Objective: In this study, we investigated the changes in the bone mineral density (BMD) associated with concomitant use of different vitamin D3 (Vit D3) preparations in women with osteoporosis receiving denosumab (DMAB) treatment.

Methods: A total of 146 women with osteoporosis who were receiving treatment with DMAB between April 2015 and July 2023 were divided into an active D3 group (eldecalcitol, Group E, n = 55) and a native D3 group (DENOTAS®, Group D, n = 91), and the changes in the BMD in the lumbar vertebrae, femoral neck, and proximal femur following treatment were compared between the two groups.

Results: No significant differences in the BMD between Group D and Group E were observed during follow-up of the patients in any of the lumbar vertebrae (0.764 [± 0.180] g/cm² vs. 0.748 [± 0.163] g/cm²), femoral neck (0.490 [± 0.081] g/cm² vs. 0.488 [± 0.072] g/cm²), or proximal femur (0.625 [± 0.097] g/cm² vs. 0.636 [± 0.094] g/cm²).

Discussion: While the use of active Vit D3 is generally considered as being advantageous for increasing the BMD, we found no differences in the BMD/percent changes in the BMD between the active and native Vit D3 groups in our study.

Conclusion: Our study suggests that either active or native Vit D3 could be used as a supplement to prevent hypocalcemia in osteoporosis patients receiving DMAB treatment.

 Atypical femoral fractures require a bone fusion strategy and prevention of fractures in the contralateral femur. Appropriate drug selection is thus required. An 82-year-old woman was diagnosed with atypical femoral fractures. Teriparatide injections were administered twice weekly after surgery. One year after initiation of treatment, the bone healing status of the fracture site, contralateral bone density, structural mechanical parameters, and bone microstructure were evaluated. Bone mineral density deterioration was observed throughout the hip, impacting structural mechanical parameters of the femoral trochanteric region. However, many bone mineral density/structural mechanical parameters of the femoral neck, which has more cortical bone, had improved. Bone strength was thus presumably enhanced by the increase in cortical bone area. Healing at the fracture site had progressed well. In addition, one year after the surgery, the patient was able to walk without a cane. These results suggest that, in this case, twice-weekly teriparatide treatment was effective in promoting bone healing on the affected side and preventing atypical femur fractures on the contralateral side.

Purpose: We compared new 4-strand suture techniques [Yoshizu parallel (YP) and Yoshizu cruciate (YC)] devised by our research group to the 6-strand Yoshizu #1 (Y1) technique, which is a combination of the Tsuge suture with a looped thread and the modified Kessler suture using double threads with two needles (Yoshizu needle).

Methods: Forty porcine flexor tendons were transected and divided into three groups. One group underwent repair using the YP technique created by placing two threads of the Yoshizu needle in parallel longitudinally (13 tendons). The other group underwent repair using the YC technique, comprising two threads of the Yoshizu needle placed in a crossing manner (13 tendons). The remaining group underwent repair using the Y1 technique (14 tendons). The repaired tendons were subjected to linear, non-cyclic load-to-failure tensile testing using a tensile test machine. The initial gap, 2-mm gap force, and ultimate strength were measured.

Results: The Y1 technique (9.4 N) resulted in a significantly lower mean load at the initial gap than the YP (16.9 N) and YC (13.4 N) techniques. There was no statistical difference in the mean 2-mm gap tensile load among the three groups (YP, 22 N; YC, 19 N; and Y1, 22.4 N). The Y1 technique (54.2 N) resulted in a significantly higher mean ultimate tensile strength than the YP (37.9 N) and YC (40.7 N) techniques.

Discussion: The YP and YC techniques do not use a transverse component at the tendon-gripping site, unlike the Y1 technique. We believe that this difference may allow the YP and YC techniques to achieve the same initial tension as the 6-strand Y1 technique despite being a 4-strand suture.

Conclusion: The new 4-strand suture techniques have the same initial tension at the repair site as the Y1 technique.

 Acute low back pain (ALBP) is generally self-limiting, with the pain intensity rapidly decreasing after its occurrence. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) may impede the recovery from ALBP injury. In our clinic, patients with ALBP are prescribed oral analgesics according to the following protocol: 1500 mg or less of acetaminophen per day (low AA) as a standard prescription, 4000-8000 mg per day (high AA) for patients with severely affected activity, NASIDs if desired, and no analgesics (NON) for children or adolescents. The quotidian pain intensity (visual analog scale [VAS]) scores of 121 patients with ALBP (61 men, 60 women; average age 47.3 years) with a self-limiting outcome were retrospectively compared between the four medicinal treatment groups using time-series analysis. The mean VAS scores did not statistically differ between the groups at the first visit until 28 days after the first visit.

