI) and radiological anteversion (RA) between the two groups. We also examined whether the simulated ROM met the required ROM criteria, defined as flexion > 110°, internal rotation > 30°, extension > 30°, and external rotation > 30°. Furthermore, we performed simulations with 36 mm femoral head and dual-mobility liner. Results The absolute errors of RI and RA from the preoperative plan were significantly smaller in the CT-based navigation group (3.7° (SD 3.5°) vs 5.1° (SD 3.5°); p = 0.022, and 3.9° (SD 3.5°) vs 6.8° (SD 5.0°); p = 0.001, respectively). The proportion of cases achieving the required ROM in all directions was significantly higher in the CT-based navigation group (42% vs 63%; p = 0.036). The achievement rates of the required ROM were significantly higher with the use of a 36 mm ball or dual-mobility liner compared to the use of a 32 mm ball (65% vs 51%; p = 0.040 and 77% vs 51%; p ≤ 0.001, respectively). Conclusion CT-based navigation enhanced required ROM achievement rates by > 20%, regardless of the ball diameter. The improved accuracy of cup placement through CT-based navigation likely contributed to the enhancement. Furthermore, the use of large femoral heads and dual-mobility liners also improved the required ROM achievement rates. In cases with a high risk of dislocation, use of these devices is preferred.

DOI： 10.1302/2633-1462.62.BJO-2024-0084.R1

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Language：English   Publisher：Skeletal Radiology  

Objective: Although some patients may experience collapse progression while others may not in post-collapse osteonecrosis of the femoral head (ONFH) with a necrotic lesion located within the weight-bearing part of the acetabulum (Type B/C1), few studies have focused on the natural course after collapse. This study aimed to clarify the correlation between necrotic volume (NV) and necrotic depth (ND) in predicting collapse progression in patients with post-collapse ONFH Type B/C1. Materials and methods: We retrospectively reviewed 54 hips with post-collapse ONFH Type B/C1 from 52 consecutive patients who were conservatively followed up for more than 1 year. We measured the amount of femoral head collapse using biplane radiographs at each follow-up period, and produced Kaplan–Meier survival curves with collapse progression (≥ 1 mm) as the endpoint. We compared NV and ND, which were calculated as the ratio of the distance from the articular surface of the femoral head to the deepest point of a necrotic lesion to the femoral head diameter in the mid-coronal slice of T1-weighted magnetic resonance imaging (MRI). Results: We observed collapse progression in 31 hips (57.4%). The NV and ND were significantly greater in hips with collapse progression than in those without collapse progression (p = 0.0127 and 0.0047, respectively). Necrotic volume was significantly correlated with ND　(rs = 0.56, p < 0.0001). Conclusion: This study suggests that necrotic depth on the mid-coronal slice of T1-weighted MRI can be a substitute for necrotic volume to predict collapse progression in ONFH Type B/C1.

DOI： 10.1007/s00256-024-04741-0

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Language：English   Publisher：JBJS Open Access  

Background:Spinopelvic abnormalities have been reported to be a risk factor for dislocation after total hip arthroplasty (THA). This study aimed to compare the kinematics of the pelvis and hip joints in patients with and without spinopelvic abnormalities after THA and to elucidate dynamic forward-leaning movement during chair-rising, which are not detectable through static radiographs.Methods:This case series included 108 hips that underwent dynamic anteroposterior radiographic imaging of the sit-to-stand motion after THA. The average age at surgery was 68 ± 10 years, with 95 hips (88%) in women (average body mass index, 23.5 ± 3.2 kg/m2). Kinematic analysis was performed to measure the anterior pelvic plane angle (APPa) and hip flexion/extension angles from seated to standing positions using model-image registration techniques. Pelvic incidence (PI) and lumbar lordosis (LL) were measured to calculate PI-LL.Results:Flatback deformity was present in 45 hips (42%) and stiff spinopelvic mobility (SPM) in 35 hips (32%), with both deformities present in 21 hips (19%). The pelvis was consistently significantly posteriorly tilted in the flatback deformity group throughout the movement compared with the normal group, with the greatest difference observed in the standing position. The hip flexion angles in the flatback deformity group showed significant extension in the standing position (7° greater than that in the normal group). For stiff SPM, a significant posterior tilt in the standing position was observed. Accordingly, the range between the maximum hip flexion and extension was 13° greater. There was no significant difference between the maximal flexion and extension centers.Conclusions:Patients with flatback deformities consistently exhibited posterior APPa, especially when standing. In stiff SPM, a large range of hip flexion and extension while chair-rising increased the risk of impingement, indicating the necessity for a wider range of motion without changing the target orientation. These findings highlight the importance of considering spinopelvic alignment when planning cup positioning in THA to minimize the risk of dislocation.Level of Evidence:Level III. See Instructions for Authors for a complete description of levels of evidence.

DOI： 10.2106/JBJS.OA.24.00151

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Language：English   Publisher：Journal of Bone and Joint Surgery  

Background: This study aimed to determine the acetabular position to optimize hip biomechanics after transposition osteotomy of the acetabulum (TOA), a specific form of periacetabular osteotomy, in patients with hip dysplasia. Methods: We created patient-specific finite-element models of 46 patients with hip dysplasia to simulate 12 virtual TOA scenarios: lateral rotation to achieve a lateral center-edge angle (LCEA) of 30°, 35°, and 40° combined with anterior rotation of 0°, 5°, 10°, and 15°. Joint contact pressure (CP) on the acetabular cartilage during a single-leg stance and simulated hip range of motion without osseous impingement were calculated. The optimal acetabular position was defined as satisfying both normal joint CP and the required range of motion for activities of daily living. Multivariable logistic regression analysis was used to identify preoperative morphological predictors of osseous impingement after virtual TOA with adequate acetabular correction. Results: The prevalence of hips in the optimal position was highest (65.2%) at an LCEA of 30°, regardless of the amount of anterior rotation. While the acetabular position minimizing peak CP varied among patients, approximately 80% exhibited normalized peak CP at an LCEA of 30° and 35° with 15° of anterior rotation, which were the 2 most favorable configurations among the 12 simulated scenarios. In this context, the preoperative head-neck offset ratio (HNOR) at the 1:30 clock position (p = 0.018) was an independent predictor of postoperative osseous impingement within the required range of motion. Specifically, an HNOR of <0.14 at the 1:30 clock position predicted limitation of required range of motion after virtual TOA (sensitivity, 57%; specificity, 81%; and area under the receiver operating characteristic curve, 0.70). Conclusions: Acetabular reorientation to an LCEA of between 30° and 35° with an additional 15° of anterior rotation may serve as a biomechanics-based target zone for surgeons performing TOA in most patients with hip dysplasia. However, patients with a reduced HNOR at the 1:30 clock position may experience limited range of motion in activities of daily living postoperatively. Clinical Relevance: This study provides a biomechanics-based target for refining acetabular reorientation strategies during TOA while considering morphological factors that may limit the required range of motion.

