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Hideyuki Kawabata, Shunsuke Nakamura, Hironori Kakoi, Tomonori Nagamin ...
2007 Volume 56 Issue 2 Pages
153-156
Published: 2007
Released on J-STAGE: June 01, 2007
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We report a case of extensive osteochondritis dissecans (OCD) in the patellofemoral joint.
A 14-year-old male complained of pain and locking of the left knee after playing basketball.
Roentgenograms showed irregularity of the joint surface, and MRI confirmed extensive defect of the cartilage at the anterior aspect of the lateral femoral condyle.
He was treated with operative therapy which included curattage of the subchondral bone, and reduction and fixation of the exfoliated osteochondral fragment with some absorbable pins.
Four months after operation, he secured full range of motion without pain and catching in the left knee joint. Both roentgenograms and MRI confirmed union by reduced osteochondral flagment.
Some studies have reported OCD in the patellofemoral joint as comparatively rare in recent years.
However, the pathology of OCD occurring the patellofemoral joint has not been clarified in detail, however we suspect that repeated shearing force on the juvenile cartilage during sports activities may cause diseases.
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Eiichi Nakamura, Yasunari Oniki, Satoshi Kudo, Takeshi Maekawa, Hirosh ...
2007 Volume 56 Issue 2 Pages
157-161
Published: 2007
Released on J-STAGE: June 01, 2007
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Werner syndrome is a rare autosomal recessive systematic disease caused by Werner syndrome gene mutations on chromosome 8, which is considered an adult progeria model. The present study reports a 57-year-old man with Werner syndrome and quadriceps tendon rupture. One year ago, he could not extend his right knee immediately after trying to stand upright to avoid falling in the bathroom. At first examination, the range of motion was from 0° to 125° in his right knee, but he could not walk without help. Delle and tenderness were seen on the quadriceps tendon just above the patella in his right knee. On radiograph, there were a few small calcifications within the quadriceps tendon. MRI on his right knee showed complete rupture of the tendon from the attachement of the patella. The diagnosis was complete quadriceps tendon rupture based on tendinous vulnerability due to calcium deposits. Some augmentation was considered necessary in addition to primary repair. We chose autogenous semitendinosus (ST) tendon as the augmentation material. During operation, we harvested the ST tendon in his right crus. And then, we added the eight-figure augmentation with the ST tendon after repair of the quadriceps tendon using Krachows method. Approximately one year after surgery, he could walk by himself despite flexion of 110° and extension lag of 10° in his right knee.
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Katsuhiko Murakami, Tetsurou Aitani
2007 Volume 56 Issue 2 Pages
162-164
Published: 2007
Released on J-STAGE: June 01, 2007
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Total knee arthroplasty (TKA) is a successful procedure for pain relief and restoration of walking ability. However, the range of motion after TKA is not satisfactory. The NexGen LPS-Flex allows an enlarged flexion angle, with a maximum of 155 degrees. This prosthesis has both a mobile bearing and a fixed bearing. The decision to use which TKA is made during the operation according to the soft tissue balance. We have experience of using LPS-Flex fixed type total knee arthroplasty and report short-term results. Between June 2002 and December 2005, 70 knees from 55 patients underwent total knee arthroplasty. The seven male and 48 female patients averaged 76.7 years of age (range; 64-89). The mean follow up term was 23.3 months (3-45 months). The mean postoperative flexion angle was 115.2 degrees. The postoperative average range of motion remained at the preoperative condition. The maximum flexion angle of 10 knee joints was over 130 degrees. Postoperatively all patients had no pain, no complications, and no component troubles. The result of this study is satisfactory, but careful follow-up is mandatory for this type of prosthesis.
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Hidehiko Kido, Kenzo Shirasawa, Manabu Irie, Akihisa Yamashita, Junya ...
2007 Volume 56 Issue 2 Pages
165-170
Published: 2007
Released on J-STAGE: June 01, 2007
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Post-operative infection of total knee arthroplasty (TKA) is a serious complication that is difficult to treat. The following is a review of the methods of treatment for infections at our department, and the post-operative results.
From April 1998 to December 2005, TKA was performed at our department on 276 knees, three of which (1.1%) developed a post-operative infection. The primary diseases were rheumatoid arthritis (RA) in two patients and osteoarthritis (OA) in one. All were late infections, occurring a year and a half or more after the operation. One RA patient and OA patient underwent implant removal and placement of antibiotic cement spacer followed by secondary revision arthroplasty. The remaining patient had a methicillin-resistant Staphylococcus aureus (MRSA) infection and underwent implant removal and placement of antibiotic cement spacer followed by so-called resection arthroplasty. This patient is currently being followed up.
