Continuous local antibiotic perfusion (CLAP) has recently attracted attention as a new drug delivery system for orthopaedic infections. CLAP is a direct continuous infusion of high-concentration gentamicin (1,200 μg/ml) into the bone marrow. As it is a new system, its influence on the bone marrow is unknown. This study aimed to examine the effects of high-concentration antibiotics on human bone tissue-derived cells. Cells were isolated from the bone tissue grafts collected from six patients using the Reamer-Irrigator-Aspirator system, and exposed to different gentamicin concentrations. Live cells rate, apoptosis rate, alkaline phosphatase (ALP) activity, expression of osteoblast-related genes, mineralization potential, and restoration of cell viability and ALP activity were examined by in vitro studies.Aims
Methods
The preventive effects of bisphosphonates on articular cartilage in non-arthritic joints are unclear. This study aimed to investigate the effects of oral bisphosphonates on the rate of joint space narrowing in the non-arthritic hip. We retrospectively reviewed standing whole-leg radiographs from patients who underwent knee arthroplasties from 2012 to 2020 at our institute. Patients with previous hip surgery, Kellgren–Lawrence grade ≥ II hip osteoarthritis, hip dysplasia, or rheumatoid arthritis were excluded. The rate of hip joint space narrowing was measured in 398 patients (796 hips), and the effects of the use of bisphosphonates were examined using the multivariate regression model and the propensity score matching (1:2) model.Aims
Methods
Recent reports show that spinopelvic mobility influences outcome following total hip arthroplasty. This scoping review investigates the relationship between spinopelvic parameters (SPPs) and symptomatic femoroacetabular impingement (FAI). A systematic search of EMBASE, PubMed and Cochrane for literature related to SPPs and FAI was undertaken as per PRISMA guidelines. Clinical outcome studies and prospective/retrospective studies investigating the role of SPPs in symptomatic FAI were included. Review articles, case reports and book chapters were excluded. Information extracted pertained to symptomatic cam deformities, pelvic tilt, acetabular version, biomechanics of dynamic movements and radiological FAI signs.Abstract
Introduction
Methods
This study aimed to evaluate the accuracy of implant placement with robotic-arm assisted total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH). The study analyzed a consecutive series of 69 patients who underwent robotic-arm assisted THA between September 2018 and December 2019. Of these, 30 patients had DDH and were classified according to the Crowe type. Acetabular component alignment and 3D positions were measured using pre- and postoperative CT data. The absolute differences of cup alignment and 3D position were compared between DDH and non-DDH patients. Moreover, these differences were analyzed in relation to the severity of DDH. The discrepancy of leg length and combined offset compared with contralateral hip were measured.Aims
Methods
With recent progress in cancer treatment, the number of advanced-age patients with spinal metastases has been increasing. It is important to clarify the influence of advanced age on outcomes following surgery for spinal metastases, especially with a focus on subjective health state values. We prospectively analyzed 101 patients with spinal metastases who underwent palliative surgery from 2013 to 2016. These patients were divided into two groups based on age (< 70 years and ≥ 70 years). The Eastern Cooperative Oncology Group (ECOG) performance status (PS), Barthel index (BI), and EuroQol-5 dimension (EQ-5D) score were assessed at study enrolment and at one, three, and six months after surgery. The survival times and complications were also collected.Aims
Methods
The purpose of this study was to report functional outcome scores following arthroscopic acetabular chondral procedures using the U.K. Non-Arthroplasty Hip Registry (NAHR). Data on adult patients who underwent hip arthroscopy between January 2012 and December 2018 was extracted from the NAHR. Patients who underwent femoral sided chondral procedures were excluded. Patients who underwent osteophyte excision or a concurrent extra-articular procedure were also excluded. Cases were then classified according to the acetabular chondral procedure performed – ‘chondroplasty’, ‘microfracture’ or ‘none’ (no chondral procedure recorded). Outcomes comprised EuroQol-5 Dimensions (EQ-5D) index and the International Hip Outcome Tool 12 (iHOT-12), preoperatively and at 6 and 12 months.Background
Methods
The aim of this study was to use registry data to report and compare early patient outcomes following arthroscopic repair or debridement of the acetabular labrum. Data on adult patients who underwent arthroscopic labral debridement or repair between January 2012 and March 2019 was extracted from the UK Non-Arthroplasty Hip Registry dataset. Patients who underwent microfracture, osteophyte excision or a concurrent extra-articular procedure were excluded. Outcomes comprised EuroQol-5 Dimensions (EQ-5D) index and the International Hip Outcome Tool 12 (iHOT-12), preoperatively and at 6 and 12 months.Objectives
Methods
This study aimed to investigate the effect of body mass index (BMI) on functional outcome following hip preservation surgery using the U.K. Non-Arthroplasty Hip Registry (NAHR). Data on adult patients who underwent hip arthroscopy or periacetabular osteotomy (PAO) between January 2012 and December 2018 was extracted from the UK Non-Arthroplasty Hip Registry dataset allowing a minimum of 12 months follow-up. Data is collected via an online clinician and patient portal. Outcomes comprised EuroQol-5 Dimensions (EQ-5D) index and the International Hip Outcome Tool 12 (iHOT-12), preoperatively and at 6 and 12 monthsBackground
