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Eiji Suenaga, Yasuo Noguchi, Seiya Jingushi, Toshihide Shuto, Yasuharu ...
2003 Volume 52 Issue 1 Pages
1-4
Published: 2003
Released on J-STAGE: April 28, 2004
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We observed ultrasonographic blood flow findings of the nutritional artery of the recollapsed femoral head in patients with osteonecrosis treated by transtrochanteric rotational osteotomy of the femoral head. Between July 1998 and September 2000, the nutritional artery of 26 hips (23 patients) were observed intraoperatively by ultrasonography. After rotating the femoral head, the nutritional artery was checked by ultrasonography in fibrofatty tissue beneath divided quadratus femoris muscle seven times while changing the angle of hip flexion. The patients consisted of 16 males and seven females with a mean age of 41 years (age range: 23 to 60 years). Recollapsed femoral head was identified in five (19%) of the 26 patients after one year or more followup. The hips of the recollapsed femoral head confirmed ultrasonographic flow at an average of one (range: 0 to 3 times), and the hips without recollapsed femoral heads demonstrated a mean four times (range: 2 to 7 times). There was significant difference between with and without recollapse. We conclude that ultrasonographic findings of the nutritional artery is helpful for assessing the short-term results of hips treated by transtrochanteric rotational osteotomy of the femoral head.
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Toshiyuki Ishiko, Masatoshi Naito, Isao Asayama, Tetsu Yamaguchi, Yuic ...
2003 Volume 52 Issue 1 Pages
5-9
Published: 2003
Released on J-STAGE: April 28, 2004
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The purpose of the present study is to report the mid-term results of modified Sugioka transtrochanteric valgus ostetomy (TVO) for the treatment of secondary osteoarthritis. The lateral displacement of the greater trochanter was simultaneously performed. Fourteen TVOs were performed in 14 patients with unilateral osteoarthritis of the hip from 1993. We assessed 8 hips in 8 patients in this study. The mean age of the patients at the time of surgery was 46.4 years (41 to 55 years). The average follow-up was 3.9 years (2.4-7.2years). The patients were evaluated for radiographic changes of the joint space, roof osteophyte, weight bearing surface of acetabulum, AHI, abductor lever arm, capital drop, bone cyst in the acetabulum or femoral head as well as clinical results using JOA score. The mean JOA score improved from 57.4 to 76.3. The widening of joint space, lengthening of weight bearing surface of acetabulum were seen in seven hips. The length of the abductor lever arm after surgery was not proportional to the JOA score at the latest follow-up. In one patient, total hip arthroplasty was required after 2.2 years. This procedure is considered useful for the treatment of osteoarthritis in dysplastic hips.
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Taketoshi Kanazawa, Takahiro Okawa, Manabu Kubo, Masaru Kumagai, Shini ...
2003 Volume 52 Issue 1 Pages
10-17
Published: 2003
Released on J-STAGE: April 28, 2004
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We report the results of a long-term follow up study of Chiari pelvic osteotomy for early stage coxarthrosis with severe acetabular dysplasia. The subiects were 14 hips in 14 Ninomiya-type 2 patients. The average age at the time of operation was 23.7 years and the average follow up term after operation was 13 years and 6 months. Twelve hips underwent only Chiari procedure and 2 hips underwent Chiari procedure combined with varus osteotomy. The clinical result showed improved pain and total JOA score (pain: from 23.9 to 33.6 points, total: form 73.9 to 85.4 points). The radiographic assessment showed that only one hip progressed in stage.
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Tetsu Yamaguchi, Masatoshi Naito, Isao Asayama, Toshiyuki Ishiko, Moto ...
2003 Volume 52 Issue 1 Pages
18-22
Published: 2003
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Arthroscopic synovectomy can be useful for management of inflammatory conditions, but total synovectomy is difficult using current techniques. Traditional open synovectomy requires dislocation of the femoral head from the acctabulum, with the inherent risk of avascular necrosis and prolonged rehabilitation period. The purpose of this report of two cases is to describe the indication of arthroscopic surgery for the treatment of the synovial chondromatosis of the hip joint.
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Tadahito Yamamoto, Takahiro Kishi, Toru Yonei
2003 Volume 52 Issue 1 Pages
23-28
Published: 2003
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The authors present a case of Charcot joint of the hip joint treated with cementless bipolar hip prosthesis. A 52-year-old man presented with a painless limp. Examination revealed a positive Romberg sign, positive Argyll Robertson pupil, and depression of pallesthesia in his left lower limb. Serum treponema pallidum hemagglutination was positive. Radiograph showed fracture of the femoral neck and typical Charcot joint on his left hip joint. Femoral head prosthetic replacement was carried out without bone cement. During the one-year follow-up, the case did not develop dislocation or loosening of the prosthesis.
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Mitsuru Sakaguchi, Nobuyuki Hirai, Masaki Kinjo, Ogimoto Shinsaku
Article type: Others
Subject area: Others
2003 Volume 52 Issue 1 Pages
29-34
Published: 2003
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Herein is reported the results of revision endoprosthesis with an Exeter stem, using impaction cancellous allografts and cement. One male and two females underwent primary endoprosthesis with cement at other hospitals, using non-Exeter stems to correct the fracture of the neck of the femur. The mean age at the time of primary intervention was 74.0 years (ranging from 70 to 84 years). At the mean 8 year-follow-up period (ranging 1 to 13 years) after the first operation, loosening of the primary endoprosthesis occured with severe pain and revision surgeries with Exeter stems were performed by the first author, using impaction bone grafting technique. In all three hips reviewed at the mean follow-up period of 13 months after revision surgery, there were no complications and satisfactory results with evidence of graft incorporation were observed.
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Kazumasa Maeda, Toshimitsu Koga, Tadatsugu Morimoto, Yukihiko Tsutsumi ...