The post-operative progress of the two patients with secondary revision arthroplasty using antibiotic cement spacer was favorable, and the treatment proved effective for post-operative infection after TKA. However, there are cases where the course of treatment or the types of pathogen make secondary revision arthroplasty difficult. There is therefore a need to investigate therapeutic strategies in the light of each case.
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Ryuji Nagamine, Kenso Katai, Keiichi Kondo
2007 Volume 56 Issue 2 Pages
171-175
Published: 2007
Released on J-STAGE: June 01, 2007
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Single radius in the sagittal plane is the concept of the femoral component of Scorpio Superflex and Advance systems. This concept has been established based on the anatomic configuration of the femur. When the joint gap is set equal between in extension and in flexion during posterior stabilized total knee arthroplasty, however, a larger femoral component is used because the flexion gap in flexion becomes larger after excision of the posterior cruciate ligament. In this study, the concept was verified even when a larger femoral component was used. Sawbones with femoral components were attached to the specially designed device so that the bone could be rotated around the epicondylar axis. Pictures of the components were taken from 90° knee flexion to 135° in 15° increments, and the distances from the epicondylar axis to the most posterior points of the medial and lateral condyles were measured on the pictures. Two systems had single radius when the component with anatomic size was used. With a larger component, however, the single radius did not exist. The size and design of the femoral component should be established based on both the anatomic configuration of the femur and ligament balancing.
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Taihei Koguchi, Tamiko Koshiba, Yasuaki Suruga, Yoshihito Yukita, Osam ...
2007 Volume 56 Issue 2 Pages
176-178
Published: 2007
Released on J-STAGE: June 01, 2007
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We report the results of osteosynthesis of femoral neck fractures with Hansson Pin. From November 2003 to December 2005, we treated 37 patients with femoral neck fractures with or without the displacement. According to the modified Gardens classification, there were six stage 1 subjects, 10 stage 2, 16 stage 3 a, three stage 3 b and two stage 4. Six were men and 31 were women, and their mean age was 76 years. Thirty fractures were united and three were switched to hemiarthroplasty. Overall union ratio was 81%: 100% in stages 1 and 2, 88% in stage 3 a, and 0% in stages 3 b and 4. The cause of non-union was poor reduction in five and bone fragility in two (steroid induced and hemodialysis). We can use Hansson Pin in minimal displacement and reducible fractures, but in irreducible cases, we should consider the merits of this method for patients with risks and bone fragility.
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Akihisa Yamashita, Kenzo Shirasawa, Hidehiko Kido, Manabu Irie, Junya ...
2007 Volume 56 Issue 2 Pages
179-182
Published: 2007
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Osteoporosis-induced femoral neck fracture is a major traumatic disorder in elderly patients. This fracture is often treated surgically. Although many implants have been developed, we use cannulated cancellous screw (CCS) for femoral subcapital fracture fixation as it offers advantages such as rotational stability, compression of fracture site, and technical convenience. Complications of surgical treatment for femoral subcapital fracture, such as non-union of fracture and post-traumatic femoral head necrosis, have been reported. Subtrochanteric fracture after CCS osteosynthesis is rarely seen. We have experienced three cases of subtrochanteric fracture after CCS operation. The common denominator in all three patients seemed to be entry point in the lateral cortex below the level of the lesser trochanter, the highest screw angle of insertion, without washer engagement. It is therefore important to pay attention to the screw inserted site, screw angle, and screw location during the CCS operation. Furthermore, we have also identified the following guidelines for our CCS operation of femoral subcapital fractures: 1) lowest angle of screw insertion, 2) insertion above inferior edge of lesser trochanter, 3) three-point fixation, 4) parallel insertion of all screws, 5) apex distal triangle pattern if three screws are inserted, and 6) use of washer.
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Ken Narita, Joji Noguchi, Gishichiro Shimoyama, Toshiro Shinozaki
2007 Volume 56 Issue 2 Pages
183-187
Published: 2007
Released on J-STAGE: June 01, 2007
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Twenty-seven patients with displaced femoral neck fractures were treated either by internal fixation (IF) with hook-pin or hemiarthroplasty (HA).
Thirteen patients (mean age: 69 years) were treated with IF, and fourteen patients (mean age: 80 years) were treated with HA. Hip complications were six cases in the IF group and zero in the HA group. But three cases in the HA group had general complications and three patients in the IF group were required re-operations. In our opinion, hip complications in the IF group do not necessarily require additional surgery, so internal fixation should be considered as the treatment of choice in patients with displaced femoral neck fractures according to their conditions.
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Akihisa Yamashita, Kenzo Shirasawa, Hidehiko Kido, Manabu Irie, Junya ...
