We present the results of 36 total hip arthroplasties using Per Fix HA Prosthesis with a mean follow-up period of 19 months (range; 6 to 45 months). The average Japan Orthopaedic Association hip score increased from 45.7 points prior to the operation to 85.1 points at the last follow-up. All radiographs were examined for the presence of initial gap, reactive line, radiolucent line, osteolysis and loosenig. Our radiological results showed that the HA coating can provide durable implant fixation.
Loss of correction due to lack of fixation rigidity of staples still remains a problem after high tibial oeteotomy (HTO). Ogata has developed a new staple design which is characterized by the blade-like inserting portion and the addition of one cortical screw at the distal portion. After using this staple, we concluded that the staple should be placed as proximally as possible in the upper tibial fragment to accomplish staple fixation before. Varus deformation and destruction of the lateral joint due to recurrence sometimes requires TKA in patients after HTO. We developed a new staple based on Ogata's design, which is characterized by the addition of one cancellous screw at the proximal portion. This study was carried out to compare the fixation rigidity of Ogata's staple with our new staple. The proximal part of the tibia was mounted, and bending load was applied antero-posteriorly and latero-medially at the distal point to the osyeotomy site by using a mechanical testing machine. Two groups were compared statistically. In the antero-posterior loading test, the maximum load before breakage was 81.7±20.8N in Ogata's staple, and 174.9±34.8N in our modified design. In the latero-medial loading test, the maximum load before breakage was 528.8±118.4N in Ogata's staple, and 815.8±222.7N in our design. The results of this study showed that our staple has adequate fixation rigidity, which prevents loosening of the staple.
Twenty cases with osteoarthritis of the knee joint were treated by high tibial osteotomy combined with open meniscetomy of the discoid lateral meniscus. In all cases, good clinical and radiological results were obtained. The average JOA score improved from 63.3 points to 82.8 points, and the average femorotibial angle (FTA) was corrected from 182.8° to 167.2°. There were no cases, experiencing pain in the lateral compartment of the knee joint. The results indicated our method is not inferior to the usual high tibial osteotomy.
We reviewed ninety-two patients who were more than forty years old when they underwent arthroscopic meniscectomy. Their mean age was 56.7 years (range: 40 to 80 years). These patients were evaluated using the Japanese Orthopaedic Association Score for meniscus injuries. There was no correlation between age, grade of osteoarthritis on preoperative radiograghs, grade of articular cartilage degeneration, and surgical results. Arthroscopic meniscectomy was proven to be an effective procedure for patients over the age of 40.
We investigated the effects of graft linkage material on range of motion, anterior instability, and bone tunnel enlargement on 37 knees in 37 patients who underwent ACL reconstruction using hamstring autograft at one year postoperatively. The knees were divided into three subgroups depending on the graft materials and fixation techniquesuged; In Group A (15 knees), the fixation technique using Endobutton® and Tefron tape® was applied to the femoral side, while post screw with #5 Ethibond was used on the tibial side. In Group B (7 knees), endobutton fixation using 2.5mm wide Telos artificial ligament® was applied to the femoral side with the same fixation as Group A to the tibial side. In Group C (15 knees), the same fixation as Group B was applied to the femoral side and fixation with double staples using 3mm width Telos artificial ligament® to the side. There were no significant differences in the postopertive range of motion between the three groups, although anterior instability in Group B was smaller than that in Group B and Group C. However, the incidence and amount of bone tunnel enlargement in the coronal plane on the femoral side in Group A was larger than those of the other two groups, but there was no difference in those on the tibial side.
We performed a prospective study to evaluate serial changes in the magnetic resonance imaging (MRI) appearance of periligamentous tissues in tibial bone tunnels after anterior cruciate ligament (ACL) reconstruction with hamstring autografts. Thirty-six knees in 36 patients were examined by MRI at 6, 12, 24, 48 weeks after ACL reconstruction. Periligamentous tissue between the graft and bone tunnel mainly showed high signal intensity, and a part of the periligamentous tissue showed low signal at 6 weeks. Most of the periligamentous tissue still showed high signal intensity at 12 weeks, but the intensity was lower than that at 6 weeks. The low intensity area included in the periligamentous tissue increased. A band-shaped low signal intensity area was observed in the periligamentous tissue around the graft at 24 weeks, the thickness of which increased at 48 weeks. The MRI results suggest that in most patients, the maturation of the tendon-bone interface occurs until 24 weeks after the ACL reconstruction.
