Low-energy distal radius fractures (DRFs) are the most common upper arm fractures correlated with bone fragility. Vitamin D deficiency is an important risk factor associated with DRFs. However, the relationship between DRF severity and vitamin D deficiency is not elucidated. Therefore, this study aimed to identify the correlation between DRF severity and serum 25-hydroxyvitamin-D level, which is an indicator of vitamin D deficiency. This multicentre retrospective observational study enrolled 122 female patients aged over 45 years with DRFs with extension deformity. DRF severity was assessed by three independent examiners using 3D CT. Moreover, it was categorized based on the AO classification, and the degree of articular and volar cortex comminution was evaluated. Articular comminution was defined as an articular fragment involving three or more fragments, and volar cortex comminution as a fracture in the volar cortex of the distal fragment. Serum 25-hydroxyvitamin-D level, bone metabolic markers, and bone mineral density (BMD) at the lumbar spine, hip, and wrist were evaluated six months after injury. According to DRF severity, serum 25-hydroxyvitamin-D level, parameters correlated with bone metabolism, and BMD was compared.Aims
Methods
Total knee arthroplasty (TKA) is an effective surgical intervention, which alleviates pain and improves function and health-related quality of life in patients with end-stage arthritis of the knee joint. With improvements in anesthesia, general health care, and surgical techniques, this procedure has become widely accepted for use in very elderly patients. However, many elderly patients tend to have compromised function and low reserve capabilities of organs and are therefore likely to develop various complications during the perioperative period. Thus, elderly patients often hesitate to undergo simultaneous bilateral TKA (SBTKA). Our purpose was to report the short-term results and clinical complications of octogenarians undergoing SBTKA. Between 2015 and 2016 all patients greater than 80years of age who underwent SBTKA by a single surgeon were retrospectively evaluated demographics, comorbidity, complications, and 30days mortality following SBTKA. Arthroplasty was performed sequentially under general anesthesia by one team led by primary surgeon. After the first knee, the patient's cardiopulmonary status was assessed by anesthesiology to determine whether or not to begin the second side. Cardiopulmonary decompensation, such as significant shifts in heart rate, oxygen saturation or blood pressure, was not showed. Then the second procedure was undertaken. Inclusion criteria of this study was underlying diseases were osteoarthritis. Exclusion criteria were (1) previous knee surgery; (2) underlying diseases were osteonecrosis, rheumatoid arthritis, fracture, and others. Fifty-seven patients with an average age of 82.7years were identified. The results of these procedures were retrospectively compared with those of patients greater than 80years of age of 89 patients unilateral TKA (UTKA) that had been performed by the same surgeon.Introduction
Materials and Methods
It has been reported that the rate of complications around the patella after Total Knee Arthroplasty(TKA) is 1–12%, and the patella dislocation is the most common one. We will report a case that had the patella dislocation after TKA caused by malrotation of the components.INTRODUCTION
PURPOSE
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.
The purpose of this study is to evaluate stiff knees which have a preoperative arc of motion (AOM) < 65 degrees and maximum flexion < 90 degrees under anesthesia for primary TKA. We prospectively evaluated 25 knees, 20 patients, the follow up period was 5±3 years, OA 13, RA 10 and traumatic OA 2 knees. All case were medial para-patella approaches and snip was added in one knee operation, 23 PS-type and 2 constrain-type TKAs.Purpose
Material and Methods
Appropriate soft tissue balance is an important factor for postoperative function and long survival of total knee arthroplasty(TKA). Soft tissue balance is affected by ligament release, osteophyte removal, order of soft tissue release, cutting angle of tibial surface and rotational alignment of femoral components. The purpose of this study is to know the characteristics of soft tissue balance in ACL deficient osteoarthritis(OA) knee and warning points during procedures for TKA. We evaluated 139 knees, underwent TKA (NexGen LPS-Flex, fixed surface, Zimmer) by one surgeon (S.A.) for OA. All procedures were performed through a medial parapatellar approach. There were 49 ACL deficient knees. A balanced gap technique was used in 26 ACL deficient knees, and anatomical measured technique based on pre-operative CT was used in 23 ACL deficient knees. To compare flexion-extension gaps and medial- lateral balance during operations between the two techniques, we measured each using an original two paddles tensor (figure 1) at 20lb, 30lb and 40lb, for each knee at a 0 degree extension and 90 degree flexion. We measured bone gaps after removal of all osteophytes and cutting of the tibial surface, then we measured component gaps after insertion of femoral components. Statistical analysis was performed by t-test with significant difference defined as P<0.05.INTRODUCION
METHODS