2007 Volume 56 Issue 2 Pages
188-192
Published: 2007
Released on J-STAGE: June 01, 2007
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Femoral peritrochanteric fracture is a major traumatic disorder in elderly patients. We have been using intramedullary hip screw (IMHS) for surgical treatment since November 2001. Asian IMHS (A-IMHS) is a more low profile and less invasive implant. Between April and December 2005, 34 patients underwent osteosynthesis using the A-IMHS for this fracture. They consisted of nine men and 25 women with the mean age of 84 years. For these patients, we investigated the short-term results of the A-IMHS fixation.
Radiographycally, the tip of the lag screw was located at the superior-anterior of the femoral head in 55.9% of the patients. After an average follow-up period of 2.8 months, the mean sliding distance of the lag screw was 2.34 mm (0 to 14 mm). Post-operational fracture displacement with cut out of the lag screw was noted in only one out of the 34 patients.
Although many intramedullary fixation systems for femoral trochanteric fracture have been developed, we prefer the A-IMHS as it offers a beneficial sleeve mechanism. The advantages of the sleeve mechanism include easy compressive fixation and prevention of excessive sliding and back out of the lag screw. We conclude that A-IMHS is a very useful fixation system for femoral peritrochanteric fractures.
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Takahiro Yara, Yoichiro Ishida, Atsuya Hanaoka, Ryuji Imamura, Toshihi ...
2007 Volume 56 Issue 2 Pages
193-196
Published: 2007
Released on J-STAGE: June 01, 2007
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The main aim of this study was to investigate survival prognoses and functional results in the elderly aged 90 years and over with hip fractures. We analyzed 48 patients admitted to our hospital between 1996 and 1999 with hip fractures and followed up until death or for at least five years. All patients were treated surgically. The significant predictors of survival were the preoperative American Society of Anesthesiologist score, walking ability, number of preoperative complicating diseases and vertebral fractures, fracture type, and type of surgery. The significant predictors of recovery of walking ability were the preoperative American Society of Anesthesiologist score and dementia. These data emphasize the importance of protecting against vertebral fracture in osteoporosis treatment. Importantly, the operative procedure is the only useful predictor after injury among those significantly related to survival prognosis. Consequently seems important to further investigate the possibility that invasion associated with operation is greater for hemiarthroplasty than other operative procedures in the elderly, through well-designed, randomized studies.
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Takuya Ikuta, Futoshi Kuga, Mintaku Yo, Yasunori Tome
2007 Volume 56 Issue 2 Pages
197-201
Published: 2007
Released on J-STAGE: June 01, 2007
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Twenty cases of tibial fracture were treated surgically by minimally invasive plate osteosynthesis.
All cases achieved good bone union. No implant-related complications were observed.
Minimally invasive plate osteosynthesis is a useful method for proximal and distal tibial fractures, as well as for tibial shaft fractures for which intramedullary nailing is not suitable.
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Akihisa Yamashita, Kenzo Shirasawa, Hidehiko Kido, Manabu Irie, Junya ...
2007 Volume 56 Issue 2 Pages
202-206
Published: 2007
Released on J-STAGE: June 01, 2007
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We performed minimally invasive plate osteosynthesis (MIPO), which is biological fracture fixation, for surgical stabilization of fractures of the lower extremities in six patients after August 2005. The patients consisted of two men and four women, of whom two cases had distal femoral fractures and four had leg fractures respectively. We used various locking compression plate systems (LCP), which previded angular stability in the MIPO operation.
In these patients, one suffered tibial proximal-end fracture which resulted in malunion showing varus deformity at the fracture site one year after the operation. The other suffered femoral distal-end open fracture associated with intramuscular MRSA abscess one month after the MIPO operation, but the patient fully recovered by surgical drainage and antibiotic therapy without plate removal.
Although we preferred the intramedullary nail (IMN) for stabilization of the fracture of the lower extremity, especially for diaphyseal fracture, the MIPO operation was well indicated for fractures reaching the metaphysis or articular surface, complicated with diabetes mellitus, as well as open wound and skin and soft tissue damage rather than IMN.
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Tomofumi Miyazato, Yuki Furukawa, Ayahito Kawabata, Reiko Mawatari, Os ...