We have performed over 400 ACL reconstruction procedures since 1991. In this paper, we report ACL reconstruction cases augumented by Kennedy-Lad. They were followed up for at least 5 years after operation. Forty cases were male and twenty-two cases were female. Operation was performed using essentially the same criteria, same technigue, and by the same doctor. The purpose of this operation was to prevent knee laxity due to creeping or stretching, as well as to prevent arthritis due to rupture of the artificial ligament. For this purpose, several techniques, were used, the most important of which was making the ligament by composite graft. The results were satisfactory, indicating that composite graft is useful for preventing arthritis and laxity.
We report cases who underwent vascularized flaps for dermal soft tissue defects of the lower extremities in children. Subjects were patients treated at our department during the past 15 years. They consisted of 10 boys and 2 girls aged 3 to 15 years, with an average age of 8.1 years. A total of 12 flaps, 3 scapular flaps, and 9 peroneal vascular island reverse flaps were transfered. All flaps survived. The vascularized flap proved better than free skin graft. Because it grows as the child grows older, ulcers rarely occur. Peroneal vascular island flaps are safe and able to cover massive skin defects without causing microvascular anastomoses. Scapular flaps as free flaps often numerous advantages including increased safety and ability without vascular anatomical variation. These results suggest that the vascularized flap is useful for the coverage of skin defects in children.
Seven tibial shaft fractures were treated with TRUE FLEX. Six patients were male and one was female. The mean age was 32 years at the time of surgery. According to the AO classification, two cases were A1 fractures, two A3 fractures, two B2 fractures, and the other was a C2 fracture. Three were open fractures and two had associated fractures. Interlocking screw was not used in any of these cases. All cases achieved union. The five-flute feature of TRUE FLEX provides rotational control resulting in effective fixation of tibial shaft fractures.
We have treated condylar and Supracondylar fractures using mainly intramedullary Supracondylar (IMSC) nail since 1994. To achieve dynamization, an IMSC nail with proximal oval screw holes was devised and has been used since 1997. We reviewed the surgical results of 39 patients with condylar and supracondylar fractures treated using IMSC nails from 1994 to 2000. They consisted of 22 cases which were treated using normal IMSC nails and 17 cases treated using the improved IMSC nails. The former resulted in 5 complications (nail/screw damage, non-union, etc.), but the latter had no complications. We concluded that IMSC nails with proximal oval screw holes are effective in preventing complications.
19 patients with tibial condylar fractures were treated between January 1994 and January 2000 at our hospital. The patients consisted of 8 males and 11 females, aged 16 to 73 years (mean age: 47.2 years). The mean duration of follow-up was 2 years and 7 months (range: 3 months to 6 years and 6 months). They were classified as type A (1 case), type C (8 cases), type E (2 cases), and type F (8 cases) according to Hohl's classification. The operations were performed by using plate, tibial bolt, and cannulated cancellous screw. Repairing the injured meniscus and ligaments was essential to the success of the operation. Autograft (or HA graft) was necessary in some cases. Clinical results were accessed anatomically and functionally according to Hohl and Luck's method. In anatomical assessment, there were 13 excellent cases and 6 good cases. There were 13 excellent cases, 4 good cases, and 2 fair cases in functional assessment. The results were satisfactory for the most part.
We treated 9 cases of peri and intra-ariticular fractures of lower extremities using the Ilizarov external fixator. The age of the patients ranged from 8 to 78 years, and the average age was 55. One case was supracondylar fracture, three were tibal condyle fractures, and 5 were distal end of tibial fractures. Six cases were closed and 3 were open fractures. The average duration of external fixation was 13.5 weeks. At the last follow up, fractures had healed without nonunion. From these results, we concluded that the Ilizarov method is useful in treating comminuted peri and intra-ariticular fractures.