OBJECTIVE: We evaluated the changes in gait function during 2 years of daytime rehabilitation.

METHODS: This study included 31 patients who started daytime rehabilitation between December 2017 and December 2021 and continued it for at least 2 years. Locomotive syndrome stages 1, 2, and 3 were observed in 7, 10, and 14 patients, respectively. We used the 2-step and Timed Up and Go (TUG) tests to evaluate gait function for 24 months.

RESULTS: The 2-step test scores did not differ significantly from the baseline scores. The TUG test scores of all patients improved significantly after 6 months compared to the baseline scores, and the improvement was maintained after 24 months. The TUG test scores improved significantly after 24 months in patients with locomotive syndrome stages 2 and 3.

DISCUSSION: TUG test scores improved significantly after 6 months compared to the baseline scores, and this improvement was maintained even after 24 months.

CONCLUSION: Gait training in daytime rehabilitation improved gait function, and the improved function was maintained even after 2 years.

 In the surgical treatment of patients with knee osteoarthritis (knee OA), the choice of surgical method should be carefully considered. At our hospital, knee OA is treated with total knee arthroplasty (TKA), unicondylar knee replacement (UKA), and high tibial osteotomy (HTO). In this study, we examined the trends and problems of adaptation in each surgical procedure. It is important to evaluate the condition of the knee and select a surgical procedure that can improve the patient's activities of daily living, and the indication for the surgical procedure should not be forcibly expanded.

 Platelet-rich plasma (PRP) therapy has recently attracted attention as an innovative treatment strategy for osteoarthritis of the knee (knee OA) in the field of orthopedic surgery. In this study, we examined the clinical outcomes of intra-articular PRP therapy in patients with knee OA at our hospital, as well as the reasons that led the patients to seek the therapy. Improvement in the scores was observed on both the modified numeric rating scale (MNRS) and Knee Injury and Osteoarthritis Outcome Score (KOOS), the rating scales used to evaluate the clinical outcomes after PRP therapy. The results revealed a significant improvement of the scores on both scales, and significant efficacy was observed even in patients with end-stage knee OA. The reason that led the patients to seek PRP therapy was an explanation about the treatment provided by the physician as part of the medical consultation in about a half (45.7%) of the patients, and as a result of being influenced by media advertisements for the therapy in 21.6% of the patients. Thus, the number of patients seeking the treatment after it is offered as a treatment option by the consulting physician in routine medical practice is higher than that seeking the treatment as a result of being influenced by advertisements for the procedure.

 We examined whether changes in the knee extensor muscle strength can be evaluated by measuring the quadriceps muscle volume using magnetic resonance imaging (MRI). Muscle strength and muscle volume were evaluated over time in patients who had undergone anterior cruciate ligament reconstruction using a measuring device and MRI, respectively. Preoperative assessment of the muscle strength using a muscle strength measuring device showed lower strength than expected based on the muscle volume. This suggested that MRI-based muscle volume measurement may provide a more accurate assessment of the potential muscle strength in painful and dysfunctional knees by comparing the muscle strength to that of the healthy contralateral knees.

 We examined the percent changes in the muscle strength, muscle volume, and intramuscular fat density in subjects who underwent muscle-strengthening exercises. The subjects continued muscle-strengthening exercises for the quadriceps for 8 weeks. During this period, changes in the muscle strength were measured over time, with magnetic resonance imaging (MRI)-based measurements of the muscle volume and intramuscular fat density. A significant correlation was observed between the percent changes in the muscle strength/muscle volume of the quadriceps and muscle-strengthening exercises. In addition, a significant correlation was also observed between the percent changes in the muscle volume and intramuscular fat density. Muscle-strengthening exercises were found to increase the muscle volume and decrease the intramuscular fat density.

 We evaluated the effects of radial pressure wave (RPW) therapy in patients with plantar fasciitis with a limited range of ankle dorsiflexion. We studied 17 feet of 11 patients. RPW irradiation was performed every week for a total of 4 sessions. Pain during walking, bilateral ankle dorsiflexion angles, and the scores on a self-administered foot evaluation questionnaire (SAFE-Q) were evaluated before the therapy and immediately and 4 weeks after completion of the therapy. The numerical rating scale (NRS) and ankle dorsiflexion angle improved significantly after the therapy, and the SAFE-Q scores for some parameters also improved significantly (p < 0.05). Our findings suggest that RPW therapy is effective for the treatment of patients with plantar fasciitis with a limited range of ankle dorsiflexion.