Methods
Slipped capital femoral epiphysis (SCFE) creates a complex deformity of the hip that can result in cam type of femoroacetabular impingement (FAI), which may in turn lead to the early development of osteoarthritis of the hip. The purpose of this study was to evaluate the existing literature reporting on the efficacy of hip arthroscopic treatment of patients with FAI secondary to SCFE. A systematic computer search was conducted based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using Embase, PubMed (Medline), and Cochrane Library up to November 2019. Data such as patient demographics, surgical outcomes and complications that described arthroscopic surgery following FAI secondary to SCFE were retrieved from eligible studies. Two authors independently reviewed study inclusion and data extraction with independent verification.Background
Methods
Several reports demonstrated the overcoverage of the anterior acetabulum. Anterior CE angle over 46°may be a probable risk factor for pincer FAI syndrome after a rotational acetabular osteotomy. In addition, a highly anteverted femoral neck, reported as a risk factor for posterior impingement, has been found in DDH patients. These findings indicate proper acetabular reorientation is essential to avoid anterior or posterior impingement after periacetabular osteotomy (PAO). The aim of this study was to evaluate the relationship between acetabular three-dimensional (3D) alignment reorientation and clinical range of motion (ROM) after periacetabular osteotomy (PAO). A total of 53 patients who underwent curved PAO (CPO) for DDH from January 2014 to April 2017 were selected. Three (5.7%) of them were lost to follow-up. Therefore, the data from 58 hips, contributed by 50 patients (44 women and 6 men), were included in the analysis. Pre- and postoperative computed tomography (CT) scans from the pelvis to the knee joint were performed and transferred to a 3D template software (Zed Hip; Lexi, Tokyo, Japan). The pelvic plane axis was defined according to the functional pelvic plane. The pre- and postoperative lateral and anterior 3D center-edge (CE) angles were measured on the coronal and sagittal views through the center of the femoral head. The pre- and postoperative 3D center-edge (CE) angles and femoral anteversion were measured and compared with clinical outcomes, including postoperative ROM.Introduction
Methods
The influences of posterior tibial slope on the knee kinematics have been reported in both TKA and UKA. We hypothesized the posterior tibial slope (PTS) would affect the sagittal knee alignment after UKA. The influences of PTS on postoperative knee extension angle were investigated with routine lateral radiographies of the knee after UKA. Twenty-four patients (26 knees; 19 females, 7 males) underwent medial UKA were involved in this study. Average age was 74.8 ± 7.2 years. The mean preoperative active range of motion were − 4.1° ± 6.3°in extension and 123.2° ± 15.5° in flexion. All UKAs were performed using fixed bearing type UKA (Zimmer Biomet, ZUK), with adjusting the posterior slope of the proximal tibial bone cut according to the original geometry of the tibia. Routine lateral radiographies of the knee were examined preoperatively, 6 months after the surgery. PTS and knee extension angles with maximal active knee extension (mEXT) and one-leg standing (sEXT) were radiographically measured. We used the fibular shaft axis (FSA) for the sagittal mechanical axis of the tibia. PTS was defined as the angle between the medial tibial plateau and the perpendicular axis of FSA. Extension angles (mEXT and sEXT) were defined as the angles between FSA and distal femoral shaft axis (positive value for hyperextension). The changes of PTS and the influences of PTS on sEXT at each time period were analyzed using simple linear regression analysis (p<0.05).Introduction
Materials & Methods
A-70-year old woman underwent uncomplicated total hip arthroplasty using a titanium modular stem with a 46mm CoCr femoral head, a titanium shell, and a metal linear (Wright Medical Technology). Eight years after implantation, she presented with a painful left hip. A pelvic radiograph revealed adequate positioning of both hip implants without any signs of wear of loosening. CT scanning confirmed the presence of a 5 × 5 cm soft tissue mass in the ilium above the cup component accompanied by the iliac fracture. The patient was diagnosed as having an adverse reaction to metal debris (ARMD) after a metal-on-metal THA and revision was performed. Perioperatively?tissue necrosis and partial destruction of the abductor mechanism were found in the absence of any macroscopic infection. Both the neck trunnion and bore of the head showed slight signs of corrosion. The modular neck was revised with a ceramic 28mm head and a new dual-mobility liner(Zimmer Biomet). The iliac fracture was fixed with a porous trabecular metal augment(Zimmer Biomet). The histopathology of tissue sample revealed extensively necrotic material with focal cellular areas of inflammatory cells containing macrophages and neutrophilas. Metalic debris was also scattered in the necrotic materials. After the revision, the patient was recovered without pain or dislocation, and iliac fracture was well fixed. Instability is a substantial problem in the revision of ARMD. Extensive necrosis with gross deficiency of the abductor mechanism is associated with postoperative dislocation. Revision of failed MoM THA a dual-mobility device an effective strategy.