2007 Volume 56 Issue 2 Pages
207-210
Published: 2007
Released on J-STAGE: June 01, 2007
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Ipsilateral fractures of the femoral hip and shaft are rare and are usually encountered in high-energy trauma. The diagnosis of undisplaced hip fracture is difficult and is missed at the initial assessment. We report a case of bilateral femoral hip and shaft fractures. A 57-year-old man was injured in a traffic accident. Initial diagnosis was bilateral shaft fracture of the femur (right shaft fracture was open) and other multiple fractures. On the same day, debridement and external skeletal fixation were performed on the open fracture. After several days, right neck fracture was found on X-ray and cannulated compression hip screw was added. On standby left femoral shaft fracture was treated by antegrade femoral nail. Postoperative X-ray revealed left trochanteric fracture, which was replaced using a long γ nail. All fractures healed without postoperative infection, non-union, or avascular necrosis.
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Koji Sameshima, Yoshihisa Kawauchi, Hiroyuki Maruyama, Hiromi Sasaki, ...
2007 Volume 56 Issue 2 Pages
211-213
Published: 2007
Released on J-STAGE: June 01, 2007
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Excellent results were obtained in the use of hyperbaric oxygen therapy in conservative treatment for a spinal infection disease, are reported in this study.
The records of eight patients with spinal infection were reviewed. Six patients had pyogenic spondylitis (cervical spine one case, thoracic spine two cases, lumbar spine three cases), and two patients had lumbar spine epidural abscess.
The cause of infection was hematogenous infection in six cases, epidural tube in one, and stellate ganglion block in one. The conservative treatment plan consisted of feeding antibiotic agent after identification of the origin bacteria in the puncture of the lumber disc or blood culture and ten to 20 hyperbaric oxygen therapy sessions.
Good results (CRP normal) were achieved in six cases, and fair (CRP degradation) in two cases.
Discharge took ten to 60 days from start of treatment (an average of 34.2 days).
For spinal infection diseases without neurological symptoms, conservative treatment was the treatment of first choice, but good results were provided when hyperbaric oxygen therapy was combined.
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Hiroshi Ohmiya, Keiichiro Okajima, Yasuyuki Abe, Manabu Tanoue, Naoya ...
2007 Volume 56 Issue 2 Pages
214-216
Published: 2007
Released on J-STAGE: June 01, 2007
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Recently, there have been a large number of patients taking anticoagulants for the treatment of cardio/cerebrovascular diseases. It is a shared idea not to administer anticoagulants to patients before spiral surgery, due to risks of intraoperative hemorrhage or postoperative epidural hematoma. Since Feburary 2005, we have performed spinal surgeries on several patients with perioperative cerebral infarction for which anticoagulants were prescribed. We compared approximately 450 cases of spinal surgeries with the same number of patient treated before 2005 in terms of risk factors, amount of hemorrhage (intraoperative/postoperative), duration of drain insertion, and postoperative complications.
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Kenichi Seo, Seiichi Kawamura, Yoshiaki Imasawa, Shinichi Sasaki, Masa ...
2007 Volume 56 Issue 2 Pages
217-221
Published: 2007
Released on J-STAGE: June 01, 2007
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We studied the short-term results of non-constrained total elbow arthroplasty in patients with rheumatoid arthritis (RA).
Eight elbows in seven patients were followed up for this study. Prior to surgery, the elbows were graded 4 or 5 according to Larsen radiological criteria. The patients were followed up for an average of 14.5 months (range: 3 months to 2 years 5 months).
According to Kudos category, seven elbows had painful instability, and one had painful stiffness. The results, assessed according to the scoring system of the Japanese Orthopaedic Association, revealed remarkable improvement in pain and daily activities. Average rating of the elbows improved from 35.1 to 78.1 points.
We would like to emphasize that the use of a non-constrained prosthesis necessitates greater attention to the operative technique, including insertion of components and repair of soft tissue balance. In conclusion, total elbow arthroplasty is considered to be a valuable procedure for restoring daily life activities of patients with rheumatoid arthritis.
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Toshifumi Fujiwara, Atsushi Shiranita
2007 Volume 56 Issue 2 Pages
222-227
Published: 2007
Released on J-STAGE: June 01, 2007
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We report a new surgical treatment based on osteosynthesis for symptomatic accessory navicular. We surgically treated five cases of symptomatic accessory navicular between 2002 and 2003. The average age at the time of surgery was 14 years, and the average follow-up period was 6.4 months. All cases were classified as Veitch type 2.
The surgical method was drilling to the symptomatic accessory navicular by a 1.5mm Kirschner wire and fixation by a 1.5mm PLLA thread pin. Post-operative treatment was weight bearing in a plaster cast for three to four weeks, and then exercise in the ankle range of motion. The average period to disappearance of foot pain after operation was six weeks.
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Kaoru Arakaki, Ichiro Owan, Norimasa Sunakawa, Akira Omine, Takeshi Ya ...