Osteogenesis imperfecta is thought to be characterized by good bone union despite bone insufficiency causing fracture and deformity. We report two female patients who underwent surgical treatment for pseudoarthrosis of the femur with mild osteogenesis imperfecta who had gone without treatment for a long period of time. They were 12 and 31 years old at the time of surgery. Each fractured their femur on one side, one at 4 and one at 2 years of age, but had not been treated due to lack of pain. As a result, they exhibited limping, shortening of the leg, and bulging of the proximal thigh just before surgery. Muscle release around the hip and bone resection followed by correction with Ender nailing in the region with pseudoarthrosis was performed. Good bone fusion was achieved in both cases. To obtain good bone fusion, fixation with Ender nailing should be considered for pseudoarthrosis of the femur complicated by osteogenesis imperfecta. Correction of the mechanical axis and discrepancy of lower extremities are important in addition to the correction of deformity.
La décortication ostéomusculaire réalisée par Robert Judet en 1962 nous parait être la meilleure technique opératoire pour des pseudarthroses aseptiques et septiques des os longs. Son princiip consiste à détacher au ciseau frappé des copeaux de corticale osseuse en les laissant adhérentes au périoste qui les envéllope et aux muscles qui s'y insèret. Ces petits greffons pédiculés peuvent même en milieu septique. Nous avons traité 195 cas de pseudarthroses des os longs (175 aseptiques, 20 septiques) entre 1971 et 1999 par décortication. Nous avons obtenu la consolidation osseuse 164cas/195cas (99.5%) Les résultats cliniques confirment la valeur de ce procédé.
We operatively treated 9 cases of intermittent claudication for lumbago. They included 6 cases (4 females, 2 males) treated with Luque rod fixation and 3 cases (all females) treated with pedicle screw fixation. Their ages ranged from 53 to 73 years (average: 67 years). 7 cases who were diagnosed with lumbar instability included 2 cases developing after posterior decompression, while the other 2 cases were multiple osteoporotic fracture. One case of pedicle screw fixation required re-operation to remove the vertebral screw. Luque rod fixation is useful especially for elderly persons with osteoporosis, due to vector breakage because break up a vector and decreased operative invasion.
In Western culture, smoking is regconized as a factor which increases the rate of pseudarthrosis. However, in Japan we have only a few reports on the relationship between bone union and smoking. We report the effects of smoking upon lumbar posterolateral fusion. 49 patients underwent surgery from July 1996 to March 2000. The mean age was 48.2 years. 34 patients were male and 15 were female. 24 patients were smokers and 25 patients were nonsmokers. We observed their smoking habits and evaluated bone union on radiographs. 29.2% of the smokers developed pseudarthrosis, whereas the rate was 8.0% among the nonsmokers. In cases with instrument, 16.7% of the smokers had developed pseudarthrosis, whereas the rate was 0% among the nonsmokers. Smoking has adverse effect on bone union of lumbar posterolateral fusion.
The merits of fixation on lumbar surgery are widely known. Tight fixations may cause disorder of the adjoining disc after along interval. Solutions such as the Graf system were developed to cossect such problems: as its purpose is to stabilize intervertabral fixed joints. We performed unilateral posterolateral fusion on the lumbar spine for stabilization. In this paper, we report the clinical and radiographical results of postoperative surgery. 36 patients (10 men, 26 women) with an average age of 45 years (range: 24 to 70) underwent unilateral postlateral fusion from June 1996 to April 2000. The average follow-up time was 15 months. We evaluated clinical symptoms using the JOA score, and determined the recovery rate by Hirabayashi's method. We also evaluated bone union, and range of motion of fixed intervertebral joint. The mean JOA score was 12.7 before operation, and 26 postoperatively. The mean recovery rate was 84.9%. The rate of bone union was 83.6%. The instability of the intevetebral fixed joint undergoing surgery improved from 6.5 degrees preoperatively to 4.5 degrees postoperatively. We started to obtain good results from the middle term. Unilateral lumbar posterolateral fusion is effective for stabilization. We consider unilateral posterolateral fusion to be an effective option when other cossective produses are doubtful.
We experienced a case of lumbar disc herniation migrated to the posterior epidural space, combined with bladder bowel disturbance. A 64-year-old man had lumbar pain, bilateral weakness in both legs, and bladder bowel disturbance. He was admitted to our hospital. Myelogram, CTM, and MRI showed a mass compressed epidural space at L1/2 level. We suspected lumbar disc herniation migrated to the posterior epidural space or epidural tumor. After laminectomy at L1/2, a mass posteriorly compressed the dura, reaching in a stalk to the L1/2 space. Histopathological examination showed this mass to be a composed disc with inflammatory cell infiltration.