2003 Volume 52 Issue 1 Pages
35-38
Published: 2003
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We present short-term results of cementless total hip arthroplasties (THA) in the aged. 36 consecutive patients (38 hips) who underwent THA from March 1999 to December 2001 were enrolled in the study. The subjects were 80 years old or above, and the mean age was 84.0 years (range 80 to 95 years). There were 33 women and 3 men. Primary THA was 35 hips and revision THA was 3 hips. Preoperative diagnosis was 21 cases of osteoarthoritis, 5 rapidly destructive coxarthropathy, 9 fracture, and 3 necrosis of the femoral head. The mean follow-up period was 15 months (6 to 36 months). We evaluated clinical and roentgenographic results. Two patients had thigh pain. They started walking execises in postoperative 6.5 days. All cases were defined as bone ingrowth fixation. There were no roentogenographical loosening and sinking. We concluded that short-term results of cementless THA in the aged is an efficacious treatment.
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Tokushige Nishizato, Hiroaki Kiya, Takao Yuge, Toru Fujimoto, Manabu T ...
2003 Volume 52 Issue 1 Pages
39-42
Published: 2003
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The results of 53 consecutive primary total hip arthroplasties using the anatomic locking hip system were reviewed for cases over 5 years old. The clinical JOA score of 45.9 points improved to 85.4 points post operatively. In roentgenographic assessment of femoral component, 44 joints were classified into bone ingrown fixation, and 9 joints into stable fibrous fixation. There was no unstable fixation, and no revision surgery was performed.
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Kenji Taguchi, Shinichi Harada, Hiroshi Enomoto, Kunihiko Okano, Masuh ...
2003 Volume 52 Issue 1 Pages
43-47
Published: 2003
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We performed total hip arthroplasy (THA) using the Osteonics hip system which consists of MS type, AD type and HA type. All patients underwent THA from 1990 to 1997 and were followed up for more than five years. There were 32 hips (4 males and 28 females) in 29 patients with an average age of 53 years (range: 34 to 64). The follow-up time ranged from 5.2 years to 10.9 years, averaging 8.2 years. MS type was used in 12 patients, AD type in 14 patients, and HA type in 6 patients. We evaluated the clinical results using the JOA score, and change in migration, subsidence, and osteolysis on X-ray. During the follow-up period of about 6 years, the JOA score of the HA type was higher than the other types. No migration, subsidence, or osteolysis was found in any type, but osteogenesis was detected in the HA type for the most port.
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Risako Yamamoto, Itsushi Baba, Tadayoshi Sumida, Hideki Manabe, Akihis ...
2003 Volume 52 Issue 1 Pages
48-51
Published: 2003
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The authors operated on 61 tumors of the cervical spinal cord from 1980 to 2000, of which 15 were dumbbell tumors. Two were resected by anterior approach, 8 by posterior approach, and 7 by both the anterior and posterior approaches simultaneously. To preserve the alignment of neck, laminoplasty or partial laminectomy with bone graft was performed. The tumors were resected including the capsule to prevent recurrence, and gross total resection was achieved in 13 patients. There were no symptoms of recurrence.
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Yoshiya Arishima, Kazunori Yone, Yoshihiro Ryoki, Kosei Ijiri, Ginryu ...
2003 Volume 52 Issue 1 Pages
52-55
Published: 2003
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Selective muscle release (Matsuo’s method) was performed on five patients with cervical myeloradiculopathy due to athetoid cerebral palsy. After operation, their symptoms, including involuntary motion of the neck, neck pain, muscle weakness of upper extremities, improved. However, laminoplasty was performed on a patient with severe myeopathy. Using this procedure, cervical spinal segmental instability due to involuntary motion of the neck and hyper-tonus of cervical muscles was reduced. We believe that this procedure may be useful when selected for the treatment of cervical myeloradiculopathy combined with athetoid cerebral palsy, especially in patients showing mild neurological deficient.
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Taisei Matsumoto, Masayoshi Oga, Jyunichi Arima, Ko Ikuta, Soichiro Na ...
2003 Volume 52 Issue 1 Pages
56-59
Published: 2003
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This study reviewed an over 5-year follow-up results of 21 patients who underwent anterior spinal fusion for cervical degenerative spondylosis between 1989 and 1996. The average patients age was 50.7 years. The mean JOA score improved to 16.0 on the last follow-up from the preoperative score of 13.2. Clinical success was defined according to Hirabayashi’s scale. The average was 73.7%. The latest X-p showed increase of the range of motion (19 out of 21 cases) and degeneration (12 out of 21 cases) in intervertebral disc adjacent to the fused disc. We recommend long term follow-up, because of the risk of cervical disc herniation and the progress of degenerative spondylosis in intervertebral disc adjacent to the fused disk.
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Kimiaki Sato, Noriyuki Ando, Kenjiro Nakama, Kensei Nagata
2003 Volume 52 Issue 1 Pages
60-63
Published: 2003
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We investigated the clinical results in 28 young adult patients with cervical myelopathy under 40, from January 1990 to December 2001. Four patients were female and 24 were male. The diagnosis was disc herniation in 19 patients, ossification of the posterior longitudinal ligament (OPLL) in 3, athetoid cerebral palsy in 3, Klippel-Feil syndrome in 1, and developmental canal stenosis without other cervical disease in 2. Their mean age was 34 (22 to 40) years. Nineteen patients were treated by expansive laminoplasty, and the other 9 by anterior interbody fusion. The operative results were evaluated according to the Japanese Orthopaedic Association (JOA) score, after a mean follow-up period of 44 (2-139) months. The mean JOA score was 11.0 points before surgery and 15.1 points after surgery. The overall mean recovery rate by JOA score was 63.2%. The preoperative and postoperative JOA scores were significant lower in patients with a preoperative long duration of symptoms compared with patients with a short duration of symptoms before surgery. These results suggest that early surgical treatment provides satisfactory results in young adult patients with cervical myelopathy.