DOI： 10.2106/JBJS.23.01132

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Language：Japanese   Publisher：West-Japanese Society of Orthopedics & Traumatology  

<p>【目的】寛骨臼形成不全に伴う前・初期変形性股関節症の自然経過と進行に関連する因子を検討すること．【方法】2005年から2012年に当科で股関節手術を施行された患者のうち，非手術側が前・初期股関節症で，5年以上経過観察が可能であった134例134関節（男性10例，女性124例）を対象とした．初回評価時年齢は14-82歳（平均51歳），経過観察期間は5-22年（平均13年）であった．THA施行あるいは進行期への病期進行をエンドポイントとして関節生存率と進行に関連する因子を調査した．【結果】前・初期股関節症は5年で8％，10年で22％，15年で40％がTHA施行あるいは進行期へ病期が進行していた．単変量・多変量解析の結果，初回評価時年齢が独立した予後因子であり，高齢であるほどTHA施行あるいは病期が進行しやすかった．【結語】前・初期股関節症は経年的にTHAあるいは病期進行の割合が増加し，高年齢がリスク因子であった．</p>

DOI： 10.5035/nishiseisai.73.696

CiNii Research

Language：Japanese   Publisher：西日本整形・災害外科学会  

【目的】寛骨臼形成不全に伴う前・初期変形性股関節症の自然経過と進行に関連する因子を検討すること.【方法】2005年から2012年に当科で股関節手術を施行された患者のうち,非手術側が前・初期股関節症で,5年以上経過観察が可能であった134例134関節(男性10例,女性124例)を対象とした.初回評価時年齢は14-82歳(平均51歳),経過観察期間は5-22年(平均13年)であった.THA施行あるいは進行期への病期進行をエンドポイントとして関節生存率と進行に関連する因子を調査した.【結果】前・初期股関節症は5年で8%,10年で22%,15年で40%がTHA施行あるいは進行期へ病期が進行していた.単変量・多変量解析の結果,初回評価時年齢が独立した予後因子であり,高齢であるほどTHA施行あるいは病期が進行しやすかった.【結語】前・初期股関節症は経年的にTHAあるいは病期進行の割合が増加し,高年齢がリスク因子であった.(著者抄録)

Language：Japanese   Publisher：日本股関節学会  

特発性大腿骨頭壊死症(ONFH)の単純CT矢状面における前方壊死域の位置を評価し、圧潰進行の有無との関連を調査した。2010～2019年に当科を初診したONFH患者のうち、発症後1年以上保存的に経過観察が可能であり、経過観察中に単純CTを撮像したType B/C1の31例(男性18例、女性13例、平均44歳)、35関節を対象とした。1mm以上の圧潰進行あり群23関節と圧潰進行なし群12関節との間に、性別、関連因子、初診時年齢、経過観察期間、Type B/C1の内訳に有意差はなかった。前方壊死境界域と骨頭中心を通る線と鉛直方向のなす角度(ANBA)は圧潰進行あり群で有意に大きく、ANBAと圧潰進行ありに関するROC曲線ではANBAのカットオフ値は75°、AUCは0.85であった。1mm以上の圧潰進行をエンドポイントとした生存時間分析ではANBA 75°以上の群で有意に生存率が低下していた。ONFHにおける前方壊死境界域の位置は圧潰進行に関連している可能性があると考えられた。

Language：Japanese   Publisher：日本股関節学会  

当院で大腿骨転子部骨折に対し骨接合術を施行した37例(男性7例、女性30例、手術時年齢中央値87歳)を対象に、受傷前・術後1年での日常生活動作(ADL)に影響を与える因子について検討した。その結果、約5割の症例は術後1年で更衣・排泄・椅子からの起立が維持されていた。術後1年時のADL影響因子として、手術待機時間は影響せず、受傷前の認知FIMが良好であるほど、術後1年の更衣の悪化を防止することが示唆された。

Language：English   Publisher：Journal of Bone and Joint Surgery  

Background:The incidence of developmental dysplasia of the hip (DDH) in Japanese newborns has reduced drastically following a primary prevention campaign initiated around 1972 to 1973; this perinatal education campaign promoted maintaining the hips of newborns in the naturally flexed-leg position. The purpose of the present study was to describe the life course epidemiology of hip osteoarthritis (OA) in adolescent and adult patients and to assess its association with exposure to the primary prevention campaign for DDH.Methods:We included new patients with hip OA diagnosed from January 1, 2022, to December 31, 2022, at 12 core hospitals (8 special-function hospitals and 4 regional medical care support hospitals). The trend in the percentage of hips with a history of DDH treatment in childhood was estimated with use of a centered moving average using the birth year of the patient. We compared the prevalence of severe subluxation (Crowe type II, III, or IV) between patients with secondary hip OA due to hip dysplasia who were born in or before 1972 and those who were born in or after 1973.Results:Overall, 1,095 patients (1,381 hips) were included. The mean age at the time of the survey was 63.5 years (range, 15 to 95 years). A total of 795 patients (1,019 hips; 73.8% of hips) were diagnosed with secondary OA due to hip dysplasia. Approximately 13% to 15% of hips among patients born from 1963 to 1972 had a history of DDH treatment in childhood; however, the percentage decreased among patients born in or after 1973. The prevalence of severe subluxation (Crowe type II, III, or IV) among patients born in or after 1973 was 2.4%, which was significantly less than that among patients born in or before 1972 (11.1%; odds ratio, 0.20; p < 0.001).Conclusions:As of 2022, secondary hip OA due to hip dysplasia is still responsible for most new cases of adolescent and adult hip OA seen in core hospitals in Japan. However, the perinatal education campaign initiated 50 years ago, which utilized a population approach and advocated for maintaining the hips of newborns in the naturally flexed-leg position, may have improved the environmental factors of DDH, as indicated by the apparently reduced need for treatment of DDH in childhood and the associated severe subluxation. This may result in a reduced need for challenging hip surgery later in life.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

