The Masquelet technique is a variable method for treating critical-sized bone defects, but there is a need to develop a technique for promoting bone regeneration. In recent studies of bone fracture healing promotion, macrophage-mesenchymal stem cell (MSC) cross-talk has drawn attention. This study aimed to investigate macrophage expression in the induced membrane (IM) of the Masquelet technique using a mouse critical-sized bone defect model. The study involved a 3-mm bone defect created in the femur of mice and fixed with a mouse locking plate. The Masquelet (M) group, in which a spacer was inserted, and the Control (C) group, in which the defect was left intact, were established. Additionally, a spacer was inserted under the fascia of the back (B group) to form a membrane due to the foreign body reaction. Tissues were collected at 1, 2, and 4 weeks after surgery (n=5 in each group), and immunostaining (CD68, CD163: M1, M2 macrophage markers) and RT-qPCR were performed to investigate macrophage localization and expression in the tissues. The study found that CD68-positive cells were present in the IM of the M group at all weeks, and RT-qPCR showed the highest CD68 expression at 1 week. In addition, there was similar localization and expression of CD163. The C group showed lower expression of CD68 and CD163 than the M group at all weeks. The B group exhibited CD68-positive cells in the fibrous capsule and CD163-positive cells in the connective tissue outside the capsule, with lower expression of both markers compared to the M group at all weeks. Macrophage expression in IM in M group had different characteristics compared to C group and B group. These results suggest that the IM differs from the fibrous capsules due to the foreign body reaction, and the macrophage-MSC cross-talk may be involved in Masquelet technique.
Recent researches indicate that both M1 and M2 macrophages play vital roles in tissue repair and foreign body reaction processes. In this study, we investigated the dynamics of M1 macrophages in the induced membrane using a mouse femur critical-sized bone defect model. The Masquelet method (M) and control (C) groups were established using C57BL/6J male mice (n=24). A 3mm-bone defect was created in the right femoral diaphysis followed by a Kirschner wire fixation, and a cement spacer was inserted into the defect in group M. In group C, the bone defect was left uninserted. Tissues around the defect were harvested at 1, 2, 4, and 6 weeks after surgery (n=3 in each group at each time point). Following Hematoxylin and eosin (HE) staining, immunohistochemical staining (IHC) was used to evaluate the CD68 expression as a marker of M1 macrophage. Iron staining was performed additionally to distinguish them from hemosiderin-phagocytosed macrophages. In group M, HE staining revealed a hematoma-like structure, and CD68-positive cells were observed between the spacer and fibroblast layer at 1 week. The number of CD68-positive cells decreased at 2 weeks, while they were observed around the new bone at 4 and 6 weeks. In group C, fibroblast infiltration and fewer CD68-positive cells were observed in the bone defect without hematoma-like structure until 2 weeks, and no CD68-positive cells were observed at 4 and 6 weeks. Iron staining showed hemosiderin deposition in the surrounding area of the new bone in both groups at 4 and 6 weeks. The location of hemosiderin deposition was different from that of macrophage aggregation. This study suggests that M1 macrophage aggregation is involved in the formation of induced membranes and osteogenesis and may be facilitated by the presence of spacers.
This study aimed to examine the effects of SRT1720, a potent SIRT1 activator, on osteoarthritis (OA) progression using an experimental OA model. Osteoarthritis was surgically induced by destabilization of the medial meniscus in eight-week-old C57BL/6 male mice. SRT1720 was administered intraperitoneally twice a week after surgery. Osteoarthritis progression was evaluated histologically using the Osteoarthritis Research Society International (OARSI) score at four, eight, 12 and 16 weeks. The expression of SIRT1, matrix metalloproteinase 13 (MMP-13), a disintegrin and metalloproteinase with thrombospondin motifs-5 (ADAMTS-5), cleaved caspase-3, PARP p85, and acetylated nuclear factor (NF)-κB p65 in cartilage was examined by immunohistochemistry. Synovitis was also evaluated histologically. Primary mouse epiphyseal chondrocytes were treated with SRT1720 in the presence or absence of interleukin 1 beta (IL-1β), and gene expression changes were examined by real-time polymerase chain reaction (PCR).Objectives
Methods
Post-operative (postop) lower limb alignment in unicompartmental knee arthroplasty (UKA) has been reported to be an important factor for postop outcomes. Slight under-correction of limb alignment has been recommended to yield a better clinical outcomes than neutral alignment. It is useful if the postop limb alignment can be predicted during surgery, however, little is known about the surgical factors affecting the postop limb alignment in UKA. The purpose of this study was to examine the influence of the medial tibial joint line elevation on postop limb alignment in UKA. Seventy-four consecutive medial UKAs were enrolled in this study. All the patients received a conventional fixed bearing UKA. Pre-operative (preop) and postop limb alignment was examined using long leg radiograph and lower limb alignment changes were calculated. Femoral and tibial osteotomy thickness were measured during surgery. Medial tibial joint line change was defined as polyethylene thickness minus tibial osteotomy thickness and sawblade thickness (1.27mm). Positive values indicated a tibial joint line elevation. Medial femoral joint line change was defined as femoral distal component thickness (6.5mm) minus femoral distal osteotomy thickness and sawblade thickness. Positive values indicated a femoral joint line reduction. Medial joint distraction width was also calculated by tibial joint line elevation plus femoral joint line reduction. The correlation of lower limb alignment change with polyethylene insert thickness, the medial tibial joint line elevation, femoral joint line reduction, or joint distraction width were analyzed.Background