2007 Volume 56 Issue 2 Pages
228-232
Published: 2007
Released on J-STAGE: June 01, 2007
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We report a 56-year-old female patient with persistent groin pain after total hip arthroplasty (THA). The patient began to complain of groin pain four months after THA. The pain increased with active flexion and passive hyperextension of the hip joint. There were no signs of infection or aseptic loosening of the components. Contrast arthrography showed iliopsoas tendon was enhanced in the anterior region of the acetabular rim, and intra-articular injection of lidocaine relieved the pain. Conservative treatment was ineffective and fibrotic thickened iliopsoas tenotomy was performed. There was no: recurrence, and the patient remains asymptomatic two years after surgery.
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Yasuhiro Mitsui, Eiji Nishioka, Yasuaki Ninomiya, Kensei Nagata
2007 Volume 56 Issue 2 Pages
233-236
Published: 2007
Released on J-STAGE: June 01, 2007
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We evaluated 10 patients (six males and four females) undergoing surgical treatment for calcaneal fracture from 2000 to 2004. The average age of the patients was 58.4 years. The mean follow-up period was nine months. The types of fracture were evaluated according to Essex-Lopresti classification and Sanders classification. We treated eight cases with modified Westhues method and two cases with open reduction internal fixation using plate. Clinical assessment was made using the score of Maxfield. Excellent or good results were confirmed in nine patients except in a patient undergoing modified Westhues method.
We recommend that the treatment for calcaneal fracture should be determined based on not only plain roentgen findings but also CT findings.
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Satoshi Kamada, Osamu Soejima, Kengo Nishio, Hirotaka Karashima, Masat ...
2007 Volume 56 Issue 2 Pages
237-241
Published: 2007
Released on J-STAGE: June 01, 2007
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The fracture of the hook of the hamate is relatively uncommon, and still tends to be misdiagnosed as, for example, tenosinovitis of the flexor carpi ulnaris or simple wrist sprain. A fifty-seven-year-old male golfer had difficulty in strongly gripping golf-clubs because of left hand pain when flexing his left little finger. He visited us three months after he suffered an injury while playing golf. He had visited other hospitals but was only told that he had a simple wrist sprain.
Radiogram, computed-tomography, three-dimensional computed-tomography, and MRI findings revealed nonunion of the hook of the hamate in addition to ruputured flexor tendon.
Intraoperative findings reveled nonunion of the hamate hook and rupture of the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) of the left little finger. We surgically removed a fragment of the hamate and sutured the proximal ends to the distal ends of the each tendon tightly using a modified Kessler suture.
Six monthes after surgery, the patient was able to start swinging golf clubs as a single digit handicaper again and was satisfied with the results.
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Tadatsugu Morimoto, Akihiko Asami, Kazumasa Maeda, Yasutaka Kugimoto, ...
2007 Volume 56 Issue 2 Pages
242-245
Published: 2007
Released on J-STAGE: June 01, 2007
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Numerous approaches have been advocated for spinal epidural metastasis of prostate carcinoma, but there are no common recommendations for its treatment.
Hormonal therapy, high-dose steroid, radiation therapy, laminectomy and various combination therapies have been used in the past. We report a 80-year-old man with spinal epidural metastasis of prostate carcinoma treated by hormonal therapy only.
Hormonal therapy relieved his low back pain and restored neurological symptoms.
MRI showed a significant decrease in the size of spinal epidural metastasis after the start of treatment. Our case suggests that hormonal therapy may be of value in the treatment of spinal epidural metastasis of prostate carcinoma.
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Shinji Miyoshi, Sakae Sato, Hirokazu Nohara, Fuminori Kanaya
2007 Volume 56 Issue 2 Pages
246-250
Published: 2007
Released on J-STAGE: June 01, 2007
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We present five male patients with six yellow ligament cysts (mean age: 61.5 years). All patients complained of leg pain, and four had intermittent claudication. Their mean preoperative lumbar score of the Japanese Orthopaedic Association was 13. MRI revealed that the cyst was located posterior to the dura, and had low intensity in T1-WI and a high-intensity area surrounded by a low-intensity ring in T2-WI. The cyst was resected in all patients. Modified Loves procedure with fenestration was performed in three patients and semicircumferential decompression and en-block laminectomy was performed in each patient because of combined spinal canal stenosis. One patient developed another cyst at the left side after one year of removal of the right cyst. There was an elliptical cyst inside the yellow ligament, and pathological examination revealed necrotic tissue surrounded with a fibrous wall. Postoperative follow-up ranged from 3 to 37 months. Leg pain was relieved in all patients. The lumbar score improved by 25 with a mean improvement of 79%.