 I reviewed our findings of joint fluid analysis from patients with knee joint diseases in our clinic, focusing on the white blood cell-to-neutrophil ratio. The most severe inflammation was pyogenic arthritis, followed by pseudogout, rheumatoid arthritis (hereinafter “RA”), and gout. Osteoarthritis, osteonecrosis, and traumatic arthritis were classified as mild inflammation. I further investigated the details of the cases of pseudogout, RA, and gout, all of which need to be differentiated from each other. I found that the white blood cell count was significantly higher in pseudogout than in gout. No significant difference in the white blood cell count was observed between pseudogout and RA, or between RA and gout.

 The effects of focused shock wave (FSW) therapy on tennis elbow were examined in relation to the total energy dose and the influence of the practitioners. The results showed that a total energy dose of about 18 J was necessary to expect a therapeutic effect of FSW, and that the therapeutic effect was better in the hands of a practitioner with appropriate knowledge and skills.

 We studied the condition of 60 hips after total hip arthroplasty (THA) using a CT-based navigation system (Group N) and 60 hips after robotic arm-assisted THA (Group R) by comparing matched pairs from the two groups. The results revealed that the accuracy of cup placement was significantly better in Group R. In addition, the number of screws used in the operation was significantly fewer, the operation time was significantly shorter, and the volume of blood loss was significantly lower in Group R than in Group N. These results suggest accurate control of the robotic arm motion in Group R.

 We investigated the changes over time in the status of catastrophic thinking due to nocturnal pain in 22 patients with shoulder periarthritis who had undergone physiotherapy for 2 months. Patients with severe nocturnal pain engaged in more severe catastrophic thinking than patients with mild nocturnal pain. When providing physical therapy to patients with severe nocturnal pain, it is necessary to not only focus on the anti-inflammatory drug treatment, but also on psychological factors, by including guidance for activities of daily living (ADLs) and for positioning of the body during sleep. It is important for patients to feel that, despite the pain and limited range of motion, there are useful countermeasures that they can take.

 In recent years, low-intensity pulsed ultrasound (LIPUS) has come to be recognized as an effective tool for fracture treatment. However, there are still some limitations in respect of insurance reimbursement. In this study, we investigated the compliance rate (Co) with the use of the LIPUS device, not covered by insurance, lent to 67 young athletes with fractures. The Co was 47.1%, being higher for those with stress fractures than those with fresh fractures. Stress fractures are an important issue that could threaten an athlete's career. Therefore, expanded application of LIPUS is expected in the future.

 We evaluated whether training using a commercially available wide rubber band for strengthening the shoulder external rotation muscle would be useful for functional training and strengthening of the infraspinatus muscle. We examined 22 shoulders of 11 healthy male volunteers. Using 3 grasping methods, we compared the muscle activity of the infraspinatus and deltoid posterior fibers during shoulder external rotation muscle strength training using a commercially available wide rubber band. The results showed significantly higher muscle activity of the infraspinatus muscle, with no difference in muscle activity among the 3 grasping methods. These results suggest that shoulder external rotation muscle strength training using a wide rubber band can train and strengthen the function of the infraspinatus muscle.

 With the use of a wearable device (WD), we investigated the differences in the elbow external stress during pitching between working adults with and without baseball experience (experienced vs. inexperienced). Six adults each of the experienced and inexperienced groups with no previous history of elbow pain underwent measurement of the elbow valgus torque (EVT), arm slot, and arm speed. The EVT was significantly higher in the experienced group (35.4 Nm) than in the inexperienced group (23.3 Nm), whereas the arm speed was significantly greater in the inexperienced group than in the experienced group.

 The author investigated the actual situation of secondary fracture prevention. The proportion of patients who received intervention by testing for osteoporosis was examined by age group and fracture site for the two time periods of 2019 and 2021. The overall percentage of patients who underwent testing for osteoporosis was 62% in 2019 and 90% in 2021. In both years, the testing rate in patients in their 50s was low (27% in 2019 and 50% in 2021). In addition, the testing rate at the ankle joint area was also low in both years (16% in 2019 and 54% in 2021). The testing rates were high overall, but were low in relatively young patients and in patients with fractures around the ankle joint.

 We evaluated the efficacy of radial pressure wave (RPW) therapy in knee osteoarthritis (KOA) patients with pain originating from the infrapatellar fat pad (IFP). KOA patients identified as positive by Jason test underwent 4 sessions of RPW therapy biweekly. Their visual analogscale (VAS) scores were evaluated before therapy, and immediately and 4 weeks after the end of therapy. The VAS scores at rest and during walking significantly improved (p < 0.05) following the RPW therapy. Therefore, RPW therapy may be considered as being effective for pain originating from the IFP.