Methods
Recently, kinematic aligned total knee arthroplasty (TKA) has gained interest for achieving better clinical outcomes over mechanical aligned TKA. The primary goal of kinematic aligned TKA is to position the femoral and tibial components so that the angles and levels of the distal and posterior femoral joint lines and the tibial joint line are each restored to the patient's natural alignment, and not to a neutral limb alignment that is unnatural for most patients. Despite good clinical outcomes reported at short to mid-term follow-up, surgeons should know reasons why this method is useful and safe surgery and carefully assess the long-term outcomes until this new technique is settled as standardized procedure for TKA. The main purpose of the present study was to compare postoperative radiography and clinical scores following kinematic and mechanical aligned TKA. Sixty TKAs—30 kinematic and 30 mechanical aligned—were performed in patients with varus-type osteoarthritis using a navigation system. Using postoperative double-leg and single-leg standing long leg radiographs, joint line orientation angle to the floor, conventional mechanical axis (cMA), and true mechanical axis (tMA; line from hip center to the lowest point of calcaneus) were compared between the two groups. One-year after surgeries, range of motion and the patient-derived score of the 2011 Knee Society Score (2011 KSS), which includes four categories: symptoms, patient satisfaction, patient expectations, and functional activities, e.g., walking/standing, standard activities, advanced activities, and discretionary activities, were compared between the two groupsPurpose
Methods
The influence of soft tissue balance in mobile-bearing posterior-stabilized (PS) total knee arthroplasty (TKA) on the patellofemoral (PF) joint was investigated in thirty varus-type osteoarthritis patients. Intraoperative soft tissue balance including joint component gap and varus/valgus ligament balance and the medial/lateral patellar pressure were measured throughout the range of motion after the femoral component placement and the PF joint repair. The lateral patellar pressure, which was significantly higher than the medial side in the flexion arc, showed inverse correlation with the lateral laxity at 60° and 90° of flexion. The lateral patellar pressure at 120° and 135° of flexion also inversely correlated with the postoperative flexion angle. Surgeons should take medial and lateral laxity into account when considering PF joint kinematics influencing postoperative flexion angle in PS TKA.
Tibia vara seen in Japanese patients reportedly influences the tibial component alignment when performing TKA. However, it is unclear whether tibia vara affects the component position and size selection. We therefore determined (1) the amount of medial tibial bow, (2) whether the tibia vara influences the aspect ratio of the tibial resected surface in aligning the tibial component with the tibial shaft axis (TSA), and (3) whether currently available tibial components fit the shapes of resected proximal tibias in terms of aspect ratio. The study was performed using CT data from 90 lower limbs in 74 Japanese female patients with primary varus knee OA, scheduled for primary TKAs between January 2010 and March 2012. We measured the tibia vara angle (TVA; the angle between the TSA and the tibial mechanical axis), proximal varus angle (PVA; angle between the TSA and the line connecting the center of the tibial eminence and the center of the proximal 1/3 of the tibia) using three-dimensional preoperative planning software [Fig.1]. Then the mediolateral and middle AP dimensions of the resected surface when the tibial component was set so that its center aligned with the TSA was measured. We determined the correlations of the aspect ratio (the ML dimension divided by the AP dimension) of the resected surface with TVA or PVA and compared the aspect ratios to those of five prosthesis designs.Objective
Material and Methods
Total knee arthroplasty(TKA) for patients with severe varus deformity has become common operation in Japan because of the rapid aging of the population. Treatment of severe malalignment, instability and bone defects is important. Here we report the clinical results of total knee arthroplasty for 23 knees with severe varus deformity. We defined a severe varus knee femorotibial angle(FTA) as one exceeding 195 degrees. The average observation period was 64 months. Autologous bone graft was performed for 3 knees and augmentation and long tibia stem was used for 3 knees. We used SF-36 for clinical evaluation. Image assessment was based on the standing HKA(Hip-Knee-Ankle)angle, and the Knee Society TKA roentgenographic evaluation and scoring system. The mean SF-36 score improved from 47.6 points to 63.7 points after TKA. The standing mean HKA angle was 204°(range 197° to 215°) before surgery and was corrected to 185°(range 176° to 195°). The post-operative standing HKA angle was classified as HKA>184°, 184°>HKA>177°, HKA<176°. A clear zone appeared in zone1 on tibia APX-ray in 4 knees belonging to the HKA>184° group. Our 23 knees achieved good results, and careful postoperative observation is still necessary especially in the vgarus group.