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Tosihiko Izumi, Shunji Matsunaga, Hikaru Sakamoto, Yasuomi Kawasoe, Jy ...
2003 Volume 52 Issue 1 Pages
64-66
Published: 2003
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Object: The postoperative quality of life of patients with cervical spondylotic myelopathy(CSM) ramains unclear. The current study evaluated occupational recovery after surgical treatment for patients with CSM. Method: Across sectional survey was performed using 70 patients with CSM who were employed prior to surgical treatment. Pre-surgical occupations were classified into three categories; light sedentary, light labor, and heavy labor. High-rise workers and automobile drivers were analyzed separately. The subjects were rated by occupational category for occupational recovery ratio. Factors analyzed for impact on recovery were pre- and post-surgery severity of myelopathy, age at surgery and gender. Of the 70 patients studied, 38 (54%) returned to work. Poor results were observed in heavy labor, high-rise workers and professional drivers. The length of time required for return to work differed among occupations. The category of occupation, pre-surgery severity of myelopathy, and post-surgery severity of myelopathy correlated significantly with occupational recovery. Conclusion: Patient occupation should be carefully considered when designing post-surgery occupational rahabilitation programs. In addition, postoperative advice on suitability of occupation should be provided to patients.
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Kei Yamada, Kenji Yoshida, Hisashi Yamashita, Hisashi Hoshiko, Hidetom ...
2003 Volume 52 Issue 1 Pages
67-72
Published: 2003
Released on J-STAGE: April 28, 2004
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This study was counducted on 41 patients with atlantoaxial rotatory fixation (AARF) consisting of 24 males and 17 females, whose age ranged from 3 to 26 years with an average age of 7.1 years, and who were seen at our hospital zero to 53 days after AARF onset. Nine patients were treated by neck color fixation, 31 patients treated by Glisson’s traction and one was lying on the bed with the neck fixed by the sandbags primarily. In 5 of the 9 patients treated by the neck color, torcicollis, restricted neck motion, and pain did not improve and therefore they were treated by Glisson’s traction. In all patients treated by Glisson’s traction, torcicollis and neck pain improved completely. However, 4 patients (according to Fielding’s classification: type-1; two patients and type-2; two) sustained recurrence. Three patients with the recurrence were not fixed by neck color after correction of deformity Glisson’s traction. A patient who was injured in falling (major trauma) was fixed by the neck color after the correction of deformity. These results suggest that AARF induced by major trauma should be primarily treated by Glisson’s traction, and additional neck color fixation should be done after correction of deformity by Glisson’s traction.
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Satoshi Wake, Masao Eto, Tadashi Tomonaga, Kazuhiro Takahara, Manabu K ...
2003 Volume 52 Issue 1 Pages
73-76
Published: 2003
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A case of pyogenic lumber facet infection is reported. A 15-years-old man had lumbago and a fever of 38 degress. Lumber X-ray indicated scoliosis and blood tests showed increased leukocyte count and C-reactive protein (CRP). He had tenderness and local heat of the right para vertebral muscle (PVM). The soft tissue surrounding the right L2/3 facet joint and PVM showed abnormal intensity on Magnetic resonance imaging (MRI). For the reasons mentioned above, we diagnosed the illness as pyogenic lumber facet joint infection. Centesis was performed using computed tomography (CT), and as a result, a little yellow pus was extracted from the facet joint. Staphyrococcus aureus was detected by the cultivation of bacteria. He was given an intravenous drip infusion of the suitable antibiotic. Six days later, clinical symptoms inproved and 25 days later, infection signs normalized. MRI was proved useful in the diagnosis of this disease.
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Kohei Yamasaki, Hideo Yasumatsu, Fumito Tanabe, Naoya Kawabata, Yuichi ...
2003 Volume 52 Issue 1 Pages
77-80
Published: 2003
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Generally, the treatment for intervertebral pyogenic spondylitis consists of external fixation, chemotherapy, and rest in bed. Cases requiring surgical treatment are rare, but we performed operation percutaneous discectomy for these two cases who resisted conservative therapy, and obtained satisfactory results. Both cases showed improvement. The duration of intravenous drip of antibiotics is until the CRP, ESR and, WBC data normalized. Internal use of antibiotics was maintained for twelve weeks. External fixation was used until clinical symptoms, serum chemistry, and image normalized. Percutaneous discectomy in toponarcosis is effective for medical treatment.
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Fumie Kyushima, Takafumi Nakamura, Taro Kikuchi, Yoshihiro Sakamoto, Y ...
2003 Volume 52 Issue 1 Pages
81-86
Published: 2003
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We report on 8 cases with pyogenic spondylitis comprised of 5 males and 3 females, for which early correct diagnosis was not made and treatment for different diseases was given. Five out of 8 cases were treated as collagen diseases and given steroids, 2 cases were diagnosed as matastasis of malignancy to the spine, and the last as respiratory infection. In 7 cases, even when lesions on X-rays were too small to achieve correct diagnosis as spondylitis, MRI was helpful by providing characteristic findings such as low intensity area on T1 weighted image and high on T2. However, in one case with cervical spondylitis, MRI taken at an early stage did not reveal a small pyogenic spondylitis lesion. To prevent overlooking pyogenic spondylitis, we should therefore pay particular attention to making correct diagnosis for patients with neck or back pain, and symptoms of inflammation.
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Kyoji Hayashi, Kazunori Yone, Shunji Matsunaga, Kosei Ijiri, Yoshihiro ...
2003 Volume 52 Issue 1 Pages
87-89
Published: 2003
Released on J-STAGE: April 28, 2004
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We performed video-assisted thoracoscopic surgery (VATS) combined with posterior surgery for two patients with dumbbell tumor at the thoracic level. The patients were a 35-year-old male and a 51-year-old female. Following the resection of the intra-spinal-canal portion of the tumor with posterior approach, the intra-thoracic lesion was resected using VATS instead of conventional approach in both patients. Complete resection of tumor was successfully performed without neurological complication. VATS is useful for the treatment of dumbbell tumor at the thoracic level.
