記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Postoperative change of the joint line convergence angle (JLCA) is known to be a factor affecting correction error in opening wedge high tibial osteotomy (OWHTO). The purpose of this study was to assess whether preoperative planning that considers change of the JLCA can achieve accurate correction in the standing position after OWHTO. METHODS: OWHTO was performed for 109 knees with osteoarthritis of the knee. The amount of angular correction was planned aiming to achieve mechanical valgus of 5° in 55 knees (conventional planning), and it was adjusted in 54 knees (adjusted planning) according to the preoperative JLCA as follows: not changed with JLCA ≤ 3°; decreased 1° with JLCA 4-6°; decreased 2° with JLCA 7-8°; and decreased 3° with JLCA ≥ 9°. The hip-knee-ankle (HKA) angle, JLCA, and medial proximal tibial angle (MPTA) were measured on standing long-leg radiographs. Correction error ≤ 2º was defined as the acceptable range, and correction error > 2º was defined as an outlier. RESULTS: The conventional planning group had a significantly greater postoperative HKA angle than the adjusted planning group (6.1º and 4.9º, respectively). The mean JLCA decreased from 4.8º to 2.6º in the conventional planning group and from 4.6º to 2.7º in the adjusted planning group. The conventional planning group had significantly greater postoperative MPTA than the adjusted planning group (96.2º and 94.7º, respectively). The rate of outliers with correction error > 2º was significantly lower in the adjusted planning group (9%) than in the conventional planning group (24%). The rate of the MPTA > 95º was significantly lower in the adjusted planning group (30%) than in the conventional planning group (69%). CONCLUSIONS: This study demonstrated that preoperative planning with adjustment of the correction angle according to the preoperative JLCA improved correction accuracy in the standing position after OWHTO.

DOI： 10.1186/s13018-024-05096-x

PubMed

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本骨・関節感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本骨・関節感染症学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

It is well known that increased posterior tilt of the pelvis is an effective strategy for avoiding impingement of the femur with the pelvis during movement. Daily repetitive collisions become mechanical loads, and the more frequently they occur, the more tissue damage and pain they cause. Therefore, reducing the rate of occurrence of impingement is important to avoid aggravation of symptoms. This study aimed to evaluate the effects of changes in posterior pelvic tilt on the risk of impingement between the femur and the anterior inferior iliac spine (AIIS)/subspine in various functional postures. Patients with femoroacetabular impingement syndrome (FAIS) who were candidates for hip arthroscopic osteochondroplasty between October 2013 and June 2020 were included. A three-dimensional reconstructed model was used to simulate the incidence of impingement at 12 hip positions required for activities of daily living. We predicted value of the spatial incidence of impingement assumed that hip motion should exceed 130/30 degrees without impingement. Impingement was measured at three pelvic positions: an anterior tilt of 10°, in the functional pelvic plane and a posterior tilt of 10°. Multivariate linear-mixed models were used to assess the effect of covariate-adjusted posterior pelvic tilt on the impingement incidence in the AIIS region. AIIS type, center-edge angle, acetabular version and femoral version were used as covariates. The impingement rates and locations of the three pelvic tilt postures were assessed. Seventy-eight patients (60 males and 18 females; average age, 46 ± 15.1 years) with FAIS were analyzed. A multivariate linear-mixed model revealed a coefficient of -0.8% (95% confidence interval -0.9 to -0.7%; P < 0.001) for posterior pelvic tilt. Thus, posterior pelvic tilt affects AIIS impingement incidence. After adjusting for anatomical effects, the posterior pelvic tilt should be addressed to avoid impingement.

DOI： 10.1093/jhps/hnae003

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本骨折治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本関節病学会  

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1302/2046-3758.134.BJR-2023-0188.R1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background The aim of this study was to determine the incidence of deep tissue injury (DTI) and potential risk factors after surgery in the lithotomy position. Methods All patients who underwent surgery in the lithotomy position under general anesthesia at a single center between January 2017 and December 2021 were retrospectively evaluated. The medical records of these patients were reviewed, and patient demographic and clinical characteristics, surgical data, and occurrence of DTI were recorded. Results During the study period, 5146 patients, 2055 (39.9%) males and 3091 (60.1%) females, with a mean age of 57.3 ± 17.4 years, underwent surgery in the lithotomy position. Seven (0.14%) patients developed DTI on their calf following surgery. All presented with severe pain and swelling, requiring prolonged hospital stay. Multivariate analysis showed that male sex (odds ratio (OR): 11.43; 95% confidence interval (CI): 1.15-113.34, p = 0.037), higher BMI (OR: 1.32; 95% CI: 1.17-1.50, p = 0.0001), and longer operation time (OR: 1.01; 95% CI: 1.004-1.014, p = 0.0002) were independent risk factors for postoperative DTI. Optimal cut-off values for BMI and operation time were 23.5 kg/m2 (sensitivity = 100%; specificity = 64%) and 285 minutes (sensitivity = 100%; specificity = 90%), respectively. Conclusion Factors significantly associated with DTI include male sex, higher BMI, and prolonged operation time.

DOI： 10.7759/cureus.57413

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Differences between the bacterial culture results of the preoperative fluid, intraoperative tissue, and sonication fluid of implants in the diagnosis of periprosthetic joint infection (PJI) are important issues in clinical practice. This study aimed to identify the differences in pooled diagnostic accuracy between culture sample types for diagnosing PJI by performing a systematic review and meta-analysis. METHODS: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. A comprehensive literature search of PubMed, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library databases was performed. Data extraction and study assessment using the quality assessment of diagnostic accuracy studies were performed independently by two reviewers. The pooled sensitivity, specificity, summary receiver operating characteristic curve, and area under the summary receiver operating characteristic curve were estimated for each sample type. RESULTS: There were thirty-two studies that were included in the analysis after screening and eligibility assessment. The pooled sensitivities of preoperative fluid, intraoperative tissue, and sonication fluid for the diagnosis of PJI were 0.63 (95% confidence interval [CI] 0.56 to 0.70), 0.71 (95% CI 0.63 to 0.79), and 0.78 (95% CI 0.68 to 0.85), while the specificities were 0.96 (95% CI 0.93 to 0.98), 0.92 (95% CI 0.86 to 0.96), and 0.91 (95% CI 0.83 to 0.95), respectively. The area under the curves for preoperative fluid, intraoperative tissue, and sonication fluid were 0.86, 0.88, and 0.90, respectively. CONCLUSIONS: Sonication fluid culture demonstrated better sensitivity compared with the conventional culture method, and preoperative fluid culture provided lower sensitivity in diagnosing PJI.

DOI： 10.1016/j.arth.2024.03.016

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The aim of the present study was to investigate the association between chondrogenic differentiation and Wnt signal expression in the degenerative process of the human meniscus. Menisci were obtained from patients with and without knee osteoarthritis (OA), and degeneration was histologically assessed using a grading system. Immunohistochemistry, real-time polymerase chain reaction (PCR), and Western blot analysis were performed to examine the expressions of chondrogenic markers and of the components of Wnt signaling. Histological analyses showed that meniscal degeneration involved a transition from a fibroblastic to a chondrogenic phenotype with the upregulation of SOX9, collagen type II, collagen type XI, and aggrecan, which were associated with increased Wnt5a and ROR2 and decreased TCF7 expressions. OA menisci showed significantly higher expressions of Wnt5a and ROR2 and significantly lower expressions of AXIN2 and TCF7 than non-OA menisci on real-time PCR and Western blot analysis. These results potentially demonstrated that increased expression of Wnt5a/ROR2 signaling promoted chondrogenesis with decreased expression in downstream Wnt/β-catenin signaling. This study provides insights into the role of Wnt signaling in the process of meniscal degeneration, shifting to a chondrogenic phenotype. The findings suggested that the increased expression of Wnt5a/ROR2 and decreased expression of the downstream target of Wnt/β-catenin signaling are associated with chondrogenesis in meniscal degeneration.

DOI： 10.1002/jor.25825

PubMed

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記述言語：日本語   出版者・発行元：関東整形災害外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：関東整形災害外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: This study aimed to investigate the anterior-posterior (AP) displacement of the tibial tuberosity (TT) and to assess the difference between closed wedge and opening wedge high tibial osteotomies (OWHTO and CWHTO). METHODS: One hundred consecutive knees with osteoarthritis that underwent OWHTO (50 knees) or CWHTO (50 knees) were investigated retrospectively. The femorotibial angle (FTA) was measured on AP radiographs of the knee. AP displacement of the TT, posterior tibial slope (PTS), the modified Blackburne-Peel index (mBPI), and the modified Caton-Deschamps index (mCDI) were measured on lateral radiographs of the knee. RESULTS: Patients had a mean correction angle of 12.58 ± 2.84° and 18.98 ± 5.14° (P < 0.001), with a mean AP displacement of TT of 0.84 ± 2.66 mm and 7.78 ± 3.41 mm (P < 0.001) in OWHTO and CWHTO, respectively. The AP displacement of the TT per correction of 1° was significantly greater in CWHTO than in OWHTO (P < 0.001). A significant correlation was found between the correction angle and AP displacement of the TT in CWHTO (r = -0.523, P < 0.001), but not in OWHTO. The change of PTS per correction of 1° was significantly greater in OWHTO than in CWHTO (P < 0.001). The changes of mBPI and mCDI per correction of 1° were significantly greater in CWHTO than in OWHTO (P < 0.001 and P < 0.001, respectively). CONCLUSIONS: There was greater anterior displacement of the TT in CWHTO than in OWHTO, which was correlated with the correction angle. The results suggested that CWHTO would be better than OWHTO when a concomitant anteriorization of TT is required.

DOI： 10.1051/sicotj/2024020

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1097/CORR.0000000000002955

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Periprosthetic joint infection (PJI) is one of the most intractable orthopedic diseases, partly because of the difficulty in differentiating septic from aseptic conditions. We aimed to evaluate and consolidate the diagnostic accuracy of the quantitative assessment of serum albumin (Alb), globulin (Glb), and albumin-globulin ratio (AGR), alone or in combination with the inflammatory marker, C-reactive protein (CRP), for PJI. We searched the PubMed, CINAHL, and Cochrane Library databases for studies that quantitatively measured Alb, Glb, or AGR for the diagnosis of PJI up until the 30 April 2023. A total of 2339 patients were included from 10 studies, including 845 patients with a definitive diagnosis of PJI and 1494 with non-PJI. The pooled sensitivity, specificity, and area under the curve (AUC) in the summary receiver-operating characteristic curve were as follows: 0.625, 0.732, and 0.715 for Alb; 0.815, 0.857, and 0.887 for Glb; 0.753, 0.757, and 0.875 for AGR; 0.788, 0.837, and 0.876 for CRP; 0.879, 0.890, and 0.917 for the CRP-Alb ratio; and 0.845, 0.855, and 0.908 for the CRP-AGR ratio. Serum Alb, Glb, and AGR levels are feasible and accurate diagnostic markers for PJI, and the combination of these markers with CRP levels may potentially improve preoperative serum diagnostic accuracy. Future prospective studies are required to verify these findings because of the small numbers of included studies.

DOI： 10.3390/jcm12247512

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Fungal periprosthetic joint infections are one of the most intractable orthopedic disorders. Continuous local antibiotic perfusion allows direct administration of the antifungal agent micafungin into the local infection area at biofilm-disruptive concentrations, while controlling the dead space in addition to conventional treatment. Although the appropriate use of continuous local antibiotic perfusion requires familiarity with the characteristics of local antibiotic perfusion, it is a versatile treatment modality that can improve the clinical outcomes of fungal periprosthetic joint infection in combination with conventional treatment methods.

DOI： 10.1016/j.artd.2023.101245

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Patient demographic and clinical characteristics may be factors associated with the success of conservative treatment for pyogenic spondylitis. The ability of imaging findings at initial diagnosis to predict patient outcomes remains unclear. The aim of this study was to investigate the risk factors associated with conversion surgery after conservative treatment for pyogenic spondylitis, with a special focus on the initial computed tomography (CT) findings. METHODS: This study enrolled 35 patients with pyogenic spondylitis who underwent CT and magnetic resonance imaging (MRI) at diagnosis and were followed-up for more than 6 months. Patients were diagnosed by MRI, and the degree of bone destruction was assessed on CT cross-sectional images. Vertebral body destruction was classified as grades 0 (almost normal), 1 (endplate irregularity), 2 (vertebral body destruction not involving the posterior wall), and 3 (destruction involving the posterior wall). Patients were divided into four groups based on grade of bone destruction and their clinical characteristics were compared. RESULTS: 1, 11, 11, and 12 patients were classified as grades 0, 1, 2, and 3, respectively. Univariate analysis showed no significant differences in the demographic and clinical characteristics of the four groups. Eighteen (51.4 %) patients had been treated surgically, with the rate of surgical treatment being significantly higher in patients with grade 3 (83.3 %) than in those with grades 0 + 1 (25 %) and grade 2 (45.5 %) (P < 0.05). Multivariate analysis showed that epidural abscess on MRI (odds ratio [OR] 10.8, 95 % confidence interval [CI] 1.68-69.7), grade 3 bone destruction on CT (OR 3.97, 95 % CI 1.21-13.0), and C-reactive protein (CRP) improvement rate after 1 week of treatment (OR 0.95, 95 % CI 0.91-0.99) were risk factors for surgery. CONCLUSIONS: Early surgical treatment should be considered for patients with pyogenic spondylitis who present with an epidural abscess on MRI and bone destruction extending to the posterior wall on CT at the time of diagnosis.

DOI： 10.1016/j.jos.2023.10.015

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Antibiotic susceptibility is very important for the successful treatment of orthopedic infections, particularly for implant-related infections. While the minimum inhibitory concentrations (MICs) of Staphylococcus species were well investigated for the isolates from the respiratory tract, investigations for orthopedic pathogens are very limited. We investigated the antibiotic MIC values of Staphylococcus species isolated from orthopedic infections and compared them with those of respiratory medicine isolates used as a control. METHODS: The MICs of vancomycin (VCM), arbekacin (ABK), teicoplanin (TEIC), linezolid (LZD), and rifampicin (RFP) of a total of consecutive 259 (89 orthopedic and 170 respiratory) Staphylococcus speciesisolated in our laboratory from January 2013 to July 2016 were retrospectively reviewed. Differences between the MICs of each antibiotic in orthopedic and respiratory samples were determined. RESULTS: The number of methicillin-sensitive Staphylococcus aureus (MSSA) with a VCM MIC of <0.5 μg/mL among respiratory isolates was significantly higher than that among orthopedic isolates, while those with a MIC of 2 μg/mL were significantly lower (P = 0.0078). The proportion of methicillin-resistant coagulase-negative staphylococci (MRCNS) isolates with a VCM MIC of 2 μg/mL was significantly higher in orthopedic samples than that of methicillin-resistant Staphylococcus aureus (MRSA) (P < 0.001) in respiratory isolates. The proportion of MRCNS orthopedic isolates with an RFP MIC of >2 μg/mL was significantly higher (P = 0.0058) than that of other orthopedic staphylococci. CONCLUSIONS: The VCM MICs of Staphylococcus species from orthopedic infections were higher than those of respiratory samples, particularly MRCNS from implant-related samples.

DOI： 10.7759/cureus.49535

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: There is limited data on the impact of COVID-19 epidemic on the number of orthopaedic surgeries in Japan. METHODS: We conducted a nationwide hospital survey asking for the monthly number of orthopaedic surgeries performed at each facility from January 2019 to June 2021. Those facilities that had performed at least 100 surgeries in 2019 were included for analyses. The facilities were further grouped by prefecture and by hospital characteristics. A brief health economic evaluation was also performed. Risk ratios were compared using univariate analyses with P < 0.05 considered statistically significant. RESULTS: Questionnaire was sent to 1988 hospitals with 1671 hospitals (84%) responding. The survey data indicated a total number of orthopaedic surgeries decreased in 2020 compared to 2019 (1,061,541 vs 1,119,955 P < 0.01), and also for the first six months of 2021 compared to the same period in 2019 (530,388 vs 550,378 P < 0.01). In 2020, over 50% of all facilities in nearly all of the prefectures saw a decline in surgical procedures. The risk of incurring more than a 25% decease in the number of surgeries was significantly higher in 2020 for class I designated medical institutions compared to those that were not designated for any types of infectious diseases among the institutions with a tertiary emergency medical center in 2020 (crude risk ratio 2.9: 95% CI 1.2-7.4, p = 0.02) and in 2021 (crude risk ratio 4.7: 95% CI 1 0.9-12.1, p < 0.01). The estimated total nationwide decrease of revenue were in the range of approximately \29.2 to \116.8 billion per year for orthopaedic surgeries alone. CONCLUSION: There was a statistically significant decrease in the number of orthopaedic surgeries in Japan. The magnitude of the decline varied by prefectures and hospital characteristics, with the greater impact imposed on medical institutions with higher classification functions. The estimated immediate health economic impact was sizable.

DOI： 10.1016/j.jos.2023.08.016

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Shelf acetabuloplasty has been performed in patients with developmental dysplasia of the hip (DDH); however, the appropriate position of the shelf has not been determined, particularly with respect to avoiding range of motion (ROM) loss. The aim of this study was to investigate the frequency of ROM inhibition and the influence of 3D position of the shelf following actual shelf acetabuloplasty and virtual surgery using computer simulation analysis. Computed tomography data from 15 patients with DDH who underwent shelf acetabuloplasty were collected between August 2019 and February 2022. The three-dimensional models of a hip joint were constructed using Zed Hip®. Maximal internal rotation (MIR) at 45° and 90° flexion was measured in each patient. The frequency and position of ROM inhibition was determined in a real postoperative model virtually. In addition, a second analysis using virtual acetabuloplasty was performed. Upon placing the shelf, three patterns were provided for the following four parameters: height, coronal inclination, center-edge angle (CEA), and anteroposterior position. The predictors for ROM inhibition were analyzed using a logistic regression model. In the actual postoperative model, a limitation of MIR at 90° and 45° of flexion occurred in 60% and 66.7% of patients, respectively. A higher CEA and anterior position are major factors limiting MIR. The analysis of the virtual shelf acetabuloplasty model revealed that anterior position and CEA were significant factors causing ROM inhibition. As for clinical significance, the results of the current study indicated the optimal location of the shelf to avoid iatrogenic impingement after shelf acetabuloplasty.

DOI： 10.1002/jor.25710

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出版者・発行元：南江堂  

DOI： 10.15106/j_seikei74_1128

CiNii Books

CiNii Research

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：日本股関節学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：日本股関節学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1408202727

CiNii Research

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To identify factors associated with insufficient range of motion (ROM) improvement after the posterior pelvic tilt change in cam-type femoroacetabular impingement syndrome (FAIS). METHODS: Preoperative computed tomography (CT) images from 71 consecutive patients with FAIS treated with arthroscopic cam resection were evaluated. Using a dynamic computer simulation program, 3-dimensional models with a 10° posterior pelvic tilt from the supine functional pelvic plane (baseline) were created by CT models. Patients were divided into two groups: those who experienced >10° (effective group) and ≤10° (ineffective group) improvements in internal rotation at 90° flexion after a 10° posterior pelvic tilt. Demographic characteristics; preoperative range of internal rotation at 90° flexion; and radiographic parameters, including Tonnis grade, lateral center-edge angle, acetabular roof obliquity angle, central acetabular anteversion, cranial acetabular anteversion, femoral anteversion, and α angle, were compared in the two groups. Univariate and multivariable logistic regression analyses were performed to evaluate factors associated with insufficient ROM improvement following a 10° posterior pelvic tilt. RESULTS: The 71 patients included 58 men and 13 women, of mean age 41.4 ± 14.6 years. Posterior pelvic tilt was effective in 13 hips and ineffective in 58. Univariate analysis showed that preoperative range of internal rotation at 90°flexion, femoral anteversion, and α angle differed significantly in the two groups. Multivariable analysis showed that femoral anteversion <16° (odds ratio [OR], 7.4; 95% confidence interval [CI], 1.6-35; P = 0.012) and α angle >65° (OR, 6.7; 95% CI, 1.2-37; P = 0.027) were significant factors associated with insufficient ROM improvement after posterior pelvic tilt. CONCLUSION: Physical therapy may not be successful for patients with cam-type femoroacetabular impingement syndrome and may result in insufficient hip range-of-motion when femoral anteversion is less than 16° and α-angle is greater than 65°.