Surgeons sometimes encounter moderate or severe varus deformed osteoarthritic cases in which medial substantial release including semimembranosus is compelled to appropriately balance soft tissues in total knee arthroplasty (TKA). However, medial stability after TKA is important for acquisition of proper knee kinematics to lead to medial pivot motion during knee flexion. The purpose of the present study is to prove the hypothesis that step by step medial release, especially semimembranosus release, reduces medial stability in cruciate-retaining (CR) total knee arthroplasty (TKA). Twenty CR TKAs were performed in patients with moderate varus-type osteoarthritis (10° < varus deformity <20°) using the tibia first technique guided by a navigation system (Orthopilot). During the process of medial release, knee kinematics including tibial internal rotation and anterior translation during knee flexion were assessed using the navigation system at 3 points; (1) after anterior cruciate ligament resection (pre-release), (2) medial tibial and femoral osteophyte removal and release of minimum deep layer of medial collateral ligament (minimum release) and (3) release of semimembranosus (semimembranosus release). In addition, the kinematics after all prostheses implantation (semimembranosus release group) were assessed and compared with those assessed in another 20 patients in which only minimum release was performed (minimum release group).Purpose
Methods
The tibia first technique in unicompartmental knee arthroplasty (UKA) may have the advantage that surgeons can obtain a balanced flexion-extension gap. However, changes of the soft tissue tension during UKA has not been elucidated yet. The purpose of this study was to examine the correlation between the soft tissue tension before the femoral osteotomy and after the femoral component in place using the tensor in UKA. Thirty UKAs for isolated medial compartmental osteoarthritis or idiopathic osteonecrosis were assessed. The mean age was 71.8±8.5 years old (range: 58–85), and the average coronal plane femorotibial angle (FTA) was 181.2±3.2 degree preoperatively. All the patients received a conventional medial Zimmer Unicompartmental High Flex Knee System (Zimmer Inc, Warsaw, Ind). The actual values of the proximal and posterior femoral osteotomy were calculated by adding the thickness of the bone saw blades to the thickness of the bony cut. Using a UKA tensor which designed to facilitate intra-operative soft tissue tension throughout the range of motion (ROM), the original gap before the femoral osteotomy, the component gap after the femoral osteotomy, and component placement were assessed under 20 lb distraction forces. (Figure 1)Purpose
Methods
Patients planning to undergo total knee arthroplasty (TKA), especially in Asian and Middle Eastern countries, usually expect to be able to perform activities requiring knee flexion such as sitting cross-legged or kneeling with ease after the surgery. Postoperative range of motion (ROM) can be affected by multiple factors such as the patient's gender, age, preoperative ROM, diagnosis, the surgeon's technique, the pre- and post-operative rehabilitation program, and the design of the prosthesis. Among these, the choice of the prosthesis depends on the surgeon's preference. As a result, several trials and studies have been conducted to improve postoperative ROM by modifying prosthesis design. The present study aimed to examine the results of TKA with the NexGen LPS-Flex system (Zimmer, Warsaw, Indiana), which is one of several high-flexion total knee prostheses that were designed to achieve a wide ROM for osteoarthritis in the valgus knee. A total of 27 primary TKAs in 26 osteoarthritis patients with valgus knee deformities (femorotibial angle (FTA) ≤ 170°) were performed using the NexGen LPS-Flex fixed prosthesis between July 2003 and December 2011. The patients included 2 men (7.7%, 2 knees) and 24 women (92.3%, 25 knees) with a mean age of 72.6 years (range, 59 to 83 years) at the time of the surgery. The mean duration of follow-up after surgery was 50.1 months (range, 24 to 126 months). Knee Society Knee Score (KSKS), Knee Society Function Score (KSFS), maximum flexion angle, maximum extension angle, and radiological femorotibial angle (FTA) were evaluated pre- and post-operatively. The mean preoperative KSKS and KSFS were 42.6 points (SD 7.5) and 41.1 points (SD 8.6), respectively, which improved after surgery to 82.2 points (SD 8.2) and 80.9 points (SD 7.6), respectively (P < 0.01). The maximum flexion angle improved from 109.1° (SD 23.1) to 117.3° (SD 12.4) postoperatively, but it did not reach statistical significance (P = 0.097). The preoperative maximum extension angle improved from −9.7° (SD 10.8) to −3.6° (SD 4.9) postoperatively (p < 0.05). The mean radiological FTA was 166.4° (SD 4.2; range: 155° − 170°) preoperatively and 172.4° (SD 2.7; range: 168° − 178°) at the final follow-up, and the difference was statistically significant (P < 0.01). None of the patients had undergone revision surgery by the final follow-up. As a conclusion, the results of the present study showed that the use of NexGen LPS-Flex implant in TKA for knee osteoarthritis with valgus deformity produced a satisfactory improvement in the clinical and radiological outcomes. Further studies on the outcomes of other prosthesis are needed to determine whether the NexGen LPS-Flex implant is advantageous for osteoarthritis patients with valgus knees who undergo TKA, and further large-scale studies with longer term follow-up are necessary to verify our results.