Favorable results may be expected after resection and decompression of the yellow ligament cyst of the lumbar spine, however, further follow-up is needed since new cysts may occur at the opposite site.
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Hiroki Yoshimatsu, Tetsuya Hamada, Nobuhide Kusaba, Kenjiro Nakama, To ...
2007 Volume 56 Issue 2 Pages
251-253
Published: 2007
Released on J-STAGE: June 01, 2007
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We report on the diagnosis of multiple myeloma in 19 cases, consisting of nine males and ten females. Of these, 12 cases presented lumbago, of which nine had lumbago as the primary symptom. Fifteen cases presented hemanalysis in diagnosis. Of the 19 cases, 11 underwent detailed orthopaedic examination. Six cases were subsequently found to have spinal compression fracture and three other cases had spondylosis deformans. Fifteen cases underwent MRI, and only seven cases showed multiple myeloma findings on MRI. These results suggest that cases of severe lumbago with accompanying symptoms should undergo detailed examination.
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Masaki Yoh, Masayoshi Oga
2007 Volume 56 Issue 2 Pages
254-257
Published: 2007
Released on J-STAGE: June 01, 2007
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Recent years have seen rapid growth in the use of minimally invasive surgical procedures performed through a tubular retractor.
Applying the METRx-MD system in spinous process-splitting laminectomy, a technique invented by Watanabe et al., we found that this approach resolved excessive ablation of the facet joint of unilateral fenestration and resulted in favorable surgical outcomes.
The subject group consisted of 14 patients who underwent posterior decompression for lumbar spinal canal stenosis. The mean age of the subjects was 71.6 years. The mean follow-up observation period was 81.5 days. Mean JOA scores improved from 16.7 points preoperatively to 24.1 points postoperatively.
Blood loss during the operation ranged from 10 to 195 g (mean blood loss for one level: 31.3 g). The time taken for the procedure ranged from 58 to 296 minutes (mean time for one level: 89.1 minutes).
Fenestration via the midline spinous process-splitting approach using the METRx-MD system is capable of preserving not only the facet joint even at the upper lumbar level, but the lever arm function of the spinous process. The procedure also provides symmetrical visual fields and ease of orientation.
This procedure is recommended lumbar canal stenosis at all the lumbar levels.
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Hidehiko Kido, Kenzo Shirasawa, Manabu Irie, Akihisa Yamashita, Junya ...
2007 Volume 56 Issue 2 Pages
258-262
Published: 2007
Released on J-STAGE: June 01, 2007
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We investigated the postoperative range of motion and short-term outcome of LPS Flex TKA performed in our department, and compared 55 mobile-bearing and 30 fixed-bearing knees. The postoperative range of motion improved earlier in the mobile group than in the fixed group, but there was no significant difference in percentage flexion achieved at final observation between the two groups, with 105.0% for the mobile group and 105.7% for the fixed group, indicating good short-term outcome for both. Deep flexion can be achieved not only with mobile bearing but as a result of various factors such as surgical techniques. In particular, we found that good surgical techniques (ensuring posterior clearance) and the accurate balance adjustment of the soft tissue to achieve deep flexion markedly improved the postoperative percentage of flexion. The advantages of mobile bearing are the attainment of both deep flexion and durability, though results of in vivo kinetic analysis are still unclear. Thus careful follow-up of cases is necessary, though good long-term outcome can be expected.
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Muneaki Masuda, Toshihiro Odera, Masami Tokunaga, Satoshi Miyagi, Eiji ...
2007 Volume 56 Issue 2 Pages
263-266
Published: 2007
Released on J-STAGE: June 01, 2007
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We report the short-term clinical results of total knee arthroplasty (TKA) for osteoarthritis (OA) using NexGen LPS-Flex type implants. Since 2001, we have been following up 150 knees of 128 patients for over two years. The mean follow-up time was 2 years and 10 months (range: 12 to 51 months). Mobile bearing TKA was performed on 16 cases and fixed bearing TKA on 134 cases. We investigated range of motion (ROM), alignment (FTA, %MA), JOA score, Knee score, functional score (before and after operation), and positional angle of implants. All parameters improved significantly and implants were set at adequate positions. Sixty-seven cases showed over 130 degrees of flexion. Satisfactory results were achieved after NexGen LPS-Flex TKA, but there was no significant difference between mobile and fixed bearing TKA.
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Isao Fujibayashi, Kenji Ogawa, Masaru Kitajima, Masamori Shigematsu, M ...
2007 Volume 56 Issue 2 Pages
267-269
Published: 2007
Released on J-STAGE: June 01, 2007
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To study the etiology and progress mechanisms of rapidly destructive coxarthrosis (RDC), we conducted a trial on type and staging system of RDC, taking into account the characteristics of radiographic and histological findings, and the activity of osteoclasts in synovial membrane.