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Koji Mori, Hiroshi Hamamoto, Akihiko Kasuya
2003 Volume 52 Issue 1 Pages
90-92
Published: 2003
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The purpose of these studies is to clarify the safety and effectiveness of antibiotics-impaired calcium phosphate cement. We measured amikacin density in the following cases: (1) In the saline preserving amikacin-impaired calcium phosphate cement; and (2) In the serum and drained blood in clinical use of amikacin-impaired calcium phosphate cement. The results are following: (1) Effective amikacin density continued for 7 days in the saline; and (2) Amikacin density is quite low in serum. For drained blood, effective amikacin density continued for 2 days. Consequently, amikacin-impaired calcium phosphate cement is safe effective for clinical use.
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Teruaki Izaki, Akio Matsuzaki
2003 Volume 52 Issue 1 Pages
93-96
Published: 2003
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Patients consulting orthopedics often receive alternative treatment. We report two cases developing complications due to alternative treatment. Case1 was a 78-year-old female with degenerative spondylolisthesis whose neurological symptoms aggravated due to alternative treatment. Case2 was an 80-year-old female suffering T11 and 12 compression fractures by spinal manipulation. This paper discusses the present situation and problems of alternative treatment in Japan.
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Takayuki Yamaguchi, Masao Eto, Tadashi Tomonaga, Kazuhiro Takahara, Ma ...
2003 Volume 52 Issue 1 Pages
97-100
Published: 2003
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To determine the accuracy of MR Arthrography (MRA) in the classification of SLAP lesions, we investigated 15 patients (15 men, average 27.5 years) who underwent MRA before arthroscopic operation from 1998 to 2001. Based on the Snyder’s classification, we defined the diagnostic criteria for classification of SLAP lesion on MRA: Type I shows irregularity of the labrum, without evidence of detachment from the superior glenoid rim. Type II shows complete detachment of the bicipital-labral complex. Type III shows detachment and inferior displacement of the superior labrum. Type IV shows Gd-DTPA dissecting into the biceps tendon. MRA findings correlated with arthroscopic findings. In MRA, 4 patients were diagnosed as type I, 10 type II, and 1 type IV. But in surgical findings, 3 out of the 4 patients diagnosed as type I were type II, and 3 out of the 10 patients (type II) were type I. MRA had a sensitivity of 25%, specificity of 73%, accuracy of 60% in type I, and sensitivity of 70%, specificity of 40%, accuracy of 60% in type II. The MRA classification corresponded with those of arthroscopy in 9 out of 15 patients (60%). MRA is a useful technique in the diagnosis of SLAP lesion, but classification is still difficult.
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Mako Hirano, Kazutoshi Nomura, Noburo Hashimoto, [in Japanese], Kenji ...
2003 Volume 52 Issue 1 Pages
101-105
Published: 2003
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We report a case of septic arthritis of the shoulder joint treated by arthrotomy followed by open wound and early motion exercie. The patient was a 55-year-old male taxi driver. The infecting organism was methicillin-resistant staphylococcus aureus. At first he was treated by arthroscopic debridment which had no effect. Then we performed arthrotomy followed by open wound and early motion exercise. This open wound method was successful for infection. Concomitant antibiotics were administrated. We think arthrotomy followed by open wound and early motion exercise is a useful method for treating arthritis of the shoulder.
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Hironori Kakoi, Yasuhisa Togo, Tadashi Ogura, Yasunari Fujii
2003 Volume 52 Issue 1 Pages
106-109
Published: 2003
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We present the results of arthroscopic rotator cuff repair in seven patients (five men and two women). The average age of patients at the time of operation was 57.3 years (range, 49 to 72 years). All of the patients were followed up for at least 6 months (average, 8 months, range 6 to 15 month). We found medium (1 to 3cm) tears in three shoulders and large (3 to 5 cm) tears in four. Six glenohumeral joints had intra-articular lesions. Crescent-shaped tears were repaired in a direct tendon-to-bone fashion with suture anchors, and U-shaped tears were repaired by using margin convergence with side-to-side sutures to converger the free margin of the rotator cuff tear to the prepared bone bed. The shoulders were evaluated using the Japanese Orthopedic Association (JOA) score. The total JOA score of all the patients improved from 61 to 88.7 points. The JOA score showed improvement in the postoperative scores for pain, function, and range of motion. Arthroscopic rotator cuff repair produced satisfactory results. The arthroscopic method has the advantages of glenohumeral joint inspection, treatment of intra-articular lesions, smaller incision, no deltoid detachment, less soft-tissue dissection, less pain, and more rapid rehabilitation.
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Keisuke Akase, Masao Eto, Tadashi Tomonaga, Kazuhiro Takahara, Manabu ...
2003 Volume 52 Issue 1 Pages
110-113
Published: 2003
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Our purpose is to evaluate the relation between the tension of the repaired rotator cuff, size of the tear, linear bands of the supraspinatus muscle scanned by MRI, and postoperative JOA score. The subjects were 18 patients (15 males, 3 females) with rotator cuff tear of the shoulder aged 52 to 74 years. We measured the tension of the repaired rotator cuff at the arm at the 0°, 30°, 60° abduction positions using a simple spring scale, and we classified into three grades the linear bands of the supraspinatus by MRI. As a result, there were two grade 1 shoulders, six grade 2 shoulders, and ten grade 3 shoulders. The larger tears require higher tension repair, in particular the tension when the arm was elevated by 30° and size of the tear were found to be related. No significant difference was seen between the size of the tear and the JOA score in this study for every grade.
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Tsuyoshi Shinoda, Yozo Shibata, Koji Midorikawa, Noriaki Honjo, Takafu ...