Acquiring adaptive soft-tissue balance is one of the most important factors in total knee arthroplasty (TKA). However, there have been few reports regarding to alteration of tolerability of varus/valgus stress between before and after TKA. In particular, there is no enough data about mid-flexion stability. Based on these backgrounds, it is hypothesized that alteration of varus/valgus tolerance may influence post-operative results in TKA. The purpose of this study is an investigation of in vivo kinematic analyses of tolerability of varus/valgus stress before and after TKA, comparing to clinical results. A hundred knees of 88 consecutive patients who had knees of osteoarthritis with varus deformity were investigated in this study. All TKAs (Triathlon, Stryker) were performed using computer assisted navigation system. The kinematic parameters of the soft-tissue balance, and amount of coronal relative movement between femur and tibia were obtained by interpreting kinematics, which display graphs throughout the range of motion (ROM) in the navigation system. Femoro-tibial alignments were recorded under the stress of varus and valgus before the procedure and after implantation of all components. In each ROM (0, 30, 60, 90, 120 degrees), the data of coronal relative movement between femur and tibia (tolerability) were analyzed before and after implantation. Furthermore, correlations between tolerability of varus/valgus and clinical improvement revealed by ROM and Knee society score (KSS) were analyzed by logistic regression analysis.Introduction
Materials and Methods
Patients-reported outcome measures (PROMs) have been reported as the important methods to evaluate clinical outcomes in total knee arthroplasty (TKA). The patient satisfaction score in Knee Society Score (KSS-2011) has been used in the recent literatures. Patient satisfaction was subjective parameter, and would be affected by multiple factors including psychological factors and physical conditions at not only affected joint but also elsewhere in the body. The question was raised regarding the consistency of patient satisfaction score in KSS-2011 to other PROMs. The purpose of this study was to investigate the correlation of patient satisfaction in KSS-2011 to other categories in KSS-2011 and to other PROMs including Forgotten Joint Score (FJS-12), EuroQol-5 Dimensions (EQ-5D) and 25-questions in Geriatric Locomotive Function Scale (GLFS-25). 83 patients over 65 years old with osteoarthritic knees were involved in this study. All patients underwent CR-TKAs (Persona CRR). The means and ranges of demographics were as follows: age; 74.5 years old (65–89), Hip-Knee-Ankle (HKA) angle; 12.4 (−6.2–22.5) in varus. We asked patients to fulfill the questionnaire including KSS-2011, FJS-12, EQ-5D and GLFS-25 at 1-year postoperative follow-up visit. KSS-2011 consisted of 4 categories of questions; patient satisfaction (PS), symptoms, patient expectations (PE), functional activities (FA). We evaluated the correlation of PS to other PROMs using simple linear regression analyses (p<0.001).Introduction
Material & Method
The purpose of this study was to evaluate the in vitro effects of apocynin, an inhibitor of nicotinamide adenine dinucleotide phosphate oxidase (NOX) and a downregulator of intracellular reactive oxygen species (ROS), on high glucose-induced oxidative stress on tenocytes. Tenocytes from normal Sprague-Dawley rats were cultured in both control and high-glucose conditions. Apocynin was added at cell seeding, dividing the tenocytes into four groups: the control group; regular glucose with apocynin (RG apo+); high glucose with apocynin (HG apo+); and high glucose without apocynin (HG apo–). Reactive oxygen species production, cell proliferation, apoptosis and messenger RNA (mRNA) expression of NOX1 and 4, and interleukin-6 (IL-6) were determined in vitro.Aims
Methods
Using a simple classification method, we aimed to estimate the collapse rate due to osteonecrosis of the femoral head (ONFH) in order to develop treatment guidelines for joint-preserving surgeries. We retrospectively analyzed 505 hips from 310 patients (141 men, 169 women; mean age 45.5 years Objectives
Methods
The posterior slope of the tibial component in total knee arthroplasty (TKA) has been reported to vary widely even with computer assisted surgery. In the present study, we analyzed the influence of posterior tibial slope on one-year postoperative clinical outcome after posterior-stabilized (PS) -TKA to find out the optimal posterior slope of tibial component. Seventy-three patients with varus type osteoarthritic (OA) knees underwent PS-TKA (Persona PSR) were involved in this study. The mean age was 76.6 years old and preoperative HKA angle was 14.3 degrees in varus. Tibial bone cut was performed using standard extra-medullary guide with 7 degrees of posterior slope. The tibial slopes were radiographically measured by post-operative lateral radiograph with posterior inclination in plus value. The angle between the perpendicular line of the proximal fibular shaft axis and the line drawn along the superior margin of the proximal tibia represented the tibial slope angle. We assessed one-year postoperative clinical outcomes including active range of motion (ROM), patient satisfaction and symptoms scores using 2011 Knee Society Score (2011 KSS). The influences of posterior tibial slope on one-year postoperative parameters were analyzed using simple linear regression analysis (p<0.05).Background