In this study, we investigated the association between the number of synovial osteoclasts and each stage in collapse type RDC.
Fourteen hips with collapse type RDC and 33 hips with slowly progressive osteoarthritis as the control were analyzed.
There was a significantly large number of synovial osteoclasts in stages II and III of collapse type RDC as compared to slowly progressive osteoarthritis.
However, it was difficult to obtain the synovial tissues in stages I and IV of RDC.
Our results suggest that osteoclasts may play a critical role in joint destruction, particularly in stages II and III of collapse type RDC.
When investigating the etiology or pathologic mechanism of RDC, classifying the radiological and pathological findings according to type and staging should be cousidered.
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Yoshiya Arishima, Hideyuki Kawabata, Tomonori Nagamine, Hironori Kakoi ...
2007 Volume 56 Issue 2 Pages
270-273
Published: 2007
Released on J-STAGE: June 01, 2007
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We reviewed the clinical findings of Chiari pelvic osteotomy with arthroscopic debridement for osteoarthritis of the hip. Ten patients were available for evaluation. They were all female whose age ranged from 27 to 52 years at surgery. Three cases showed progress and the others showed end stage on roentgenogram before surgery. JOA score and arthroscopic findings were evaluated after surgery, compared with preoperative state. Arthroscopic findings were evaluated by Tanedas classification in our study.
JOA score was improved from 48 points before surgery to 74 points after surgery, especially in the pain score. Arthroscopic findings showed high-grade defect of cartilage and tear of labrum in almost cases before surgery. Seven cases were at stage 5, and the others were at stage 4 according to Tanedas classification before surgery. At the second look operation, only two cases improved in terms of Tanedas classification.
The results suggest that Chiari pelvic osteotomy with arthroscopic debridement may have some effect on reducing pain compared with only osteotomy. However, arthroscopic findings showed little improvement in almost cases. Furthermore study was necessary to find the mechanism of pain relief after Chiari pelvic osteotomy.
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Hidefumi Honke, Shunsuke Kawano, Motoki Sonohata, Masaaki Mawatari, Ta ...
2007 Volume 56 Issue 2 Pages
274-276
Published: 2007
Released on J-STAGE: June 01, 2007
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Several studies have reported that adductor release improves adduction contracture in total hip althroplasty (THA).
We have experienced many cases showing improvement of adduction contracture after THA without adductor release. One hundred and twenty-two hips of 122 patients who underwent THA from September 1998 to July 2000 were enrolled in this study. The subjects consisted of 17 males and 105 females, whose mean age at THA was 61.5 years (range; 24 to 86 years). The average duration of follow-up was 5.3 years (range; 5 to 6 years). The subjects were divided into following three groups according to their preoperative maximum abduction angle: highly adduction contracture group consisted of less than 0° (group A), slight adduction contracture group between 1° and 10° (group B), and no adduction contracture group more than 11° (group C).
We found no difference in postoperative maximum abduction angle between the groups. We believe that adductor release is not always necessary in THA.
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Hideki Kawamura, Takuya Yamamoto, Yoshimi Nagatomo, Arisa Tsuru, Yasuh ...
2007 Volume 56 Issue 2 Pages
277-281
Published: 2007
Released on J-STAGE: June 01, 2007
JOURNAL
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A case of pyogenic sacroiliitis in pregnancy is reported. A 25-year-old female at 34 weeks pregnancy presented fever and acute tenderness at the left sacroiliac joint. The laboratory tests were significant for elevated white blood cell count and C-reactive protein. Magnetic resonance images showed signal change in the left sacroiliac joint. Blood and urine cultures were positive for methicillin-sensitive Staphylococcus aureus. Intravenous antibiotic treatment (cefazoline 1 g × 3 daily) for about four weeks was performed with good response. The patient delivered by cesarean section under general anesthesia at 39 weeks pregnancy with good clinical course. Diagnosis and treatment of such causes are difficult, but one sign is low back pain caused by pyogenic sacroiliitis in pregnancy.
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Kuniyoshi Tsuchiya, Kazuhiro Yamaoka, Mitsuharu Miyagi, Takeshi Okamur ...
2007 Volume 56 Issue 2 Pages
282-286
Published: 2007
Released on J-STAGE: June 01, 2007
JOURNAL
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Eight hemodialytic (HD) patients who were surgically treated by anterior spinal fusion at the cervical level were reviewed. Postoperative neurologic recovery was generally good (53.8% in average), but substantial correction loss was observed in six out of a total of eight cases. Two cases developed pseudarthrosis, and one of whom developed recurrence of myelopathy followed by additional posterior procedure with reconstruction. Incorporation of strut grafts took nine months on average. Postoperatively no severe general complication was observed. Temporary arrhythmia was observed in one case. Two cases died during follow-up. Anterior spinal fusion provides neurological improvement but results in substantial correction loss in many cases. Posterior method with instrumentation or combined method is expected to serve as a promising treatment in the future.