The results of modified gap balancing and measured resection technique have been still controversial. We compared PS-type TKAs for osteoarthritis performed using the modified gap technique and the measured resection to determine if either technique provides superior clinical results. The modified gap technique was used in 85 knees, and the measured technique using preoperative CT was used in 70 knees. To compare intra-operative soft tissue balance, bone gap and component gap were measured using original two paddle tensor (20,30,40lb) at 0 degree extension and 90 degrees flexion. To assess the post-operative patella congruency and soft tissue balance, we measured patella tilt, condylar twist angle (CTA) and condylar lift-off angle (LOA) in radiographs. Finally, we evaluated postoperative clinical result (1–5 years) KOOS. Statistical analysis was used by StatView.INTRODUCTION
METHODS
The systematic effects of joint replacement in rheumatoid arthritis (RA) patients are that inflamed synovium and pathological articular cartilage has dissipated. Expectations of total knee arthroplasty (TKA) are reduction of inflammatory cytokines, decreased disease activity and improvement of drug efficacy and ADL. Remission of rheumatoid arthritis is defined as having a Disease Activity Score DAS28 (ESR) of less than 2.6 and Health Assessment Questionnaire (HAQ) – Disability Index, less than 0.5. We investigated whether TKA could reduce disease activity and improve ADL, and subsequent remission levels of DAS and HAQ or not.Introduction
Purpose
Malrotation of a femoral component is a cause of patellofemoral maltracking after total knee arthroplasty (TKA). We have developed a balanced gap technique in posterior stabilized total knee arthroplasty (PS-TKA) using an original tensor instrument. One of characteristics of this instrument is the ability to measure gaps even if there is a bone defect, because it has two paddles, and we can attach block augmentations. In addition it can measure the gap after a reduction of the patella with an offset mechanism. In the balanced gap technique, the femoral component rotation is decided by a tibial cut surface and ligaments balance using the tensor device. This study investigated retrospectively whether rotational alignment of femoral component rotation influenced patellofemoral joint congruency in PS- TKA. We evaluated the radiographs of 52 knees of 42 patients, who underwent TKA (NexGen LPS-Flex, fixed surface, Zimmer) by one surgeon (S.A.) for osteoarthritis or rheumatoid arthritis. All procedures were performed through a medial parapatellar approach and a balanced gap technique using a developed versatile tensor device. We measured lateral patella tilt and lateral patella shift at post-op. 6 months. To assess the rotational alignment of femoral component rotation, condylar twist angle (CTA) was measured, and to assess the postoperative flexion gap balance, a condylar lift-off angle (LOA) was measured using the epicondylar view radiographs.Introduction
Material and Methods
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 assumption that symmetric extension-flexion gaps improve the femoral condyle lift-off phenomenon and the patellofemoral joint congruity in total knee arthroplasty (TKA) is now widely accepted. For tease reasons, the balanced gap technique has been developed. However, the management of soft tissue balancing during surgery remains difficult and much is left to the surgeon's feel and experience. Furthermore, little is known about the differences of the soft-tissue stiffness (STS) of medial and lateral compartment in extension and flexion in the both cruciate ligaments sacrificed knee. It has a deep connection with the achievement of appropriate gaps operated according to the balanced gap technique. Therefore, the purpose of this study was to analyze the STS of individual compartment in vivo. The subjects presented 100 osteoarthritic knees with varus deformity underwent primary posterior stabilized (PS) – TKA (NexGen LPS-flex, Zimmer, Warsaw, USA). All subjects completed written informed consent. The patient population was composed of 14 men and 68 women with a mean age of 74.5 ± 7.5 years. The average height, weight, BMI, weight-bearing femorotibial mechanical angle (FTMA), the patella height (T/P ratio), extension and flexion angle of the knee under anesthesia were 151.9 ± 7.8 cm, 62.1 ± 9.4 kg, 26.9 ± 3.7 kg/m2, 167.7 ± 5.6 °, 0.91 ± 0.15 °, −12.0 ± 6.7° and 129.4 ± 13.8°, respectively. After finishing osteotomy and soft tissue balancing, the femoral trial prosthesis was fitted with patello-femoral joint reduction. Then, the medial and lateral compartment gaps (CG) were measured at various distraction forces (89–178 N) using a newly developed versatile tensor device at full extension and 90° flexion positioning, respectively. (Fig. 1) The STS (N/mm) was calculated from a load displacement curve generated by the intra-operative CG data and joint distraction force. Comparisons were made by Wilcoxon signed-ranks test. Correlations were analyzed with Pearson's correlation coefficient. Predictive variables were analyzed with Stepwise regression. A value of p < 0.05 was considered significant.Introduction:
Materials and Methods:
Conventional understanding of knee kinematics suggests that the femoral component should be rotationally aligned parallel to the surgical epicondylar axis (SEA). In contrast, the balanced gap technique suggests the knee be balanced in extension and flexion to achieve proper kinematics and stability of the knee without reference to fixed bony landmarks. To investigate the functional flexion-extension axis (FFEA) when a balanced gap technique was used in the posterior-stabilized total knee arthroplasty (PS-TKA), the relationships between rotational alignment of the femoral component to the postoperative flexion gap balance and to the tibial mechanical axis were evaluated radiographically. In this prospective study, 63 consecutive knees in 50 patients were included with medial osteoarthritis undergoing a primary PS-TKA (NexGen LPS-Flex, fixed surface, Zimmer; Warsaw, USA). All subjects completed written informed consent. The patient population was composed of 8 men and 42 women with a mean age of 73.0 ± 7.7 years. The average height, weight, BMI, weight-bearing femorotibial mechanical angle (FTMA), condylar twist angle (CTA), and the patella height (T/P ratio) were 150.9 ± 7.2 cm, 62.3 ± 10.1 kg, 27.3 ± 4.0 kg/m2, 167.8 ± 5.5°, 5.9 ± 1.6° and 0.94 ± 0.15, respectively. All procedures were performed through a medial parapatellar approach and a balanced gap technique used a newly developed versatile tensor device. Pre- and post-operatively, the CTA was evaluated using computed tomography (CT). To assess the postoperative flexion gap balance, a condylar lift-off angle (LOA) was evaluated using the epicondylar view radiographs. The FTMA and coronal alignment of the tibial component in reference to the tibial mechanical axis (angle β) were evaluated using plain AP radiography. The FFEA (angle θ) of the knee was calculated as the following; (angle β) + (post-operative CTA) – (LOA). Correlations were analyzed with Pearson's correlation coefficient. Predictive variables were analyzed utilizing Stepwise regression. A value of p < 0.05 was considered significant.Introduction:
Materials and Methods:
Malrotation of the femoral component is a cause of patellofemoral maltracking after total knee arthroplasty. We have developed a balanced gap technique in posterior stabilized total knee arthroplasty using an original instrument. Patellar instability is associated with an increased the tibial tubercle and the center of the groove (TT-TG) distance > 20 mm, and TT-TG is regarded as one index of a factor influencing congruity. To assess the influence on a patellofemoral joint by a modified gap technique, the purpose of this study is to compare the TT-TG distance before surgery and after total knee arthroplasty. We explored the 30 knees, 25 patients (4 male and 21 female), who underwent total knee arthroplasties (NexGen LPS-Flex, fixed surface, Zimmer; Warsaw, USA) for osteoarthritis or rheumatoid arthritis. All procedures were performed through a medial parapatellar approach and a balanced gap technique used a developed versatile tensor device. We compared the preoperative and postoperative CT at a knee flexion angle of 30 degrees. To assess the force vector of the extensor mechanism, TT-TG distance and the proximal-distal distance between the entrance of the tracheal groove and the tibial tubercle (ET-TT distance) were measured in CT. The relation of both distances (TT-TG index) that divided TT-TG in ET-TT was calculated, because the TT-TG distance was affected by the individual knee size. Three dimensional Q-angle (θ) was also calculated using TT-TG distance and ET-TT distance, sinθ = TT-TG distance/ET-TT distance. (Figure 1)Introduction
Material and 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
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
The assumption that symmetric extension-flexion gaps improve the femoral condyle lift-off phenomenon and the patellofemoral joint congruity in total knee arthroplasty (TKA) is now widely accepted. Conventional understanding of knee kinematics suggests that the femoral component should be rotationally aligned parallel to the surgical epicondylar axis (SEA). On the other hand, the theory of the balanced gap technique suggests the knee be balanced in extension and flexion to achieve proper kinematics and stability of the knee without reference to fixed bony landmarks. The purpose of our study was to evaluate the relationship between rotation alignment of the femoral component and postoperative flexion gap balance, and the femoral rotational alignment in relation to the tibial mechanical axis in patients when implanted using a balanced gap technique. The subjects presented 53 consecutive osteoarthritic (OA) varus knees underwent primary Posterior-Stabilised (PS) -TKA (NexGen LPS-flex, Zimmer). All subjects completed written informed consent. The patient population was composed of 7 men and 35 women with a mean age of 72.5 ± 8.3 years. The average height, weight, BMI, weight-bearing FTA, and the patella height (Insall-Salvati ratio: T/P ratio) were 151.7 ± 7.7 cm, 62.6 ± 11.8 kg, 27.2 ± 4.5, 184.9 ± 5.9° and 0.93 ± 0.14 respectively. All procedures were performed through a medial parapatellar approach and a balanced gap technique used a newly developed versatile tensor device which can measure the medial and lateral gaps individually and make use of the balanced gap technique guide with patellofemoral joint reduction, which had been introduced in 56th ORS 2010. Pre- and post-operatively, a condylar twist angle (CTA) was evaluated using computed tomography (CT). To assess the postoperative flexion gap balance, a condylar lift-off angle (LOA) was evaluated using the epicondylar view radiographs by adding a 1.5 kg weight at the ankle. Coronal alignment of the tibial component in reference to the tibial mechanical axis (angle θ) was evaluated using plain AP radiography. Data were expressed as mean ± SD and analysed with Stat View version 5.0.Introduction
Materials and Methods
The purpose of this study is to report that patients of bone neoplasms were treated with external fixation.