Between 1996 and 1999, eleven males underwent salvaged operation after Percutaneous Laser Disc Decompression (PLDD) at other hospitals. Their age ranged from 28 to 92 years old (mean: 56.6 years) and follow-up period from 1 month to 37 months (mean: 19 months). PLDD was performed on the cervical spine in 4 cases and lumbar spine in 7 cases. The numbar of PLDDs ranged from 1 to 8 times (mean: 3.3). At the time of salvaged operation, our diagnosis was lumbar herniated intervertebral disc (LHID) in 4 cases, cervical pyogenic discitis (CPD) in 2, and indivisual cases of cervical spondylotic myelopathy (CSM), cervical ossification of the posterior longitudinal ligament (OPLL), lumbar canal stenosis (LCS), lumbar discopathy, and lumbar extradural abscess (LEA). Salvaged operations were posterior discectomy in 4 cases of LHID, anterior decompression and fusion in 2 cases of CPD and OPLL, laminoplasty for CSM, PILF for LCS, PL-F for lumbar discopathy and laminectomy and debridement for LEA in one each. The snspected causes for requiring salvaged operations were no improvement after PLDD with appropriate indication in 4 patients, no improvement with inappropriate indication in 3, infection in 3, and in one case the cause was unknown.
The morphology of facet joints in patients with lumbar disc herniation was studied by computed tomography (CT). Fifty patients with lumbar disc herniation between the 4th lumbar vertebra and 5th lumbar vertebra and 20 normal volunteers with no history of low back pain as a control group were included in this study. Three consecutive slices parallel to the L5 superior edge of the vertebral body composed with computed tomography with 3mm interval were scanned to measure with NIH images. The morphology of the superior facet joint of the fifth lumbar vertebra was estimated by a computer. There were no statistical differences in the measured values between the two groups, nor statistical correlation between the site of the disc herniation and tropism of the facet joints. The shape of facet is one of the key points of the biomechanics of the lumbar vertebrae, however, there seems to be no relationship between the occurrence of disc herniation and facet joint tropism.
The objective of this study was to determine the clinical and radiological characteristics of patients who demonstrated kyphosis at the cervical alignment, which usually appears as an inherent lordotic curve on radiolographs in normal subjects. Forty-four patients with cervical lordosis (L-group), 18 patients with cervical straight alignment (S group), and 15 patients with cervical kyphsis (K group) were compared based on their sex, age, weight, symptoms, and clinical or radiological findings. The K group had younger female with more low back-back pain. The S or K group displayed higher positive rates in clinical tests that were helpful for the diagnosis of thoracic outlet syndrome (TOS). In the radiographs of the S or K group, cervical lateral X-Ps in the neutral position revealed the middle to inferior margin of the T1 vertebrae (as mode or median value) at the lowest level. In addition, the total spinal X-Ps demonstrated scoliosis or flat back spine in the K group. From the present results, cervical kyphotic alignment might display various symptoms and one radiological phenomenon of complicated pathogenesis related to faulty posture or TOS.
Sagittal lumbopelvic alignment and compensations are important factors for consideration in degenerative lumbar diseases. Further understanding is needed on the functional relations between parameters of the pelvic and lumbar spine system. The objective of this study was to report hip-spine alignment and movement in normal subjects. We used lateral roentogenograms of the lumbar spine and pelvis, taking in standing, forward, and backward positions. Fifty normal volunteers without LBP were studied. The mean age was 35 years (SD, 7.6). Radiographic measurements were done using Jackson s method. The mean lordosis (LO) was 47 (SD, 8.9), mean sacral inclination (SI) was 34 (SD, 7.0), and mean pelvic angle (PA) was 15 (SD, 6.0) The mean range of motion of LO was 52, SI was 12, and PA was 12. There existed correlations (p<0.05) between LO and SI, and PA and SI, but not between LO and PA on range of motion.
The purpose of this study is to evaluate the results of surgical treatment for using acromioclavicular (AC) titanium plate. Since 1999, 4 patients (2 men and 2 women, mean age 35 (18 to 47) years) were treated by using the plate, 1 with AC dislocation (Tossy grade III) and 3 with distal clavicular fractures (Neer type II). The patients were evaluated after a mean follow-up of 9 (4 to 15) months. According to Kawabe's scoring, 2 patients were excellent, 1 patient was good, and 1 patient was poor. Acromion fracture occurred in 1 patient and 2 patients complained of painful shoulder motion due to stimulus of the hook (in 1 patient, the pain decreased after removal). Satisfactory clinical results were obtained in this study. It is essential to place the hook at an appropriate posterior position in the acromion and to bend the plate to fit the clavicle.
