Japanese Journal of Joint Diseases
Online ISSN : 1884-9067
Print ISSN : 1883-2873
ISSN-L : 1883-2873
Volume 39, Issue 2
Displaying 1-13 of 13 articles from this issue
Invited Lectures
  • Takahiro OCHI
    2020 Volume 39 Issue 2 Pages 45-52
    Published: 2020
    Released on J-STAGE: August 01, 2020
    JOURNAL FREE ACCESS

    Objective: We have tried to know pathological cells which foster inflammatory cells in involved organs of patients with RA.

    Methods: Nurse-like cells (RA-NLCs) from bone marrow and synovial tissue of RA were established using the similar methods by which Wekerle H established the thymic nurse cells (16). Analyses using transmission electron microscope (TEM) and dual immunofluorescence staining studies were carried out by Sawai's group.

    Results: RA-NLCs were established from bone marrow and synovial tissue of patients with RA, and found to promote maturation and differentiation of B cells as well as T cells. RA-NLCs also supported two step differentiations of monocytes; differentiation into tartrate-resistant acid phosphatase (TRAP) -positive mononuclear cells and then into multinucleated giant bone-resorbing cells. By TEM, the characteristic dendritic cells (the DCs) were observed in RA synovial tissue forming direct physical interactions (pseudoemperipolesis) with adjacent plasma cells (PCs). The numbers of PCs in various areas tended to correlate with those of the DCs, which appeared to form survival niches for PCs. Quantitative dual immunofluorescence staining studies of these areas indicated that the majority of CD14+DCs showing RA-NLC functions were CD14+CD15+myelocytes.

    Conclusion: In patients with RA, abnormal CD14+CD15+myelocytes having RA-NLC function were found to be produced in bone marrow and form survival niches for chronic inflammation of involved organs.

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Original Articles
Case Reports
  • Daisuke SHIMAZU, [in Japanese], [in Japanese]
    2020 Volume 39 Issue 2 Pages 69-74
    Published: 2020
    Released on J-STAGE: August 01, 2020
    JOURNAL FREE ACCESS

     Rapidly destructive coxarthrosis (RDC) usually affects unilateral side. However, RDC arises at bilateral side in 10% cases. We report a case of bilateral RDC, which occurred during half year simultaneously.

     The case is an 82-year-old male. His chief complaint was bilateral groin and thigh pain. He had a medical history of bilateral TKA and hyper C-reactive proteinemia unknown origin (under follow-up at neighboring hospital). He visited our hospital 7 months ago because of persistent left knee pain for 2 months. At initial visit, blood test showed abnormally high levels of D-dimer and C reactive protein (CRP). However, deep venous thrombosis (DVT), loosening of implants and infection of left knee was not detected through precise examination. Radiograph revealed slight narrow hip joint space without destructive change of acetabulum and femoral head. One month ago, he felt swelling and severe pain of right lower limb and walking difficulty gradually got worsen due to the progressive symptoms. On admission of our hospital, radiograph, CT and MRI showed destructive change of bilateral femoral head and acetabulum. After examination of blood, blood culture and synovial fluid culture, we diagnosed preoperatively his case as bilateral RDC and performed bilateral THA 2 weeks later. After surgery, we confirmed diagnosis of bilateral RDC based on clinical course, imaging findings and pathological findings. At the period of 7 months after surgery, he could walk by himself with cane. JOA hip score was 76 points on the right and 81 points on the left respectively. Radiolucent line surrounding implants or loosening finding was not detected on radiograph.

     We experienced a case of bilateral RDC with extremely high value of D-dimer and CRP requiring differential diagnosis from DVT, pyogenic arthritis, rheumatoid arthritis, malignant tumor.

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  • [in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
    2020 Volume 39 Issue 2 Pages 75-78
    Published: 2020
    Released on J-STAGE: August 01, 2020
    JOURNAL FREE ACCESS
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  • Tatsunori IWAI, [in Japanese], [in Japanese], [in Japanese], [in Japan ...
    2020 Volume 39 Issue 2 Pages 79-82
    Published: 2020
    Released on J-STAGE: August 01, 2020
    JOURNAL FREE ACCESS

    Introduction: One of the complications of the anterior cruciate ligament (ACL) reconstruction is postoperative infection. It was reported that the incidence was about 1%. The symptoms often occur within several weeks after surgery. We report a case developing infection in 17 years after ACL reconstruction.