DOI： 10.1016/j.arthro.2023.07.012

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記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞股関節鏡手術,特にFAIに対する骨軟骨形成を中心にコンピュータシミュレーションを用いた術前計画と,計画を可能な限り正確に遂行するためのコンピュータナビゲーション支援手術の実際について詳述する.ナビゲーション支援下cam切除の精度評価,骨盤動態のコンピュータシミュレーション解析研究の結果も紹介する.

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J01554&link_issn=&doc_id=20230706040011&doc_link_id=10.11477%2Fmf.1408202727&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1408202727&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

INTRODUCTION: Tranexamic acid (TXA) has been widely utilized to reduce blood loss and allogeneic transfusions in patients who undergo lower limb arthroplasty. In recent years, there have been several articles reporting the incidence of periprosthetic joint infection (PJI) as a primary outcome of TXA administration, but no meta-analysis has been conducted to date. The present systematic review and meta-analysis evaluated the efficacy of TXA administration in preventing PJI and surgical site infection (SSI). MATERIALS AND METHODS: Pubmed, CINAHL, and the Cochrane Library bibliographic databases were searched for studies published by May 24, 2022, that evaluated the effects of TXA on PJI and SSI. Two researchers screened the identified studies based on the PRISMA flow diagram. The quality of each randomized clinical trial was assessed using Version 2 of the Cochrane risk-of-bias tool for randomized trials (ROB2.0), and the quality of cohort and case-control studies was assessed by risk of bias for nonrandomized studies (ROBANS-I). RESULTS: Of the 2259 articles identified from the database search, 31 were screened and selected. Treatment with TXA significantly reduced the incidence of overall infection, including PJI, SSI, and other infections (OR 0.55; 95% CI 0.49-0.62) (P < 0.00001), and that of PJI alone (OR 0.53; 95% CI 0.47-0.59) (P < 0.00001). TXA reduced the incidence of overall infection in patients who underwent total hip arthroplasty (THA; OR 0.51; 95% CI: 0.35-0.75) (P = 0.0005) and total knee arthroplasty (TKA; OR 0.55; 95% CI: 0.43-0.71) (P < 0.00001). Intravenous administration of TXA reduced the incidence of overall infection (OR 0.59; 95% CI 0.47-0.75) (P < 0.0001), whereas topical administration did not. CONCLUSIONS: Intravenous administration of TXA reduces the incidence of overall infection in patients undergoing both THA and TKA. LEVEL OF EVIDENCE: Level III.

DOI： 10.1007/s00402-023-04914-x

PubMed

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その他リンク： https://link.springer.com/article/10.1007/s00402-023-04914-x/fulltext.html

記述言語：日本語   出版者・発行元：(一社)日本関節病学会  

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記述言語：日本語   出版者・発行元：(一社)日本関節病学会  

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記述言語：日本語   出版者・発行元：(一社)日本骨・関節感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本骨・関節感染症学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Periprosthetic joint infection (PJI) is a serious complication after total joint arthroplasty. It is important to accurately identify PJI and monitor postoperative blood biochemical marker changes for the appropriate treatment strategy. In this study, we aimed to monitor the postoperative blood biochemical characteristics of PJI by contrasting with non-PJI joint replacement cases to understand how the characteristics change postoperatively. MATERIALS AND METHODS: A total of 144 cases (52 of PJI and 92 of non-PJI) were reviewed retrospectively and split into development and validation cohorts. After exclusion of 11 cases, a total of 133 (PJI: 50, non-PJI: 83) cases were enrolled finally. An RF classifier was developed to discriminate between PJI and non-PJI cases based on 18 preoperative blood biochemical tests. We evaluated the similarity/dissimilarity between cases based on the RF model and embedded the cases in a two-dimensional space by Uniform Manifold Approximation and Projection (UMAP). The RF model developed based on preoperative data was also applied to the same 18 blood biochemical tests at 3, 6, and 12 months after surgery to analyze postoperative pathological changes in PJI and non-PJI. A Markov chain model was applied to calculate the transition probabilities between the two clusters after surgery. RESULTS: PJI and non-PJI were discriminated with the RF classifier with the area under the receiver operating characteristic curve of 0.778. C-reactive protein, total protein, and blood urea nitrogen were identified as the important factors that discriminates between PJI and non-PJI patients. Two clusters corresponding to the high- and low-risk populations of PJI were identified in the UMAP embedding. The high-risk cluster, which included a high proportion of PJI patients, was characterized by higher CRP and lower hemoglobin. The frequency of postoperative recurrence to the high-risk cluster was higher in PJI than in non-PJI. CONCLUSIONS: Although there was overlap between PJI and non-PJI, we were able to identify subgroups of PJI in the UMAP embedding. The machine-learning-based analytical approach is promising in consecutive monitoring of diseases such as PJI with a low incidence and long-term course.

DOI： 10.1007/s00402-023-04898-8

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Hip resurfacing arthroplasty (HRA) patients require subsequent annual screening for postoperative complications. Ultrasonography may be useful for this purpose but lacks a screening protocol for hips. The purpose of this study was to evaluate the accuracy of ultrasonography for detecting postoperative complications in HRA patients using a screening protocol that specifically targets periprosthetic muscles. METHODS: We enrolled 45 hips from 40 HRA patients with a mean follow-up period of 8.2 years. MRI and ultrasonography scans were simultaneously conducted at follow-up. The ultrasonography assessments were conducted on the anterior part of the hip that targets iliopsoas, sartorius, rectus femoris, lateral with anterior superior and inferior iliac spine (ASIS and AIIS) as bony landmarks, and the lateral and posterior parts that target fascia tensor, short rotators, and gluteus minimus, medius, and maximus with greater trochanter and ischial tuberosity as bony landmarks. The accuracy of diagnosing postoperative abnormalities and the visibility of periprosthetic muscles were compared between these two modalities. RESULTS: Both MRI and ultrasonography detected an abnormal region in eight cases comprising two infections, two pseudotumors, and four patients with greater trochanteric bursitis. Among these cases, four hips required implant removal. The increase in anterior space, measured as the distance between the iliopsoas and resurfacing head, was a good indicator for the abnormal mass in these four HRA cases. In the assessment of periprosthetic muscles, MRI showed a much lower visibility than ultrasonography in the iliopsoas (6.7% vs. 100%), gluteus minimus (6.7% vs. 88.9%), and short rotators (8.8% vs. 71.4%) due to implant halation. CONCLUSIONS: By targeting periprosthetic muscles, ultrasonography can detect postoperative complications as effectively as MRI assessments in HRA patients. Ultrasonography has superior visibility in the periprosthetic muscles of HRA patients, indicating its utility for the screening of small legions in these cases which may not be visible by MRI.

DOI： 10.3390/jcm12082871

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.2106/JBJS.23.00029

PubMed

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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出版者・発行元：金原出版  

DOI： 10.18888/se.0000002452

CiNii Research

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記述言語：英語  

Although synovial sarcoma is a relatively common soft tissue sarcoma, primary intra-articular cases are extremely rare. Herein, we report a case of primary intra-articular synovial sarcoma arising from the hip joint, that was initially treated with hip arthroscopy. A 42-year-old male presented with a history of pain in the left hip for 7 years. Radiography and magnetic resonance imaging revealed the primary intra-articular lesion and simple excision with an arthroscopy was performed. Histological findings revealed spindle cell proliferation with abundant psammoma bodies. SS18 gene rearrangement was confirmed by fluorescence in situ hybridization, and the tumor was diagnosed as synovial sarcoma. Adjuvant chemotherapy and radiotherapy were performed. Local control without metastasis was achieved 6 months after excision. This is the first case of intra-articular synovial sarcoma of the hip joint excised via hip arthroscopy. When an intra-articular lesion is identified, malignancies such as synovial sarcoma should be included in the differential diagnosis.

DOI： 10.1093/jscr/rjad066

PubMed

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記述言語：日本語   出版者・発行元：金原出版(株)  

＜文献概要＞下前腸骨棘(AIIS)インピンジメントに対するコンピュータシミュレーションによる術前計画と鏡視下手術の実際を概説する。コンピュータシミュレーションでは単純X線像やCTのみでは同定が困難なAIISの骨性インピンジメント部位が明確に同定可能であり,シミュレーション仮想手術による切除モデルを用い可動域の改善が確認される。実際の手術では切除予定部位には関節包が付着しており,どこまで切除すべきか,また剥離した関節包の処置をどうするかなど技術的な課題も多い。

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The indications for hip arthroscopy have been increasing, as have been the number of patients undergoing total hip arthroplasty (THA) after hip arthroscopy. Several matched cohort studies have assessed the impact of prior hip arthroscopy on THA, but conflicting results have been observed. The purpose of this study was to evaluate the influence of prior arthroscopy on subsequent THA. METHODS: This systematic review and meta-analysis were performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 checklist. PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Library were searched to identify relevant studies. Dichotomous variables were summarized qualitatively as a meta-analysis of pooled odds ratios (ORs) and 95% confidence intervals (CIs), and continuous variables were summarized as standardized mean differences and 95% CIs. P-values <0.05 were considered statistically significant. The risk of bias was evaluated for each study, as was publication bias. RESULTS: In patients who underwent hip arthroscopy prior to THA, the ORs for dislocation, reoperation, and revision were 2.02 (P = 0.01), 1.66 (P = 0.01), and 2.15 (P = 0.001), respectively. There were no significant between-group differences in the Harris Hip Score (HHS; P = 0.40), WOMAC (P = 0.069), FJS-12 (P = 0.77), estimated blood loss (P = 0.48), and surgical time (P = 0.16). CONCLUSIONS: Prior hip arthroscopy is a risk for postoperative dislocation, reoperation, or revision after conversion THA. However, prior hip arthroscopy has no effect on patient-reported outcomes, or operative factors such as surgical time and blood loss.

DOI： 10.1016/j.jos.2022.12.016

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Previous work suggested that tenogenic differentiation of tendon stem/progenitor cells (TSPCs) was suppressed by upregulated expression of the angiogenic marker vascular endothelial growth factor (VEGF). The purpose of this study was to test the hypothesis that anti-VEGF antibody, bevacizumab, promotes in vitro tenogenic differentiation and maturation of two distinct types of TSPCs, tendon proper-derived cells (TDCs), and paratenon-derived cells (PDCs) originating from rat Achilles tendon. TDCs and PDCs were isolated from the tendon proper and the paratenon of rat Achilles tendons. TDCs and PDCs were cultured for 3 days on plates with or without VEGF. TDCs and PDCs were also cultured in collagen gel matrix, and the blocking effect of VEGF was examined by the addition of 100 ng/mL of bevacizumab. Effects of bevacizumab on tenogenic differentiation were assessed using real-time PCR, immunofluorescent staining, and western blotting. VEGF significantly attenuated expression of the Tnmd gene in both PDCs and TDCs (P<0.05). Expressions of the Scx, Tnmd, and Col1a1 genes were significantly upregulated by the addition of bevacizumab (P<0.05). Immunofluorescent staining showed that the percentage of tenomodulin-positive PDCs and TDCs was significantly higher with bevacizumab treatment than in control cultures (P<0.05). Western blotting showed that bevacizumab suppressed pVEGFR-2 protein expression in both PDCs and TDCs. Bevacizumab promoted the in vitro tenogenic differentiation and maturation of two distinct TSPCs derived from rat Achilles tendon. Since the previous studies demonstrated that TSPCs have a potential to contribute to tendon repair, attenuating VEGF levels in TSPCs by administration of bevacizumab is a novel candidate therapeutic option for promoting tendon repair.

DOI： 10.1371/journal.pone.0293463

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To compare the surgical site infection (SSI) rate in patients undergoing spinal instrumentation surgery who received vancomycin suspended in fibrin glue at the surgical site and those who did not. SUMMARY OF BACKGROUND DATA: The intrawound application of vancomycin powder for preventing SSI after spinal surgery remains controversial. Vancomycin suspended in fibrin glue is another option for local administration that may be effective. The present study assessed whether vancomycin suspended in fibrin glue could prevent SSI after spinal instrumentation surgery. METHODS: We enrolled patients who underwent posterior spinal instrumentation surgery with or without fusion for degenerative conditions, spinal trauma, or tumor. A multiple logistic regression model with inverse probability of treatment weighting (IPTW) based on propensity score was used to assess the efficacy of vancomycin suspended in fibrin glue and to account for confounding. A secondary multivariate logistic regression analysis was performed to identify the risk factors associated with SSI. RESULTS: Of the 264 patients enrolled in this study, 134 underwent application of vancomycin suspended in fibrin glue at the surgical site and 130 did not. The incidence of SSI was lower in patients who were treated with vancomycin suspended in fibrin glue (2.2% vs. 8.5%) even after IPTW adjustment (adjusted odds ratio [OR], 0.25; 95% confidence interval [CI], 0.0768-0.91; P=0.03). Multivariate logistic regression analysis showed that the treatment with vancomycin suspended in fibrin glue was significantly associated with a lower odds of SSI (OR, 0.2; 95% CI, 0.05-0.85; P=0.03). CONCLUSIONS: The administration of vancomycin suspended in fibrin glue was significantly associated with a lower likelihood of SSI in patients undergoing spinal instrumentation surgery.

DOI： 10.1097/BRS.0000000000004561

PubMed

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Abstract

Objectives

To evaluate the cost-effectiveness of biologics and methotrexate (MTX) for rheumatoid arthritis (RA) using the number needed to treat (NNT) concept and total actual health care cost.

Methods

This study included 121 RA patients with newly prescribed biologics and/or MTX between 2012 and 2017. The NNT was calculated based on the 24 week remission rate of Disease Activity Score in 28 joints using erythrocyte sedimentation rate (DAS28-ESR) and Clinical Disease Activity Index (CDAI).

Results

Remission rates were 76.4% for DAS28-ESR and 45.4% for CDAI in the biologics group and 63.6% and 24.2%, respectively, in the MTX group. The NNT was calculated as 6.4 and 4.2 in the biologics group and 34.2 and 35.2 in the MTX group, respectively. Mean total actual health care costs were 1,044,066 JPY (9835 US$)/24 weeks per treated patient in the biologics group and 75,860 JPY (715 US$)/24 weeks in the MTX group. Although the effectiveness of biologics was superior to MTX from the standpoint of NNT, the mean total health care cost and mean cost per NNT were much higher in the biologics group.

Conclusions

Cost-effectiveness is clearly higher for MTX than biologics from the standpoint of mean total health care cost per adjusted NNT under the Japanese health insurance system.

DOI： 10.1186/s12962-022-00347-2

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その他リンク： https://link.springer.com/article/10.1186/s12962-022-00347-2/fulltext.html

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Subspine impingement, or anterior inferior iliac spine (AIIS) impingement, is a type of extra-articular pathology associated with femoroacetabular impingement syndrome and often requires subsequent arthroscopic surgery. Purpose: To examine the diagnostic accuracy, prevalence, and clinical outcomes of arthroscopic treatment for AIIS impingement. Study Design: Systematic review; Level of evidence, 4. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 checklist was applied. We searched for studies on the prevalence, diagnostic accuracy, and results of surgical treatment for AIIS impingement. For each included study, data synthesis and statistical analysis were performed to identify pooled prevalence, calculate clinical outcome scores, and estimate adverse events. The QUADAS (a quality assessment tool for diagnostic accuracy studies) was used to assess the quality of the diagnostic accuracy studies, and the Risk of Bias Assessment tool for Nonrandomized Studies was used to assess the quality of the studies on arthroscopic treatment efficacy. Results: Out of an initial 791 studies, 23 were included. AIIS impingement was diagnosed by plain radiography with 76% to 86% sensitivity, 3-dimensional computed tomography with 80% to 81.8% sensitivity, magnetic resonance imaging with 80% sensitivity, and ultrasound with 92.5% sensitivity. For patients who underwent hip arthroscopy, the pooled prevalence of AIIS impingement was 18%. Significant improvement between pre- and postoperative clinical outcomes was observed: 25.75 points for the modified Harris hip score (mHHS), 46.88 points for the Hip Outcome Score-Sport subscale, 20.85 points for the Nonarthritic Hip Score, and -2.92 points for the pain visual analog scale. The minimal clinically important difference on the mHHS was exceeded by 94% of patients. The pooled incidence of surgical complications was 1%. Of 6 included studies on diagnostic accuracy, 2 were identified as having a low risk of bias, and 4 included >2 factors with a high risk of bias. All 9 included studies on treatment outcomes had at least 1 factor with a high risk of bias. Conclusion: Several imaging modalities assist in the diagnosis of AIIS impingement. The overall prevalence of AIIS impingement in patients that underwent hip arthroscopy was 18%. Clinical outcomes after arthroscopic AIIS decompression were generally favorable, with a relatively low rate of surgical complications.

DOI： 10.1177/23259671221131341

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Ovid Technologies (Wolters Kluwer Health)  

DOI： 10.1097/bto.0000000000000609

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Purpose: To compare plain radiographs with 3-dimensional (3D) computed tomography (CT) data for preoperative planning of arthroscopic lateral acromioplasty (ALA) for patients in whom ALA was performed along with arthroscopic rotator cuff repair (ARCR). Methods: Patients older than 25 years old who underwent ALA along with ARCR in our institution between October 2019 and February 2021 were included in this study. Preoperative ALA simulations were performed on plain radiographs and 3D models based on CT data. The critical shoulder angle (CSA) was compared between simulations based on radiographs and those based on 3D models. The ALA procedure was performed using the 3D model simulation, along with ARCR. The CSA after surgery was investigated using radiographs. Results: We evaluated 11 shoulders in 10 patients. There was no significant difference between the mean preoperative CSA on radiographs and 3D models (38.0° ± 2.6° vs 38.6° ± 1.8°, respectively; P = .55). The mean CSA after 4-mm ALA simulation using radiographs was not significantly different to that using 3D models (34.1° ± 2.6° vs 34.3° ± 2.5°, respectively; P = .84). Four cases (36.4%) required 8-mm ALA to reduce the CSA to <35° on radiographic analysis, and 2 (18.2%) required 8-mm ALA on 3D model analysis. The mean CSA on postoperative radiographs was significantly smaller than that on preoperative radiographs (32.1° ± 2.7° vs 38.0° ± 2.6°, respectively; P < .01). Conclusions: There was no significant difference between the mean CSA after a 4-mm ALA simulation using radiographs and that using 3D models based on preoperative CT data, which suggests that radiographs are comparable with 3D CT data models as a reliable modality for the preoperative simulation of ALA. Level of Evidence: III, retrospective comparative study.

DOI： 10.1016/j.asmr.2022.07.008

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Serum immune markers can be useful in the diagnosis of periprosthetic joint infection (PJI) by detecting long-lasting abnormal immunological conditions. The purpose of this study was to examine whether serum immune markers can improve the diagnostic accuracy of PJI. METHODS: We enrolled 51 PJI, 45 aseptic loosening, and 334 osteoarthritis patients for assessment of the discriminatory accuracy of serum markers including white blood cell count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and D-dimer, total protein, albumin (Alb), globulin (Glb), neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, platelet-lymphocyte ratio, albumin-globulin ratio (AGR), CRP-albumin ratio (CAR), and CRP-AGR ratio (CAGR). These diagnostic accuracies for low-grade PJI were also calculated in patients who had serum CRP levels <10 mg/L. RESULTS: Among serum markers, Alb, Glb, AGR, CRP, ESR, CAR, and CAGR had highly accurate diagnostic accuracy for PJI, with AUC of 0.92, 0.90, 0.96, 0.97, 0.92, 0.97, and 0.98, respectively. In low-grade PJI patients, AUC of CRP, ESR, CAR, and CAGR (0.69, 0.80, 0.65, and 0.82, respectively) was decreased, but that of Alb, Glb, and AGR (0.90, 0.88, 0.95, respectively) remained high, indicating the diagnostic utility of these immune markers. The sensitivity and specificity of AGR with cutoff value of 1.1 were demonstrated as 0.92 and 0.89, respectively, and with cutoff value of 1.2, 1.00 and 0.79, respectively, in the diagnosis of low-grade infection. CONCLUSION: Our results demonstrate the potential value of Alb, Glb, AGR, and combination indices of these immune makers with CRP in improving preoperative serum diagnosis for PJI, especially in low-grade PJI.