DOI： 10.2106/JBJS.23.01044

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Language：Japanese   Publisher：West-Japanese Society of Orthopedics & Traumatology  

<p>【目的】脚長・オフセットがforgotten joint score（FJS）-12を含めた患者立脚型アウトカムに影響するか否かを明らかにすること．【対象】当科の初回THAで，対側健常な203例203股を対象とした．術前後の単純X線画像評価と術後の患者立脚型評価（FJS-12，Oxford hip score: HS，満足度）を行い，脚長・オフセットが及ぼす影響について多変量解析した．【結果】FJS-12が有意に低スコアを示す因子は，術後の脚長が健側より長いこと，術前の重度大転子高位例であった．脚長はOHS，満足度には有意な影響を認めず，オフセットは全てに有意な影響を認めなかった．【考察】THAの際に，安定性に懸念がある場合は過延長になるよりも，オフセットを延長する方が，FJS-12への負の影響は少ないと考えられた．</p>

DOI： 10.5035/nishiseisai.73.1

CiNii Research

Language：Japanese   Publisher：西日本整形・災害外科学会  

【目的】脚長・オフセットがforgotten joint score(FJS)-12を含めた患者立脚型アウトカムに影響するか否かを明らかにすること.【対象】当科の初回THAで,対側健常な203例203股を対象とした.術前後の単純X線画像評価と術後の患者立脚型評価(FJS-12,Oxford hip score:HS,満足度)を行い,脚長・オフセットが及ぼす影響について多変量解析した.【結果】FJS-12が有意に低スコアを示す因子は,術後の脚長が健側より長いこと,術前の重度大転子高位例であった.脚長はOHS,満足度には有意な影響を認めず,オフセットは全てに有意な影響を認めなかった.【考察】THAの際に,安定性に懸念がある場合は過延長になるよりも,オフセットを延長する方が,FJS-12への負の影響は少ないと考えられた.(著者抄録)

Language：English   Publisher：(公社)日本整形外科学会  

大腿骨頭壊死(ONFH)において壊死病変の前方と外側の境界が圧潰増悪に及ぼす影響を検討した。ONFHの圧潰を呈した48例(男性28例、女性20例、平均45.6±15.1歳)55股関節を対象に単純側方X線像を用いて臼蓋荷重部に対する壊死病変の前方境界を描出し、以下の3領域に分類した。前方領域I(2関節):内側1/3以下、前方領域II(17関節):内側2/3以下、前方領域III(36関節):内側2/3以上。観察期間中、股関節痛が生じた際に二方向X線写真を撮影し、圧潰量が1mm以上を示していれば圧潰増悪と判定、前方境界領域とONFHのタイプ分類との組み合わせによって圧潰増悪を予測可能かどうか評価した。圧潰増悪をきたしたのは55股関節のうち38関節(69.0%)であり、タイプ別にみるとタイプC2の方がタイプBおよびタイプC1より有意な増悪が生じており、前方境界では前方領域IIIの方が前方領域IIより圧潰増悪率は有意に高かった。Kaplan-Meier法でも、タイプC2とタイプB、タイプC1、前方領域IIIと前方領域IIとの間にそれぞれ有意差が認められた。ONFHのタイプ分類に壊死病変の前方境界を加味することにより、圧潰増悪の予測が可能になると思われた。

Language：English   Publisher：Journal of Orthopaedic Science  

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 < 0.0001). Conclusions: Adding the location of the anterior boundary of the necrotic lesion to Type classification was useful to predict collapse progression especially in hips with Type B/C1.

DOI： 10.1016/j.jos.2023.01.011

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Language：English   Publisher：Journal of Orthopaedics  

Purpose: The dislocation rate after total hip arthroplasty for osteonecrosis of the femoral head is higher than that after total hip arthroplasty for osteoarthritis. However, few reports have investigated the factors contributing to dislocation after total hip arthroplasty for osteonecrosis of the femoral head. The aim of this study was to assess radiological factors associated with posterior dislocation after total hip arthroplasty for osteonecrosis of the femoral head. Methods: We retrospectively reviewed 179 cementless total hip arthroplasties for osteonecrosis of the femoral head using a posterolateral approach between 2002 and 2020 with a minimum follow-up period of 24 months. The following radiological factors were examined for a possible association with posterior dislocation after total hip arthroplasty: cup anteversion angle, cup inclination angle, femoral offset, and stem anteversion angle. Results: Posterior dislocation occurred in seven hips (3.9 %). Compared to hips without posterior dislocation, those with posterior dislocation exhibited a significantly smaller cup anteversion angle (p = 0.045) and a nonsignificantly greater decrease in femoral offset (p = 0.089). Based on receiver operating characteristic curve analyses, the cutoff values for predicting posterior dislocation were 9.9° for the cup anteversion angle and 8.1 mm for the decrease in femoral offset. Logistic regression analysis showed a significantly higher risk of posterior dislocation among hips with a cup anteversion angle less than 9.9° (odds ratio = 7.1, p = 0.022) or with a decrease in femoral offset over 8.1 mm (odds ratio = 5.0, p = 0.040). Conclusions: A small cup anteversion angle and a decreased femoral offset are suggested to be associated with posterior dislocation after total hip arthroplasty in patients with osteonecrosis of the femoral head.