 We report the effects of the locomotive syndrome prevention program, offered in a professional care setting for the elderly, on continuing participants (continuing group; n = 8), as well as the characteristics of participants who were unable to continue in the program (non-continuing group; n = 10). We used endpoints for evaluating the severity of locomotive syndrome and for measuring the scores on the Japanese version of Montreal Cognitive Assessment (MoCA-J). For prevention, the dual-task exercise program was chosen. The results suggested that the non-continuing group was characterized by a significant decline in cognitive function and being already in a state of reduced locomotive functions. Based on these findings, we consider that a wide range of cooperation is important for the prevention of locomotive syndrome.

 We investigated the clinical outcomes and findings on repeat arthroscopy in patients who had undergone anatomical double-bundle anterior cruciate ligament (ACL) reconstruction for hyperextended knees or general joint laxity. We classified 139 patients who were at least 1 year-postoperative and gave consent for repeat arthroscopy into two groups, namely, Laxity and Normal, according to the presence or absence of hyperextension or general joint laxity of the knees. Although there was no clear difference in the clinical outcomes between the two groups, the Laxity group showed significantly poorer findings for the posterolateral bundle. This suggests the need to review the surgical technique and rehabilitation protocols for hyperextended knees.

 Many osteoporosis patients are elderly women who often have comorbidities musculoskeletal instability, such as degenerative diseases of the knees and lumbar spine. We focused on hand grip strength (HGS) training as an exercise that elderly women can easily and safely perform alone at home on a daily basis. We investigated the relationship between HGS and bone mineral density (BMD) of the proximal femur and lumbar spine in osteoporosis patients. Our findings revealed a positive correlation between HGS and BMD of the proximal femur. These results suggest that HGS training may enhance BMD in the treatment of osteoporosis, which is primarily managed with medication.

 We report our experience with two patients who underwent medial opening wedge high tibial osteotomy (MOWHTO) to correct the mechanical axis for a malunion following a proximal tibial shaft fracture. The patients were 48-year-old and 65-year-old men who had developed varus deformities during the bone fusion process following a tibia fracture. They had a good postoperative clinical course after the MOWHTO. Their leg length discrepancy disappeared, resulting in JOA scores of 95 and 100, respectively.

 Our hospital received the Joint Commission International (JCI) accreditation in 2020. Then, it set Quality Indicators (QIs) as an initiative to improve the quality of medical care. One of the QI goals was to reduce the wait times for new rehabilitation patients. The target level, that is, the value obtained by dividing the number of new patients waiting for ≥ 30 minutes by the total number of new rehabilitation patients, was set as ≤ 5%. The values changed over time, as follows: 4.8% in 2021, 5.0% in 2022, and 4.1% in 2023. Thus, the target level was specified was appropriate.

 We examined the validity of the Flexion, Adduction, and Internal Rotation (FADIR) test on a 4-point scale from 0 to 3, depending on the location of the pain, in 91 patients with osteoarthritis of the hip joint, by calculating Spearman's rank partial correlation. The results suggested that the FADIR test on a 4-point scale is a reliable tool for evaluating the function of the hip joint, that showed convergent validity with the Visual Analogue Scale for Pain while Walking and the Japanese version of the Lower Extremity Functional Scale.

 We investigated the status of the fracture liaison service (FLS) after proximal femur fracture surgery. We examined the data of 67 patients who had undergone surgical treatment at our hospital from April 2022, at least 1 year after the surgery. The treatment initiation rate for osteoporosis was 98.5%, and the treatment continuation rate after 1 year was 70.2%. As compared with the results reported by Kawase, a co-author of this report, in 2023, improvement of the treatment continuation rate was noted. This could be due to the greater multidisciplinary involvement following the revision of the medical fees in 2022.

 A piano instructor presented to us with a displaced phalangeal fracture. Without resorting to surgical treatment, we performed knuckle-cast fixation with buddy taping under local anesthesia, combining it with early exercise therapy. After about 7.5 months, the patient scored 0 on all the 3 items of TAM200° Quick DASH, recovering to a state of being able to play the piano without any difficulty. In this article, I report our experience with this patient. If conservative treatment could restore and maintain the alignment of a phalangeal fracture, it could be a useful treatment option even for athletes and artists, besides the general population.