DOI： 10.1016/j.arth.2022.09.011

PubMed

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Femoroacetabular impingement (FAI) is primarily caused by bony impingement between the acetabulum and femoral neck during hip motion. Increasing posterior pelvic tilt improves hip range of motion in patients with FAI. Purpose: To use computer simulation analysis to compare the effects of 3-dimensional (3D) changes in pelvic tilt (sagittal tilt [St], axial rotation, and coronal tilt) with changes in a single plane (St), with the aim of improving range of motion in patients with FAI. Study Design: Controlled laboratory study. Methods: We evaluated 43 patients with FAI treated by arthroscopic cam resection. A 3D simulation was used to construct the following pelvic models: a 5° and 10° increase posteriorly in St (St5° and St10°) and a combined 5° change in St, axial rotation, and coronal tilt (Complex5°) from the baseline of the anterior pelvic plane. Improvements in maximum internal rotation (MIR) at 45°, 70°, and 90° of hip flexion and improvements in maximum flexion with no internal rotation were compared among the St5°, St10°, and Complex5° models. The pelvic models of each single-plane change of 5° and 10° were evaluated in the same simulation. Results: At 90° and 70°, there was a significant difference between the Complex5° and St10° models with respect to improvement in MIR (P = .004 at 90° of flexion; P = .017 at 70° of flexion). There was no significant difference in MIR at 45° of flexion (P = .71) or in maximum flexion (P = .42). Conclusion: At 70° and 90° of hip flexion, a combined change in 3D pelvic alignment of 5° (ie, St, axial rotation, and coronal tilt) was more effective in improving hip MIR than a 10° change in St only. Clinical Relevance: Effective physical therapy for FAI should address pelvic motion in all 3 planes rather than in a single plane.

DOI： 10.1177/23259671221123604

PubMed

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Posterior internal fixation for unstable pelvic ring fractures is often associated with complications, including pelvic hemorrhage and gluteal necrosis. Pelvic ring fixation using the S2 alar iliac screw (SAIS) without fixation of the lumbosacral vertebrae may have potential as a novel, minimally invasive technique for treating unstable pelvic ring fractures. The present study compared clinical outcomes in patients who underwent SAIS fixation within the pelvic ring with a historical control group of patients who underwent conventional trans-iliac plate fixation for the treatment of unstable pelvic ring fractures. MATERIALS AND METHODS: Thirty-two patients diagnosed with unstable pelvic fractures with sacral fracture or sacroiliac joint fracture dislocation were retrospectively evaluated. Eight consecutive patients underwent trans-iliac plate fixation from April 2012 to March 2015, and 24 consecutive patients underwent SAIS fixation from April 2015 to February 2020. Rates of soft tissue complications, intraoperative blood loss, and intraoperative blood transfusion volume were compared in these two groups. RESULTS: Mean intraoperative blood loss was significantly lower in patients who underwent SAIS fixation than in those who underwent trans-iliac plate fixation (141.0 ml vs 315.0 ml; P = 0.027), although there were no between-group differences in intraoperative blood transfusion volume (0.0 ml vs 140 ml; P = 0.105), incidence rate of soft tissue complications (4.2% vs 0%; P = 1.000), and operation time (88.5 min vs 93.0 min; P = 0.862). Bone healing was confirmed in all patients who underwent SAIS fixation without dislocation of the fracture site, whereas one patient who underwent trans-iliac plate fixation experienced a dislocation of the fracture site during follow-up (0% vs 12.5%; P = 0.250). CONCLUSIONS: SAIS fixation reduces intraoperative blood loss and ensures bone healing without major complications, including dislocation of the fracture site. SAIS fixation may therefore be an alternative, minimally invasive method of treating unstable pelvic fractures.

DOI： 10.1016/j.injury.2022.08.035

PubMed

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記述言語：日本語   出版者・発行元：日本股関節学会  

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記述言語：日本語   出版者・発行元：日本股関節学会  

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

DOI： 10.1007/s00402-022-04537-8

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その他リンク： https://link.springer.com/article/10.1007/s00402-022-04537-8/fulltext.html

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: A postoperative change in pelvic flexion following total hip arthroplasty (THA) is considered to be one of the causes of dislocation. This study aimed to predict the change of pelvic flexion after THA integrating preoperative and postoperative information with artificial intelligence. METHODS: This study involved 415 hips which underwent primary THA. Pelvic flexion angle (PFA) is defined as the angle created by the anterior pelvic plane (APP) and the horizontal/vertical planes in the supine/standing positions, respectively. Changes in PFA from preoperative supine position to standing position at 5 years after THA were recorded and which were defined as 5-year change in PFA. Machine learning analysis was performed to predict 5-year change in PFA less than -20° using demographic, blood biochemical, and radiographic data as explanatory variables. Decision trees were constructed based on the important predictors for 5-year change in PFA that can be handled by humans in clinical practice RESULTS: Among several machine learning models, random forest (RF) showed the highest accuracy (AUC = 0.852). Lumbo-lordotic angle, femoral anteversion angle, body mass index, pelvic tilt, and sacral slope were most important RF predictors. By integrating these preoperative predictors with those obtained 1 year after the surgery, we developed a clinically applicable decision tree model that can predict 5-year change in PFA with area under the curve = 0.914. CONCLUSION: A machine learning model to predict 5-year change in PFA after THA has been developed by integrating preoperative and postoperative patient information, which may have capabilities for preoperative planning of THA.

DOI： 10.1016/j.arth.2022.06.020

PubMed

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記述言語：英語  

DOI： 10.1016/j.jos.2022.05.014

PubMed

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

DOI： 10.1007/s00402-022-04444-y

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その他リンク： https://link.springer.com/article/10.1007/s00402-022-04444-y/fulltext.html

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Precise osteochondroplasty is important in arthroscopic hip surgery for cam-type femoroacetabular impingement (FAI). Although computer-assisted surgery with a navigation system may enhance the accuracy of arthroscopic osteochondroplasty, few clinical studies have assessed its accuracy. PURPOSE: To evaluate the accuracy of arthroscopic osteochondroplasty by a computed tomography (CT)-based navigation system for cam-type FAI, using 3-dimensional (3D) reconstruction with more detail compared with previous methods. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Twenty patients (14 men and 6 women) who underwent navigation-assisted arthroscopic surgery for cam-type FAI were included. The preoperative 3D model of the femur was constructed from each patient's CT data, and a planned model with virtual cam resection was generated. A femoral model was reconstructed from CT data postoperatively. The 3 models for each patient were overlaid using a 3D model registration method. Then, the contours of the bone resection area of each model were compared by measuring them. To measure the deviation between planned and actual bone resections, 4 cross-sectional images of the 3 femoral models were set at one-quarter intervals from the femoral head radius. All measurements were based on clockface lines set around the femoral neck axis at 30-minute intervals. Differences between the planned and postoperative contour lines were deemed resection deviations. RESULTS: All cam resections were performed in the anterior half of the region of interest. Therefore, only the anterior half (48 points) of the 96 points per case were analyzed. In 876 (91.3%) points of the total measurement points (960 points/20 cases), the error in resection depth was within 3 mm. Overresection was observed at 35 (3.6%) points and underresection at 49 (5.1%) points. The observed maximum deviations from the planned models were 6.3 mm overresection and -7.1 mm underresection. The alpha angles of the postoperative model at the posterior 9- to 3-o'clock position were <55° in all patients. CONCLUSION: Navigation-assisted arthroscopic osteochondroplasty showed favorable accuracy. Underresection was more frequent than overresection on the anterosuperior side of the femur, despite assistance of the navigation system.

DOI： 10.1177/03635465221074338

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Preoperative diagnosis of infection is important for appropriate surgical treatment of patients with rapid hip destruction (RHD). We investigated whether test results, including inflammatory and nutritional markers, could be used to accurately differentiate infectious and non-infectious RHD. Fifty patients with RHD who underwent total hip arthroplasty within a year of onset were observed. Infectious RHD was defined as ≥ 2 positive serological inflammatory, microbiological, or pathological evaluations. The albumin to globulin ratio (AGR), C-reactive protein (CRP)/albumin ratio (CAR), Glasgow prognostic score (GPS), modified GPS (mGPS), prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI), and platelet to lymphocyte ratio (PLR) were calculated from the blood test results. In the infectious group, the white blood cell count, platelet count, CRP level, erythrocyte sedimentation rate, CAR, GPS, mGPS, and PLR were significantly higher, while the albumin level, AGR, PNI, and GNRI were significantly lower. The CRP and albumin levels showed the highest sensitivity (1.00 for both; specificity of 0.87 and 0.73, respectively) in diagnosing infectious RHD. Combining these measurements (CAR) increased the specificity to 0.92. The accuracy of other nutritional assessments was good. Thus, nutritional assessment as well as conventional assessment of the inflammatory response can improve the accuracy of preoperative diagnosis of infectious RHD.

DOI： 10.1038/s41598-022-07678-3

PubMed

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本骨・関節感染症学会  

今回我々は真菌を伴う人工関節周囲感染症(PJI)の治療として、抗真菌薬を用いた持続局所抗菌薬灌流(CLAP)療法を行ったので報告する。症例は54歳男性で5回の人工股関節再置換術後、Candida albicansとMRSEによる股関節PJIを認めた。ミカファンギンとゲンタマイシンを併用したCLAP療法を施行し、感染の沈静化をインプラントの温存が可能であった。真菌性PJIにおいて抗真菌薬を用いたCLAP療法は治療選択の1つと考える。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本骨・関節感染症学会  

整形外科感染が難治性となる理由にバイオフィルムが関連している。インプラントや骨表面に付着しバイオフィルムを形成した付着細菌は、浮遊細菌とは異なり、細菌培養検査での偽陰性が多く、抗菌薬や免疫細胞への抵抗性を持つことに留意し、整形外科感染の診断と治療を行っていく必要がある。(著者抄録)

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Hindawi Limited  

The rapid detection of etiological agents is important for the successful treatment of iliopsoas abscess (IPA). The purpose of this study was to investigate the clinical utility of a real-time polymerase chain reaction (PCR) that targets the mecA gene for methicillin-resistant staphylococci (MRS) and the 16S rRNA gene for pan-bacteria. Our retrospective diagnostic study included 22 patients exhibiting IPAs and four patients with noninfectious iliopsoas mass regions who underwent computerized tomography or ultrasonography-guided biopsy and/or surgical treatment. Clinical symptoms, serum data, imaging analysis, and tissue microbiological culture were utilized for the diagnosis of IPA. The diagnostic accuracy of real-time PCR was determined based on the diagnosis of IPA and microbiological culture results. The microbiological culture was positive for 12 IPA cases that included 2 MRSA infections. Among 12 culture-positive IPA cases, 16S rRNA-PCR was positive in 12 and MRS-PCR in two. Among 10 culture-negative IPA cases, including 3 TB cases, 16S rRNA-PCR was positive in 8 and MRS-PCR in 2. In noninfectious iliopsoas mass patients, neither 16S rRNA nor MRS-PCR detected bacterial DNA. The sensitivity, specificity, positive predictive, and negative predictive values of 16S rRNA-PCR for diagnosing IPA were 0.91, 1.00, 1.00, and 0.67, respectively, while those for the diagnosis of MRS infection with MRS-PCR were 1.00, 0.92, 1.00, and 0.50, respectively. Real-time PCR targeting bacterial DNA can detect bacterial DNA in culture-negative cases and offer improved detectability of MRS infection in IPA patients.

DOI： 10.1155/2022/2209609

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その他リンク： http://downloads.hindawi.com/journals/bmri/2022/2209609.xml

掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.jos.2021.12.006

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記述言語：日本語   出版者・発行元：(一社)日本関節病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

CASE: We report a 4-year-old girl with congenital muscular torticollis (CMT) who was treated with sternocleidomastoid muscle (SCM) tenotomy using ultrasonography (US). Prior to the surgery, US was utilized to identify the clavicle and sternum branches of the SCM, sternohyoid muscles, internal jugular vein, and common carotid artery. Then, local anesthesia was injected into the layer between the fascial sheath of the SCM and carotid sheath to reduce bleeding and avoid vascular injury. During surgery, the SCM dissection was carefully conducted under US guidance to avoid vascular injury. No residual of SCM dissection and improvement of neck motion were confirmed before the skin closure. Postoperative course was good with no obvious complications in this patient. CONCLUSION: The intraoperative US investigation during SCM tenotomy is a useful procedure that provides vital information about dissection area of SCM and orientation of internal jugular vein that reduces the risk of insufficient tenotomy and vascular injury.

DOI： 10.2106/JBJS.CC.21.00309

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Excessive external femoral rotation (FR) can functionally increase stem anteversion (SA) and is often observed at an early stage after surgery in revision total hip arthroplasty (THA). This study was conducted to investigate the prevalence of external FR, identify the factors associated with external FR, and determine the association of FR and other factors with hip dislocation in revision THA. METHODS: We enrolled 51 revision THA patients (55 hip cases). The patient background, angle of anatomical and functional SA, FR angle, sizes and densities of muscles around the hip joint, impingement distance, and consequence of postoperative hip dislocation were assessed by reviewing their medical history and imaging data that includes computed tomography (CT) scans before and after surgery. RESULTS: Forty-five hip cases (81.8%) showed external FR (mean 13.0°). External FR was significantly correlated with anatomical SA (r =  - 0.54) and increase in functional SA (r = 0.36), which was significantly correlated with impingement distance (r = 0.46). The independent factors associated with external FR in multivariate analysis were the anatomical SA, CT densities of the psoas, gluteus medius and maximus muscles, and 2-stage revision (R2 = 0.559). During follow-up period, eight cases of revision THA showed hip dislocation. FR, functional SA, impingement distance, CT density of psoas and gluteus medius muscle, body mass index, number of past operation, and ratio of 2-stage revision THA were significantly different between cases with dislocation and non-dislocation. The odds ratio of FR and impingement distance for hip dislocation was identified as 1.061(95% confidence interval (CI): 1.011-1.114) and 0.901 (95% CI 0.820-0.991), respectively. CONCLUSIONS: Revision THA frequently causes an external FR that functionally increases the SA and impingement risk, particularly in hips with 2-stage revision with psoas and gluteus medius muscle atrophy. Patients who have undergone revision THA and have an excessive external FR may require careful monitoring for possible hip dislocation due to hip joint instability and impingement.

DOI： 10.1186/s13018-021-02744-4

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Of the several methods used to prevent surgical site infection (SSI), diluted povidone-iodine (PI) lavage is used widely. However, the clinical utility of PI for preventing periprosthetic joint infection (PJI) remains controversial. The aim of this study was to perform a systematic review and meta-analysis of the utility of dilute PI lavage for preventing PJI in primary and revision surgery. METHODS: This study was conducted in accordance with the PRISMA checklist for systematic reviews and meta-analyses. A comprehensive literature search of PubMed, CINAHL, ClinicalTrials.gov , and Cochrane Library databases was performed. The results are summarized qualitatively and as a meta-analysis of pooled odds ratios with 95% confidence intervals (95% CIs). Heterogeneity of treatment effects among studies was classified as low, moderate, or high, corresponding to I2 values of < 25%, 25-50%, and > 50%. A random effects model was applied in cases of high heterogeneity; otherwise, the fixed effects model was applied. Subgroup analyses were conducted to identify potential sources of heterogeneity. RESULTS: After the screening and eligibility assessment process, eight studies were finally extracted for analysis. Overall, the results showed that PI had no significant effect on PJI with ununified control group. However, subgroup analysis of studies with a saline control group revealed an odds ratio of 0.33 (95% CI, 0.16-0.71) for the PI group, suggesting a significant effect for preventing PJI. CONCLUSION: The systematic review and meta-analysis of the current literature demonstrates that diluted PI lavage is significantly better than saline solution lavage for preventing PJI. LEVEL OF EVIDENCE: Level I, Systematic review and meta-analysis.

DOI： 10.1186/s13018-021-02703-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

STUDY DESIGN: A retrospective cohort study. OBJECTIVE: To examine factors related to severe aggravation of pre-existing cervical lesions in patients with rheumatoid arthritis (RA) under current pharmacologic treatments with biologics. SUMMARY OF BACKGROUND DATA: Advanced RA cervical lesions carry a risk of irreversible damage to the spinal cord; however, risk factors for aggravation are unclear after the use of biologics became more popular. METHODS: Of 166 patients with pre-existing cervical lesions at baseline, 87 who had cervical X-ray images taken at baseline and at the final visit (with an interval of more than 1 year) were evaluated retrospectively. Aggravated instabilities determined at the final visit were defined as follows: atlantoaxial subluxation (AAS) = atlantodental interval ≧ 10 mm; vertebral subluxation (VS) = a Ranawat value < 10 mm; and sub-axial subluxation (SAS) = an anterior vertebral slip ≧ 4 mm or a multi-level slip ≧ 2 mm. Patients were divided into two groups based on the radiographic results: severe aggravation and non-severe aggravation. Explanatory variables were gender, age of RA onset, duration of disease, average observation period, Disease Activity Score 28 based on C-reactive protein (DAS28-CRP) at baseline, drug treatment history, presence of mutilating deformities in the hands, presence of RA-related joint surgery, and the prevalence of each cervical lesion at baseline. RESULTS: The severe group comprised 14 patients (16.1%). There was no significant difference between the two groups with respect to demographic data. Multivariate logistic regression analysis revealed that pre-existing SAS lesions (odds ratio: 7.59, 95% confidence interval: 1.16-49.6) and no history of biologic treatment (odds ratio, 0.10; 95% confidence interval, 0.17-0.58) were associated with aggravation. CONCLUSIONS: Pre-existing SAS lesions were associated with aggravation. Meanwhile, biologics may be effective at preventing aggravation.Level of Evidence: 3.

DOI： 10.1097/BRS.0000000000004220

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本骨・関節感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本骨・関節感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本骨・関節感染症学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Few reports have described the association between rheumatoid arthritis (RA) cervical lesions and osteoporosis, especially in patients with vertical subluxation (VS) that could be induced by the collapse of lateral masses in the upper cervical spine. Therefore, this study aimed to investigate the prevalence and risk factors for cervical lesions in patients with RA under current pharmacological treatments with biological agents, and to investigate the relationship between osteoporosis and VS development. METHODS: One hundred eighty-five consecutive patients with RA who underwent both cervical plain radiography and bone mineral density (BMD) scanning were enrolled. RA cervical lesions included atlantoaxial subluxation (AAS), VS, and subaxial subluxation (SAS). We assigned patients with AAS, VS, or SAS to the cervical-lesion group, and all other patients to the non-cervical-lesion group. Radiological findings, BMD, and clinical data on RA were collected. We used multivariate logistic regression analyses to assess the risk factors for cervical lesions in patients with RA. RESULTS: The cervical-lesion and non-cervical-lesion groups included 106 and 79 patients, respectively. There were 79 patients with AAS, 31 with VS, and 41 with SAS. The cervical-lesion group had a younger age of RA onset, longer RA disease duration, higher RA stage, and lower femoral neck BMD than the non-cervical-lesion group. Multivariate analyses showed that the risk factors for RA cervical lesions were prednisolone usage, biological agent usage, and higher RA stage. Prednisolone usage and femoral neck BMD were the risk factors for VS. CONCLUSIONS: Cervical lesions were confirmed in 57 % of the patients. Prednisolone usage, biological agent usage, and higher RA stage were significant risk factors for cervical lesions in patients with RA. The general status of osteoporosis might contribute to the development of VS.