DOI： 10.1016/j.jor.2023.11.015

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Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：Bone and Joint Research  

Aims Transcription factor nuclear factor kappa B (NF-κB) plays a major role in the pathogenesis of chronic inflammatory diseases in all organ systems. Despite its importance, NF-κB targeted drug therapy to mitigate chronic inflammation has had limited success in preclinical studies. We hypothesized that sex differences affect the response to NF-κB treatment during chronic inflammation in bone. This study investigated the therapeutic effects of NF-κB decoy oligodeoxynucleotides (ODN) during chronic inflammation in male and female mice. Methods We used a murine model of chronic inflammation induced by continuous intramedullary delivery of lipopolysaccharide-contaminated polyethylene particles (cPE) using an osmotic pump. Specimens were evaluated using micro-CT and histomorphometric analyses. Sex-specific osteogenic and osteoclastic differentiation potentials were also investigated in vitro, including alkaline phosphatase, Alizarin Red, tartrate-resistant acid phosphatase staining, and gene expression using reverse transcription polymerase chain reaction (RT-PCR). Results Local delivery of NF-κB decoy ODN in vivo increased osteogenesis in males, but not females, in the presence of chronic inflammation induced by cPE. Bone resorption activity was decreased in both sexes. In vitro osteogenic and osteoclastic differentiation assays during inflammatory conditions did not reveal differences among the groups. Receptor activator of nuclear factor kappa Β ligand (Rankl) gene expression by osteoblasts was significantly decreased only in males when treated with ODN. Conclusion We demonstrated that NF-κB decoy ODN increased osteogenesis in male mice and decreased bone resorption activity in both sexes in preclinical models of chronic inflammation. NF-κB signalling could be a therapeutic target for chronic inflammatory diseases involving bone, especially in males.

DOI： 10.1302/2046-3758.131.BJR-2023-0040.R3

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Language：English   Publisher：Clinical Biomechanics  

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.

DOI： 10.1016/j.clinbiomech.2023.106156

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Language：Japanese   Publisher：Kyushu Physical Therapy Association  

<p>【目的】 人工股関節置換術(THA)における高齢例増加などから、QOL低下の遷延化が懸念され、術後早期から回復期以降の術後中期の身体機能や患者立脚型評価 (PROMs)を見据えてリハビリが実施される。PROMsの1つであるOxford Hip Score(OHS)では、患者が症状を許容できる状態(Patient Acceptable Symptom State：PASS)の報告はあるが、術後中期のOHS PASSを基にした術後早期の目標値は不明である。さらに、高齢例は、PROMs関連因子や術後早期の身体機能目標値は異なる可能性がある。本研究の目的は、術後中期PROMsを基にして、術後早期の身体機能目標値を明らかにし、高齢例の留意点を明らかにすることである。 【方法】 対象は、2012年から2020年に初回THAを施行した733例(男性88例女性645例、年齢65.5±10.1歳、術後経過期間6.1±2.2年)。身体機能は、術後退院時に股関節ROM(屈曲、外転、外旋)、筋力(股屈曲、股外転、膝伸展)、疼痛(VAS)、快適歩行速度(m/秒)を評価した。PROMsは、術後1年以降に疾患特異的指標OHS、身体活動指標UCLA Activity Scale(UCLA AS)を郵送し501名(68.3%)より回答を得た。統計解析は、OHSとUCLA ASを目的変数とした重回帰分析を行い、OHSはROC曲線にて術後中期PASSの42点以上を満たすカットオフ値を算出した。また、75歳以上の高齢群(高齢群)と75歳未満の対象群(対照群)に分類し、二群間比較、歩行速度およびPROMsを目的変数とした重回分析からROC曲線にてカットオフ値を算出した。 【結果】 術後中期PROMsへの負の関連因子は、OHSは歩行速度低下、UCLA ASは高齢女性が挙げられた。OHS関連因子であった歩行速度に対するOHSのPASS42点以上を満たすカットオフ値は、0.9m/秒(AUC=0.72)と算出。歩行速度への負の関連因子として、高齢、ROM低値(股屈曲、股外旋)、筋力低値(股外転、膝伸展)が挙げられ、歩行速度0.9m/秒を満たすカットオフ値は股外転筋力0.5Nm/kg (AUC=0.72)と算出。また、年齢による検討では、高齢群151例、対象群582例に分類。群間比較では、ROMと疼痛は有意差を認めず、筋力は股屈曲(0.5±0.1、0.7±0.0)、股外転(0.4±0.1、0.5±0.0)、膝伸展(0.7±0.1、0.8±0.1)、歩行速度 (0.8±0.1、0.9±0.2)で有意差を認めた。PROMsは、OHS(42.2±0.8、44.8±0.4)、UCLA AS(4.2±0.3、5.4±0.1)で有意差を認めた。PROMs関連因子は、高齢群は、OHSには歩行速度が、UCLA ASには歩行速度と術後経過期間が関連因子であり、対照群は、OHSには歩行速度が、UCLA ASには性別が関連因子であった。なお、歩行速度カットオフ値は、両群で0.9m/秒と算出された。歩行速度への関連因子は、高齢群は股外旋ROMと膝伸展筋力、対照群は股屈曲ROM、股外転筋力、膝伸展筋力が関連因子であった。歩行速度0.9m/secを満たすカットオフ値を算出し、高齢群は膝伸展筋力0.6Nm/kg(AUC=0.72)、対照群は股外転筋力0.5Nm/kg(AUC=0.71)と算出。 【考察】 術後早期より介入可能な因子と目標値を明らかにした。中でもOHSのPASS42点には術後早期では歩行速度0.9m/秒が目標値と算出され、身体機能では股外転筋力0.5Nm/kgを目標とした介入が重要である。年齢を考慮すると、年齢に関わらずPROMsには歩行速度0.9m/秒が目標値であったが、特に高齢例は、PROMsや術後身体機能が低く、PROMsには術後経過期間が関連し、各指標低下遷延を踏まえた継続的介入が必要である。加えて、高齢例に限っては、歩行速度には膝伸展筋力が関連し、目標値0.6Nm/kgと算出され、加齢と共に遅延するとされる歩行速度を高めるには、膝伸展筋力改善の介入が重要である。 【結語】 THA後早期の身体機能は術後中期のPROMｓ予測因子である。 【倫理的配慮】本研究は、九州大学医系地区部局臨床研究倫</p>