Materials and Method
Modified gap technique has been reported to be beneficial for the intraoperative soft tissue balancing in posterior-stabilized (PS) -TKA. We have found intraoperative ligament balance changed depending on joint distraction force, which might be controlled according to surgeons' fells. We have developed a new surgical concept named as “medial preserving gap technique (MPGT)” to preserve medial knee stability and provide quantitative surgical technique according to soft tissue balance measurement using a tensor device. The purpose of this study was to compare 3-years postoperative knee stability after PS-TKA in varus type osteoarthritic (OA) knees between MPGT and measured resection technique (MRT). The subjects were 94 patients underwent primary unilateral PS-TKA for varus type OA knees. The surgical technique was MPGT in 47 patients and MRT in 47 patients. An originally developed off-set type tensor device was used to evaluate intraoperative soft tissue balance. In MPGT, medial release was limited until the spacer block corresponding to the bone thickness from proximal lateral tibial plateau could be easily inserted. Femoral component size and external rotation angle were adjusted depending on the differences of center gaps and varus angles between extension and flexion before posterior femoral condylar resection. The knee stabilities at extension and flexion were assessed by stress radiographies at 1 and 3 years after TKA; varus-valgus stress test at extension and stress epicondylar view at flexion. We measured medial and lateral joint openings (MJO, LJO) at both knee extension and flexion. MJOs and LJOs at 2 time periods were compared in each group using paired t-test. Each joint opening distance was compared between 2 groups using unpaired t-test. The significance level was set as P < 0.05.Introduction
Material & Method
The aim of this study was to investigate the effect of hyperglycaemia on oxidative stress markers and inflammatory and matrix gene expression within tendons of normal and diabetic rats and to give insights into the processes involved in tendinopathy. Using tenocytes from normal Sprague-Dawley rats, cultured both in control and high glucose conditions, reactive oxygen species (ROS) production, cell proliferation, messenger RNA (mRNA) expression of NADPH oxidase (NOX) 1 and 4, interleukin-6 (IL-6), matrix metalloproteinase (MMP)-2, tissue inhibitors of matrix metalloproteinase (TIMP)-1 and -2 and type I and III collagens were determined after 48 and 72 hours Objectives
Methods
Both measured resection technique and gap balancing technique have been important surgical concepts in total knee arthroplasty (TKA). Modified gap technique has been reported to be beneficial for the intra-operative soft tissue balancing in posterior-stabilizing (PS) -TKA. On the other hand, we have found joint distraction force changed soft tissue balance measurement and medial knee instability would be more likely with aiming at perfect ligament balance at extension in modified gap technique. The medial knee stability after TKA was reported to essential for post-operative clinical result. We have developed a new surgical concept named as “medial preserving gap technique” for varus type osteoarthritic (OA) knees to preserve medial knee stability and provide quantitative surgical technique using tensor device. The purpose of this study was to compare post-operative knee stability between medial preserving gap technique (MPGT) and measured resection technique (MRT) in PS-TKA. The subjects were 140 patients underwent primary unilateral PS-TKA for varus type OA knees. The surgical technique was MPGT in 70 patients and MRT in 70 patients. There were no significant differences between two groups in the pre-operative clinical features including age, sex, ROM and deformity. Originally developed off-set type tensor device was used to evaluate both center gap and varus angle with 40 lbs. of joint distraction force. The extension gap preparation was identical in both group. In MPGT group, femoral component size and external rotation angle were adjusted depending on the differences of center gaps and varus angles between extension and flexion before posterior femoral condylar osteotomy. The knee stabilities at extension and flexion were assessed by stress radiographies; varus-valgus stress test with extension and stress epicondylar view with flexion, at one-month and one-year after TKA. We measured joint opening distance (mm) at medial and lateral compartment at both knee extension and flexion. Joint opening distances were compared between two groups using unpaired t-test, and the difference between medial and lateral compartment in each group was compared using paired t- test (p<0.05).Introduction
Material & Method