DOI： 10.1186/s12891-021-04285-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Culture-negative periprosthetic joint infections (PJIs) can complicate diagnosis and management of PJI. This study aimed to identify risk factors for culture-negative PJI and differences in clinical characteristics between culture-positive and culture-negative PJI group. METHODS: This retrospective, cross-sectional study evaluated PJI cases obtained between January 2013 and October 2019 at our institution. These PJI cases were divided into culture-positive and culture-negative groups and then compared. The demographics, laboratory findings, and details of patient's clinical characteristics were investigated. Univariate and multivariate logistic regression analysis were performed to investigate risk factors for culture-negative PJI. RESULTS: A total of 109 PJI cases were included in the analysis: 82 (75%) culture-positive and 27 (25%) culture-negative. The mean serum white blood cell (WBC) count, C-reactive protein level, and erythrocyte sedimentation rate in the culture-negative group were significantly lower than those in the culture-positive group (p < 0.05). There were no significant differences between the two groups regarding history of prior antibacterial administration or treatment success rates. Multivariate analysis identified a low serum WBC count as a risk factor for culture-negative PJI (odds ratio = 0.78; 95% confidence interval [CI] = 0.63-0.97; p = 0.027). CONCLUSIONS: A low serum WBC count is a risk factor for culture-negative PJI, but prior antimicrobial therapy is not. The results suggest that PJI cases with lower levels of systemic inflammation are likely to be culture-negative; therefore, the possibility of a culture-negative result should be considered in suspected cases of PJI with low inflammatory markers, regardless of prior antibiotic exposure.

DOI： 10.1186/s13018-021-02450-1

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掲載種別：研究論文（学術雑誌）   出版者・発行元：SAGE Publications  

Purpose:

Dislocation is a major complication after total hip arthroplasty (THA), and pelvic stiffness is reportedly a significant risk factor for dislocation. This study aimed to investigate spinopelvic alignment, and identify preoperative factors associated with postoperative pelvic mobility.

Methods:

We enrolled 78 THA patients with unilateral osteoarthritis. The sagittal spinopelvic alignment in the standing and sitting position was measured using an EOS imaging system before and 3 months after THA. We evaluated postoperative pelvic mobility, and defined cases with less than 10° of sacral slope change as pelvic stiff type. The preoperative characteristics of those with postoperative stiff type, and preoperative factors associated with risk of postoperative stiff type were evaluated.

Results:

Sagittal spinopelvic alignment except for lumbar alignment were significantly changed after THA.A total of 13 patients (17%) were identified as postoperative pelvic stiff type. Preoperative lower pelvic and lumbar mobility were determined as significant factors for prediction of postoperative pelvic stiff type. Among these patients, nine patients (69%) did not have pelvic stiffness before THA. Preoperative factor associated with the risk of postoperative pelvic stiff type in those without preoperative stiffness was lower lumbar lordosis in standing position by multivariate regression analysis.

Conclusion:

Spinopelvic alignments except lumber alignment was significantly changed after THA. The lower pelvic mobility and lumbar alignment were identified as the preoperative predictive factors for postoperative pelvic mobility. Evaluation of preoperative lumbar alignment may be especially useful for the prediction in patients with hip contractures, for these patients may possibly experience the extensive perioperative change in pelvic mobility.

DOI： 10.1177/23094990211019099

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その他リンク： http://journals.sagepub.com/doi/full-xml/10.1177/23094990211019099

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Rehabilitation is an effective procedure for promoting functional recovery after simultaneous bilateral total knee arthroplasty (TKA); however, it has been cited as a significant economic burden of medical care. We hypothesized that preoperative factors, including age, sex, body mass index, living alone, the knee society function score (KSS), the American society of anesthesiologists (ASA) class, hemoglobin (Hb), albumin level, mean range of motion, and the Kellgren-Lawrence grade, would predict prolonged rehabilitation utilization. METHODS: In total, 191 patients undergoing simultaneous bilateral TKA in a single hospital were enrolled. The successful compliance group included patients who completed their rehabilitation program and could return to their residence within 3 weeks after surgery (n = 132), whereas the delayed group included the remaining patients (n = 59). Logistic regression analysis was performed using preoperative factors. A prediction scoring system was created using the regression coefficients from the logistic regression model. RESULTS: Logistic regression analysis revealed that age (β = - 0.0870; P <  0.01) and Hb (β = 0.34; P <  0.05) were significantly associated with prolonged rehabilitation programs, whereas body mass index, living alone, KSS score, and ASA class were not significantly associated with successful completion of rehabilitation programs; however, these factors contributed to the prediction scoring formula, which was defined as follows: [Formula: see text] The C-statistic for the scoring system was 0.748 (95% confidence interval, 0.672-0.824). The positive and negative likelihood ratios were 2.228 (95% CI, 1.256-3.950) and 0.386 (95% CI, 0.263-0.566), respectively. These results showed an increase of 15-20% and a decrease of 20-25% in the risk of prolonged rehabilitation. The optimal cutoff point for balancing sensitivity and specificity was 3.5, with 66.6% sensitivity and 78.0% specificity. CONCLUSIONS: Older age and lower preoperative Hb were significantly associated with prolonged rehabilitation programs. We defined a new scoring formula using preoperative patient factors to predict prolonged rehabilitation utilization in patients undergoing simultaneous bilateral TKA.

DOI： 10.1186/s12891-021-04211-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: The influence of pelvic tilt mobility, which can be reproduced in computer-simulation models, is an important subject to be addressed in the understanding of femoroacetabular impingement (FAI) pathophysiology. Purpose: To use computer-simulation models of FAI cases to evaluate the optimum improvement in hip range of motion (ROM) achieved by decreasing the anterior pelvic tilt and compare the results with the improvement in ROM achieved after cam resection surgery. Study Design: Controlled laboratory study. Methods: The pre- and postoperative computed tomography (CT) images from 28 patients with FAI treated with arthroscopic cam resection were evaluated. Using a dynamic computer-simulation program, 3-dimensional models with a 5° and a 10° decrease in anterior pelvic tilt from the supine functional pelvic plane (baseline) were created from the preoperative CT scans. Similar models were constructed for hips before (at baseline) and after cam resection. Improvements from baseline in maximum internal rotation at 45°, 70°, and 90° of flexion were assessed for the 5° change in pelvic tilt, 10° change in pelvic tilt, and cam resection models, and the results were compared for all conditions. Results: The combination of a 10° change in pelvic tilt and cam resection showed the largest ROM improvement from baseline (P < .001). Improvement in internal rotation in the cam resection model was significantly higher compared with the 5° pelvic tilt change model (P < .001), while there was no significant difference between the cam resection model and the 10° pelvic tilt change model. Conclusion: Decreasing anterior pelvic tilt by 10° in the preoperative computer simulation model resulted in an equivalent effect to cam resection, while a 5° change in pelvic tilt was inferior to cam resection in terms of ROM improvement. Clinical Relevance: Enough of a decrease in anterior pelvic tilt may contribute to ROM improvement that is as effective as that of cam resection surgery.

DOI： 10.1177/2325967121999464

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Stress shielding after total hip arthroplasty (THA) leads to loss of bone mineral density (BMD) around the femoral implants, particularly in the proximal area. Loss of BMD around the implant is likely to occur within 1 year after THA; however, its severity depends on patient characteristics. This study evaluated preoperative factors correlated with the severity of zone 7 BMD loss after THA. METHODS: This retrospective cohort study included 48 patients who underwent primary THA from October 2011 to December 2015. All patients underwent implantation of a Zweymüller-type femoral component without any postoperative osteoporosis medications. The objective variable was a change in zone 7 BMD after 1 year. Factors evaluated included age, body mass index, Japanese Orthopaedic Association score, Harris Hip Score, Canal Flare Index (CFI), and lumbar BMD on the frontal and lateral sides. Univariate and multivariate regression analyses identified factors correlated with loss of zone 7 BMD. RESULTS: Univariate regression analysis identified CFI (P = 0.003) and preoperative lumbar BMD on the anterior-posterior (P = 0.003) and lateral (P < 0.001) sides as being correlated with loss of zone 7 BMD. Multivariate regression analysis identified CFI (P = 0.014) and lumbar BMD on the lateral side (P < 0.001) as being correlated independently with loss of zone 7 BMD. CONCLUSION: Lower preoperative lumbar BMD on the lateral side and lower CFI were correlated with zone 7 BMD loss after THA. Patients with these characteristics should be monitored carefully for severe BMD loss after THA.

DOI： 10.1186/s12891-021-04161-4

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Synovial fluid is important for the preoperative etiological diagnosis of suspected periprosthetic joint infection (PJI) or septic arthritis (SA). GENECUBE, an automated real-time polymerase chain reaction (PCR) assay, was used to detect bacterial mecA (methicillin resistance) and was compared with microbiological cultures for preoperatively diagnosing PJI and SA in 74 patients suspected of these infections and thus earmarked for surgery. PJI and SA were diagnosed in 21 and 6 cases, respectively, using modified ICM 2018 diagnostic criteria. Microbiological cultures determined methicillin-resistant staphylococcus (MRS) as the causative organism in six samples, which were all positive in the GENECUBE assay. Significantly also, the GENECUBE assay detected six MRS infections in culture-negative but infection-diagnosed patients, and in one inconclusive case, suggesting a higher sensitivity of this assay. Compared with microbiological culture, the sensitivity and specificity of the GENECUBE assay for mecAwas 100% and 92.2%, respectively. However, GENECUBE also produced invalid results in three cases, suggesting possible PCR inhibitors in the synovial fluid samples. We additionally validated the accuracy of pan-bacterial real-time PCR targeting 16S rRNA and other tests. Pan-bacterial real-time PCR was as effective as preoperative bacterial culture testing, although the α-defensin assay had the highest sensitivity at 100%. Hence, fully automated real-time PCR targeting of the bacterial mecA gene improves the etiological diagnosis of PJI and SA by reducing the testing time and lowering the false-positive detection rates. A screening approach for α-defensin followed by bacterial mecA gene testing in synovial fluids is therefore a more efficient method of preoperatively diagnosing PJI and SA.

DOI： 10.1002/jor.24959

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: The labrum is likely to influence impingement, which may also depend on acetabular coverage. Simulating impingement using 3-dimensional (3D) computed tomography (CT) is a potential solution to evaluating range of motion (ROM); however, it is based on bony structures rather than on soft tissue. Purpose: To examine ROM when the labrum is considered in a 3D dynamic simulation. A particular focus was evaluation of maximum flexion and internal rotation angles before occurrence of impingement, comparing them in cases of cam-type femoroacetabular impingement (FAI) and borderline developmental dysplasia of the hip (BDDH). Study Design: Descriptive laboratory study. Methods: Magnetic resonance imaging (MRI) and CT scans of 40 hips (20 with cam-type FAI and 20 with BDDH) were reviewed retrospectively. The thickness and width of the labrum were measured on MRI scans. A virtual labrum was reconstructed based on patient-specific sizes measured on MRI scans. The impingement point was identified using 3D dynamic simulation and was compared with the internal rotation angle before and after labral reconstruction. Results: The thickness and width of the labrum were significantly larger in BDDH than in FAI (P < .001). In FAI, the maximum internal rotation angles without the labrum were 30.3° at 90° of flexion and 56.9° at 45° of flexion, with these values decreasing to 18.7° and 41.4°, respectively, after labral reconstruction (P < .001). In BDDH, the maximum internal rotation angles were 48.0° at 90° of flexion and 76.7° at 45° of flexion without the labrum, decreasing to 31.1° and 55.3°, respectively, after labral reconstruction (P < .001). The differences in the angles before and after labral reconstruction were larger in BDDH than in FAI (90° of flexion, P = .03; 45° of flexion, P = .01). Conclusion: As the labrum was significantly more hypertrophic in BDDH than in FAI, the virtual labral model revealed that the labrum's interference with the maximum internal rotation angle was also significantly larger in BDDH. Clinical Relevance: The labrum has a significant effect on impingement; this is more significant for BDDH than for FAI.

DOI： 10.1177/2325967120964465

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Although rotational changes in lower limb alignment after total hip arthroplasty (THA) affect functional stem anteversion, less is known about the effects of femoral rotational alignment in the standing position. This study investigated postoperative changes in femoral rotation and evaluated the association with whole-body alignment in patients who underwent THA. Methods: Sixty-five patients with unilateral hip osteoarthritis who underwent THA were enrolled. Preoperative and postoperative femoral rotation in the standing and supine positions were measured using EOS 2D/3D X-ray imaging system and computed tomography. Negative and positive changes in femoral rotation angle were indicative of internal and external rotation, respectively. The associations between femoral rotation and preoperative clinical and radiological factors were investigated. Results: Femoral rotation showed significant internal changes in both the standing (-4.7° ± 11.0°) and supine (-3.5°± 10.9°) positions after THA. The preoperative femoral rotation angle, knee flexion angle, sagittal vertical axis (SVA), lumbar lordosis, body mass index, age, and internal and external rotation angles of the hip range of motion on the contralateral side were significantly correlated with femoral rotation in the standing position after THA. Multiple regression analysis showed that preoperative femoral rotation (β = 0.416, P < .001) and SVA (β = 0.216, P = .040) were significant predictors of postoperative femoral rotation in the standing position. Conclusions: Femoral rotation had significant association with the patient-inherent posture represented by the SVA in the standing position. Because extensive external change of femoral rotation may increase the risk of hip impingement and dislocation, careful attention is required in patients with external femoral rotation and forward bent posture in the preoperative standing position.

DOI： 10.1016/j.artd.2020.06.004

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: This study aimed to assess the effect of soft tissue correction due to knee joint laxity, which induces alignment error after hybrid closed-wedge high tibial osteotomy (CWHTO). In addition, to verify whether postoperative soft tissue correction can be predicted from preoperative radiographic parameters. METHODS: A retrospective evaluation of data from patients treated by CWHTO in 2016-2019 was performed. Standing full-length anteroposterior radiograph measurement was performed pre- and post-surgery, and short anteroposterior radiographs of the knee under maximal manual varus and valgus stress were taken preoperatively. The weight-bearing line, hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), and joint line convergence angle (JLCA) were measured, in addition to JLCA under varus or valgus conditions. Soft tissue correction was defined as ΔHKA minus ΔMPTA. Multiple regression analysis was performed to evaluate preoperative factors that could influence soft tissue correction. RESULTS: Data from 49 knees were included in the analysis. The mean soft tissue correction was 3.2°, which indicates an over-correction. Multiple regression analysis revealed that JLCA (β = 0.642; p < 0.001) and valgus JLCA (β = - 0.422; p = 0.001) were significantly associated with postoperative soft tissue correction. The final model of the regression formula was described by the following equation: postoperative soft tissue correction = 0.691 × JLCA - 0.411 × valgus JLCA - 0.399. CONCLUSION: Preoperative values for JLCA and JLCA under valgus stress are associated with soft tissue correction. Surgeons should, therefore, consider these measurements to achieve postoperative limb alignment.

DOI： 10.1007/s00167-019-05762-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Total knee arthroplasty (TKA) is an established procedure for knee osteoarthritis. Multimodal analgesia is reportedly more effective for postoperative analgesia. We investigated the efficacy of 2 patches after TKA. METHODS: Seventy-nine knees that underwent unilateral TKA for osteoarthritis were included. Oral administration, local periarticular analgesic injection, and patches were adopted for pain management. The knees were randomly assigned to the flurbiprofen patch (FPP), S-flurbiprofen patch (SFPP), and control (no patch) groups. Patch treatment was continued for 14 days. Pain according to the visual analog scale, knee flexion angle, renal dysfunction, gastrointestinal injury, duration of hospitalization, dermatitis, and the rate of using additional oral nonsteroidal anti-inflammatory drugs were compared (from preoperative to postoperative day 14). RESULTS: The FPP, SFPP, and control groups included 29, 27, and 23 knees, respectively. Visual analog scale was lower in the FPP and SFPP groups than in the control group on days 1 and 3 (day 1: 24.4, 25.0, and 39.4, respectively; day 3: 25.5, 23.3, and 39.3, respectively). Knee flexion angle was larger in the SFPP group than in the control group on days 7 and 14 (day 7: 89.8° and 76.6°, respectively; day 14: 98.3° and 84.2°, respectively). Neither renal dysfunction nor gastrointestinal injury was confirmed. The duration of hospitalization did not differ among the groups. Dermatitis occurred only in the SFPP group. The rate of using additional oral nonsteroidal anti-inflammatory drugs was higher in the control group. CONCLUSION: Both patches were effective and safe as part of multimodal analgesia for postoperative TKA.

DOI： 10.1016/j.arth.2020.04.006

PubMed

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記述言語：日本語   出版者・発行元：日本股関節学会  

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出版者・発行元：南江堂  

DOI： 10.15106/j_seikei71_931

CiNii Research

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: The alpha angle used to evaluate cam morphology can be determined on different imaging views; however, 2-dimensional (2D) imaging can present limitations in terms of the reproducibility of the radial alpha angle. Recent developments in 3-dimensional (3D) high-resolution magnetic resonance imaging (MRI) have allowed detailed evaluations of the radial alpha angle. Purpose: To determine whether there are any correlations or discrepancies between the 2D alpha angle on plain radiography and the maximum radial alpha angle on 3D MRI. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 42 hips from 39 patients (19 males, 20 females) were analyzed, including 22 hips with femoroacetabular impingement (FAI; mean age, 41 years) and 20 hips with borderline developmental dysplasia of the hip (BDDH; mean age, 43 years). Radial images were reconstructed from 3D multiple echo recombined gradient echo (MERGE) MRI. Differences in the maximum radial alpha angle on MRI between hips with FAI and BDDH were evaluated. Correlations and discrepancies between the maximum radial alpha angle on MRI and alpha angles on the anteroposterior, cross-table lateral, and 45° Dunn views of radiography were also evaluated. Results: The maximum radial alpha angle was significantly higher for hips with FAI than for hips with BDDH. On average, the greatest alpha angle on radial MRI was higher than the alpha angle on each of the 3 radiographic views for both FAI and BDDH. The 45° Dunn view revealed the smallest discrepancy for both FAI (P = .005) and BDDH (P = .002). The cross-table lateral view had the highest correlation with the maximum radial alpha angle for BDDH (P < .001). Conclusion: We reconfirmed the utility of the 45° Dunn view, with it presenting the best reproducibility for the maximum radial alpha angle in the evaluation of cam morphology, while the cross-table lateral view revealed the best correlation with the maximum radial alpha angle, particularly for hips with BDDH.

DOI： 10.1177/2325967120932922

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Hip dislocation after total hip arthroplasty (THA) or hemi-arthroplasty is a rare but serious complication. Dislocation may be prevented by appropriate positioning of the cup angle of inclination and anteversion. CASE PRESENTATION: This report describes a 66-year-old woman who underwent revision THA using a computer tomography (CT)-based navigation system to treat an anterior dislocation after hemi-arthroplasty due to a severe posterior pelvic tilt. At initial presentation, her sagittal pelvic tilt angle, measured as anterior pelvic plane (APP) in the supine position, was 38 degrees posterior to the coronal plane. Owing to the posterior pelvic tilt, revision THA was performed using CT-based navigation, while dual mobility was utilized to reduce the risk of re-dislocation. Postoperatively, her sagittal pelvic tilt angle showed further progression over time, with an APP of 66 degrees posterior to the coronal plane in the standing position 3 years after revision THA. Simulation with the Zed Hip system showed that the risk of implant-to-implant impingement was much higher posteriorly than anteriorly. Gait analysis demonstrated hyperextension of the hip joint while walking, although hip joint function required for daily activity was maintained. CONCLUSIONS: Preoperative planning of implant orientation, based on posterior progression of pelvic tilt and accurate placement of components, is important to prevent dislocation in patients with severe posterior pelvic tilt. A dual mobility cup may also improve hip function in these patients.