From May 1997 to January 2000, we treated 12 patients who suffered rotator cuff tears surgically due to the use of McLaughlin's technique. We used the simple zero-position orthosis as postoperative treatment from the next day. The simple zero-position orthosis has numerous advantages compared with conventional orthosis, for example it is light, easy to put on, and inexpensive. The surgical results of the 12 patients were evaluated by the Japanese Orthopaedic Association (JOA) score. The mean JOA score improved from 59.5 to 87.8 points. So if a patient did not put off the orthosis as his likes, Simple zero-position orthosis is a useful device for the postoperative treatment of rotator cuff tears.
We applied critical path to rotator cuff tears. At the introduction of the path, we decided the criteria for discharge. The criteria were the removal of shoulder abduction brace and the activity level of patients for face-washing and eating. At the programming of the critical path, we improved the process in our hospital. After anesthesia, patients remained asleep for 6 hours, and antibiotics administration stopped 2 days after surgery. The surgical wounds were fixed with tape so that the thread did not need to be removed. We examined the patients who were 8 before and 9 after introduction of critical path. We examined the duration of brace use, average number of days of hospital stay, and JOA score. After the introduction of the critical path, the duration of wearing brace use and average number of days in the hospital became shorter. Doctors, nurses, and patients were all satisfied with the critical path.
We evaluated the findings of MRI on painful shoulders in 19 hemiplegic patients. T1-weighted (spin echo) image and T2-weighted (fast spin echo) image were scanned in 19 shoulders with the 0.5-Tesla MR system. On MRI, supraspinatus tendon tears were detected in 18 of the 19 shoulders, degenerative change in all shoulders, bone bruise in 2 shoulders, and inflammation in 13 of the 16 shoulders. Eventually most of the patients suffered wide severe injuries in rotator cuff and bone. Since many of these lesions could not be repaired by surgery, it will be important to keep their hemiplegic shoulders reduced in normal position from the onset of stroke in hemiplegic patients.
The present invention relates generally to an apparatus for exercising human muscles. It uses the electrically stimulated antagonist muscle force to resist the voluntary contracting agonist muscle. This method induas both eccentric contraction of antagonist muscle and concentric contraction of agonist muscle, which has been referred to as “closedkinetic-chain exercise”. It allows a person to receive closed-kinetic-chanin exercise at a comfortable posture and prevents osteoporosis. This study was performed to determine the electrical stimulated antagonist muscle force as a resistance of the voluntary contracting agonist muscle. Maximum electrically stimulated muscle force indicated 26% to voluntary muscle force with knee flexion, and the force ratio of antagonist muscle to agonist muscle varies according to the combination of muscles and knee joint angle.
We studied three-dimensional motion analysis of trunk rotation in baseball pitching. Six male baseball players (two experienced pitchers and four experienced field players) and an inexperienced player were studied. The subjects were filmed pitching from six directions with six motion cameras, and synchronized with each other. The angle, angle velocity of trunk rotation, duration of LFC (lead foot contact), MinR (minimum rotation), MAV (maximum angular velocity), BR (ball release), and MaxR (maximum rotation) were calculated.
We reviewed 9 patients in which 9 shoulders were operated on because of internal impingement. The mean age of the patients at operation was 20.3 years (range; 16 to 28 years). All patients had undergone arthroscopic internal impingement test, followed by arthroscopic debridement. The clinical outcome was expressed using JOA score and JOA score for athletics. All postoperative JOA scores and athletic JOA scores were higher than preoperative scores. The average follow-up period was 11 months (range; 9 to 16 months). 8 cases were able to start playing baseball again, but the ninth case was not.