Mesenchymal stem cells (MSCs) are identified by having the ability to differentiate into various tissues and typically used to generate bone tissue by a process of resembling intramembranous ossification, namely by direct osteoblastic differentiation. However, most bones develop by endochondral ossification, namely via remodeling of hypertrophic cartilaginous templates. To date, reconstruction of bone defects by endochondral ossification using mesenchymal stem cell-derived chondrocytes (MSC-DCs) have not been reported. The purpose of this study was to evaluate the effects of the transplantation of MSC-DCs on bone healing in segmental defects in rat femurs. Segmental bone defects (5, 10, 15-millimeter) were produced in the mid-shaft of the femur of the Fisher 344 rats and stabilised with an external fixator. Bone marrow was aspirated from the rat's femur and tibia at 4 weeks before operation. MSCs were isolated and grown in culture and seeded on a Poly dl-lactic-co glycolic acid (PLGA) scaffold. Subsequently, the scaffold was cultured using chondrogenic inducing medium for 21 days. The characteristics of the PLGA scaffold are radiolucent and to be absorbed in about 4 months. The Treatment Group received MSC-DCs, seeded on a PLGA scaffold, locally at the site of the bone defect, and Control Group received scaffold only. The healing processes were monitored radiographically and studied biomechanically and histologically.Introduction
Methods
The purpose of this study was to evaluate the effects of implantation of mesenchymal stem cell derived condrogenic cells (MSC-DC) on bone healing in segmental defects in rat femur. Five-millimeter segmental bone defects were produced in the mid-shaft of the femur of Fisher 344 rats and stabilized with external fixator. The Treatment Group received MSC-DC, seeded on a PLGA scaffold, locally at the site of the bone defect, and Control Group received scaffold only. The healing processes were monitored radiographically (Softex), and studied radiographically (Micro-CT) and histologically.Purpose
Methods
To investigate the outcomes of patients following the chipping procedures as an alternative to bone grafting in treatment of non-unions after long bone fracture. Sixteen patients with femoral or tibial non-union were included. The median follow-up was 24 months.Objective
Patients
what size of defect is optimal for creating an atrophic nonunion animal model has not been well defined. Our aim in this study was to establish a clinically relevant model of atrophic nonunion in rat femur by creation of a bone defect to research fracture healing and nonunion. We used 30 male Fischer 344 rats (aged 10–11 weeks), which were equally divided into six groups. The segmental bone defects to a single femur in each rat were performed by double transverse osteotomy, and different sized defects were created by group for each group (1 mm, 2 mm, 3 mm, 4 mm, 5 mm and 6 mm). The defects were measured and maintained strictly by using an original external fixator. The periosteum for each defect was stripped both proximally and distally. Thereafter, these models were evaluated by radiology and histology. Radiographs were taken at baseline and at intervals of two weeks over a period of 8 weeks. Atrophic nonunion was defined as a lack of continuity and atrophy of both defect ends radiologically and histologically at eight weeks.Introduction
Materials and methods
Reconstruction of 10mm segmental bone defects in rat by mesenchymal stem cell derived chondrogenic cells (MSC-DC) Mesenchymal stem cell derived condrogenic cells (MSC-DC) have excellent potential for healing 5 mm bone defect in rat femur. To evaluate the effectiveness of MSC-DC on bone healing in 10 mm segmental bone defects in rat femur.Background
Purpose
To determine what factors affect fracture healing with low-intensity pulsed ultrasound (LIPUS) for delayed unions and nonunions. A consecutive cohort of 101 delayed unions and 50 nonunions after long bone fractures treated with LIPUS between May 1998 and April 2007.Objective
Patients
Growing of the geriatric population has brought about increase of lower extremity fractures. The purpose of this study was to investigate the occurrence of surgical site infection after the surgery for lower extremity fractures, except proximal femoral fracture, in over eighty years old patients. Patients with closed lower extremity fracture which were treated surgically in 2011 were divided into two groups (Group O; the equal or more than 80 years old, Group Y; from 20 to 65 years old), and the incidence of infection and the outcome after its treatment was compared between Group O and Group Y.Background
Methods
In order to permit soft tissue balancing under more physiological conditions during total knee arthroplasties (TKAs), we developed an offset type tensor to obtain soft tissue balancing throughout the range of motion with reduced patella-femoral (PF) and aligned tibiofemoral joints and reported the intra-operative soft tissue balance assessment in cruciate-retaining (CR) and posterior-stabilized (PS) TKA [1, 2]. However, the soft tissue balance in unicompartmental knee arthroplasty (UKA) is unclear. Therefore, we recently developed a new tensor for UKAs that is designed to assist with soft tissue balancing throughout the full range of motion. The first purpose of the present study is to assess joint gap kinematics in UKA. Secondly, we attempted to compare the pattern in UKA with those in CR and PS TKA with the reduced PF joint and femoral component placement, which more closely reproduces post-operative joint alignment. Using this tensor, we assessed the intra-operative joint gap measurements of UKAs performed at 0, 10, 30, 45, 60, 90, 120 and 135° of flexion in 20 osteoarthritic patients. In addition, the kinematic pattern of UKA was compared with those of CR and PS TKA that were calculated as medial compartment gap from the previous series of this study.Backgrounds
Methods