DOI： 10.32298/kyushupt.2024.0_104_1

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Frontiers in Immunology  

Background: Spinal cord injury (SCI) is a devastating disease that results in permanent paralysis. Currently, there is no effective treatment for SCI, and it is important to identify factors that can provide therapeutic intervention during the course of the disease. Zinc, an essential trace element, has attracted attention as a regulator of inflammatory responses. In this study, we investigated the effect of zinc status on the SCI pathology and whether or not zinc could be a potential therapeutic target. Methods: We created experimental mouse models with three different serum zinc concentration by changing the zinc content of the diet. After inducing contusion injury to the spinal cord of three mouse models, we assessed inflammation, apoptosis, demyelination, axonal regeneration, and the number of nuclear translocations of NF-κB in macrophages by using qPCR and immunostaining. In addition, macrophages in the injured spinal cord of these mouse models were isolated by flow cytometry, and their intracellular zinc concentration level and gene expression were examined. Functional recovery was assessed using the open field motor score, a foot print analysis, and a grid walk test. Statistical analysis was performed using Wilcoxon rank-sum test and ANOVA with the Tukey-Kramer test. Results: In macrophages after SCI, zinc deficiency promoted nuclear translocation of NF-κB, polarization to pro-inflammatory like phenotype and expression of pro-inflammatory cytokines. The inflammatory response exacerbated by zinc deficiency led to worsening motor function by inducing more apoptosis of oligodendrocytes and demyelination and inhibiting axonal regeneration in the lesion site compared to the normal zinc condition. Furthermore, zinc supplementation after SCI attenuated these zinc-deficiency-induced series of responses and improved motor function. Conclusion: We demonstrated that zinc affected axonal regeneration and motor functional recovery after SCI by negatively regulating NF-κB activity and the subsequent inflammatory response in macrophages. Our findings suggest that zinc supplementation after SCI may be a novel therapeutic strategy for SCI.

DOI： 10.3389/fimmu.2023.1290100

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Language：Japanese   Publisher：West-Japanese Society of Orthopedics & Traumatology  

<p>【目的】寛骨臼移動術（TOA）などの関節温存術は，前初期変形性股関節症（OA）に推奨される治療法だが，中年期以降の患者において保存治療症例と比較された報告はなく，その有効性には結論が出ていない．本研究の目的は，中年期の初期OA患者においてTOAが保存治療と比較して股関節予後を改善するか検討することである．【方法】寛骨臼形成不全に伴う初期OAの中年期（45-64歳）患者で5年以上経過観察された患者のうち，TOAを施行されたTOA群77例（女性68例，平均年齢：51歳，平均観察期間：13年）と，対側手術から1年以上保存治療が行われた保存治療群64例（女性59例，平均年齢：53歳，平均観察期間：13年）において関節生存率を比較検討した．【結果】THA移行での関節生存率は，TOA群92％，保存治療群64%と，TOA群は保存治療群よりも関節生存率が有意に高かった．【考察】寛骨臼移動術は中年期の初期OA患者の股関節予後を改善する．</p>

DOI： 10.5035/nishiseisai.72.399

CiNii Research

Language：Japanese   Publisher：West-Japanese Society of Orthopedics & Traumatology  

<p>【目的】特発性大腿骨頭壊死症（ONFH）の予後因子として海外では壊死体積や壊死のサイズが頻用される一方，日本ではType分類が重視され，Type B/C1では圧潰進行が静止する場合もあるとの報告があるが，一定の見解は得られていない．今回Type B/C1での圧潰進行に関連する因子を検証した．【方法】2010年1月－2017年8月に当科を受診したONFH症例の中で，発症後1年以上保存的に経過観察し得たType B/C1の39例41股を対象とした．単純X線で発症時から各受診時の圧潰幅を計測し，1mm以上の圧潰進行の頻度を調査した．また単純MRIを用い壊死体積（％），サイズを表すCombined Necrotic Angle，深さを表すNecrotic Depth Ratioを評価し，圧潰進行の有無と比較した．【結果】41股中25股（60.9％）で1mm以上の圧潰進行を認めた．圧潰進行群では圧潰非進行群と比べ，壊死体積，Combined Necrotic Angle，Necrotic Depth Ratioはいずれも有意に高値であった．【考察】Type B/C1で壊死体積やサイズ，壊死の深さを加味することで圧潰進行の予測に有用であった．</p>

DOI： 10.5035/nishiseisai.72.445

CiNii Research

Language：English   Publisher：Scientific Reports  

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 < 0.001). Furthermore, the median SRI was greater in the severe dysplasia subgroup (18.9%) than in the moderate (3.5%) and borderline-to-mild (− 1.3%) dysplasia subgroups (p < 0.05). Quantification of acetabular concavity asphericity by the SRI showed that dysplastic hips had a more lateral acetabular concave point than normal hips, and that the severity of hip dysplasia had an effect on the acetabular concavity asphericity.

DOI： 10.1038/s41598-023-42630-z

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1038/s41598-023-42630-z.