DOI： 10.1186/s12891-020-03263-9

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Stress shielding after total hip arthroplasty (THA) can induce bone mineral density (BMD) loss around the femoral implant. Several studies using drug have described methods to prevent BMD loss around implants following THA. Switching from teriparatide to alendronate was reported to increase lumbar BMD; on the other hands, it is unclear whether switching from teriparatide to alendronate is effective around the implant. The aim of this study is that changes in BMD is compared in patients switched from teriparatide to alendronate, in patients treated with alendronate alone, and in control patients without medication after total hip arthroplasty. PATIENTS AND METHODS: Patients were randomized into three groups, those switched to alendronate after teriparatide (switch: n = 17), those receiving continuous alendronate (ALD: n = 15), and control untreated patients (control: n = 16) and followed up for 2 years after THA. Baseline periprosthetic BMD was measured by dual-energy X-ray absorptiometry (DEXA) 1 week after THA, followed by subsequent measurements at 1 and 2 years postoperatively. Lumbar BMD was also evaluated at preoperatively, 1 and 2 years postoperatively. RESULTS: Two years after surgery, BMD (%) at zone 1 was significantly higher in the switch group than in the control group (P = 0.02). BMD (%) at zone 7 was significantly higher in the switch and ALD groups than in the control group (P = 0.01, P = 0.03). Lumbar BMD (%) anterior-posterior (AP) side was significantly higher in the switch group than in the ALD and control groups 2 years after surgery. On the other hand, lumbar BMD (%) lateral side was significantly higher in the switch and ALD groups than control group 2 years after surgery. CONCLUSIONS: Switching therapy had a significant effect on BMD of the lumbar spine and zones 1 and 7 at 2 years postoperatively. At zone 1 in particular, it was found to be more effective than ALD alone. TRIAL REGISTRATION: UMIN, registry number UMIN000016158. Registered 8 January 2015.

DOI： 10.1186/s13018-020-1547-5

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SAGE Publications  

<sec><title>Background:</title> Anterior inferior iliac spine (AIIS) impingement is an important risk factor for revision hip arthroscopy. Although a morphological classification system is available, evaluating AIIS impingement with respect to joint kinematics remains a challenge.

</sec><sec><title>Purpose:</title> To use computer simulation analysis to ascertain the prevalence of AIIS impingement before and after osteochondroplasty.

</sec><sec><title>Methods:</title> A total of 35 joints from 30 cases (20 males and 10 females; average age: 43.3 ± 13.7 years) were analyzed. All joints had cam morphology and underwent hip arthroscopic osteochondroplasty. A three-dimensional model of each joint was constructed pre- and postoperatively. Joint kinematic simulation software (ZedHip®, Lexi, Tokyo) was used to identify the impingement point on the acetabular side and the incidence (expressed as a percentage) of AIIS impingement calculated. Radiographic and clinical evaluation was performed pre- and postoperatively.

</sec><sec><title>Results:</title> AIIS impingement was observed postoperatively in six joints but preoperatively in only one joint. The rate of AIIS postoperative impingement was significantly higher than that of preoperative impingement. All impingement points were located on the inferior aspect of the AIIS apex. However, there were no significant differences between the AIIS impingement and non-impingement groups in terms of clinical outcome.

</sec><sec><title>Conclusion:</title> The incidence of AIIS impingement after osteochondroplasty was 17% by computer simulation analysis. Osteochondroplasty may result in subsequent AIIS impingement.

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DOI： 10.1177/2309499020935533

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その他リンク： http://journals.sagepub.com/doi/full-xml/10.1177/2309499020935533

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SAGE Publications  

<sec><title>Background and purpose:</title> This nationwide questionnaire survey was performed to clarify the prevalence of groin pain in unicycle athletes and to reveal the relationship between groin pain and factors such as age or athletic career.

</sec><sec><title>Patients and methods:</title> To evaluate the prevalence of groin pain, the questionnaire was sent to 1304 unicyclists belonging to the Japan Unicycle Association. All subjects aged 6 years or older at the time they answered the questionnaire.

</sec><sec><title>Results:</title> Overall, 17% of unicyclists complained of groin pain. Pain was more common in those aged 13–19 years and in those with a career lasting more than 6 years.

</sec><sec><title>Conclusion:</title> The incidence of groin pain (17%) among unicyclists is higher than that among athletes participating in other sports. Unicyclists aged between 13 and 19 years old and those with an athletic career of more than 6 years often suffer from groin pain.

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DOI： 10.1177/2309499020934201

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その他リンク： http://journals.sagepub.com/doi/full-xml/10.1177/2309499020934201

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Culture-negative infections can complicate the diagnosis and management of orthopedic infections, particularly periprosthetic joint infections (PJIs). This study aimed to identify differences in rate of detection of infection and organisms between cultured using standard and enriched methods. METHODS: This retrospective, cross-sectional study evaluated PJI samples obtained between January 2013 and December 2017 at Yokohama City University Hospital. Samples were assessed using standard and enrichment culture techniques. White blood cell counts, C-reactive protein levels, type of microorganism (coagulase-positive or coagulase-negative), and methicillin-resistant Staphylococcus were investigated. RESULTS: A total of 151 PJI samples were included in the analysis; of these, 68 (45.0%) were positive after standard culture while 83 (55.0%) were positive only after enrichment culture. The mean white blood cell counts and C-reactive protein levels were significantly lower in the enrichment culture group than in the standard culture group (P < .01). The rate of methicillin-resistant Staphylococcus and coagulase-negative Staphylococci was significantly higher in the enrichment culture group than in the standard culture group (P < .01). CONCLUSION: The enrichment culture method has a higher rate of detection of infection than standard culture techniques and should, therefore, be considered when diagnosing orthopedic infections, particularly PJI.

DOI： 10.1016/j.arth.2019.08.035

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Hydroxyapatite- (HA-) coated implants tend to achieve good osteoinductivity and stable clinical results; however, the influence of the coating on the prevention of bone mineral density (BMD) loss around the implant is unclear. The purpose of this randomized controlled trial was to evaluate the effectiveness of HA-coated implants for preventing BMD loss and to determine the status of bone remodeling after total hip arthroplasty (THA), making comparisons with non-HA-coated implants. Methods: A total of 52 patients who underwent primary THA were randomly allocated to HA and non-HA groups. BMD was measured by dual-energy X-ray absorptiometry (DEXA) at 1 week postoperation to form a baseline measurement, and then 24 weeks and 48 weeks after surgery. The relative change in BMD was evaluated for regions of interest (ROIs) based on the Gruen zone classifications. 18F-fluoride positron emission tomography (PET) was performed at 24 weeks postsurgery, and the maximum standardized uptake values (SUVmax) were evaluated in the proximal (HA-coated) and distal (non-HA-coated) areas in both groups. Results: There were significant differences in BMD loss in ROIs 3 and 6 (p = 0.03), while no significant difference was observed in ROI 7 at either 24 or 48 weeks postsurgery. There was no significant correlation between PET uptake and BMD (24 or 48 weeks) in either group. Conclusion: The influence of a HA coating in terms of BMD preservation is limited. No significant correlation was found between BMD and SUVmax measured by PET, either with or without the use of a HA coating.

DOI： 10.1155/2020/4154290

PubMed

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記述言語：英語  

Osteoblastoma is a relatively rare benign bone-forming tumor accounting for less than 1% of all bone tumors. This report describes a patient with an osteoblastoma in the femoral head complicated by coexistence of femoroacetabular impingement. A 25-year-old male rugby football player complained of severe right hip pain after an injury during rugby practice. The pain became progressively worse despite resting from sports activity and rehabilitation for 4 months. The image inspection revealed bone tumor complicated by cam-type femoroacetabular impingement and a labral injury. Hip arthroscopic surgery was planned using a navigation system and a three-dimensional model for both complete debridement and cam resection. The tumor was resected by open surgery using a posterior approach. The bone tumor was diagnosed histopathologically as an osteoblastoma. The patient's symptoms improved markedly after surgery, with no evidence of local tumor recurrence or hip arthritis 1 year later.

DOI： 10.1177/2050313X20978022

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記述言語：日本語   出版者・発行元：(一社)日本関節病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To evaluate radially reconstructed 3.0-Tesla 3-dimensional multiple-echo recombined gradient echo (MERGE) magnetic resonance imaging (MRI) without arthrography for the assessment of acetabular labrum tears, using arthroscopic evaluation as the reference standard. METHODS: A total of 71 consecutive hips, including 29 with femoroacetabular impingement, 26 with borderline developmental dysplasia of the hip, and 16 with early-stage osteoarthritis, were evaluated in this retrospective study. MERGE MRI findings were evaluated according to the modified Czerny classification for 3 regions of interest: anterior region, anterolateral region, and lateral region. Cases with severe degeneration that was not concordant with any stage in the original Czerny classification were defined as stage Ⅳ. MERGE MRI findings were compared with arthroscopic findings, and the sensitivity, specificity, positive predictive value, and negative predictive value in terms of the existence of labrum tears were calculated. RESULTS: MERGE MRI findings revealed labrum tears more frequently in the anterolateral region than in the anterior and lateral regions (P < .01). In cases of femoroacetabular impingement and borderline developmental dysplasia of the hip in particular, labrum tears were more frequently observed on MRI in the anterolateral region than in the lateral region (P < .05). In comparison with MRI findings and arthroscopic findings, our newly defined stage IV in the modified Czerny classification was more frequently observed in cases with a Multicenter Arthroscopy of the Hip Outcomes Research Network (MAHORN) classification of degenerative or complex (P < .01). The average sensitivity and specificity of all regions for the existence of labrum tears were 85% and 56%, respectively. Sensitivity and specificity were 79% and 50%, respectively, in the anterior region; 96% and 50%, respectively, in the anterolateral region; and 70% and 57%, respectively, in the lateral region. CONCLUSIONS: We validated the diagnostic performance of 3.0-Tesla 3-dimensional MERGE MRI for evaluating acetabular labrum tears and made comparisons with arthroscopic findings. Radially reconstructed MERGE magnetic resonance images showed excellent sensitivity for the diagnosis of labrum tears, particularly in the anterolateral region. The newly defined stage IV was distinctive of early-stage osteoarthritis cases with degeneration and/or complex arthroscopic findings. The noninvasive imaging modality of radially reconstructed MERGE MRI may be an alternative to magnetic resonance arthrography for evaluating labrum tears. LEVELS OF EVIDENCE: Level Ⅱ, development of diagnostic criteria.

DOI： 10.1016/j.arthro.2019.05.006

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SAGE PUBLICATIONS LTD  

Background and purpose: The pathology of the posterior acetabular lesions, so-called "contrecoup regions", in femorocacetabular impingement (FAI) has not been elucidated fully. F-18-fluoride positron emission tomography/computed tomography (PET/CT) can visualize abnormal uptake caused by impingement. Therefore, we aimed to evaluate posterior acetabular uptake on PET/CT in FAI patients. Patients and methods: Patients with FAI who underwent F-18-fluoride PET/CT between October 2014 and October 2016 were retrospectively evaluated. The maximum standardized uptake value (SUVmax) in the posterior acetabulum was evaluated. The mean SUVmax of FAI with cam morphology (the cam group) was compared with that of FAI with pincer morphology (the pincer group). In addition, the numbers of cases with SUVmax >= 6 and SUVmax < 6 in each group were evaluated. The entire study cohort was also grouped according to SUVmax, and the mean alpha and center edge angles were evaluated. Results: In total, 41 hips were analyzed (34 hips in the cam group and 7 in the pincer group). The mean SUVmax of the cam group (11.2 +/- 7.4) was significantly higher than that of the pincer group (4.9 +/- 1.9) (p < 0.01). The incidence of cases with SUVmax >= 6 in the cam group was significantly high (p < 0.01). In the overall cohort, the mean alpha angle of the SUVmax >= 6 group was significantly higher than that of the SUVmax < 6 group (p < 0.01). Conclusion: Evaluation of posterior acetabular uptake suggests an association between cam morphology and increased posterior acetabular uptake.

DOI： 10.1177/2309499019868929

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective: A history of venous thromboembolism (VTE) is a risk factor for newly formed VTE after total hip arthroplasty (THA). However, its morbidity and association with postoperative VTE are not clear and, therefore, were investigated in this study. Methods: Four-hundred and nineteen patients scheduled for primary THA were included. We preoperatively identified any VTE factors such as obesity, age, and history of VTE by interviewing and duplex ultrasonography for all patients, and the patients were assigned into 'high-' or 'low-risk' groups, that were the indication whether chemoprophylaxis was administered after surgery. Postoperative VTE was also examined on the day 7 by enhanced computed tomography (CT) for all patients. Results: Preoperative VTE were detected in 48 patients (11.4%), and postoperative VTE were found in 44 (10.5%). Linear and multivariate logistic regression analysis revealed osteonecrosis and preoperative VTE were the independent factors associated with postoperative VTE (Odds ratio (OR) 1.0 e-7 and 5.00, respectively). In the survey of each risk group, only preoperative VTE was recognized as a risk factor for high-risk group, and longer operation time for low-risk group. Conclusion: The present study confirmed high frequency of preoperative VTE which was still the strongest risk factor for postoperative asymptomatic VTE.

DOI： 10.1080/14397595.2018.1524959

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出版者・発行元：南江堂  

DOI： 10.15106/j_seikei70_332

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.arth.2018.09.072

PubMed

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記述言語：日本語   出版者・発行元：東日本整形災害外科学会  

3.0 Tesla（以下 3T）Multiple Echo Recombined Gradient Echo（MERGE）MRIを用いて股関節唇をmodified Czerny分類で評価した．鏡視下所見と比較し，関節唇損傷診断におけるMERGE MRIの診断能を検討した．関節唇損傷は前外側に好発し，前方と前外側では感度90％以上，特異度100％であり，MERGE MRIの有用性が示された．

DOI： 10.24645/jejot.31.1_61

CiNii Books

CiNii Research

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その他リンク： https://search.jamas.or.jp/link/ui/2019247310

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞はじめに 2003年にGanzらが初めて体系的に提唱したfemoroacetabular impingement(FAI)の概念において,"The radiographs often appear normal at first"と記載されているように,単純X線像では一見大きな異常所見を認めないことが1つの特徴であり,その診断を困難にする最も大きな要因といえる.一方で明らかな形態的なFAI所見を有するにもかかわらず無症候な例も多く,その診断には臨床症状,理学所見,画像所見の3つを統合することが必要となる.画像診断として,単純X線像やcomputed tomography(CT)では大腿骨骨頭頸部移行部の骨性隆起(cam形態)や寛骨臼の過剰被覆(pincer形態)などの形態学的情報が得られ,さらにmagnetic resonance imaging(MRI)では関節唇などの軟部組織の損傷状態およびその質的情報も得ることが可能である.しかし,従来用いられてきた画像診断では形態学的変化や質的変化が生じる以前の,より早期の異常を捉えることは困難であり,特にFAIにおける重要な病態の1つである骨性インピンジメント部位を同定するには不十分である.近年,細胞レベルでの代謝活動を画像化する機能的画像診断であるsingle photo emission computed tomography(SPECT)やpositron emission tomography(PET)などの核医学検査を用いてFAI症例を評価した報告が散見される.本稿ではわれわれが試みてきた18F-fluoride PET/CTによるFAIの病態評価に関する研究と最新知見について論述する.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Here, we present a rare case of a preadolescent boy with a prominent bony bump on the femoral neck. The main histological feature was concordant with a reactive osteochondromatous lesion possibly induced by repetitive microtrauma, probably because of overtraining as a soccer goalkeeper. The nature of this pathological change is consistent with the growth of a cam deformity. Especially in the preadolescent age group, we should note that repetitive use of the same joint kinematics may induce a prominent cam deformity.

DOI： 10.1097/JSM.0000000000000479

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記述言語：日本語   出版者・発行元：日本股関節学会  

50代女性。右股関節痛を主訴に受診し、右股関節唇損傷と診断された。右股関節には境界型寛骨臼蓋形成不全も認め、関節鏡視下手術の予定となり、手術までの間(3ヵ月間)理学療法を外来で行った。初期評価時の右股関節可動域は屈曲80°、外転15°、外旋20°、内旋0°であり、右股関節痛のVASは8.8cmであった。理学療法プログラムは、背筋群の柔軟性および腰椎・骨盤の可動性の改善を目的に、腰背部のモビライゼーションと、骨盤前傾・後傾の自動運動を実施した。結果、最終評価時に右股関節痛のVASは5.3cmに改善し、右股関節可動域は外転が20°、内旋が25°に改善した。治療効果が得られた理由として、腰椎屈曲・骨盤後傾の可動性が改善したことで、股関節屈曲時の協調的な骨盤後傾が可能となり、大腿骨頭頸部と寛骨臼縁の間でのインピンジメントが軽減し、それに伴い、関節唇に加わる負荷が軽減したことが考えられた。

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記述言語：日本語   出版者・発行元：日本股関節学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To examine the influence of femoral neck resection on the mechanical strength of the proximal femur in actual surgery. METHODS: Eighteen subjects who received arthroscopic cam resection for cam-type femoroacetabular impingement (FAI) were included. Finite element analyses (FEAs) were performed to calculate changes in simulative fracture load between pre- and postoperative femur models. The finite element femur models were constructed from computed tomographic images; thus, the models represented the shape of the original femur, including the bone resection site. Three-dimensional image analysis of the bone resection site was performed to identify morphometric factors that affect strength in the postoperative femur model. Four oblique sagittal planes running perpendicular to the femoral neck axis were used as reference planes to measure the bone resection site. RESULTS: At the transcervical reference plane, both the bone resection depth and the cross-sectional area at the resection site correlated strongly with postoperative changes in the simulated fracture load (R2 = 0.6, P = .0001). However, only resection depth was significantly correlated with the simulated fracture load at the reference plane for the head-neck junction. The resected bone volume did not correlate with the postoperative changes in the simulated fracture load. CONCLUSIONS: The results of our FEA suggest that the bone resection depth measured at the head-neck junction and transcervical reference plane correlates with fracture risk after osteochondroplasty. By contrast, bone resection at more proximal areas did not have a significant effect on the postoperative femur model strength in our FEA. The total volume of resected bone was also not significantly correlated with postoperative changes in femur model strength. CLINICAL RELEVANCE: This biomechanical study using FEA suggest that there is a risk of femoral neck fracture after arthroscopic cam resection, particularly when the resected lesion is located distally.

DOI： 10.1016/j.arthro.2018.03.036

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DOI： 10.1302/0301-620X.100B8.BJJ-2018-0414.R1

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: A postoperative change in femoral rotation following total hip arthroplasty (THA) might be the cause of dislocation due to the change in combined anteversion. However, very few studies have evaluated the femoral rotation angle following THA, or the factors that influence femoral rotation. We aimed to evaluate changes in femoral rotation after THA, and to investigate preoperative patient factors that influence femoral rotation after THA. METHODS: This study involved 211 hips treated with primary THA. We used computed tomography to measure the femoral rotation angle before and one week after THA. In addition, multiple regression analysis was performed to evaluate preoperative patient factors that could influence femoral rotation after THA. RESULTS: The femoral rotation angle was 0.2 ± 14° externally before surgery and 4.4 ± 12° internally after surgery (p < 0.001). Multiple regression analysis revealed that sex (β = 0.19; p = 0.003), age (β = 0.15; p = 0.017), preoperative anatomical femoral anteversion (β = - 0.25; p = 0.002), and preoperative femoral rotation angle (β = 0.36; p < 0.001) were significantly associated with the postoperative femoral rotation angle. The final model of the regression formula was described by the following equation: [postoperative femoral rotation angle = 5.41 × sex (female: 0, male: 1) + 0.15 × age - 0.22 × preoperative anatomical femoral anteversion + 0.33 × preoperative femoral rotation angle - 10.1]. CONCLUSION: The current study showed the mean internal change of 4.6° in the femoral rotation angle one week after THA. Sex, age, preoperative anatomical femoral anteversion and preoperative femoral rotation were associated with postoperative femoral rotation. The patients who were male, older, and who exhibited lesser preoperative anatomical femoral anteversion or greater preoperative femoral rotation angles, tended to demonstrate an externally rotated femur after THA. Conversely, patients who were female, younger, and who exhibited greater preoperative anatomical femoral anteversion or lesser preoperative femoral rotation angles, tended to demonstrate an internal rotation of the femur after THA.