2003 Volume 52 Issue 1 Pages
114-117
Published: 2003
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Latissimus dorsi transfer was performed on two male patients with massive irreparable rotator cuff tears. Their ages were 60 and 50 years old. Clinical results were evaluated using the JOA score. The preoperative JOA scores were 40 and 55 points, respectively. Because, in both cases, MR images and arthroscopic findings revealed massive rotator cuff tears that could not be repaired successfully, we performed latissimus dorsi transfer. The postoperative JOA scores were 80 and 73.5 points. We concluded that latissimus dorsi transfer can serve as an alternative procedure for massive irreparable rotator cuff tears.
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Makoto Sasaki, Hidehiko Matsumoto, Mahito Kawashima, Hiroaki Tamura
2003 Volume 52 Issue 1 Pages
118-120
Published: 2003
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We detected an osteoarthritis of the glenohumeral joint in a considerably severe state by arthroscopy, which could not be detected by physical examination, X-Ray and M.R.I. before operation. A 75 years old woman suffered from right shoulder pain due to no distinct causes, and had no rotator cuff tears. We found remarkable abrasion of the articular cartilage and many free bodies in the glenohumeral joint by arthroscopy. Although treatment failed without operation, she recovered completely from glenohumeral joint lesions by arthroscopic surgery. It is necessary to pay attention to such symptoms when examining aged patients with shoulder pains.
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Kuniaki Moridera, Hiroaki Tanaka, Takashi Ikeda, Shin Fukuyama, Manabu ...
2003 Volume 52 Issue 1 Pages
121-124
Published: 2003
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A total of 13 patients with acute Tossy grade III acromioclavicular (AC) dislocation were treated operatively: 6 patients by the Neviaser method, 4 patients by the Cadenat method, and 3 patients by closed reduction and Kirschner wire fixation, between April 1994 and November 2001. The functional results of the AC joint were assessed with the 100 point scale of Kawabe et al. The mean total points of the scale were 87.4, 76.2, and 85.4, with the Neviaser method, Cadenat method, and closed reduction and Kirschner wire fixation, respectively. In conclusion, there were no significant differences in the functional results between these three operative methods.
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Tatsuki Karasugi, Hiroshi Mizuta, Eiichi Nakamura, Satoshi Kudo, Takas ...
2003 Volume 52 Issue 1 Pages
125-128
Published: 2003
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A 51-year-old woman had undergone anteromedial displacement of tibial tuberosity for the patello-femoral (PF) osteoarthritis of her left knee. At the time of surgery, an extensive area with exposure of the subchondral bone had been found at both the lateral articular surface of the patella and the opposite lateral aspect of the sulcus. She later came back working as a farmer with no symptons postoperatively. At 15 years after surgery, she underwent arthroscopic examination for traumatic chondral injury of the lateral femoral condyle. Under arthroscopy, the previous cartilage degenerative area in the PF compartment was found to be covered uniformly by a white repartative tissue, without any exposure of the subchondral bone. The pathological finding of this reparative tissue showed the characteristic feature of the fibrocartilage that has combined properties of the cartilage and fibrous tissue.
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Shusaku Matsuda, Toshihiro Ohdera, Masami Tokunaga, Shiro Hiroshima, E ...
2003 Volume 52 Issue 1 Pages
129-132
Published: 2003
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We have been using double spike plate (DSP) for fixation in anterior cruciate ligament (ACL) reconstruction using hamstrings since March 2000. A set force of 80N in male and 60N in female was applied for graft tension with the knee in full extension. We compared this procedure (DSP group; 52 patients) with manual maximum fixation using the Post screw before March 2000 (Post group; 102 patients). The purpose of this study was to clarify the clinical results of this procedure. The DSP group was significantly better than the Post group in the JOA score, Lachman and Jerk test (P<0.05). The average side-to-side anterior laxity difference with the KT-2000 arthrometer was 1.7mm in the DSP group, and 2.0mm in the Post group. No significant difference in the quadriceps and hamstring muscle strength were observed between the two groups with the Biodex machine and range of motion. There were no patients who resulted in contracture or graft failure, so the initial strength applied for the graft was not set high in this procedure.
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Hiroya Ikari, Toshihiro Ohdera, Masami Tokunaga, Shiro Hiroshima, Eiji ...
2003 Volume 52 Issue 1 Pages
133-136
Published: 2003
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Postoperative infection resulting from arthroscopic anterior cruciate ligament (ACL) reconstruction is rare. We reviewed cases associated with infection after ACL reconstructive surgery. We have performed 261 ACL reconstructions using hamstrings between September 1997 and January 2002 at out hospital. We observed 4 (1.5%) knees with postoperative infection. All patients had Staphylococcus epidermidis of the knee joint. Three patients underwent arthroscopic debridement. All 4 patients healed from the infection without removal of the ACL graft and achieved improved stability in the operated knees.
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Takuya Ikuta
2003 Volume 52 Issue 1 Pages
137-140
Published: 2003
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This study reports the clinical results of 15 patients who underwent open partial meniscectomy for isolated medial meniscus injury. In all cases, the meniscus was torn horizontally or transversely at the posterior segment or corner. Knee pain decreased without complications in all cases, and paresthesia of the anterior lower leg was observed in one case. This method is useful when the scope is limited because it can be performed without impairing the articular surface.
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Yoshiko Nishi, Teiji Katou, Toshitake Yakushiji, Yasuhiro Kawazoe, Nao ...
2003 Volume 52 Issue 1 Pages
141-144
Published: 2003
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Mobilization or total elbow arthtroplasty is indicated for advanced elbow joint osteoarthritis in elderly people. While patients with rheumatoid arthritis and/or those who are retired are suited for total arthroplasty, those still engaged in hard physical work are not. Three patients with limited elbow flexion less than 90 degrees, ages 62, 60, and 73, were treated by mobilization. Three returned their form work without any pain and instability in the elbow joint. Limited elbow flexion, 83, 75, and 80 degrees before operation improved to 140, 122, and 115 degrees three weeks post operatively. Even if advanced, severely deformed elbow joints are observed in elderly patients, and mobilization is recommended for those involved in work requiring hard labor.