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Akihiko Asami, Yasutaka Kugimoto, Tadatsugu Morimoto
2007 Volume 56 Issue 2 Pages
287-289
Published: 2007
Released on J-STAGE: June 01, 2007
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Anterior or posterior interosseous nerve syndrome is a neuralgic amyotrophy characterized by the sudden onset of neuropathic pain, followed by weakness of the innervated muscles in the upper extremity. Nerve constriction is seen under microscopic neurolysis of the funicles in some cases. Neuralgic amyotrophy of the lower extremity is known as lumbosacral plexus neuropathy and some cases have been reported, while nerve constriction is very rare and there is no report in these cases. Our case of common peroneal nerve palsy is presented. Symptoms occurred after multiple total arthroplasties of the lower extremities. As conservative treatment showed no improvement, neurolysis and tendon transfer were performed. Intraoperative findings showed nerve constriction of the funicles of the common peroneal nerve. Bridle procedure using tibialis posterior tendon was effective for this case.
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Isao Shirachi, Hiroko Fukuda, Tomoya Uchikawa
2007 Volume 56 Issue 2 Pages
290-293
Published: 2007
Released on J-STAGE: June 01, 2007
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We experienced the perforation of two screws into the pelvis in cases using the implant system. We therefore switched to the CHS (compression hip screw) and Monoaxial systems.
Since September 2003, we heve been using the biaxial proximal femoral nail.
Between September 2003 and March 2005, we treated 59 cases of femoral trochanteric fractures with the Targon PF Nail. Eight cases were men and 52 women.
We used 125° nails in 46 cases and 130° nails in 13 cases.
Back-out of support sleeve was seen in one case and skin necrosis in one.
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Tadatsugu Morimoto, Akihiko Asami, Yasutaka Kugimoto, Toshinori Nakao, ...
2007 Volume 56 Issue 2 Pages
294-297
Published: 2007
Released on J-STAGE: June 01, 2007
JOURNAL
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The gait-load test (GLT) is a famous valuable symptom provocation test in patients with lumber spinal canal stenosis (LSS). But the utility of the GLT in patients with thoracolumbar intradural-extramedullary tumor (TL-IET) have not been assessed. We report two cases of TL-IET. At rest, they had slight low back pain only by interview and seldom had objective findings. We observed changes in symptoms and neurologic condition before and after the GLT. During the GLT, both of them experienced severe low back pain, but muscle strength and deep tendon reflexes in their lower limbs did not change. From the fact that the GLT can spotlight latent symptoms, it could serve as a symptom provocation test in patients with TL-IET just as in LSS. But it is not useful for determining the responsible level because of little changes in neurologic findings after the GLT.
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Kazuhiro Yoshimitsu, Kenji Yoshida, Kenji Tanaka, Hidetomo Nakamura, T ...
2007 Volume 56 Issue 2 Pages
298-302
Published: 2007
Released on J-STAGE: June 01, 2007
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Thirty-three patients with fractures of the tibial plateau treated from January 2000 to December 2004 were reviewed retrospectively. The subjects included sixteen males and seventeen females with an age range of 18 to 82 years (mean: 53 years). The fracture types were classified according to the Hohls revised classification: local compression type, five cases; split compression type, fourteen cases; total depression type, five cases; rim avulsion type, one case; and bicondylar type, eight cases. Bony unions were obtained in all cases. There was no relationship between the clinical results and residual deformities varus and valgus. Factors related to poor clinical results were advanced depression of the joint surface at the tibial plateau.
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Akinori Takeyama, Ichiro Yoshimura, Kazuki Kanazawa, Masatoshi Naito
2007 Volume 56 Issue 2 Pages
303-305
Published: 2007
Released on J-STAGE: June 01, 2007
JOURNAL
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We applied the arthroscopic technique in the treatment of ankle arthrodesis. The patient was a 55-year-old man who had previously fractured his ankle. When he visited our hospital, he had end-stage ankle arthritis. A 2.7 mm arthroscope and other equipment were used from anterior 3-portals. Articular cartilage and subchondral bone were removed by curetters and abraders, followed by screw fixation to maintain the neutral position. He was casted for non-weightbearing for six weeks. At 10 weeks after surgery, bony union was achieved and he had no pain and complications.
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