Osgood-Schlatter disease is found frequently in young athletes. Conservative treatment is effective for most patients with this disease, however, some patients have persistent symptoms after epiphyseal arrests. We treated eight patients with intractable pain by posterior transfer of tibial tuberosity. The clinical outcomes of this surgery were reviewed. Seven men and one woman underwent this surgery. Six of the eight patients had knee pain during athletic activities, and the remaining two during heavy work. The follow-up period was five to 170 months, averaging 92 months. Complete relief of pain and resumption of activity were obtained in six of eight patients. One patient had knee pain after athletic activities, and the remaining one patient had local pain in tibial tuberosity. However, both patients were relieved from their preoperative severe pain. We concluded that this operative procedure is effective for Unresolved Osgood-Schlatter disease.
We treated 48 cases of femoral neck fractures between March 1998 and April 2000. The patients, consisting of 10 males and 38 females with a mean age of 72 years, were treated using compression hip screw (CHS) and cannulated cancellous screw (CCS). The purpose of this study was to investigate their clinical results. The bony union rate was 89% in Garden stages I and II and 72% in stages III and IV. There was a significant difference between bony union and alignment index (P<0.05) value. The most important factor was the quality of reduction.
Internal fixation procedures with use of compression hip screw (CHS) were carried out in 134 patients with intracapsular fracture of the femoral neck from June, 1990 to June, 2000. In this study, 98 patients followed-up for more than 3 months were evaluated. The mean age was 72.1 years (range: 19 to 96). The average follow-up time was 15.1 months (range: 3 to 96). These cases were classified according to Garden stage classification; Stage I, 20 cases; Stage II, 42 cases; Stage III, 31 cases; and Stage IV, 5 cases. The late segmental collapse rate was 4.1%. The nonunion rate was 2.0%. Internal fixation procedures with use of CHS showed good results.
We conducted an epidemiological study of hip fracture in Hirado City. There were 25 patients (2 men and 23 women) in 1998. The number of patients increased markedly with age. After adjustment of age changes in the population, the incidence of hip fracture was 46.9 in a hundred thousand. This incidence is showing a tendency to increase, and we expect a higher number of hip fractures in the future.
The postoperative results of the gamma nail for trochanteric and subtrochanteric fractures were studied in 74 cases from January 1999 to August 2000. Postoperative complications observed were postoperative femoral fractures in 5 cases, stable fractures in 3 cases, and unstable fractures in the remaining case. In stable fractures, the nail sometimes obstructs reduction, causing the postoperative fractures. To avoid fractures, it is nessesarry to study the appropriate surgical techniques and select the devices carefully.
Femoral and trochanteric fractures of the ipsilateral femur are rare. Only 3 cases have been reported previously to our knowledge. A pathological study was done on our case. A 89-year-old woman fell down and consulted our clinic complaining of left coxalgia. A plain radiograph, tomogram, and MRI showed femoral and trochanteric fractures in the left femur. Bipolar prosthesis replacement was done one week after the injury. Pathology of the femoral neck and trochanteric fracture showed interval between these injuries, suggesting that the trochanteric fracture occured after femoral neck fracture.
Twelve hips in eleven infants with developmental dysplasia of the hip (DDH) treated by open reduction were reviewed. According to Graf's classification ultrasonographically there was one type D hip, seven type III hips and four type IV hips. Magnetic resonance imaging showed that all 12 limbuses were interposed between the acetabulum and femoral head. The shape of limbuses on magnetic resonance imaging represent the complexities of developmental dysplasia of the hips more clearly than ultrasonographic classifications. Two types of DDH resulted in open reduction. The first type had iatrogenic complexities and the second type teratologic. The former type of DDH was derived from missed diagnosis at the time of examination of newborn hips or inadequate usage of the Pavlik harness in the course of treatment. Conservative treatment is effective for this type of hip by addressing the given problems; however, open reduction may be more effective for the latter type of DDH because of complexities.
Selective soft tissue release is commonly performed for hip subluxation and dislocation in cerebral palsy. We performed this method on 187 children and examined 33 hips in 27 children with cerebral palsy in which the pre-operative migration percentage was over 50. The subjects included 15 men and 12 women whose average age at operation was 6.9 years (range: 2.1 to 13.2). The mean duration of follow-up was 5.6 years(range: 2.1 to 8.8). We evaluated radiographes just before operation, one year after operation, and at final examination. The results were for the most part good, but some cases required osteotomy.