Language：Japanese   Publisher：西日本整形・災害外科学会  

【目的】寛骨臼移動術(TOA)などの関節温存術は,前初期変形性股関節症(OA)に推奨される治療法だが,中年期以降の患者において保存治療症例と比較された報告はなく,その有効性には結論が出ていない.本研究の目的は,中年期の初期OA患者においてTOAが保存治療と比較して股関節予後を改善するか検討することである.【方法】寛骨臼形成不全に伴う初期OAの中年期(45-64歳)患者で5年以上経過観察された患者のうち,TOAを施行されたTOA群77例(女性68例,平均年齢:51歳,平均観察期間:13年)と,対側手術から1年以上保存治療が行われた保存治療群64例(女性59例,平均年齢:53歳,平均観察期間:13年)において関節生存率を比較検討した.【結果】THA移行での関節生存率は,TOA群92%,保存治療群64%と,TOA群は保存治療群よりも関節生存率が有意に高かった.【考察】寛骨臼移動術は中年期の初期OA患者の股関節予後を改善する.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

【目的】特発性大腿骨頭壊死症(ONFH)の予後因子として海外では壊死体積や壊死のサイズが頻用される一方,日本ではType分類が重視され,Type B/C1では圧潰進行が静止する場合もあるとの報告があるが,一定の見解は得られていない.今回Type B/C1での圧潰進行に関連する因子を検証した.【方法】2010年1月-2017年8月に当科を受診したONFH症例の中で,発症後1年以上保存的に経過観察し得たType B/C1の39例41股を対象とした.単純X線で発症時から各受診時の圧潰幅を計測し,1mm以上の圧潰進行の頻度を調査した.また単純MRIを用い壊死体積(%),サイズを表すCombined Necrotic Angle,深さを表すNecrotic Depth Ratioを評価し,圧潰進行の有無と比較した.【結果】41股中25股(60.9%)で1mm以上の圧潰進行を認めた.圧潰進行群では圧潰非進行群と比べ,壊死体積,Combined Necrotic Angle,Necrotic Depth Ratioはいずれも有意に高値であった.【考察】Type B/C1で壊死体積やサイズ,壊死の深さを加味することで圧潰進行の予測に有用であった.(著者抄録)

Language：English   Publisher：Journal of Orthopaedic Research  

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 < 0.0001). Receiver operating characteristic analysis showed that the cutoff value for the degree of collapse in femoral heads with articular surface irregularities at the lateral boundary was 1.1 mm. Next, for femoral heads with <3-mm collapse (n = 28), articular surface irregularities were quantitatively assessed based on the number of automatically counted negative curvature points. Quantitative evaluation showed that the degree of collapse was positively correlated with the presence of articular surface irregularities (r = 0.95, p < 0.0001). Histological examination of articular cartilage above the necrotic region (n = 8) revealed cell necrosis in the calcified layer and abnormal cellular arrangement in the deep and middle layers. In conclusion, articular surface irregularities of the necrotic femoral head depended on the degree of collapse, and articular cartilage was already altered even in the absence of macroscopically determined gross irregularities.

DOI： 10.1002/jor.25539

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Language：Japanese   Publisher：(一社)日本関節病学会  

目的:寛骨臼形成不全(DDH)に対するperiacetabular osteotomy(PAO)の至適な骨片の移動方向・移動量については定まった指標がない。本研究の目的は,PAOにおいて,股関節の力学的環境を最適化する骨片の移動方向・移動量を明らかにすることである。方法:DDH患者(LCE角<25°)の32例32股(全例女性,平均年齢40歳,平均LCEA9°)を対象とした。股関節CT DICOM dataを用い,立位骨盤傾斜を再現した上で有限要素解析を行った。LCEA30°・35°・40°に前方回転0°・5°・10°・15°を追加した12通りのPAOシミュレーションを行い,片脚立位想定時の寛骨臼軟骨の接触面積・最大接触圧力(Max CP)を算出した。正常ボランティア16例16股の結果からMax CPの正常範囲は4.1MPa未満とした。結果:前方回転(-)よりも前方回転(+)で接触面積は増加し,Max CPは減少した。12通りのPAOシミュレーションの中で,Max CPが正常化する割合はLCE角30°+前方回転15°のときで87.5%(27/32股)と最も多く,続いてLCE角35°+前方回転15°のときで84.4%(27/32股)であった。考察:PAOの際,寛骨臼の側方回転に前方回転を追加することで接触面積は増大し,接触圧力は減少した。症例により骨片の至適位置は異なるが,LCE角30°～35°に前方回転を15°追加した際,Max CPは最も正常化しやすいことが示唆された。(著者抄録)

Publisher：Journal of Orthopaedic Research  

The number of total joint replacements is increasing, especially in elderly patients, and so too are implant-related complications such as prosthesis loosening. Wear particles from the prosthesis induce a chronic inflammatory reaction and subsequent osteolysis, leading to the need for revision surgery. This study investigated the therapeutic effect of NF-ĸB decoy oligodeoxynucleotides (ODN), mesenchymal stem cells (MSCs), and genetically-modified NF-ĸB sensing interleukin-4 over-secreting MSCs (IL4-MSCs) on chronic inflammation in aged mice. The model was generated by continuous infusion of contaminated polyethylene particles into the intramedullary space of the distal femur of aged mice (15−17 months old) for 6 weeks. Local delivery of ODN showed increased bone mineral density (BMD), decreased osteoclast-like cells, increased alkaline phosphatase (ALP)-positive area, and increased M2/M1 macrophage ratio. Local injection of MSCs and IL4-MSCs significantly decreased osteoclast-like cells and increased the M2/M1 ratio, with a greater trend for IL4-MSCs than MSCs. MSCs significantly increased ALP-positive area and BMD values compared with the control. The IL4-MSCs demonstrated higher values for both ALP-positive area and BMD. These findings demonstrated the therapeutic effects of ODN, MSCs, and IL4-MSCs on chronic inflammatory osteolysis in aged mice. The two MSC-based therapies were more effective than ODN in increasing the M2/M1 macrophage ratio, reducing bone resorption, and increasing bone formation. Specifically, MSCs were more effective in increasing bone formation, and IL4-MSCs were more effective in mitigating inflammation. This study suggests potential therapeutic strategies for treating wear particle-associated inflammatory osteolysis after arthroplasty in the elderly.

DOI： 10.1002/jor.25434

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Language：English  

DOI： 10.1093/jhps/hnac047

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1002/jor.25539.