Appropriate intraoperative soft tissue balancing is recognized to be essential in total knee arthroplasty (TKA). However, it has been rarely reported whether intraoperative soft tissue balance reflects postoperative outcomes. In this study, we therefore assessed the relationship between the intra-operative soft tissue balance measurements and the post-operative stress radiographs at a minimum 1-year follow-up in cruciate-retaining (CR) TKA, and further analyzed the postoperative clinical outcome. The subjects were 25 patients diagnosed with osteoarthritis with varus deformity and underwent primary TKA. The mean age at surgery was 72.0 ± 7.5 years (range, 47–84 years). The Surgeries were performed with the tibia first gap technique using CR-TKA (e motion, B. Braun Aesculap) and the image-free navigation system (Orthopilot). We intraoperatively measured varus ligament balance (°, varus angle; VA) and joint component gap (mm, center gap; CG) at 10° and 90° knee flexion guided by the navigation system, with the patella reduced. At a minimum 1-year follow-up, post-operative coronal laxity at extension was assessed by varus and valgus stress radiographs of the knees with 1.5 kgf using a Telos SE arthrometer (Fa Telos) and that at flexion was assessed by epicondylar view radiographs of the knees with a 1.5-kg weight at the ankle. After calculating postoperative VA and CG from measurements of radiographs, measurements and preoperative and postoperative clinical outcome, such as Knee Society Clinical Rating System (Knee score; KSS, Functional score; KSFS) and postoperative knee flexion, were analyzed statistically using linear regression models and Pearson's correlation coefficient.Introduction
Methods
In cruciate-retaining total knee arthroplasty (TKA), among many factors influencing post-operative outcome, increasing the tibial slope has been considered as one of the beneficial factors to gain deep flexion because of leading more consistent femoral rollback and avoiding direct impingement of the insert against the posterior femur. In contrast, whether increasing the tibial slope is useful or not is controversial in posterior-stabilized (PS) TKA, Under such recognition, accurate soft tissue balancing is also essential surgical intervention for acquisition of successful postoperative outcomes in TKA. In order to permit soft tissue balancing under more physiological conditions during TKAs, we developed an offset type tensor to obtain soft tissue balancing throughout the range of motion with reduced patello-femoral(PF) and aligned tibiofemoral joints and have reported the relationship between intra-operative soft tissue balance and flexion angles. In this study, we therefore assessed the relationship between intra-operative soft tissue balance assessed using the tensor and the tibial slope in PS TKA. Thirty patients aged with a mean 72.6 years were operated PS TKA(NexGen LPS-Flex, Zimmer, Inc. Warsaw, IN) for the varus type osteoarthritis. Following each bony resection and soft tissue release using measure resection technique, the tensor was fixed to the proximal tibia and femoral trial prosthesis was fitted. Assessment of the joint component gap (mm) and the ligament balance in varus (°)was carried out at 0, 10, 45, 90and 135degrees of knee flexion. The joint distraction force was set at 40lbs. Joint component gap change values during 10-0°,45-0°, 90-0°, 135-0° flexion angle were also calculated. The tibial slopes were measured by postoperative lateral radiograph. The correlation between the tibial slope and values of soft tissue balance were assessed using linear regression analysis.Introductions
Materials and methods
Total knee arthroplasty (TKA) with a computer-assisted navigation system has been developed to improve the accuracy of the alignment of osteotomies and implantations. One of the most important goals of TKA is to improve the flexion angle. Although accurate soft tissue balancing has been recognized as an essential surgical intervention influencing flexion angle, the direct relationship between post-operative flexion angle and intra-operative soft tissue balance during TKA, has little been clarified. In the present study, therefore, we focused on the relationship between them in cruciate-retaining (CR) TKA with a navigation system. The subjects were 30 consecutive patients (2 men, 28 women), who underwent primary CR TKA (B. Braun Aesculap, e-motion) between May 2006 and December 2009. TKAs were performed using a image-free navigation system (OrthoPilot; B. Braun Aesculap, Tuttlingen, Germany). All cases were osteoarthritis with varus deformity. Average patient age at the time of surgery was 74.0 years (range, 62-86 years). After all bony resections and soft tissue releases were completed appropriately using a navigation system with tibia-first gap technique, a tensor was fixed to the proximal tibia and the femoral trial was fitted. Using the tensor that is designed to facilitate soft tissue balance measurements throughout the range of motion with a reduced patello-femoral (PF) joint and femoral component in place, the joint component gap and ligament balance (varus angle) were measured after the PF joint reduced and femoral component in place (Fig.1). Assessments of joint component gap and ligament balance were carried out at 0°, 30°, 60°, 90°, 120° flexion angle, which were monitored by the navigation system. Joint component gap change values during 30°- 0°, 60°- 0°, 90°- 0°, 120°- 0° flexion angle were calculated. The correlation between post operative flexion angles and pre-operative flexion angle, intra-operative joint component gaps, joint component gap change values and ligament balances were assessed using linear regression analysis.Introduction
Materials and methods
Using a tensor for total knee arthroplasty (TKA) that is designed to facilitate soft tissue balance measurements with a reduced patello-femoral (PF) joint, we examined the influence of pre-operative deformity on intra-operative soft tissue balance during posterior-stabilized (PS) TKA. Joint component gap and varus angle were assessed at 0, 10, 45, 90 and 135° of flexion with femoral trial prosthesis placed and PF joint reduced in 60 varus type osteoarthritic patients. Joint gap measurement showed no significant difference regardless the amount of pre-operative varus alignment. With the procedures of soft tissue release avoiding joint line elevation, however, intra-operative varus angle with varus alignment of more than 20 degrees exhibited significant larger values compared to those with varus alignment of less than 20 degrees throughout the range of motion. Accordingly, we conclude that pre-operative severe varus deformity may have the risk for leaving post-operative varus soft tissue balance during PS TKA.