We used SCFE screws in 8 patients with slipped capital femoral epiphysis. No hips showed further slipping after in situ pinning. Age of crisis was 11 to 16 (mean: 13.7 years old). The duration of follow-up was more than 2 years. Epiphysial closure after operation was observed at 9 to 16 months (mean: 11 months). The average JOA score before operation was 77 points, and 98 points after. There were no severe complications such as avascular necrosis, chondrolysis, or osteoarthritis. Short neck defomity was seen, but neither buried screw heads inside the cortex seen in CCS nor penetration of screw were seen.
It has been reported in recent years that use of ultrasound stimulation is effective for false joint and delayed union after fracture. However, there have been very few reports of use for callotasis. We obtained good results by using ultrasound stimulation for callus formation in callotasis. The case was a 12-year-old girl, and she was diagnosed with hypochondroplasia. She had been on growth hormone therapy since age 10. The therapy had been becoming gradually less effective, she therefore underwent lengthening of both lower limbs. Thelengthening rate was 1mm per day and the total length gained was 95mm. Upon completion of lengthening, callus formation was found to be very poor. So we began the use of ultrasound stimulation. After two weeks, improvement of callus formation was seen on radiograph. The final, healing index was 32.4 days per cm. Use of ultrasound stimulation for callotasis from the beginning of treatment allows removal of the external fixator earlier than when it is not used. Ultrasound simulation thus offers important benefits for patients.
We report 4 cases of deformity and shortning of the forearm with bone tumor treated by callotasis. Four patients (3 women and 1 man) ranging in age from 7 to 13 years (average age: 10 years) underwent lengthening of the forearm bone. The original disease was osteochondroma (3 cases) and enchondroma (1 case). Lengthened forearm bones involved both the radius and ulna in 1 case and the ulna in 3 cases. Mono-tube lengthener was used for all cases. The lengthening obtained in the forearm bones ranged from 15 to 39mm (average: 27.8mm). The distraction rate was 8.1 to 27.1% (average: 19.1%). The healing index was 31.8 to 82.0day/cm (average: 56.3day/cm). Distraction callus fracture was recognized in 1 case, with posterior interosseous nerve temporary palsy as a complication.
Fibrodysplasia ossificans progressiva (FOP) is characterized by progressive soft tissue ossification and congenital malformation of the great toes. This report describes a 26-year-old female with advanced FOP. Painful swelling of muscles in her neck and upper spine leading to ossification began at age 2. Her entire spine and shoulder joints were eventually fused in early childhood. Treatment with EHDP (ethane-1-hydroxy-1, 1-diphosphonate, 20mg/kg/day) alone was ineffective. She became rapidly disabled at the age of 18 due to fixation of the hips and knees by ectopic bones. Her condition remained unchanged until swelling and pain of the left ankle developed at age 26. Laboratory tests revealed elevation of transforming growth factor-β1. Treatment with intravenous administration of pamidronate (3-amino-1-hydroxypropylidene-1, 1-bisphosphonate) and corticosteroid, oral administration of EHDP, and irradiation (20 Gy) were performed. The swelling and pain gradually resolved without calcification. The combination of bisphosphonate with irradiation might be effective in the prevention of local calcification in this type of case.
Between May 1998 and July 2000, we treated some osteoporosis patients with etidronate. Among these patients, we studied the changes of bone metabolic markers and bone mineral density in 17 cases. All cases were examined with bone metabolic markers such as osteocalcin (OC), pyridinoline (Pyr), and deoxypyridinoline (D-pyr). We also examined bone mineral density (BMD) using DXA in all cases. Bone resorption makers (Pyr, D-pyr) decreased 3 months after beginning treatment, and bone formation maker (OC) decreased 9 months after beginning treatment. BMD in lumbar spine and femoral neck showed no remarkable changes. BMD in calcaneus increased 6 months after beginning treatment. In this study, suppression of bone resorption was evident, but our research indicates that BMD increase occurs over a longer period of time.
Psoriatic arthritis (PsA) is a psoriasis-associated inflammatory arthritis that is usually seronegative for rheumatoid factor. In Japan, the prevalence of PsA in general population ranges from 0.02 to 0.04%. We report two cases of PsA who under went total hip arthroplasty of both hips. It is a known fact that, patients with PsA have higher infection rates after total arthroplasty. Precautions are thus required in the preoperative as well as postoperative periodto prevent joint sepsis. In particular, the use of a topical corticosteroid or other dermatologic treatment should be considered for skin protection in total joint arthroplasty.