 In the field of orthopedics, an urgent goal for 2025 is to prevent the rapid increases in primary and secondary fractures due to osteoporosis. The Ministry of Health, Labour and Welfare's “Healthy Japan 21” (third phase) has also set a target of 15% for the osteoporosis screening participation rate (screening rate), which is currently in the 4% range. In the field of dentistry, there are concerns about the pathophysiology and management of medication-related osteonecrosis of the jaw. Therefore, there is hesitation towards surgical procedures, such as tooth extraction. Alveolar bone density measurement (Bone Right®) is expected to be useful for resolving these problems. Therefore, I introduce its practical application here.

 The purpose of this study was to clarify the relationship between nocturnal pain and the range of motion of the shoulder in patients with supraspinatus and infraspinatus tears. A total of 284 patients were divided into two groups according to the presence or absence of nocturnal pain. The shoulder joint range of motion and the patient demographics were evaluated. The results showed significant decreases in the range of shoulder flexion and abduction in the subject group with nocturnal pain. However, multiple logistic regression analysis identified no significant relationship.

 The Hata area in Kochi Prefecture is an underpopulated region with a population of 80 000 living in an area of approximately 2000 square kilometers. The proportion of people over the age of 65 years in this population is 40%. A regional post-referral treatment plan for proximal femoral fractures has been deployed electronically in this region since 2003. Notwithstanding, there is a trend towards increase in the incidence of proximal femoral fractures in this region. In 2022, a management fee for secondary fracture prevention was included in the national insurance coverage, and was also therefore included in the regional post-referral treatment plan. Implementation of activities related to the Clinical Standards for Fracture Liaison Services (FLS) is a requirement for calculation of the management fee for secondary fracture prevention. Therefore, various efforts are ongoing to implement FLS.

 This report presents the results of a questionnaire survey conducted by the Japanese Clinical Orthopaedic Association (JCOA) on the results of medical screening (fiscal year 2023) in children who were examined after implementation of the school medical screening program for locomotive organs. Data on a total of 2879 cases were obtained. The most common diagnosis was scoliosis. Other diagnoses included Osgood disease, lumbar spondylolysis, herniated disc, and baseball elbow. Subsequent measures taken after the diagnosis were observation with guidance in 51.4% of cases and referral to other specialists in 3.3% of cases. Of all the children, 2.8% had undiagnosed stiffness of the lower limbs, which may be a locomotive symptom in children. Guidance, including on stretching, is needed.

Purpose: PFC-FD^TM (platelet-derived factor concentrate, freeze-dried) therapy is expected to have therapeutic effects in patients with knee osteoarthritis because it stimulates growth factors.

Subjects and Methods: Eight knees of 6 patients with knee osteoarthritis in whom PFC-FD therapy had been requested for both knees, and multiple sessions of the therapy had been requested for one knee.

Results: Some patients showed improvement in the symptoms in response to PFC-FD injection.

Discussion: There are several issues that require to be addressed in the future, including the optimal rehabilitation protocols.

Conclusion: We report our experience with PFC-FD^TM therapy. We propose to conduct further studies in the future.

Introduction: We investigated the severity of locomotive syndrome in daycare users at our hospital and the usefulness of the Fall Risk Index-5 items version (FRI-5) as a screening tool for locomotive syndrome.

Subjects and method: The severity of locomotive syndrome was assessed in 24 daycare users at our hospital. The subjects were divided into 2 groups based on the results of FRI-5, and the percentages by the severity of locomotive syndrome were compared between the groups.

Results: All the subjects were revealed to have locomotive syndrome. The mean FRI-5 score was above the cutoff value in all the subjects.

Discussion: Our results suggest the FRI-5 as a useful screening tool for locomotive syndrome.

 Platelet-Rich Plasma (PRP) therapy is a regenerative medicine technique that has been demonstrated to show efficacy in the treatment of knee osteoarthritis (KOA). In this study, we examined the effects of multidisciplinary collaboration and work efficiency in 21 co-medical staff members on the treatment in 374 patients who received PRP therapy. It was confirmed that the accuracy of evaluation of the treatment effects and patient satisfaction improved with the use of the task-shifting approach and appointment system, leading to an improvement in the quality of life (QOL) of the patients.

 We compared the mentality between patients with multiple anterior cruciate ligament (ACL) injury (multiple group [Group M]) and those with first-time ACL injury (primary group [Group P]). We studied 88 patients with ACL injuries diagnosed at our hospital and determined to be eligible for surgery. Group M consisted of 17 patients and Group P of 71 patients. There was no significant difference in the anxiety level or mentality after injury between the two groups. However, Group M showed lower levels of anxiety, higher confidence in returning to sports, and higher psychological competitiveness with increasing years of experience.