There have been few reports with efficient treatments for neglected distal tibiofibular syndesmosis disruption. Here we will report four cases of successful anatomical reconstruction with autologous gracilis tendon, using the interference fit anchoring (IFA) system. All four cases were males between 20 and 58 years of age at the time of surgery (mean age 36 years). The post-injury period to surgery was between 7 and 59 months (mean 20.1 months), with the consultation period being from 5 to 19 months (mean 9.5 months). Radiographs at the time of injuries were all malleolar fractures of pronation-external rotation (PE) stage 3 in the Lauge-Hansen classification. Stress tests for distal tibiofibular syndesmosis were positive in all cases (dilation more than 2 mm). Arthroscopic drilling was conducted in two cases with a cartilaginous injury of trochlea of talus. Distal tibiofibular syndesmosis was anatomically repositioned and was fixed with screws after bony and soft tissues within the tibiofibular syndesmosis were removed and fibular adhesion was dissected. Ipsilateral autologous gracilis tendon was passed through foramen in the insertion of the anterior inferior tibiofibular tendon on tibia and fibula, and was fixated using the IFA system. The preoperative Japanese society for surgery of the foot (JSSF) score was from 26 to 74 points (mean 43.5) and postoperative JSSF score was from 67 to 100 (mean 89.5). In a case where there was a poor outcome, five years of post injury had passed before the surgery. Although the JSSF score improved to 67 points postoperatively (from the preoperative score of 26) in this case, arthroscopic arthrodesis was conducted 5 months postoperatively due to persistent pain. Anatomical reconstruction with autologous gracilis tendon using the IFA system showed a favorable functional prognosis overall. However, there was a case with progressive degenerated changes of injured distal tibiofibular syndesmosis due to a prolonged post-injury period resulted in a poor outcome.
Tibial and femoral bone tunnel widening (TW) has been observed following anterior cruciate ligament (ACL) reconstruction. We developed a χ12 mm cannulated cancellous screw (Intercondylar Ligament Screw, ICLS) for femoral fixation to reduce TW. The purpose of this study is to introduce our surgical method and its results. We employed an original ICLS system developed to reduce the needed distance between the tibial and femoral-fixation points (distance between fixation points, DbF) in ACL reconstruction. Five-strand (sometimes four or six-strand) hamstring grafts are connected to the ICLS. Tibial fixation is achieved with a Ligament Tension Screw, which had been developed by Murase et al. rom 2001 to 2008, 169 knees underwent ACL reconstruction at our hospitals using our ICLS system. TW was evaluated by radiographs at least three months postoperatively. An enlargement of more than 2 mm was considered TW. The following was also evaluated: range of motion, the limb symmetry index (LSI, injured leg divided by uninjured and multiplied by 100), value of knee extension power in OKC, anterior knee laxity, Lysholm score, and DbF. The average length of DbF was 38.1 mm (n=132). Only 6.7% (n=104) of cases showed more than 2 mm of TW. Mean LSI was 83.3%(n=77) four months postoperatively. The mean Lysholm score was 96.2(n=68) at three months after ACL reconstruction. The mean side-to-side difference in anterior tibial translation, measured with use of a KT-2000 or Knee Lax, was 1.60 mmï1/4N=57ï1/4‰. We were able to reduce TW after ACL reconstruction using our ICLS system with good results.
There was, however, no significant difference in CR-TKA by resetting the patella. There was no significant difference in the ratio of medial/lateral load in both PSTKA and CR.-TKA. Conclusion &
Significance: Soft tissue balancing of PS-TKA with medial parapatellar approach should be performed after resetting the patella.
However, optimal duration for CFNB to decrease pain and accelerate rehabilitation program after TKA has not been addressed. We, therefore, compared three groups of patients which had different duration of CFNB (0, 2, and 5days) in this study.
Outcomes including visual analog scale (VAS) pain scores and range of motion (ROM) were compared at 1st, 3rd, 6th, 14th and 21th days after surgery. In addition, the postoperative date when patients could walk stably with parallel bar, walker, or T-cane were recorded and compared.
ROM did not show significant difference among the three groups over postoperative days 1st to 21st (P>
0.05), although groups with the CFNB showed greater ROM at all time points. The CFNB 5 days group obtained stable walking ability with T-cane earlier than other groups (P<
0.05). No patient had any side effect by having CFNB in this study.
Newer prosthetic total knee arthroplasty (TKA) designs as well as unicondylar TKAs spare the anterior cruciate ligament (ACL). Although success of these procedures requires near normal ACL function, little has been written about the arthritic ACL. This study was designed to evaluate the relationship between cross sections of the intercondylar notch and the macroscopic condition of ACL degeneration. Thirty osteoarthritic patients who underwent TKA as a result of severe osteoarthritis were randomly selected. Occupation rate of the osteophytes to the notch width were measured at the anterior 1/3, middle 1/3, and posterior 1/3 notche images obtained from preoperative tunnel view. Macroscopic conditions of the ACL and PCL were classified into four types of Normal, Frayed, Partial rupture, and Absent. The macroscopic ACL conditions were Normal: 9 cases, Frayed: 9 cases, Partial rupture: 9 cases, and Absent: 3 cases. The macroscopic PCL conditions were Normal: 24 cases, Frayed: 3 cases, Partial rupture: 3 cases, and Absent: 0 case. Occupation rate of the osteophytes to the notch correlated to the preoperative femorotibial angle (p<
0.05). In terms of ACL, the occupation rate of the osteophytes to the notch were 22.9%, 28.8%, 46.0%, and 81.8% in Normal, Frayed, partial ruptured, and Absent, respectively. The patients with more than 40% occupation rate showed either partial rupture or absent of the ACL during the surgery. We conclude that occupation rate of the osteophytes to the notch is a good predictor of evaluating the ACL degeneration in osteoarthritic knee.