The development of bone cysts in hemodialysis patients is common, but no massive bone cysts of the condylus fumeri medialis, and the condylus tibiae medialis have been reported. This report describes a 70-year-old woman with a history of hemodialys for 23 years. She presents with a large bone cyst of the condylus fumeri medialis, and the condylus tibiae medialis. Arthroscopic synovectomy, curettage of the cyst, and iliac bone graft were performed. The inflammatory synovium discovered within the cyst was positive for β-2 microglobulin staining.
Patients with gonarthrosis often experience mild inflammatory symptoms such as thermal sensation in the knees in addition to pain. Intraarticular injection of steroids and other agents are widely used to treat such symptoms. Evaluation of such treatment, however, is largely dependent on complaints by patient and the subjectivity of the person administering the treatment. There is also a lack of objective indicators. In the present study, we investigated changes before and after treatment by monitoring the skin temperature of the knees, and performing frequency analysis of skin temperature variation to examire its usefulness.
In rheumatoid arthritis (RA), inflammation of the joint is caused by gene products of different cell types in synovium. The analysis of specific gene expression provides insight not only into the underlying pathological cause, but provides the opportunity to target selective genes. The purpose of this study was to determine the specific gene expression in synovial cells in RA. Synovium was obtained from RA patients during TKA. Partial cDNA sequences from subsets of mRNAs of synovial cells were amplified by reverse transcription and the polymerase chain reaction (RT-PCR). Sixteen pairs of primers were selected for differential display. Specific amplification of the cells was detected by comparing the OA tissue and cell line (THP-1). The detected specific cDNAs was amplified by PCR and the sequences were surveyed in the Gene Bank. Secreted Frizzled Related protein (sFRP), KIAA1363 protein, Folate receptor 2 (FOLR2), Nuclear factor of kappa light polypeptide gene enhancer in B-cell 1 (NFKB1) were detected as specific expressing genes in RA synovium. sFRPs is a recently identified novel family acting to modulate Wnt signaling, which is involved in cell differentiation and apoptosis. Further study is necessary to ascertain the effects of sFRPs on the pathology of RA.
It has been suggested that MR is an excellent imaging procedure for the evaluation of rheumatoid arthritis of the cervical spine. Twelve patients (age range: 48 to 78 years, mean: 62.5 years) suffering from rheumatoid arthritis with atlantoaxial subluxation were examined with MR imaging. Conventional MR imaging was performed pre- and postoperatively. We evaluated the width and intensity of the spinal cord, reduction of periodontoid pannus and the cervicomedullary angle. Five of eight patients (62.5%) with cervical myelopathy had changes of intensity in the spinal cord. The cervicomedullary angle of the patients with vertical subluxation was significantly smaller than those without it. In patients with evidence of cervical myelopathy, the rate of decrease in cord compression improved significantly after surgery. We found the reduction of periodontoid pannus postoperatively in 33% of the patients (four out of twelve).
We report total knee arthroplasty for rheumatoid arthritic knee with severe varus or valgus deformity. Case 1 was a 68-year-old woman who had severe varus deformity. Preoperative femoro tibial angle was 209 degrees; it improved to 180 degrees after total knee arthroplasty and bone transplant operation. Case 2 was a 57-year-old woman who had severe valgus deformity. Preoperative femoro tibial angle was 145 degrees; it improved to 167 degrees after total knee arthroplasty and bone transplant operation. In both cases, preoperative extension disorder of the knee completely improved. In total knee arthroplasty for severe deformity, accurate bone cutting, even soft tissue balancing and selection of suitable implant are very important. Moreover, emphasis should be placed on the timing of the operation.
This paper reports a case of total elbow arthroplasty for mutilans deformity with olecranon fracture in rheumatoid arthritis. A 55-year-old woman presented with a 12-year history of arthritis involving the hands, wrists, hips, knees, ankles, and elbows. She had already undergone bilateral TKA and THA. She could walk only with a pair of crutches. At one point she stumbled and fell, fracturing her left olecranon process. She underwent total elbow arthroplasty and osteosynthesis. The fracture was treated with tension-band wiring after the components were implanted. Three weeks later, pain was completely relieved and she was able to walk with crutches. The arc of flexion ranged from 20 degrees to 120 degrees. The result of the operation was satisfactory. During the operation, we suffered approach, prosthetic selection and humeral component placement.