    Case: A 39-year-old man received ACL reconstruction on his left knee using double-bundle hamstring autograft 17 years ago. His past medical history was the left meniscal suture three years ago. He was referred to our hospital from the private doctor because he showed signs of pain, swelling and heat of his left distal thigh with unknown etiology. We performed emergency surgery because we diagnosed his left femoral osteomyelitis and abscess around his left femur. We found no ligament tear, meniscal tear or infection in his left knee joint with arthroscopy. We washed, and performed debridement against his left thigh pus from the subcutaneous and muscular layers to femur. We found lytic bone defect around the end button in front of the femur, so we removed it, washed and injected a biopex containing an antibiotic. We successfully controlled knee infection.

    Discussion: Infection after reconstruction often occurs in a knee joint within a few weeks after surgery. We speculated that the late infection of this case occurred around the end button and osteomyelitis occurred. We were able to control the infection by washing and performing debridement of the infection area and administered antibiotics. Even if a long period of 17 years after the surgery has passed, the infection can still occur. Therefore it is necessary to perform the early diagnosis and the appropriate treatment when the infection symptoms are recognized.

    Conclusion: We experienced a case developing infection in 17 years after ACL reconstruction.

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  • Fimiyoshi KAWASHIMA, [in Japanese], [in Japanese], [in Japanese], [in ...
    2020 Volume 39 Issue 2 Pages 83-87
    Published: 2020
    Released on J-STAGE: August 01, 2020
    JOURNAL FREE ACCESS

    Introduction: Habitual patella dislocation can occur in young patients with open growth plate and requires surgery. We treated a patient with this condition with vastus medialis advancement, lateral retinaculum release, and Roux-Goldthwait procedure.

    Case Presentation: The patient was an 11-year-old girl who had initial patella dislocation during a hurdle race at 7 years old. She became aware of knee pain and anxiety that interfered with daily life. At the first examination, valgus knee was note and the patella was dislocated laterally in knee flexion ≥30°. Apprehension test was positive and Kujara score was 65. Plain radiography showed a valgus knee, lateral deviation of the patella, and a Q angle of 21°. In the lateral view, the patella appeared thick, but patella alta was absent. In the axial view, the sulcus angle was 173°and the patella was dislocated laterally at flexion ≥30°. Based on these findings, the patient was diagnosed with habitual patella dislocation and surgical treatment was selected. Normal surgical procedures, such as medial patellofemoral ligament (MPFL) reconstruction and anterior transfer of tibial tuberosity, may influence the epiphyseal growth plate because growth plate was open. Thus, stabilization was applied using lateral retinaculum release, vastus medialis advancement, and Roux-Goldthwait procedure. In after-treatment, plaster fixation was performed for 2 weeks and ROM training up to 90°was initiated at 2 weeks. ROM with no limitation was permitted at 6 weeks. At one year after surgery, ROM is 0-153°, there is no patella dislocation or anxiety, negative apprehension test, and the course is favorable with no interference with activities of daily living.

    Discussion: Habitual patella dislocation often has an anatomical predisposition and develops with open growth plate. Early reduction of the patella resulted in favorable fitting of the pulley surface in pulley dysplasia cases, suggesting that early treatment is desirable. Roux-Goldthwait procedure for treatment before closure of the epiphyseal growth plate may be useful for distal realignment not requiring osteotomy. However, poor outcomes have been reported in some cases treated with this procedure alone, so modified Roux-Goldthwait procedure by combination with vastus medialis advancement and lateral retinaculum release, and a favorable outcome was achieved. However, stabilization is difficult even with the modified Roux-Goldthwait procedure in cases with muscle weakness and hypotonia, showing that the indication is limited. Flexible procedures including MPFL reconstruction are also needed for cases with an open epiphyseal growthplate.

    Conclusion: Treatment of habitual patella dislocation before closure of the epiphysea growth plate with stabilization using a modified Roux-Goldthwait procedure resulted in a favorable short-term postoperative outcome.

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