DOI： 10.1186/s12891-018-2110-y

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記述言語：日本語   出版者・発行元：(一社)日本関節鏡・膝・スポーツ整形外科学会  

【目的】本研究の目的は、femoroacetabular impingement(FAI)症例におけるpositron emission tomography/computed tomography(PET/CT)での集積部位とコンピュータシミュレーションでのインピンジメント部位を比較検討することである。【対象および方法】18F-fluoride PET/CTを撮影したcam-type FAI症例のうちmaximum standardizeduptake value(SUVmax)が6以上であった24股24例を対象とした。CT画像の大腿骨頸部正面像を6領域に分割し、個々の症例についてSUVmaxが位置する領域およびコンピュータシミュレーションでのインピンジメント部位が位置する領域を調査した。また、これら2つの領域の一致率を0°から90°の範囲で10°ごとの股関節屈曲角度において算出した。【結果】SUVmax領域はproximal middleが24股中12股(50%)と最も多かった。24股中20股(83.3%)においてSUVmax領域といずれかの屈曲角度におけるインピンジメント領域が一致した。SUVmax領域とインピンジメント領域の一致率は屈曲60°(p=0.02)と70°(p=0.034)において屈曲90°での一致率に対して有意に高かった。【結語】18F-fluoride PET/CTを用いることにより、cam-type FAI症例における異常集積部位の詳細な位置情報を得ることができた。SUVmax領域とインピンジメント領域の一致率は屈曲60°と70°において屈曲90°での一致率に対して有意に高く、この結果からcam-type FAI症例において屈曲90°よりも小さい屈曲角度でより頻繁にインピンジメントが生じている可能性が示唆された。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本関節鏡・膝・スポーツ整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本リハビリテーション医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To clarify the concordance rate of the location of uptake on positron emission tomography/computed tomography (PET/CT) and the impingement point demonstrated in computer simulation in femoroacetabular impingement (FAI) syndrome with cam morphology. METHODS: We included hip joints with FAI syndrome that underwent 18F-fluoride PET/CT. We also excluded hips with SUVmax <6. Each hip was evaluated for the region of the SUVmax point on PET/CT as well as the impingement point by computer simulation. We used ZedHip software (Lexi, Tokyo, Japan) for impingement simulation analysis based on CT data. Bony impingement is identified if there is a mesh in acetabular and femoral side contact in at least one unit. We investigated the rate of concordance between these 2 regions for each 10° flexion angle of the hip, ranging from 0° to 90°. RESULTS: Twenty-two hips of 22 patients were evaluated. The SUVmax region was most frequently distributed in the proximal middle region in 12 hips. In 18 of 22 hips (81.8%), the SUVmax region was concordant with the impingement region for at least one flexion angle. The concordance rates in 50° (P = .034), 60° (P = .007), 70° (P = .011), and 80° (P = .046) of flexion were significantly higher than in 90° of flexion. CONCLUSIONS: It was possible to visualize and clarify the detailed location of abnormal uptake in FAI syndrome patients with cam morphology by applying 18F-fluoride PET/CT. The concordance rates in 50°, 60°, 70°, and 80° of flexion were significantly higher than in 90° of flexion, which suggested that impingement may more frequently occur at less than 90° of flexion in FAI syndrome with cam morphology. LEVEL OF EVIDENCE: Level III, cross-sectional diagnostic study.

DOI： 10.1016/j.arthro.2017.10.055

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Precise osteochondroplasty is key for success in hip arthroscopic surgery, especially for femoroacetabular impingement (FAI) caused by cam or pincer morphology. In this Technical Note, we present computer-assisted hip arthroscopic surgery for FAI, including preoperative planning by virtual osteochondroplasty and intraoperative computer navigation assistance. The important concept of this technique is that navigation assistance for osteochondroplasty is based on planning made by computer simulation analysis. The navigation assistance allows us to perform neither too much nor too little osteochondroplasty. Specifically, computer simulation was used to identify the impingement point. Virtual osteochondroplasty was then performed to determine the maneuvers that would improve range of motion. Thereafter, the planning data were transported to a computed tomography-based computer navigation system that directly provided intraoperative assistance. Thus, computer-assisted technology including preoperative simulation, virtual osteochondroplasty planning, and intraoperative navigation assistance may promote precise hip arthroscopic surgery for FAI.

DOI： 10.1016/j.eats.2017.10.013

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/s12891-017-1828-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1080/14397595.2017.1295825

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/s12891-017-1778-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/s12969-017-0183-z

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記述言語：日本語   出版者・発行元：日本整形外科超音波学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Bone mineral density (BMD) loss around femoral implants, particularly in the proximal femur, is a common outcome after total hip arthroplasty. Previous studies reported the prevention of postsurgical decrease in BMD with the use of osteoporosis drug therapy. This randomized study evaluated the efficacy of alendronate and alfacalcidol for preserving BMD over a long-term follow-up. METHODS: Sixty consecutive patients with hip osteoarthritis who had undergone primary cementless total hip arthroplasty were randomly assigned to an alendronate (n = 20), alfacalcidol (n = 18), or control (n = 22) group. Periprosthetic BMD was measured using dual-energy X-ray absorptiometry at 1 week, 1 year, and the current follow-up (minimum 9 years after surgery). Changes in BMD are reported as mean percentages relative to the values at 1 week (baseline reference). RESULTS: All groups showed a significant decrease in the BMD of the calcar at the current follow-up compared to the values at both 1 week and 1 year postoperatively (P < .001). The BMD values were significantly higher in the alendronate group than in the alfacalcidol and control groups (P < .05). The BMD values at the current follow-up were 76% ± 30% (alendronate group), 64% ± 22% (alfacalcidol group), and 59% ± 22% (control group) of the baseline values. CONCLUSION: Our findings demonstrate the efficacy of early administration of alendronate for the prevention of bone loss in the calcar region.

DOI： 10.1016/j.arth.2017.02.036

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: The aim of this study was to evaluate the normal distribution of sodium fluoride-18 (NaF-18) and to clarify the differences in uptake according to location and the type of the bone using positron emission tomography (PET) / computed tomography (CT). METHODS: We retrospectively reviewed NaF-18 PET/CT images from 30 patients with hip joint disorders. PET/CT scans were performed 40 min after injection of approximately 185 MBq of NaF-18. To evaluate the relationship between the distribution of NaF-18 uptake and bone density, we compared the maximum standardised uptake values (SUVmax) on PET and the Hounsfield Units (HUs) on CT of the lumbar vertebra, ilium, and proximal and distal femurs. Regions of interests were defined both outside and inside the cortical bone to measure whole bone and cancellous bone only, respectively. RESULTS: The distribution of NaF-18 differed according to the skeletal site. The lumbar vertebra showed the highest SUVmax for both whole bone and cancellous bone, followed by the ilium, proximal femur, and distal femur. The bones differed significantly in SUVmax. The distal femur showed the highest HU, followed by the proximal femur, ilium, and vertebra. Profile curve analyses demonstrated that the cancellous bones showed higher SUVmax and lower HU than the cortical bones. CONCLUSIONS: Our results demonstrate the difference in NaF-18 uptake between cancellous and cortical bones, which may explain differences in uptake by location. NaF-18 uptake does not appear to be strongly correlated with bone density, but rather with bone turnover and blood flow.

DOI： 10.3413/Nukmed-0867-16-12

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Rotational acetabular osteotomy (RAO) is an effective joint-preserving surgical treatment for adulthood hip dysplasia (AHD). Despite sufficient correction of acetabular dysplasia, some patients still experience osteoarthritis (OA) progression and require total hip arthroplasty (THA). The purposes of the current study were to investigate the survival rate and the risk factors for OA progression or THA requirement after RAO and to explore whether acetabular overcorrection relates to OA progression. METHODS: Fifty-six patients (65 hips, mean age: 36.5 ± 11.7 years) with AHD who underwent RAO and were followed up for >10 years (mean: 15.0 ± 3.2 years) were enrolled in this study. A Kaplan-Meier survival analysis was performed to assess the non-OA progression rate and THA-free survival rate of RAO during the 10-year follow-up. To analyze the risk factors for OA progression and THA requirement, the Cox proportional hazards regression analysis was performed. RESULTS: No OA progression was found in 76.7% of the patients, and THA was not required in 92.3% during the 10-year follow-up. By multivariate regression analysis, older age at the time of surgery was a risk factor for both OA progression (hazard ratio [HR] = 1.047, 95% confidence interval [CI] = 1.005-1.091) and THA requirement (HR = 1.293, 95% CI = 1.041-1.606). CONCLUSION: RAO is an effective surgical procedure for symptomatic patients with AHD that prevents OA progression and protects the hips from undergoing THA. However, older patients have a higher risk for both OA progression and THA requirement.

DOI： 10.1186/s12891-017-1556-7

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記述言語：日本語   出版者・発行元：(一社)日本関節鏡・膝・スポーツ整形外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本関節鏡・膝・スポーツ整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.arthro.2016.08.018

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BRITISH EDITORIAL SOC BONE JOINT SURGERY  

Objectives
In total hip arthroplasty (THA), the cementless, tapered-wedge stem design contributes to achieving initial stability and providing optimal load transfer in the proximal femur. However, loading conditions on the femur following THA are also influenced by femoral structure. Therefore, we determined the effects of tapered-wedge stems on the load distribution of the femur using subject-specific finite element models of femurs with various canal shapes.
Patients and Methods
We studied 20 femurs, including seven champagne flute-type femurs, five stovepipe-type femurs, and eight intermediate-type femurs, in patients who had undergone cementless THA using the Accolade TMZF stem at our institution. Subject-specific finite element (FE) models of pre- and post-operative femurs with stems were constructed and used to perform FE analyses (FEAs) to simulate single-leg stance. FEA predictions were compared with changes in bone mineral density (BMD) measured for each patient during the first postoperative year.
Results
Stovepipe models implanted with large-size stems had significantly lower equivalent stress on the proximal-medial area of the femur compared with champagne-flute and intermediate models, with a significant loss of BMD in the corresponding area at one year post-operatively.
Conclusions
The stovepipe femurs required a large-size stem to obtain an optimal fit of the stem. The FEA result and post-operative BMD change of the femur suggest that the combination of a large-size Accolade TMZF stem and stovepipe femur may be associated with proximal stress shielding.

DOI： 10.1302/2046-3758.59.2000525

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その他リンク： http://orcid.org/0000-0002-2846-0864

記述言語：日本語   出版者・発行元：日本股関節学会  

当院でCam-type femoroacetabular impingement(FAI)に対し関節鏡視下骨軟骨形成術を行った10例を対象に、CTデータより有限要素モデルを作成し、有限要素解析法を用いて骨切除部の位置や切削形状と術後大腿骨強度との関連について検討した。その結果、術後有限要素モデルの強度低下と有意な相関を示したのは、head-neck junction部に近い、より遠位部での切削深度および頸部断面における骨切除部面積であった。骨頭中心に近い部位ではそれらのパラメーターと強度低下との関連性が低く、また骨切除部全体の体積は術後骨モデルの強度とは相関を認めなかった。以上より、骨切除部の位置、すなわち頸部のより遠位部で骨切除量が多くなると術後大腿骨頸部骨折リスクが高くなることが示唆された。

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS  

Background: Although few studies have examined the direct effect of stress shielding on clinical outcomes, periprosthetic bone loss due to stress shielding is still an issue of concern, especially when physicians perform uncemented total hip arthroplasty (THA) in younger patients. Differences in femoral stem design may affect the degree of postoperative stress shielding. Therefore, the characteristics of the behavior for stress shielding of each type of femoral stem should be determined. This study compares differences in bone mineral density (BMD) change in the femur after primary THA between 3 major types of uncemented stems.
Methods: Among a total of 89 hips, 26 hips received THA with a fit-and-fill type stem (VerSys Fiber Metal MidCoat; Zimmer, Inc, Warsaw, IN), 32 hips received a tapered rectangular Zweymuller-type stem (SL-Plus; Smith & Nephew Inc, Memphis, TN), and 31 received a tapered wedge-type stem (Accolade TMZF; Stryker Orthopaedics, Mahwah, NJ). BMD measurements were performed with a HOLOGIC Discovery device (Hologic Inc, Waltham, MA).
Results: BMD in the medial-proximal femur was maintained for 3 years after THA in the group with the tapered wedge-type stem. BMD in the lateral-proximal femur was maintained for 3 years after THA in the group with the Zweymuller-type stem. There were no significant differences in the Harris Hip Score among the 3 stem groups preoperatively and 1, 2, and 3 years after surgery.
Conclusion: There are clear differences in postoperative BMD loss of the proximal femur among these 3 commonly used uncemented stems. (C) 2016 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.arth.2016.02.009

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/s12891-016-1120-x

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記述言語：日本語   出版者・発行元：医学書院  

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記述言語：日本語   出版者・発行元：(株)メジカルビュー社  

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記述言語：日本語   出版者・発行元：(株)医学書院  

人工関節周囲感染に関する問題は近年さかんに取り上げられている.なかでも診断に関する進歩は目覚ましく,診断基準も含め世界的なコンセンサスも得られつつある.本稿では人工関節周囲感染診断における,各種バイオマーカー,分子生物学的診断法,病理診断,核医学画像診断などについての最新知見を述べる.(著者抄録)

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その他リンク： http://search.jamas.or.jp/link/ui/2016211593

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

ObjectiveThe diagnosis of painful hip without remarkable radiographic findings is still challenging. In recent years, femoroacetabular impingement (FAI) has been recognized as an important cause of painful hip. The hypothesis of this study was that local bone turnover may be accelerated in painful hip, especially in FAI lesions. To test this, patients with unilateral symptomatic hip underwent F-18-fluoride PET, which directly correlates with osteoblast activity and therefore bone turnover.Patients and methodsIn total, 27 patients with unilateral symptomatic painful hip were enrolled. The diagnosis included 15 cam-type FAI cases, six labral tear cases, and six early-stage osteoarthritis cases. The region of interest for cam and pincer lesions was identified and the maximum standardized uptake value (SUVmax) in these regions and the contralateral asymptomatic regions were measured by F-18-fluoride PET. The SUVmax ratio was defined as symptomatic side SUVmax/asymptomatic side SUVmax. The angle and center-edge angle were measured by plain radiograph.ResultsThe SUVmax of both cam and pincer lesions were significantly higher than the SUVmax of the contralateral regions (P&lt;0.0001). The cam SUVmax ratio correlated positively with the angle (r=0.5, P=0.007). Patients with an angle of more than or equal to 60 degrees had a significantly higher cam SUVmax ratio than the less than 60 degrees group (P=0.017).ConclusionThis study showed the accelerated local bone turnover in painful hip, partly in FAI cases. Accelerated bone turnover may play a significant role in FAI pathophysiology; therefore, its recognition by imaging modality may contribute toward a more sensitive diagnosis in painful hip.

DOI： 10.1097/MNM.0000000000000456

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Korean Orthopaedic Association  

Rotational acetabular osteotomy (RAO) is a well-established surgical procedure for patients with acetabular dysplasia, and excellent long-term results have been reported. However, RAO is technically demanding and precise execution of this procedure requires experience with this surgery. The usefulness of computer navigation in RAO includes its ability to perform three-dimensional (3D) preoperative planning, enable safe osteotomy even with a poor visual field, reduce exposure to radiation from intraoperative fluoroscopy, and display the tip position of the chisel in real time, which is educationally useful as it allows staff other than the operator to follow the progress of the surgery. In our results comparing 23 hips that underwent RAO with navigation and 23 hips operated on without navigation, no significant difference in radiological assessment was observed. However, no perioperative complications were observed in the navigation group whereas one case of transient femoral nerve palsy was observed in nonnavigation group. A more accurate and safer RAO can be performed using 3D preoperative planning and intraoperative assistance with a computed tomography-based navigation system.

DOI： 10.4055/cios.2016.8.1.99

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：関東整形災害外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER JAPAN KK  

The advances in computer assistance technology have allowed detailed three-dimensional preoperative planning and simulation of preoperative plans. The use of a navigation system as an intraoperative assistance tool allows more accurate execution of the preoperative plan, compared to manual operation without assistance of the navigation system.
In total hip arthroplasty using CT-based navigation, three-dimensional preoperative planning with computer software allows the surgeon to determine the optimal angle of implant placement at which implant impingement is unlikely to occur in the range of hip joint motion necessary for daily activities of living, and to determine the amount of three-dimensional correction for leg length and offset. With the use of computer navigation for intraoperative assistance, the preoperative plan can be precisely executed.
In hip osteotomy using CT-based navigation, the navigation allows three-dimensional preoperative planning, intraoperative confirmation of osteotomy sites, safe performance of osteotomy even under poor visual conditions, and a reduction in exposure doses from intraoperative fluoroscopy. Positions of the tips of chisels can be displayed on the computer monitor during surgery in real time, and staff other than the operator can also be aware of the progress of surgery. Thus, computer navigation also has an educational value. On the other hand, its limitations include the need for placement of trackers, increased radiation exposure from preoperative CT scans, and prolonged operative time. Moreover, because the position of a bone fragment cannot be traced after osteotomy, methods to find its precise position after its movement need to be developed. Despite the need to develop methods for the postoperative evaluation of accuracy for osteotomy, further application and development of these systems are expected in the future. (C) 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jos.2015.10.023

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS  

The pelvis generally tilts to the posterior with movement from the supine to standing position, and with time after total hip arthroplasty (THA). This study aimed to investigate changes in pelvic tilt from the preoperative supine position to the standing position at 5 years after THA (pelvic change, PC). We measured pelvic tilt using a 2D-3D matching technique in 77 unilaterally affected patients who underwent primary THA. PC in 8% of all patients was &lt;=-20 degrees, and the greatest PC was -25 degrees. In these patients, posterior pelvic tilt continued up to 5 years after THA. These patients were older, and their lumbo-lordotic angle was small. For such cases, cup orientation should be planned to account for continuous posterior change in pelvic tilt after THA. (C) 2016 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.arth.2015.07.026

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS  

In this study, the effect of teriparatide for the prevention of bonemineral density (BMD) loss after THA was compared with alendronate in a randomized controlled trial. Forty-eight patients were assigned to three groups, namely, the teriparatide, alendronate, and no medication groups. Dual-energy x-ray absorptiometry (DEXA) was performed at 1 week post-surgery as a baseline reference, followed by subsequent measurements at 12, 24, and 48 weeks postoperatively. For periprosthetic BMD loss, a significant effect of teriparatide was demonstrated, though its effect was similar to alendronate. On the other hand, higher lumbar BMD was observed in the teriparatide group than in the alendronate group at 48 weeks post-surgery. Teriparatide administration may be one reasonable option for osteoporotic patient to preserve the periprosthetic BMD after THA. (C) 2016 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.arth.2015.07.017

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUNDS/AIMS: We prospectively studied 78 prostheses with conventional femoral head and 86 prostheses with large head (Magnum) of metal-on-metal total hip arthroplasty (MoM THA) with two years follow-up. METHODS: Clinical outcomes and blood metal ion were evaluated. RESULTS: There were no significant differences of clinical outcomes between groups. 1.17 ± 1.01 μg/L of blood cobalt ion in Magnum was significantly lower than 1.99 ± 2.34 μg/L in conventional group. No dislocation was observed in Magnum while one dislocation in conventional group. MoM THA with large head is useful if the implants are positioned in appropriate alignment, however longer follow-up will be necessary. CLINICAL TRIAL REGISTRATION: NCT01010763 (registered on ClinicalTrials.gov).