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publisher：西日本整形・災害外科学会  

災害現場における四肢切断(field amputation)は非常に稀である.我々は,field amputationを依頼された1例を経験したので報告する.症例は75歳女性.土砂崩れにより両下腿が家財の下敷きとなった.当初は家屋倒壊の恐れがあり救出が難航したため,災害医療チームからfield amputationを要請された.現場での災害医療チームの加療により全身状態は安定し,また家屋倒壊の危険性が下がり,救出の目処がたったためfield amputationは施行しなかった.発生から約18時間後に救出され,当院搬送時,両下腿の筋区画内圧の上昇を認めたため緊急で減張切開を行った.全身管理を行い,幸い圧挫症候群は免れた.左下腿は開放骨折と筋壊死を広範囲に認め救肢困難であり,受傷後5日で左大腿切断術を行った.右下肢は筋デブリードマンや植皮術を重ね,最終的に救肢し得た.field amputationの報告は少なく,確立した適応はないため,患者や現場環境を総合的に判断することが重要である.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

[背景]大腿骨転子部骨折ではK-wireやエレバトリウムを用いた直接的整復を要する場合もあるとされるが,その効果を評価した報告は少ない.今回,直接的整復が術後整復位の保持に与える影響を調査した.[方法]2018年12月から当院で同一機種の髄内釘を用い手術を施行したJensen分類TypeIII-Vの51例を対象とし,非観血的整復群(IR群27例)と直接的整復群(DR群24例)の2群間で,術直後から術後2週での整復位の変化とsliding量について単純X線像を用いて比較した.[結果]IR群6例(24%)が術直後subtype Nから術後2週でsubtype Pへ矯正損失した一方,DR群全例でsubtype NまたはAに保持された(p=0.02).sliding量の平均はIR群2.1mm,DR群2.2mmであった(p=0.96).術後単純CTを撮像し得たDR群の13例全例で前内方の骨性支持を得ていた.[考察]直接的整復は非観血的整復と比べ,より確実な骨性支持の獲得と術後整復位の保持に寄与する可能性が示唆された.(著者抄録)

Language：Japanese   Publisher：Japanese Society for Joint Diseases  

<p><b>目的</b>：寛骨臼形成不全（DDH）に対するperiacetabular osteotomy（PAO）の至適な骨片の移動方向・移動量については定まった指標がない。本研究の目的は，PAOにおいて，股関節の力学的環境を最適化する骨片の移動方向・移動量を明らかにすることである。</p><p><b>方法</b>：DDH患者（LCE角<25°）の32例32股（全例女性，平均年齢40歳，平均LCEA 9°）を対象とした。股関節CT DICOM dataを用い，立位骨盤傾斜を再現した上で有限要素解析を行った。LCEA 30°・35°・40°に前方回転0°・5°・10°・15°を追加した12通りのPAOシミュレーションを行い，片脚立位想定時の寛骨臼軟骨の接触面積・最大接触圧力（Max CP）を算出した。正常ボランティア16例16股の結果からMax CPの正常範囲は4.1MPa未満とした。</p><p><b>結果</b>：前方回転（−）よりも前方回転（＋）で接触面積は増加し，Max CPは減少した。12通りのPAOシミュレーションの中で，Max CPが正常化する割合はLCE角30°＋前方回転15°のときで87.5%（27/32股）と最も多く，続いてLCE角35°＋前方回転15°のときで84.4%（27/32股）であった。</p><p><b>考察</b>：PAOの際，寛骨臼の側方回転に前方回転を追加することで接触面積は増大し，接触圧力は減少した。症例により骨片の至適位置は異なるが，LCE角30°～35°に前方回転を15°追加した際，Max CPは最も正常化しやすいことが示唆された。</p>

DOI： 10.11551/jsjd.42.36

CiNii Research

Language：English   Publisher：Scientific Reports  

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.

DOI： 10.1038/s41598-022-23427-y

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PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)  

DOI： 10.1186/s13287-020-02086-8.

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1038/s41598-022-23427-y.

Language：Japanese   Publishing type：Research paper (scientific journal)  

DOI： 10.1111/jgs.18058.

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publisher：西日本整形・災害外科学会  

当院では大腿骨近位部骨折(本骨折)に対し可能な限り準緊急手術を行い,手術までの平均所要期間を骨接合術0.64日,人工骨頭置換術(BHA)3.1日のように日単位で報告してきた.本研究では,2018年に当院で本骨折に対し手術を行い術後1年のアンケート調査に同意した92名を対象とし,受診から手術までの具体的な所要時間(手術待機時間)とそれに与える影響因子を検討した.術式別の手術待機時間は,BHA群:145時間,骨接合術群:44時間でありBHA群で有意に長かった.骨接合術群において抗血栓薬の使用例の手術待機時間は有意に長かった(抗血栓薬あり:108時間,抗血栓薬なし:17時間).骨接合術群の中で手術待機時間が48時間以上であった場合,周術期合併症やせん妄が有意に増加した.BHA群ではクリーンルームや人員の確保が必要であったため手術待機時間が長くなったと考えられた.抗血栓薬は特に骨接合術群において手術待機時間を延長させていた.(著者抄録)

Publisher：Journal of Orthopaedic Translation  

Background: A critical size bone defect is a clinical scenario in which bone is lost or excised due to trauma, infection, tumor, or other causes, and cannot completely heal spontaneously. The most common treatment for this condition is autologous bone grafting to the defect site. However, autologous bone graft is often insufficient in quantity or quality for transplantation to these large defects. Recently, tissue engineering methods using mesenchymal stem cells (MSCs) have been proposed as an alternative treatment. However, the underlying biological principles and optimal techniques for tissue regeneration of bone using stem cell therapy have not been completely elucidated. Methods: In this study, we compare the early cellular dynamics of healing between bone graft transplantation and MSC therapy in a murine chronic femoral critical-size bone defect. We employ high-dimensional mass cytometry to provide a comprehensive view of the differences in cell composition, stem cell functionality, and immunomodulatory activity between these two treatment methods one week after transplantation. Results: We reveal distinct cell compositions among tissues from bone defect sites compared with original bone graft, show active recruitment of MSCs to the bone defect sites, and demonstrate the phenotypic diversity of macrophages and T cells in each group that may affect the clinical outcome. Conclusion: Our results provide critical data and future directions on the use of MSCs for treating critical size defects to regenerate bone. Translational Potential of this article: This study showed systematic comparisons of the cellular and immunomodulatory profiles among different interventions to improve the healing of the critical-size bone defect. The results provided potential strategies for designing robust therapeutic interventions for the unmet clinical need of treating critical-size bone defects.