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Hiroo Matsuse, Nobuhiro Tanaka, Hiroshi Inoue, Hiroki Yoshimatsu, Keij ...
2003 Volume 52 Issue 1 Pages
145-149
Published: 2003
Released on J-STAGE: April 28, 2004
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Isolated dislocation of the proximal or distal interphalangeal joint of fingers is common, but simultaneous dislocation of both joints is rare. Two cases of simultaneous dislocation of both interphalangeal joints in the same finger are reported.
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Tatsuhiro Shiroishi, Hiroshi Yasunaga, Keisuke Ohta, Hitoshi Matsunaga ...
2003 Volume 52 Issue 1 Pages
150-153
Published: 2003
Released on J-STAGE: April 28, 2004
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(Objective) Recent advances in testing equipment have facilitated more frequent diagnosis of soft tissue tumors of the hand in outpatient clinics. To determine whether location, size and morphology can aid the diagnosis of soft tissue tumors of the hand, we analyzed data obtained from patients who underwent surgery at our institution. (Methods) Histopathological diagnosis, onset order, onset location and clinical features were retrospectively evaluated from 98 soft tissue tumors of the hand and wrist that were surgically resected after 1997. (Results) The 97 tumors consisted of: 58 ganglions, 7 epidermoid tumors, 6 glomus tumors, 5 hemangiomas, 4 neurogenic tumors, 4 giant cell tumors of the tendon sheath, 3 lipomas, 3 mucous cysts, and 8 other benign tumors. None of the 98 soft tissue tumors were malignant. The most common location of ganglions was the flexor tendon sheath, followed by the dorsal side of the wrist. The majority of epidermoid cysts arose in the subcutaneous tissue of the finger, while glomus tumors tended to arise under the nails. The onset location for the other soft tissue tumors varied. Spontaneous pain and tenderness were commonly seen with the glomus tumors; tenderness was commonly seen with the hemangiomas; and tenderness and irradiating pain were commonly seen with the neurogenic tumors.
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Shigeyuki Kanai, Masazumi Kawamoto, Hiroshi Endo, Hideaki Higashino, N ...
2003 Volume 52 Issue 1 Pages
154-157
Published: 2003
Released on J-STAGE: April 28, 2004
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We investigated bone mass, tibial bone tissue, and urinary deoxypyridinoline (Dpd), as markers of bone metabolism in experimental osteopenia model (ovariectomized) rats. Decreased bone mass in all rats showed significant positive correlation with increased urinary Dpd. Moreover continuity of trabecular bone was lost in the ovariectomied rats. The findings suggest that the markers of bone metabolism can be utilized for selection of treatment, and/or evaluation of the treatment, and possibly decision-making concerning the start treatment.
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Makoto Kukita, Yoshihisa Kawauchi, Koji Samejima, Setsuro Komiya
2003 Volume 52 Issue 1 Pages
158-161
Published: 2003
Released on J-STAGE: April 28, 2004
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We used β-TCP (β-tricalcium phosphate) which is an absorbent, artificial bone filling material of absorption nature for various kinds of disorders on 8 patients, and good results were obtained. Two men and 6 women with a mean age of 61.9 years (range: 29-83 years) were treated. The breakdown of the disorders are as follows; 2 hip central migrations, 2 femur fractures after THA, 2 lumbar spine posterolateral fusions, 1 avascular necrosis of the femoral head, and 1 enchondroma of the phalanx. The follow-up period ranged from 4 months to 2 years (average: 1 year). β-TCP was absorbed in several months, to serve as a self bone substitut, and enough synostosis was provided. Complications such as heterotopic ossification or foreign body reaction were not noted. With the exception of the phalanx, we used it for load part this series, but enough synostosis is provided both. These results suggest that β-TCP is an ideal artificial bone filling material.
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Kiyofumi Mitsutake, Tomoko Matsumoto, Toshiyuki Tsurumoto, Hiroyuki Sh ...
2003 Volume 52 Issue 1 Pages
162-165
Published: 2003
Released on J-STAGE: April 28, 2004
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In order to know the changes of bone mineral density in patients with rheumatoid arthritis (RA) after joint replacement of the lower extremities, we examined 10 RA patients (1 male and 9 females, average age 59.4) who underwent joint replacement of the knee joint and/or hip joint. We measured the bone mineral density of the lumbar spine, radius at 1/3 distal end and calcaneus by the method of Dual Energy X-ray Absorptiometry (DEXA) with different time processes, pre- and post-operation of 18 to 57 months. The patients showed severe walking disability before operation, and improvement after. After the operation, the bone mineral density increased both in the lumbar spine and calcaneus, but decreased in the radius. These results demonstrate that calcaneus is influenced by weight bearing, especially in joint replacement. Furthermore, this improvement in walking affects total body activity, resulting in increased bone mineral density of the lumbar spine.
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Yasunari Oniki, Teiji Kato, Toshitake Yakushiji, Kensuke Yonemura, Mik ...
2003 Volume 52 Issue 1 Pages
166-169
Published: 2003
Released on J-STAGE: April 28, 2004
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In congenital proximal radioulnar synotosis (CPRS), synostosis recurs in many cases despite release. Kanaya et al. recently reported an operative procedure including separation of the synostosis and placement of a free vascularized fascio-fat graft between the radius and ulna to prevent recurrent ankylosis. Their results show no recurrent synostosis and good range of motion in the forearm. We performed Kanaya’s procedure on two boys. Since supination was not enough, during the operation, rotation osteotomy of the ulna was performed. The first case was an 18-year-old boy. His right forearm was fixed at 20 degres pronation and his left forearm at 80 degrees pronation. We performed the modified Kanaya’s procedure including rotation osteotomy of the ulna on his left forearm. Four years after operation, he is able to rotate his left forearm to 50 degrees pronation and 53 degrees supination. The second case was a 10-year-old boy. Both forearms were more or less in the neutral position due to ankylosis. We operated on his left forearm. Three years after operation, he is able to rotate his left forearm to 0 degrees pronation and 85 degrees supination. No recurrence of synostosis in the forearm has been observed in these two cases.