DOI： 10.1016/j.jor.2015.05.008

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記述言語：日本語   出版者・発行元：(一社)日本関節病学会  

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記述言語：日本語   出版者・発行元：(株)メジカルビュー社  

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記述言語：日本語   出版者・発行元：(株)メジカルビュー社  

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記述言語：日本語   出版者・発行元：金原出版  

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記述言語：日本語   出版者・発行元：日本股関節学会  

大腿骨頭壊死症49例71関節を対象に、dual energy X-ray absorptiometryを用いて骨頭圧潰の有無と大腿骨頭部骨密度(BMD)の関連について検討した。骨頭圧潰群は42例、非圧潰群は29例であった。大腿骨頭部外側部のBMDは骨頭圧潰群で有意に高値を示し、骨頭圧潰部周囲において骨代謝亢進に伴う骨形成の促進が行なわれている可能性が考えられた。

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記述言語：日本語   出版者・発行元：日本股関節学会  

症例は48歳男性で、20歳時に鬱病と診断され、アルコール依存症と診断された。46歳時に右表面置換型人工股関節全置換術(HRA)、翌年に左HRAを施行した。両側ともにBirmingham HIP Resurfacing Systemを使用し、カップ径は両側56mm、骨頭径は両側50mmを使用した。術後経過良好であった、術後7ヵ月より左股関節痛が出現した。身長173cm、体重65kg、BMI 21.7で自動動屈曲時の左股関節痛を認めた。Scarpa三角の圧痛は認めず、Patrickテスト陰性であった。疼痛出現時関節単純X線でルースニング、radiolucent line、骨融解などの異常所見を認めなかった。カップの外方開角は右38°左33°、前方開角は右23°左16°であった。血液検査では白血球7000μL、CRPは0.03mg/dl、赤沈3mm/1時間と炎症所見陰性であった。MRIでも股関節周囲の液体貯留や偽腫瘍を思わせるような腫瘤は認めなかった。股関節単純X線軸位像、CT像で臼蓋前縁から約12mmのカップの突出を認めた。臨床症状、画像所見から腸腰筋インピンジメントを疑い、腸腰筋造影、キシロカインテストを行い、造影剤注入時に再現痛を認め、キシロカイン注入により疼痛は一過性に改善した。腸腰筋インピンジメントと診断し、股関節鏡視下腸腰筋切筋術を施行した。術後は翌日より歩行訓練を開始し、術後1週間で疼痛はVAS 100から18へ改善し、ノンアスレチックヒップスコアも64まで改善した。

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER JAPAN KK  

Although an adverse relationship between osteoporosis and osteoarthritis (OA) has been reported, it remains controversial. In most previous reports of OA, bone mineral density (BMD) changes in the subtrochanteric region have not been clarified, whilst BMD of the femoral neck and trochanteric region has been well investigated. In our current study, we investigated the BMD ratio compared to the contralateral side in the whole proximal femurs of hip OA patients. We aimed to clarify the morphologic factor that may influence these BMD ratios. We performed dual energy X-ray absorptiometry (DEXA) analysis of 69 hip joints from unilateral progressed OA cases. The minimum joint space, center edge angle, Sharp angle, acetabular head index, neck-shaft angle, and leg length discrepancy were also measured as radiographic factors. The correlation between BMD ratio and radiographic morphologic factors was then evaluated by logistic regression. The BMD ratio was higher in the femoral neck than in the distal region. In terms of radiographic factors, the neck-shaft angle was revealed to influence the decreased BMD ratio in the distal subtrochanteric part, whilst the leg length discrepancy and Sharp angle showed a relationship with the increased BMD ratio in the proximal neck region. The discrepancy in the BMD ratio between the femoral neck and the distal subtrochanteric region in the proximal femur is influenced by several morphologic factors.

DOI： 10.1007/s00774-014-0610-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：TAYLOR & FRANCIS LTD  

The mechanism underling bone mineral density (BMD) loss that occurs in the femur after total hip arthroplasty (THA) remains unknown. We compared the equivalent stress and strain energy density (SED) to BMD in the femur after THA using subject-specific finite element analyses. Twenty-four patients who had undergone primary cementless THA were analysed. BMD was measured using dual-energy X-ray absorptiometry (DEXA) at 1 week and 3, 6 and 12 months after THA. Seven regions of interest (ROIs) were defined in accordance with Gruen's system (ROIs 1-7). Computed tomography images of the femurs were acquired pre- and postoperatively, and the images were converted into three-dimensional finite element (FE) models. Equivalent stress and SED were analysed and compared with DEXA data. BMD was maintained 1 year after THA in ROIs 3, 4, 5 and 6, whereas BMD decreased in ROIs 1, 2 and 7. FE analysis revealed that equivalent stress in ROIs 3, 4, 5 and 6 was much higher than that in ROIs 1, 2 and 7. A significant correlation was observed between the rate of changes in BMD and equivalent stress. Reduction of equivalent stress may contribute to decrease in BMD in the femur after THA.

DOI： 10.1080/10255842.2013.869320

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Objectives. The purposes of this study were 1) to examine the changes in the hip joint center (HJC) position and the femoral off set (FO) after total hip arthroplasty (THA) and 2) to investigate the effects of the HJC and FO on isometric abductor muscle strength.
Methods. We evaluated 51 patients who underwent unilateral primary THA. The FO, and horizontal and vertical distances from the HJC to the tip of the teardrop were measured and isometric hip abductor muscle strength was measured.
Results. The HJC of the affected side moved medially postoperatively compared with that of the unaffected side (p &lt; 0.05), and the FO was reconstructed similarly to the unaffected side. There were significant negative correlations between the changes in the horizontal distance from the HJC and FO to the tip of the teardrop. An increase in the FO and infero-medial cup position optimized hip abductor muscle strength.
Conclusion. The HJC was reconstructed medially and superiorly, and the change in the FO after THA was influenced by the change in the horizontal distance of the HJC. Multiple regression analysis revealed that the medial and inferior HJC and increase in the FO constitute an effective procedure for restoring abductor strength.

DOI： 10.3109/14397595.2014.988863

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN EPIDEMIOLOGICAL ASSOC  

Background: Nontraumatic osteonecrosis of the femoral head (ONFH) is a rare disorder caused by ischemic necrosis of unknown etiology. A few studies have demonstrated trends in the number of patients with ONFH. However, there are no data on temporal trends in characteristics such as age, gender, and causative factors. To investigate this, we examined data from a multicenter hospital-based sentinel monitoring system in Japan.
Methods: A total of 3041 newly-diagnosed ONFH patients from 34 participating hospitals who were reported to the system from 1997-2011 were analyzed. We examined age at diagnosis, potential causative factors, and underlying diseases for which patients received systemic steroid administration. Their temporal trends were assessed according to date of diagnosis in 5-year intervals (1997-2001, 2002-2006, and 2007-2011).
Results: The gender ratio and distribution of potential causative factors did not change. Regarding underlying diseases requiring steroid administration, the proportion of patients with systemic lupus erythematosus decreased in males (10% to 6.4%) and in females (37% to 29%). Proportion of patients with renal transplantation fell consistently across the study period in both males (3.8% to 1.2%) and females (3.2% to 0.8%). In contrast, the proportion of patients receiving steroids for pulmonary disease (except asthma) significantly increased in both males (0.5% to 5.5%) and females (0.5% to 3.6%).
Conclusions: This large descriptive study is the first to investigate temporal trends in the characteristics of ONFH, which provide useful information for future studies.

DOI： 10.2188/jea.JE20140162

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

ObjectiveWe investigated the usefulness of F-18-fluoride PET as a predictor of femoral head collapse in patients with osteonecrosis (ON) before radiographic changes occur.Patients and methodsSixty-six hips of 42 patients diagnosed with ON of the femoral head were included in this study. We evaluated the relationship between the maximum standardized uptake value (SUVmax) in F-18-fluoride PET and the Ficat classification. We evaluated the relationship between SUVmax and the presence of femoral head collapse on plain radiography at 12 months after F-18-fluoride PET in 23 hips of 18 patients with Ficat classification stage 1 or 2. A receiver operating characteristic analysis was carried out to calculate the cut-off SUVmax for the prediction of femoral head collapse. We analyzed the relationship between SUVmax and femoral head collapse on plain radiography in the 23 hips using a logistic regression model.ResultsSUV(max) increased according to the progression of the Ficat classification stage. The mean SUVmax was 12.35.9 in the collapse group and 4.9 +/- 1.3 in the noncollapse group (P&lt;0.01). The cut-off SUVmax of 6.45 (sensitivity: 0.80, specificity: 0.92) was used for the prediction of femoral head collapse. In the univariate analysis, SUVmax, type classification, and ring sign were related significantly to femoral head collapse.ConclusionWe showed that the quantitative assessment of SUVmax in F-18-fluoride PET was useful to predict femoral head collapse in ON. F-18-Fluoride PET might reflect accelerated bone metabolism because of microcollapse of the femoral head, which is undetectable on plain radiography.

DOI： 10.1097/MNM.0000000000000284

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記述言語：日本語   出版者・発行元：(株)メジカルビュー社  

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記述言語：日本語   出版者・発行元：(株)メジカルビュー社  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BRITISH EDITORIAL SOC BONE JOINT SURGERY  

In this study we used subject-specific finite element analysis to investigate the mechanical effects of rotational acetabular osteotomy (RAO) on the hip joint and analysed the correlation between various radiological measurements and mechanical stress in the hip joint.
We evaluated 13 hips in 12 patients (two men and ten women, mean age at surgery 32.0 years; 19 to 46) with developmental dysplasia of the hip (DDH) who were treated by RAO. Subject-specific finite element models were constructed from CT data. The centre-edge (CE) angle, acetabular head index (AHI), acetabular angle and acetabular roof angle (ARA) were measured on anteroposterior pelvic radiographs taken before and after RAO. The relationship between equivalent stress in the hip joint and radiological measurements was analysed.
The equivalent stress in the acetabulum decreased from 4.1 MPa (2.7 to 6.5) pre-operatively to 2.8 MPa (1.8 to 3.6) post-operatively (p &lt; 0.01). There was a moderate correlation between equivalent stress in the acetabulum and the radiological measurements: CE angle (R = -0.645, p &lt; 0.01); AHI (R = -0.603, p &lt; 0.01); acetabular angle (R = 0.484, p = 0.02); and ARA (R = 0.572, p &lt; 0.01).
The equivalent stress in the acetabulum of patients with DDH decreased after RAO. Correction of the CE angle, AHI and ARA was considered to be important in reducing the mechanical stress in the hip joint.

DOI： 10.1302/0301-620X.97B4.33736

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

DOI： 10.3109/14397595.2014.931505

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(株)アークメディア  

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その他リンク： http://search.jamas.or.jp/link/ui/2015167052

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

ObjectiveThe imaging diagnosis of osteoarthritis (OA) of the hip, especially in its early stages, is a technically challenging but essential aspect of our increased understanding of the pathophysiology of this disorder. We recently applied F-18-fluoride PET for the detection of abnormal bone turnover in early-stage OA. In our current study, we have compared the diagnostic and analytical capabilities of F-18-fluoride PET and MRI modalities in a hip OA patient series.Patients and methodsA total of 85 hip joints, including hips at various stages of OA as well as painful, dysplastic, and normal contralateral hips, were analyzed. The average age of our study patients was 50 (range 24-75) years. The Kellgren and Lawrence (K/L) grade was used for radiographic evaluations. Hip pain was graded on the basis of pain severity. F-18-Fluoride PET and MRI data obtained during the same period (within 3 months) were compared for all joints in the study.ResultsWe identified PET positivity (i.e. SUVmax&gt;6.5) in 47 joints, whereas MRI-positive findings were evident in 25 joints. Most (96%) of the MRI-positive joints were also PET positive. The percentage of MRI-positive joints and PET uptake-positive joints was 6 and 18% in K/L grade 0, 16 and 48% in K/L grade 1, 27 and 65% in K/L grade 2, 73 and 87% in K/L grade 3, and 100 and 100% in K/L grade 4, respectively. Among the 23 MRI-negative but PET-positive joints, 21 joints had a K/L grade below 2, and 12 joints showed greater than moderate hip pain.Conclusion(18)F-Fluoride PET can detect bone abnormalities earlier than MRI in OA of the hip. This probably reflects accelerated bone remodeling due to high stress and may be followed by the appearance of bone marrow edema on MRI.

DOI： 10.1097/MNM.0000000000000214

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

ObjectiveThe imaging diagnosis of osteoarthritis (OA) of the hip, especially in its early stages, is a technically challenging but essential aspect of our increased understanding of the pathophysiology of this disorder. We recently applied F-18-fluoride PET for the detection of abnormal bone turnover in early-stage OA. In our current study, we have compared the diagnostic and analytical capabilities of F-18-fluoride PET and MRI modalities in a hip OA patient series.Patients and methodsA total of 85 hip joints, including hips at various stages of OA as well as painful, dysplastic, and normal contralateral hips, were analyzed. The average age of our study patients was 50 (range 24-75) years. The Kellgren and Lawrence (K/L) grade was used for radiographic evaluations. Hip pain was graded on the basis of pain severity. F-18-Fluoride PET and MRI data obtained during the same period (within 3 months) were compared for all joints in the study.ResultsWe identified PET positivity (i.e. SUVmax&gt;6.5) in 47 joints, whereas MRI-positive findings were evident in 25 joints. Most (96%) of the MRI-positive joints were also PET positive. The percentage of MRI-positive joints and PET uptake-positive joints was 6 and 18% in K/L grade 0, 16 and 48% in K/L grade 1, 27 and 65% in K/L grade 2, 73 and 87% in K/L grade 3, and 100 and 100% in K/L grade 4, respectively. Among the 23 MRI-negative but PET-positive joints, 21 joints had a K/L grade below 2, and 12 joints showed greater than moderate hip pain.Conclusion(18)F-Fluoride PET can detect bone abnormalities earlier than MRI in OA of the hip. This probably reflects accelerated bone remodeling due to high stress and may be followed by the appearance of bone marrow edema on MRI.

DOI： 10.1097/MNM.0000000000000214

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

F-18-fluoride positron emission tomography (F-18-fluoride PET) is a functional imaging modality used primarily to detect increased bone metabolism. Increased F-18-fluoride PET uptake suggests an association between increased bone metabolism and load stress at the subchondral level. This study therefore examined the relationship between equivalent stress distribution calculated by finite element analysis and F-18-fluoride PET uptake in patients with hip osteoarthritis. The study examined 34 hips of 17 patients who presented to our clinic with hip pain, and were diagnosed with osteoarthritis or pre-osteoarthritis. The hips with trauma, infection, or bone metastasis of cancer were excluded. Three-dimensional models of each hip were created from computed tomography data to calculate the maximum equivalent stress by finite element analysis, which was compared with the maximum standardized uptake value (SUVmax) examined by F-18-fluoride PET. The SUVmax and equivalent stress were correlated (Spearman's rank correlation coefficient =0.752), and higher equivalent stress values were noted in higher SUVmax patients. The correlation between SUVmax and maximum equivalent stress in osteoarthritic hips suggests the possibility that F-18-fluoride PET detect increased bone metabolism at sites of stress concentration. This study demonstrates the correlation between mechanical stress and bone remodeling acceleration in hip osteoarthritis. (c) 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:78-83, 2015.

DOI： 10.1002/jor.22717

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記述言語：日本語   出版者・発行元：アークメディア  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：HINDAWI PUBLISHING CORPORATION  

We aimed to evaluate the effects of pelvic tilt on polyethylene wear after total hip arthroplasty (THA). A total of 105 joints treated with primary THA were included; conventional polyethylene (CPE) liners were used in 43 hips and highly cross-linked polyethylene (HXLPE) liners were used in the remaining 62 hips. The pelvis was tilted 6 degrees posteriorly in the standing position as compared to the supine position, which resulted in significant increases of 1.7 degrees and 2.8 degrees in cup inclination in the CPE and HXLPE groups, respectively. Moreover, the change in pelvic tilt resulted in significant increases of 3.6 degrees and 4.9 degrees in cup anteversion in the CPE and HXLPE groups, respectively. For the CPE group, multiple regression analysis showed a significant association between the angle of pelvic tilt (PTA) and cup inclination and the polyethylene wear ratio. The adjusted R-2 of the regression model was larger for measures obtained in the standing position as compared to the supine position. For the HXLPE group, there was no significant relationship between radiographic parameters and polyethylene wear. Close observation of polyethylene wear is recommended for patients with severe posterior pelvic tilt who have undergone THA with conventional polyethylene.

DOI： 10.1155/2015/327217

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Objective. Antibiotic-loaded hydroxyapatite block (AHAB) allows gradual release of antibiotics for long duration without thermal damage and, therefore, is potentially a more effective antibacterial spacer than antibiotic-loaded polymethylmethacrylate cement (ALAC). The purposes of this study are to assess the utility of AHAB for the treatment of periprosthetic joint infection (PJI) or septic arthritis (SA) of the hip and to assess the potency of AHAB and ALAC in vitro.
Methods. AHAB was utilized in two-stage reconstruction surgery for 20 PJI and 7 SA patients. Clinical success was confirmed if the patients did not show any sign of recurrence of infection during the follow-up period. Duration and amount of active vancomycin (VCM) released from AHAB and ALAC spacer were investigated in vitro.
Results. Two-stage reconstruction using AHAB significantly improved hip function and showed 100% clinical success with mean follow-up of 37 months. The in vitro duration of the active effect of VCM released from AHAB (21 days) was longer than that from ALAC (7 days) and the amount of active VCM released from AHAB was higher than that from ALAC.
Conclusions. AHAB promises to release higher amounts of active VCM for longer durations than ALAC; therefore, it is a promising treatment for intractable PJI or SA.

DOI： 10.3109/14397595.2015.1031360

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Objective. The prediction of hip osteoarthritis (OA) progression is still a difficult issue. We have adopted F-18-fluoride positron emission tomography (PET) for the evaluation of hip osteoarthritis, and investigated the prediction utility of F-18-fluoride PET for both pain worsening and OA progression using a logistic regression model.
Materials and methods. A total of 57 hip joints were analyzed for progression risk factors for pain worsening and minimum joint space (MJS) narrowing by logistic regression analysis. Sex, age, BMI, existence of pain, the PET maximum standardized uptake value (SUVmax), Kellgren and Lawrence grade, MJS, and follow-up period were used as explanatory variables. Receiver operating characteristic analysis was performed to calculate the cutoff value of the SUVmax.
Results. Multivariate logistic regression analysis revealed significant differences only in the SUVmax values for pain worsening and MJS narrowing. The odds ratio of the SUVmax for pain worsening was 1.89, and for MJS narrowing it was 11.02. The SUVmax cutoff value was 7.2 (sensitivity: 1.00, specificity: 0.84) for pain worsening and 6.4 (sensitivity: 0.92, specificity: 0.83) for MJS narrowing.
Conclusions. Our results indicate that the PET SUVmax is a best predictor of pain worsening and MJS narrowing. This imaging modality has a great potential for the prediction of OA progression.

DOI： 10.3109/14397595.2015.1045257

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS  

Between 1986 and 1997, 136 porous-coated anatomic (PCA) total hip arthroplasties were performed for patients with osteoarthritis of the hip, and data were available for 60 hips at final follow-up (mean follow-up, 15.2 years). Of these, 18 hips had undergone revision: 12 for the acetabular component, 10 for the femoral component, and 4 for both components. Survival rate at 23 years postoperatively was 60% for the acetabular component and 82% for the femoral component. Multivariate Cox proportional hazards regression showed that annual polyethylene wear rate, size, and abduction angle of the acetabular component were significantly associated with acetabular component revision surgery, and that annual polyethylene wear rate and filling ratio of the femur were associated with femoral component revision surgery. (C) 2014 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.arth.2013.11.015

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記述言語：日本語   出版者・発行元：医学書院  

細胞レベルでの代謝活動を画像化する機能的画像診断であるPETは,形態学的変化や質的変化を捉える単純X線やCT,MRIとは異なる情報を得ることができる.特に骨代謝亢進を捉える18F-fluoride PETはさまざまな骨関節疾患に有用である可能性がある.われわれはこれまでに変形性股関節症の早期診断や病期進行予測,特発性大腿骨頭壊死症における骨頭圧潰の予測,人工関節周囲感染と無菌性ゆるみとの鑑別などに応用し,その有用性を報告してきた.今後,骨シンチグラフィに変わる新たな骨イメージングとしての役割が期待される.(著者抄録)

DOI： 10.11477/mf.1408200053

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記述言語：日本語   出版者・発行元：(株)医学書院  

細胞レベルでの代謝活動を画像化する機能的画像診断であるPETは,形態学的変化や質的変化を捉える単純X線やCT,MRIとは異なる情報を得ることができる.特に骨代謝亢進を捉える18F-fluoride PETはさまざまな骨関節疾患に有用である可能性がある.われわれはこれまでに変形性股関節症の早期診断や病期進行予測,特発性大腿骨頭壊死症における骨頭圧潰の予測,人工関節周囲感染と無菌性ゆるみとの鑑別などに応用し,その有用性を報告してきた.今後,骨シンチグラフィに変わる新たな骨イメージングとしての役割が期待される.(著者抄録)

DOI： 10.11477/mf.1408200053

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J01554&link_issn=&doc_id=20141028120009&doc_link_id=10.11477%2Fmf.1408200053&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1408200053&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Libertas Academica Ltd.  