DOI： 10.1016/j.jot.2022.05.010

Scopus

Language：Japanese   Publisher：西日本整形・災害外科学会  

2018年1月～12月に当院で大腿骨近位部骨折(本骨折)に対し手術加療を行い,本研究に同意した98例(男性17例,女性82例)を対象とし,術後1年での日常生活動作(立ち上がり動作・更衣)へ影響を及ぼす因子について調査した.約半数の症例で術後1年における日常生活動作は維持されていた.また術後1年で新たに施設へ入所となった症例の特徴として,Body Mass Index低値,認知機能低下などが明らかとなった.従って,本骨折症例に対し,従来の身体機能に関するリハビリテーションに加え,栄養面や認知機能訓練など多方面から介入することにより,日常生活動作の維持や在宅復帰に繋がる可能性が示唆された.(著者抄録)

Language：English   Publisher：Frontiers in Bioengineering and Biotechnology  

Wear particles from joint arthroplasties induce chronic inflammation associated with prolonged upregulation of nuclear factor kappa-B (NF-κB) signaling in macrophages and osteoclasts, which leads to osteolysis and implant loosening. Mesenchymal stromal cell (MSC)-based therapy showed great potential for immunomodulation and mitigation of osteolysis in vivo, especially in the chronic phase of inflammation. We previously generated genetically modified MSCs that secrete the anti-inflammatory cytokine interleukin 4 (IL-4) in response to NF-κB activation (NFκB-IL-4 MSCs). However, whether the impact of sexual difference in the internal environment can alter the therapeutic effects of IL-4 over-secreting MSCs that simultaneously mitigate prolonged inflammation and enhance bone formation remains unknown. This study investigated the therapeutic effects of unaltered MSCs versus NFκB-IL-4 MSCs in mitigating chronic inflammation and enhancing bone formation in male and female mice. The murine model was established by continuous infusion of polyethylene particles contaminated with lipopolysaccharide (cPE) into the medullary cavity of the distal femur for 6 weeks to induce chronic inflammation. Unaltered MSCs or NFκB-IL-4 MSCs were infused into the femoral intramedullary cavity in sex-matched groups beginning 3 weeks after primary surgery. Femurs were harvested at 6 weeks, and bone marrow density was measured with micro-computational tomography. Numbers of osteoclast-like cells, osteoblasts, and macrophages were evaluated with histochemical and immunofluorescence staining. cPE infusion resulted in severe bone loss at the surgery site, increased tartrate-resistant acid phosphatase positive osteoclasts and M1 pro-inflammatory macrophages, and decreased alkaline phosphatase expression. MSC-based therapy effectively decreased local bone loss and polarized M1 macrophages into an M2 anti-inflammatory phenotype. In females, unaltered MSCs demonstrated a larger impact in enhancing the osteogenesis, but they demonstrated similar anti-inflammatory effects compared to NFκB-IL-4 MSCs. These results demonstrated that local inflammatory bone loss can be effectively modulated via MSC-based treatments in a sexually dimorphic manner, which could be an efficacious therapeutic strategy for treatment of periprosthetic osteolysis in both genders.

DOI： 10.3389/fbioe.2022.962114

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PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

DOI： 10.1002/jor.25434.

Language：Japanese   Publishing type：Research paper (scientific journal)  

Publisher：Bioengineering  

A critical-size bone defect is a challenging clinical problem in which a gap between bone ends will not heal and will become a nonunion. The current treatment is to harvest and transplant an autologous bone graft to facilitate bone bridging. To develop less invasive but equally effective treatment options, one needs to first have a comprehensive understanding of the bone healing process. Therefore, it is imperative to leverage the most advanced technologies to elucidate the fundamental concepts of the bone healing process and develop innovative therapeutic strategies to bridge the nonunion gap. In this review, we first discuss the current animal models to study critical-size bone defects. Then, we focus on four novel analytic techniques and discuss their strengths and limitations. These four technologies are mass cytometry (CyTOF) for enhanced cellular analysis, imaging mass cytometry (IMC) for enhanced tissue special imaging, single-cell RNA sequencing (scRNA-seq) for detailed transcriptome analysis, and Luminex assays for comprehensive protein secretome analysis. With this new understanding of the healing of critical-size bone defects, novel methods of diagnosis and treatment will emerge.

DOI： 10.3390/bioengineering9040171

Scopus

Language：English   Publisher：Journal of Orthopaedic Science  

DOI： 10.1016/j.jos.2019.05.016

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PubMed

Language：English   Publisher：(公社)日本整形外科学会  

症例は31歳男性で、交通事故を受傷し近医に救急搬送された。重度の右股関節痛を訴え、CTにて右寛骨臼骨折と診断され3週間の臥床安静とされた。3ヵ月後には杖歩行可能となったが、受傷4ヵ月後に左股関節痛を自覚し、疼痛が徐々に増悪したためその2ヵ月後に当院外来受診となった。左脚での立位時と下肢を交差させての座位時に疼痛の増悪をきたし、CT所見では左大腿骨頭の軽度軟骨下圧壊を認め、MRIでは圧壊領域周囲に骨髄浮腫様病変が検出された。後方関節面は保持されていたため、受傷7ヵ月後に経転子下前方回転骨切り術を施行した。術中所見では大腿骨頭の前上方部圧壊が認められ、針生検を行ったところ、組織病理学的に圧壊領域における軟骨下プレートとセメントラインの破断が生じており、骨折仮骨に伴って架橋が形成されていた。骨壊死所見はみられず、外傷性大腿骨頭軟骨下骨折と診断した。術後3ヵ月、骨切り部における骨治癒が認められ、2年後の画像所見では関節適合性が得られていた。

Language：Japanese   Publishing type：Research paper (scientific journal)  

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DOI： 10.3390/bioengineering8110165.

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DOI： 10.3390/biomedicines9050499.

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Event date： 2022.8

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Venue：Seoul   Country：Korea, Republic of  

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