Titanium alloys such as Ti-6Al-4V and Ti-6Al-7Nb have been widely used as orthopedic implants such as artificial hip joint, because of their high mechanical strengths and good biocompatibilities. Recently, new kinds of titanium-based alloys free from elements such as V and Al, which are suspicious for cytotoxicities, are being developed. Ti-15Zr-4Ta-4Nb (Ti-15-4-4) is one of such alloys and shows high mechanical strength and corrosion resistance which are comparable to those of the Ti-6Al-4V alloy. In the present study, chemical treatments for providing bone-bonding ability to this alloy were investigated. Apatite-forming ability in a simulated body fluid (SBF) was used as an indication of the bone-bonding ability. Ti-15-4-4 alloy plates 10×10×1 mm3 in size were soaked in 5M-NaOH solution at 60 °C for 24 h, soaked in 100mM-CaCl2 solution at 40 °C for 24 h, heated at 600 °C for 1 h and then soaked in hot water at 80 °C for 24 h. Surface structural changes of the alloy with these treatments were analyzed by a field emission scanning electron microscope (FE-SEM) attached with an energy-dispersive X-ray spectrometer (EDX), Thin-film X-ray diffraction (TF-XRD) and Fourier transform confocal laser Raman spectroscopy (FT-Raman). Scratch resistance of surface layer of the alloy was measured by a thin-film scratch tester. Apatite-forming ability of the specimens was examined by soaking them in SBF for 3 days. Long-term stability of the apatite-forming ability was examined after keeping the specimens in an incubator with relative humidity of 95 % at 80 °C for 1 week. A sodium hydrogen titanate layer about 500 nm in thickness was formed on the surface of the alloy by the NaOH treatment. This specimen formed some amounts of apatite in SBF within 3 days, but its scratch resistance was as low as less than 10 mN. When the NaOH-treated specimen was subsequently heat treated, the sodium hydrogen titanate transformed into sodium titanate to give scratch resistance as high as 92 mN, but lost its apatite-forming ability. When the NaOH-treated specimen was soaked in CaCl2 solution, the sodium hydrogen titanate was isomorphously transformed into calcium hydrogen titanate. Thus treated specimen increased its apatite-forming ability, but its scratch resistance was still low. When the NaOH- and CaCl2-treated specimen was subsequently heat treated, the calcium hydrogen titanate transformed into calcium titanate to give scratch resistance as high as 169 mN. However, its apatite-forming ability was lost. Thus treated specimen was then soaked in hot water. As a result, its apatite-forming ability remarkably increased without decreasing scratch resistance. It showed high apatite-forming ability even after a long-term-stability test. The NaOH-, CaCl2-, heat- and hot-water-treated Ti-15-4-4 alloy is believed to be promising materials for artificial joints, because of its high apatite-forming ability with long-term stability as well as high scratch resistance.
The precise orientation of the acetabular component is one of the important factors in total hip arthroplasty (THA). Computed tomography (CT) provides image data for accurate measurements of the orientation of the acetabular component. However, in many studies in the literature, the orientation of the acetabular component after THA has been expressed as a combination of inclination angle (IA) and version angle (VA) measured on radiographs. For measuring VA, an anteroposterior (AP) radiograph of the hip joint, or a cross-table lateral radiograph has been used. The accuracy of these radiological measurements was not thoroughly studied. The purpose of this study was to evaluate the accuracy of measurements on radiographs comparing to those on CT.
Side shift exercise was originally described by Mehta. Since 1986, we adopted it for the treatment of idiopathic scoliosis. Outcome of the side shift exercise for the patients with idiopathic scoliosis after skeletal maturity was evaluated retrospectively. Fifty-three patients with idiopathic scoliosis whose curve was greater than 20 degrees by the Cobb’s method were included in the study. All the patients were treated only by the side shift exercise and their treatment was started after skeletal maturity. Skeletal maturity was diagnosed by Risser’s method as either grade IV or grade V. The study comprised five men and forty-eight women. Twenty-six patients had thoracic curve, eight had thoracolumbar curve, and nineteen had double major curve. Patients were instructed to shift their trunk to the concavity of the curve repetitively while they were standing and to maintain the side shift position while they were sitting. In double major curve, larger curve was the subject of the treatment. The average age at the beginning of the treatment was 16.3 years (range, 13 to 27 years), and the average age at final follow-up was 19.8 years (range, 14 to 33 years). The average follow-up period was 3.5 years (range, one to 11 years). The average Cobb angle at the beginning of the treatment was 33.3 degrees (range, 20 to 74 degrees), and the average Cobb angle at final follow-up was 32.2 degrees (range, 10 to 73 degrees). Curves of four patients decreased 10 degrees or more. Most of long term follow-up studies reported that untreated idiopathic scoliosis progressed even after skeletal maturity. Although the follow-up period was much shorter, results of the present study suggested that the side shift exercise was a useful treatment option for the management of idiopathic scoliosis after skeletal maturity.