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Naotoshi Ninomiya, Tsutana Fukunaga, Takanori Kuroki, Takayuki Satake
2003 Volume 52 Issue 1 Pages
170-173
Published: 2003
Released on J-STAGE: April 28, 2004
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We report a method of femoral varus osteotomy performed with the threadwire saw in three patients. The purpose was prevent proximal femoral fracture and perform the proximal femoral osteotomy precisely. Richard et al. reported fourteen complications of proximal femoral fractures occurring in 157 patients; Peter J. et al. reported sixteen complications in 79 patients. We performed femoral varus osteotomy with the threadwire saw, and no complications occurred in our patients. The average age of patients at operation was 8 years (range 2 to 13 years). The average follow-up was 1 year 7 months (range 1 year 2 months to 2 years 3 months). All patients underwent operation of the left hip joint. Avulsion fracture of the lesser trochanter occurred easily with the chisel, and the risk of damage to the femoral nerve, artery, and vein were high when varus osteotomy of the femur was performed. Osteotomy using a T-saw produces bone cross section smooth, allowing the medical cortical bone to be arranged in order. We conclude that use of the threadwire saw for femoral osteotomy does not cause avulsion fracture and damage to the femoral nerve, artery, vein and tendon of the iliopsoas muscle.
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Erina Fukunaga, Yoshihiro Ryoki, Ginryu Fukumoto, Masahiro Yokouchi, S ...
2003 Volume 52 Issue 1 Pages
174-176
Published: 2003
Released on J-STAGE: April 28, 2004
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Sarcoidosis is a granulomatous disease of unknown etiology. It commonly involves the pulmonary hilar lymph nodes, lungs, eyes, liver, and skin; however, skeletal muscles are rarely involved. We experienced a case of recurrent muscular sarcoidosis of the bilateral surae. The patient was a 57-year-old female, who presented masses with pain in her bilateral surae. Serological examination was within the normal range. MRI of the nodule showed a star-shaped area of lower signal intensity surrounded by an area of higher signal intensity. Marked uptake of 67 Ga was observed in these regions. Resection was performed on the right surae. Histological examinations showed granulomas composed of multinuclear giant cells and epithelioid cells. Sarcoidosis was diagnosed. Four months later, symptoms disappeared and the size of higher signal intensity area of the nodule reduced. MRI and 67 Ga scintigram were useful for diagnosis, and resection was successful in this patient.
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Takanori Chibana, Toshitake Yakushiji, Kensuke Yonemura, Teiji Kato, Y ...
2003 Volume 52 Issue 1 Pages
177-180
Published: 2003
Released on J-STAGE: April 28, 2004
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We report a 31-year-old man who had parosteal lipoma inducing large pressure erosion of the right distal femur. A parosteal lipoma is a rare benign tumor composed of mature adipose tissue that is firmly adherent to the periosteum of the underlying bone. This tumor is known to be caused by bone change (cortical hyperostosis, bowing defomity, or pressure erosion). This case presented large pressure erosion of the underlying bone, which is the rarest pattern of bone change.
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Taketoshi Date, Kenji Kumagai, Hiroyuki Shindo, Tohru Hirano, Koutarou ...
2003 Volume 52 Issue 1 Pages
181-184
Published: 2003
Released on J-STAGE: April 28, 2004
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A parosteal lipoma is a benign fatty neoplasm closely related to the periosteum. This report describes a 42-year-old man with parosteal lipoma. He was aware of swelling of his left shoulder since the summer of 2001. In hospitalization, we recognized a tumor with a diameter of about 8cm in his left shoulder which was elastic and soft. We recognized an osseous projection in proximal lesion of his humerus on a simple X-ray image and found fatty lesion surrounding this osseous projection in contact with the humerus in CT and MRI. It was partially enhanced in contrasting MRI. After needle biopsy, we performed tumor excision. A fatty tumor adhered to an osseous projection. In histology, the osseous projection was covered in thick cartilaginous tissue partly like cartilage cap, and osteochondroma was suspected. The differentiation of the merger of a lipoma and osteochondroma, and parosteal lipoma to determine the presence of fibrous tissue is an interesting issue.
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Yoshimi Nagatomo, Takuya Yamamoto, Sadanobu Sameshima, Setsuro Komiya
2003 Volume 52 Issue 1 Pages
185-188
Published: 2003
Released on J-STAGE: April 28, 2004
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We treated of localized pigmented villonodular synovitis limiting a flexion of the right knee. The case was a 33-year-old male who complained of a limited flexion because of knee pain. Our clinical examinations, there was a mass in the anterolateral femorotibial joint space, restriction of knee motion (0-90°), clear yellow joint fluid. We suspected of a meniscal injury, but MR images demonstrated an intra-articular mass on the lateral side below the patella, suggesting an intra-articular tumor. We opened the joint to recognize the yellow-brown tumor originating in the synovium on the lateral side below the patella, and resected it with surrounding synovia. The pathologic diagnosis of the mass was pigmented villonodular synovitis. At present, 4 months postoperatively, the patient is free of pain, although the motion range of the knee of 0° to 135°.
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Hiroki Irie, Teiji Kato, Toshitake Yakushiji, Yasuhiro Kawazoe, Kensuk ...