The purpose of this study was to describe a clinical evaluation of the etiological factors in osteochondritis dissecans (OCD) of the knee from radiographic and arthroscopic findings. Twenty-two knees of 20 patients (16 male and 4 female, 16.1 years old in average at surgery) with symptomatic OCD of the femoral condyle were studied. The medial femoral condyles were affected in 16 knees of 14 patients (medial group) and the lateral femoral condyle in 6 knees of 6 patients (lateral group). These two groups were compared using radiological location and arthroscopic findings. In radiography, the location of OCD was classified in accordance with Cahill et al. (1989). On the anteroposterior view, five zones were numbered 1 to 5 from medial to lateral. On the lateral view, three zones were labeled A,B and C from anterior to posterior. In the medial group, the locations of OCD were 23BC(12), 2BC(1), 23ABC(1) and 23C(2); 14(88%) of 16 knees involved in non-meniscal area. In the lateral group, the locations of OCD were 45C(4), 5C(1) and 4BC(1); 5(83%) of 6 knees involved in meniscal area. In arthroscopy the medial group did not have medial meniscal tear, while the lateral group had 5 lateral meniscal lesions of 6 knees; 3 discoid meniscus (2 with tear and 1 without tear), 2 bucket-handle type tear and one no meniscal lesion. Lateral meniscal lesions (with or without discoid) might cause OCD of the lateral femoral condyle. In the medial femoral condyle, we thought that OCD did not relate to meniscal lesions.
The purpose of this study is to elucidate the possibility of an ideal joint alignment after monofocal lengthening of tibia in achondroplastic patients. In 10 cases of the alignments of knee and ankle joints of tibias in which plane radiographs were examined.Unilateral fixators were applied to both tibias,after lengthening in the normal manner, deformity was corrected manually in a single procedure without anesthesia. In order to determine the amount of angle to be corrected, a line was first drawn on the radiograph from the center of the knee joint to the center of the ankle joint. (This line is named the Knee-ankle line: KAL). Next we drew a line along the ankle joint and measured the angle between this line and KAL. We also drew a line across the tibial plateau and measured the medial angle between this line and KAL. We tried to align the ankle joint perpendicular to KAL and the medial angle between the tibial plateau and KAL at 87 degrees , instead of trying to align the axis of the tibial shaft perfectly straight. The medial angles between the line across the tibial plateau and KAL were corrected to 86 degrees in average, with a range from 84 to 90 degrees, and the medial angles between the line across the ankle joints were corrected to 87 degrees in average, ranging from 80 to 90 degrees in result. In conclusion, joint alignments of tibias in achondro-plastic patients were able to be corrected successfully without any complications using our monofocal lengthening technique. And severe varus deformities of tibias can be corrected even with monofocal lengthening technique by trying to correct the alignments of knee and ankle joints rather than trying to straighten tibial shafts.
To clarify the normal range of articular cartilage volumes of the patella and femur in the human knee joints of healthy adults using three-dimensional magnetic resonance imaging and to analyze the correlation of the articular volumes with the background characteristics. Fifty seven knees of 57 healthy volunteers aged from twenties to forties (30 males and 27 females), who had no past history of joint disease or trauma in the legs, were imaged by a fat-suppressed three-dimensional sequence (SPGR; 1.5T GE; Horizon LX 8.2.5) The obtained data were analyzed by 4 examiners independently with a computer workstation, and a average of the four was adopted as the articular volume. Analyzed characteristics factors of the volunteers were: age, body weight, height, leg length, foot size, circumference of the thigh and lower leg, quadriceps angle, foot angle, body-mass index, and general laxity. The mean articular cartilage volume was 7.2 +- 1.6 ml. It was significantly larger in males than in females. Concerning the relationship between the volume and the characteristic factors, there was a significant correlation of the cartilage volume with the foot size in males (r=0.47), and with height, leg length and foot size in females (r=0.53, 0.60, 0.60, respectively), but no significant correlation with the other factors. Conclusion. The articular cartilage volumes of the patella and femur was 7.2+- 1.6 ml. The size of skeletal structure, especially the skeletal size of the lower extremity, were assumed to be important factors in estimating cartilage volume.
The purpose of this study is to report that patients of bone neoplasms were treated with external fixation.
Femoral lengthening has been associated with narrowing of the joint space at the hip. We have studied the joint space before lengthening in 20 patients with a short femur due to a femoral-shaft fracture (15) or distal femoral epiphyseal injury (5). Their mean age at injury was 16 years (3 to 27) and the mean shortening was 5.4 cm (1.1 to 14). We found that the hip joint space of the shortened femur was significantly narrower (p <
0.001) than that on the normal side, with a mean narrowing ratio of 15.5% (−5 to +43). The narrowing ratio was directly related to the period spent non-weight-bearing (p <
0.001), but not to the amount of femoral shortening. We have shown that the joint space of the hip in patients with post-traumatic femoral shortening was narrowed even before femoral lengthening had been started.