2003 Volume 52 Issue 1 Pages
189-193
Published: 2003
Released on J-STAGE: April 28, 2004
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Although hemangioma of extremities is not rare, there are only a few cases of hemangioma in the hands and feet. We experienced 3 cases of hemangioma with severe pain in hands and a foot. The first case was a 12-year-old girl, who had pain and swelling in the right index finger; a tumor lesion was depicted in MRI. MRI showed a small mass on the ulnar side of the proximal phalanx which was iso-intensity with T1WI and high-intensity with T2WI. The resected tumor was cavernous hemangioma. The second case was a 31-year-old woman, who had pain and swelling in the right index finger, (cavernous hemangioma). The third case was a 19-year-old man, who had severe pain on the bottom of his right foot, and walked with a limp. Glomus tumor was suspected preoperatively, however it was hemangioma. None of the patients had pain after resection. It is necessary to suspect hemangioma in the cases with continuous pain, even if no tumor is observed in the appearance.
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Yoshinori Ueno, Hiroaki Koga, Fumihiro Miyaguchi, Koushirou Imai, Taka ...
Article type: Others
Subject area: Others
2003 Volume 52 Issue 1 Pages
194-196
Published: 2003
Released on J-STAGE: April 28, 2004
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We present a patient who underwent reconstruction of the ilium for abdominal hernia. The patient was a 65-year-old female, who complained of gait disturbance and constipation. In August 2000, she underwent wide resection of malignant fibromatous histiocytoma of the right pelvis. In January 2001, magnetic resonance imaging revealed herniation of the intestine through the ilium deficit and abdominal hernia was diagnosed. In March 2001, she underwent cleisis operation for abdominal hernia. In June 2001, however, magnetic resonance imaging revealed recurrence of hernia. A torus, 15 cm × 18 cm in size, was observed on the right abdominal wall, and trendelenburg sign was positive. Plain radiography and computed tomography revealed diffuse bone defect. In September 2001, reconstruction of ilium using hydroxyapatite ceramics was performed. Five months after surgery, gait disturbunce and constipation were improved.
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Mari Osaki, Takeshi Minamizaki, Hiroyuki Hirakawa, Yasuhiro Kameyama, ...
2003 Volume 52 Issue 1 Pages
197-201
Published: 2003
Released on J-STAGE: April 28, 2004
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The prognosis of bone and soft tissue sarcomas with clinically detectable metastasis at initial presentation (M1 cases) is commonly poor. This study examined the clinical course and outcome of 10 M1 patients diagnosed between 1989 and 2002 at Tottori University and National Yonago Hospital. The patients included 7 males and 3 females, aged 11-87 years (median, 37.8). They were diagnosed with osteosarcoma in 2 cases, malignant fibrous histiocytoma in 3 cases, leiomyosarcoma in 2 cases, and 1 case each of rhabdomyosarcoma, epithelioid sarcoma, and extraskeletal Ewing sarcoma. The metastatic sites at initial presentation were lungs in 6 cases, lymph nodes in 4 cases, bones in 3 cases, and skin in one case. Eight patients received surgical treatment for the primary lesion and five of them for the metastatic lesion. In 4 who underwent complete resection of the primary and metastatic lesions after chemotherapy, 2 of them are free of disease and 1 is alive with disease. The 2-year survival rate was 20.6%. These findings suggest that the combination of aggressive surgery for primary and metastastatic sites and chemotherapy can improve the prognosis for patients with bone and soft tissue sarcomas including clinically detectable metastasis at initial presentation.
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Hiroko Inoue, Takatomo Mine, Yoshinari Goto, Yasuhiro Yamaoka, Koichir ...
2003 Volume 52 Issue 1 Pages
202-205
Published: 2003
Released on J-STAGE: April 28, 2004
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We report the reconstruction of tibial bone tumors. One case was a giant cell tumor; 5 cases were osteosarcoma. We experienced these cases from 1989 to 2001, and follow up time was 8 months to 13 years. Many authors say reconstruction of tibial bone tumor is very difficult because of the high infection rate involved. However, we succeeded in achieving good results in a short follow-up by soft tissue cover of soleus, and had no cases of infection. We will next consider breakage of the prosthesis in a long follow-up.
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Takashi Kumon, Hiroaki Kiya, Takao Yuge, Toru Fujimoto, Manabu Taguchi ...
2003 Volume 52 Issue 1 Pages
206-209
Published: 2003
Released on J-STAGE: April 28, 2004
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We report two cases of infected total knee arthroplasty. One case was osteoarthritis and the other case was rheumatoid arthritis. In both cases, the detected microorganism was MSSA. Treatment consisted of resection arthroplasty (removal of the implant and debridement of infected tissue) with closed continuous irrigation. Both cases had no symptoms of infection after resection arthroplasty. One case showed extension lag and lateral instability. Neither experienced pain and they are able to walk without knee brace. For indicated cases, resection arthroplasty is a useful treatment for infected total knee arthroplasty.
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Kei Kawaguchi, Yasushi Momota, Kotaro Hoshino
2003 Volume 52 Issue 1 Pages
210-214
Published: 2003
Released on J-STAGE: April 28, 2004
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We evaluated the clinical results of total knee arthroplasty in 17 cases using the LPS-Flex system in comparison with 22 cases using the NexGen CR system. All knees had osteoarthritis. In the cases using the LPS-Flex system, patients consisting of 3 males and 11 females (mean age: 76.8 years) were follow up postoperatively for 4 to 15 months (mean follow-up: 8.6 months). In the cases using the NexGen CR system, patients consisting of 3 males and 14 females (mean age: 76.9 years) were follow up postoperatively for 9 to 43 months (mean follow-up: 25.9 months). In the cases using the LPS-Flex system, the mean fiexion angle improved from 131.8° to 138.2°, and the mean Japanese Orthopedic Assocciation (JOA) score improved from 51.2 to 86.0 points. There were 10 out of 17 cases (59.0%) which achived flexion of more than 140°. On the other hand, in the cases using the NexGen CR system, the mean reach flexion angle deteriorated from 113.2° to 112.4°, and the mean JOA score improved from 49.5 to 77.0 points. The LPS-Flex system is advantageous in postoperative flexion and has no complications. The short-term results of LPS-Flex system was good.
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