Iatrogenic injuries to the vascular system are a rare but serious complication of hip surgery. We report a case of an 83-year-old man who presented with intrapelvic migration of a screw into the space between the external iliac artery and vein 21 years after hip arthrodesis. The patient was treated with laparotomy, and the damaged artery was excised and sutured. This is the first case of a late vascular complication secondary to screw migration after hip arthrodesis.

DOI： 10.4137/CCRep.S16159

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER JAPAN KK  

Several previous studies have reported that bone mineral density (BMD) loss around femoral implants is a common outcome, particularly in the proximal femur, after total hip arthroplasty (THA). The purpose of this study was to investigate the effectiveness of alendronate monotherapy and combined therapy using alendronate and alfacalcidol for BMD preservation around femoral implants after primary THA. This study series included 60 patients who were classified into monotherapy (alendronate alone) (n = 18), combined-therapy (alendronate and alfacalcidol) (n = 20) or non-medication (n = 22) groups. The periprosthetic BMD and profile of the biochemical markers such as bone-specific alkaline phosphatase and serum N-terminal telopeptides of type-1 collagen (NTX) were measured at 1, 12, 24 and 48 weeks after surgery. The BMD values in the region of the calcar of monotherapy and combined-therapy patients were maintained and were significantly higher than those of non-medication patients at each measurement period. The plasma levels of NTX in the monotherapy and combined-therapy groups were found to be significantly lower than those in the non-medication group at each measurement period. In conclusion, the monotherapy and combined-therapy regimens significantly prevent periprosthetic BMD loss around femoral implants, most notably in the calcar, compared to no medication.

DOI： 10.1007/s00774-013-0526-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：TAYLOR & FRANCIS LTD  

Objectives. The purpose of this prospective study was to evaluate the utility of preferential application of pharmacoprophylaxis based on the quantitative evaluation by soluble fibrin (SF) and plasminogen activator inhibitor-1 (PAI-1) analysis on the day after total hip arthroplasty (THA).
Methods. A hundred and sixteen patients were enrolled. High-risk patients were defined as those with elevated levels of SF or PAI-1, beyond their cut-off values, on the day after THA. For high-risk patients, fondaparinux was administered for 10 days postoperatively. When both plasma levels of SF and PAI-1 were less than their cutoff levels, the patients were regarded to be at low risk. For low-risk patients, only mechanical prophylaxis was applied.
Results. Sixty patients (52%) were considered to be at high risk. Among them, venous thromboembolism (VTE) was detected in five patients (8%) by CT angiography. In addition, there were four patients (3%) who developed bleeding complications. Fifty-six patients (48%) were considered to be at low risk, and only one patient (2%) developed VTE.
Conclusion. The measurement of SF and PAI-1 levels on the day after surgery may be helpful to identify the individual risk for postoperative VTE. According to this evaluation, a half of patients might not need to administer anticoagulant agents following surgery.

DOI： 10.3109/14397595.2013.868781

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER JAPAN KK  

Several previous studies have reported that bone mineral density (BMD) loss around femoral implants is a common outcome, particularly in the proximal femur, after total hip arthroplasty (THA). The purpose of this study was to investigate the effectiveness of alendronate monotherapy and combined therapy using alendronate and alfacalcidol for BMD preservation around femoral implants after primary THA. This study series included 60 patients who were classified into monotherapy (alendronate alone) (n = 18), combined-therapy (alendronate and alfacalcidol) (n = 20) or non-medication (n = 22) groups. The periprosthetic BMD and profile of the biochemical markers such as bone-specific alkaline phosphatase and serum N-terminal telopeptides of type-1 collagen (NTX) were measured at 1, 12, 24 and 48 weeks after surgery. The BMD values in the region of the calcar of monotherapy and combined-therapy patients were maintained and were significantly higher than those of non-medication patients at each measurement period. The plasma levels of NTX in the monotherapy and combined-therapy groups were found to be significantly lower than those in the non-medication group at each measurement period. In conclusion, the monotherapy and combined-therapy regimens significantly prevent periprosthetic BMD loss around femoral implants, most notably in the calcar, compared to no medication.

DOI： 10.1007/s00774-013-0526-x

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DOI： 10.1016/j.arth.2013.09.040

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

BACKGROUND CONTEXT: Rapid diagnosis and accurate detection of etiological agents in pyogenic spinal infection (PSI) patients are important.
PURPOSE: The purpose of this study was to evaluate the clinical usefulness of methicillin-resistant Staphylococcus-specific polymerase chain reaction (MRS-PCR) and broad-range universal PCR (U-PCR) for diagnosing PSI.
STUDY DESIGN: A prospective diagnostic study.
PATIENTS: Thirty-two clinically suspect PSI patients and six control patients who underwent computerized tomography-guided biopsy and/or surgical treatment were enrolled.
METHODS: Tissue samples were examined by microbiological culture, histopathology, and real-time PCR (MRS-PCR and U-PCR). The diagnostic accuracy of real-time PCR was analyzed based on the definitive diagnosis of infection, defined as a positive result from microbiological culture or histopathology.
RESULTS: All six control subjects were negative for PSI for all analyses. Twelve clinically suspect PSI subjects received definitive diagnoses (PSI group). The non-PSI group consisted of six control subjects plus the remaining 20 patients from the PSI clinically suspect group. MRS-PCR results were positive for all MRS-cultured PSI subjects. U-PCR was positive for all subjects in the PSI group with one discrepancy between real-time PCR and microbiological culture results in differentiation between gram-positive and gram-negative bacteria. In the non-PSI group, MRS-PCR and U-PCR were positive in three and seven cases, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of MRS-PCR for diagnosing MRS infection were 1.00, 0.91, 0.57, and 1.00, respectively; those for the diagnosis of bacterial infection with U-PCR were 1.00, 0.73, 0.63, and 1.00, respectively.
CONCLUSION: Identification of MRS infection and ability to differentiate between gram-positive and gram-negative bacteria is rapidly achieved using MRS-PCR and U-PCR. Real-time PCR provides a sensitive molecular diagnosis of PSI and may contribute to antibiotic selection. (C) 2014 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.spinee.2013.10.044

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

DOI： 10.1002/jor.22553

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：POLSKIE TOWARZYSTWO MIKROBIOLOGOW-POLISH SOCIETY OF MICROBIOLOGISTS  

Real-time polymerase chain reaction (PCR) is currently widely used for the diagnosis of infections. We evaluated the time after treatment during which real-time PCR can detect dead bacteria. The presence of bacterial DNA was identified by real-time PCR through methicillinresistant Staphylococcus (MRS)-PCR and universal PCR. Methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus epidermidis, and Escherichia coli were each killed with alcohol, antibiotics, or heat treatment in vitro. The detection periods of MRS-PCR for MRSA treated by alcohol, vancomycin, linezolid, and heat were found to be less than 16, 8, 12, and 8 weeks, respectively. The detection period of universal PCR for S. epidermidis treated by alcohol, cefazolin, and heat was less than 20, 20, and 4 weeks, whereas that for E. coli was 8, 20, and 4 weeks, respectively. The presence of detectable bacterial DNA in infected arthroplasty patients before and after successful treatment was also assessed by MRS- and universal PCR. MRS-PCR was positive in 6 patients before treatment and all became negative after a mean interval of 20.8 weeks (95% confidential interval, 13.2 to 33.7) after treatment. Universal PCR detected remnant bacterial DNA in 4 patients at a mean of 15.2 weeks (95% CI, 12.4 to 18.0) after treatment and was negative in 7 patients at a mean of 17.3 weeks (95% CI, 10.6 to 24.0) after treatment. Our studies revealed that real-time PCR detects dead bacteria for several weeks, but this capability decreases with time and is likely lost by 20 weeks after treatment.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：INFORMA HEALTHCARE  

Background and purpose There are several diagnostic tests for periprosthetic joint infection (PJI). We evaluated the properties of preoperative serum C-reactive protein (CRP), real-time polymerase chain reaction (PCR), and histopathological evaluation of frozen and permanent sections in clinical cases with culture-positive PJI.
Patients and methods 63 joints involving 86 operations were analyzed using serum CRP measurement prior to operation and tissue samples were collected intraoperatively for real-time PCR and histopathology. We calculated the sensitivity, specificity, likelihood ratio of positive test results (PLR), and likelihood ratio of negative test results (NLR) for each test in relation to positive microbiological culture results as the gold standard.
Results The sensitivity and specificity of diagnosis with serum CRP were 90% and 85%, respectively. The corresponding values for real-time PCR and histopathology of frozen and paraffin tissue sections were 90% and 45%, 71% and 89%, and 90% and 87%, respectively. Serum CRP had a PLR of 5.8 and an NLR of 0.12, and real-time PCR had a PLR of 1.6 and an NLR of 0.18. The corresponding figures for frozen tissue sections were 6.6 and 0.32, and those for paraffin sections were 7.1 and 0.11, respectively.
Interpretation The results suggest that real-time PCR and histopathology of frozen sections is a good combination. The former is suitable for screening, with its high sensitivity and good NLR, while the latter is suitable for definitive diagnosis of infection, with its excellent specificity and good PLR.

DOI： 10.3109/17453674.2013.862460

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS  

Stress shielding after total hip arthroplasty (THA) remains an unsolved issue. Various patterns of mechanical stress appear according to the type of femoral stem used. To compare differences in mechanical stress conditions between Zweymuller type and fit-and-fill type stems, finite element analysis (FEA) was performed. Differences in bone mineral density (BMD) changes in the femur were also compared. Maximum stress was confirmed in Gruen zone 4, whereas zone 1 had the minimum amount of stress with both types of implant. The Zweymuller stem group had less mechanical stress and lower BMD in zone 7 than the fit-and-fill stem group. In conclusion, differences in mechanical stress may be related to changes in BMD after THA. (C) 2013 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.arth.2013.04.034

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER JAPAN KK  

Background Leg length discrepancy (LLD) following total hip arthroplasty (THA) is a leading cause of patient dissatisfaction. However, no reports have described the influence of lower limb alignment on LLD after THA. In the present study, we firstly investigated the change in lower limb alignment after THA. Secondly, we determined the influence of lower limb alignment on LLD after THA. Thirdly, we evaluated the influence of LLD in the entire lower leg on the clinical outcomes after THA.
Methods We followed up with 54 unilateral hip osteoarthritis (OA) patients 1 year after THA. For the radiological assessment of LLD and lower limb alignment, we obtained anteroposterior radiographs of the pelvis and both lower legs in entirety in a standing position before and 1 year after THA. The Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36) were also obtained to assess the clinical outcome.
Resuts The alignment of the affected leg, which was more valgus than the unaffected leg before THA, tended toward varus after THA, and the discrepancy between the lower limb alignments on both sides decreased. However, the alignment discrepancies that remained after THA influenced the LLD measured on the radiograph of the entire lower leg, and this LLD influenced the clinical outcome as measured by the HHS and the WOMAC score.
Conclusions LLD in the entire lower leg should be corrected for a better clinical outcome after THA.

DOI： 10.1007/s00776-013-0457-3

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Purpose: Recent studies have reported the acceleration of subchondral bone remodeling during the development of osteoarthritis (OA). However, it is not possible to evaluate such molecular abnormalities using conventional radiographic techniques. We have applied F-18-fluoride PET to the analysis of painful or dysplastic hips at various stages of OA and then compared this with radiographic findings and clinical findings.
Methods: A consecutive series of 65 joints from 48 patients (average age, 40 years; range, 19Y72 years) with a hip joint complaint or radiographic dysplastic hip were enrolled in this study. Twenty-five contralateral joints without any evidence of OA or clinical symptoms were assigned as a normal control group. Radiographic evaluations were performed on the basis of Kellgren and Lawrence grade and the minimum joint space. Clinical evaluations were performed using the grading scale for pain severity and the SUVmax was measured for each joint. The association between SUVmax and the radiographic or clinical findings was evaluated.
Results: F-18-fluoride PET shows a significantly higher uptake value for progressive-stage OA cases than for early-stage cases and also shows a significantly higher uptake value in cases with severe pain. Even in early-OAstage patients who do not show joint space narrowing on a plain x-ray, cases with severe pain show a significantly higher uptake value.
Conclusions: F-18-fluoride PET has great potential as an imaging method for diagnosing early-stage OA without any marked radiographic changes.

DOI： 10.1097/RLU.0b013e31828d30c0

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Background: Diagnosis and identification of the etiological agent of septic arthritis (SA) in children is an important issue, as early treatment based on accurate diagnosis of joint infections can prevent potentially disabling complications. The purpose of this study was to evaluate the efficacy of real-time polymerase chain reaction (PCR) for the diagnosis of SA in children.
Patients and Methods: Twenty children with suspected SA who had joint pain and underwent surgical treatment were enrolled in this study. Their preoperative clinical and laboratory findings were investigated. Tissues obtained during operation were subjected to microbiological culture and real-time PCR, including methicillin-resistant Staphylococcus (MRS)-specific PCR and broad range universal PCR. Infection was confirmed if the result of microbiological culture was positive. Furthermore, abnormal clinical and laboratory findings and improvement in the symptoms and posttreatment data were also defined as the final diagnosis of infection.
Results: Out of the 20 patients, 19 were diagnosed with the infection. The remaining patient was postoperatively diagnosed with juvenile idiopathic arthritis. Abnormal preoperative body temperatures, white blood cell counts, C-reactive protein levels, and erythrocyte sedimentation rates were observed in 6, 9, 15, and 12 cases, respectively. The results of microbiological culture, MRS-PCR, and universal PCR were positive in 9, 2, and 15 cases, respectively. Analysis of the melting peak in universal PCR revealed that of the 15 cases, 10 had gram-positive and 5 had gram-negative infections. The sensitivity and specificity for the diagnosis of SA were, respectively, 0.47 and 1.00 in microbiological culture and 0.79 and 1.00 in real-time PCR.
Conclusions: Successful diagnosis of infection and differentiation between gram-positive and gram-negative bacteria were achieved using MRS-PCR and universal PCR. Hence, real-time PCR is useful and has greater sensitivity than microbial culture for diagnosing SA in children.

DOI： 10.1097/BPO.0b013e318279c6b6

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Fondaparinux (FPX), a selective inhibitor of factor Xa, is widely used for the prophylaxis of venous thromboembolism (VTE) after total joint arthroplasty. However, the association between plasma FPX concentration and adverse events and the occurrence of VTE has not been clarified thus far. We aimed to prospectively evaluate these associations by measuring anti-Xa activity of FPX in patients undergoing total hip arthroplasty (THA) and investigate whether factors such as age, body weight, and renal function influence the anti-Xa levels. We enrolled 85 patients who underwent primary THA. All patients received subcutaneous FPX (2.5 mg/day for 14 days) after surgery. Anti-Xa activity was measured on postoperative days 1, 3, 7, and 14. To assess VTE, multidetector row computed tomography was performed in all patients at 1 week after surgery. The median levels of anti-Xa activity increased as follows (medians with 95 % confidence interval): 0.00 (0.00-0.01) mg/L, 0.13 (0.11-0.14) mg/L, 0.19 (0.17-0.20) mg/L, and 0.24 (0.22-0.25) mg/L on postoperative days 1, 3, 7, and 14, respectively. The plasma accumulation of FPX was more likely in patients with renal impairment than in those with normal renal function. In contrast, a poor correlation was observed between the plasma levels of anti-Xa activity and age or body weight. No differences were observed in the anti-Xa activity in patients with and without postoperative VTE or bleeding. Substantial increase in the levels of anti-Xa activity was observed, especially in patients with renal impairment, after subcutaneous administration of FPX 2.5 mg after THA.

DOI： 10.1007/s11239-012-0773-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

Several recent studies have demonstrated the limited accuracy of conventional culture methods for diagnosing periprosthetic infections. We have applied real-time polymerase chain reaction (PCR) assays for the rapid identification of bacteria around implants and reported its utility. However, the capability of quantification is also a useful feature of this type of assay. The aim of our study was to validate the usefulness of quantitative analyses using real-time PCR of cases with clinical periprosthetic infections in comparison with more established tests, such as C-reactive protein (CRP) levels, microbiologic cultures, and histopathology. Fifty-six joints with suspected infections were reviewed retrospectively. A universal PCR assay was used to perform the quantitative analyses. The differences in the threshold cycles between clinical samples and a negative control (Delta Ct) in each case were calculated. The results of the quantitative PCR assay were compared with CRP levels, microbiologic cultures, and histopathology. There was a significant correlation found between the CRP and Delta Ct values. There were also significant differences found in the Delta Ct values according to CRP levels, with higher CRP levels showing higher Delta Ct values. Similarly, there were significant differences in the Delta Ct measurements in our culture results and among our pathologic evaluations. We confirmed that quantification by universal PCR based on the Delta Ct correlated with preoperative CRP levels and was associated with the microbiologic culture results and pathologic severity. This quantification method may be valuable for assessing infection severity. (C) 2012 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.diagmicrobio.2012.06.017

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：W B SAUNDERS CO  

Two cases of neuropathy of a motor branch caused by a midpalmal ganglion are presented. In the first case the ganglion originated from the midcarpal joint, protruded into the thenar muscle, and compressed the motor branch of the median nerve. In the second case the ganglion, distal to the fibrous arch of the hypothenar muscles, originated from the third carpometacarpal joint and compressed the motor branch of the ulnar nerve. In both cases muscle weakness and finger deformity recovered well after resection of the ganglion. This clinical condition is rare compared with carpal tunnel syndrome and Guyon's tunnel syndrome, which are caused by a ganglion in the wrist. Copyright (C) 2001 by the American Society for Surgery of the Hand.

DOI： 10.1053/jhsu.2001.24146

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：東日本整形災害外科学会  

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記述言語：日本語   出版者・発行元：(株)全日本病院出版会  

大腿骨寛骨臼インピンジメント(femoroacetabular impingement:FAI)症候群は、股関節動作時に骨頭頸部移行部と、寛骨臼縁が繰り返し接触・衝突し、力学的な負荷が加わることにより関節唇、さらには関節軟骨に損傷をきたす病態とされている。筆者らは骨盤後傾がインピンジメントに与える影響を検証するため、術前およびcam切除後のCT画像において三次元動的シミュレーションを行った。その結果、シミュレーションにおいて骨盤の後方傾斜により股関節最大内旋角度に改善がみられること、さらには骨盤後方傾斜10°においてcam切除と同等の可動域改善が得られることが示された。このことは、手術介入の有無に関わらず、股関節屈曲と骨盤後傾の連動した動作の十分な獲得がインピンジメントの状態を改善させることを示唆している。(著者抄録)

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：神奈川整形災害外科研究会  

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記述言語：日本語   出版者・発行元：神奈川県医師会  

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記述言語：日本語   出版者・発行元：(一社)日本骨・関節感染症学会  

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記述言語：日本語   出版者・発行元：日本創外固定・骨延長学会  

開放骨折や粉砕骨折の治療において、創外固定は内固定手術までの一時固定として出血コントロールや軟部組織ダメージの最小化といった意味も含めて重要である。【症例】64歳女性、Gustilo type 3Bの左脛骨プラトー開放骨折に対して新しい創外固定器FastFrameを使用した。入院中の経過で皮弁の表層感染や合併症に治療を要したが、受傷121日目に加療継続目的に転院となった。今回使用したFastFrameは本邦では2019年から使用可能となった新しい創外固定器であり、牽引や整復位の保持が容易であり、人的制限や時間的制限を要することの多い開放骨折での使用などに適すると考えられた。(著者抄録)

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記述言語：日本語   出版者・発行元：日本創外固定・骨延長学会  

開放骨折や粉砕骨折の治療において、創外固定は内固定手術までの一時固定として出血コントロールや軟部組織ダメージの最小化といった意味も含めて重要である。【症例】64歳女性、Gustilo type 3Bの左脛骨プラトー開放骨折に対して新しい創外固定器FastFrameを使用した。入院中の経過で皮弁の表層感染や合併症に治療を要したが、受傷121日目に加療継続目的に転院となった。今回使用したFastFrameは本邦では2019年から使用可能となった新しい創外固定器であり、牽引や整復位の保持が容易であり、人的制限や時間的制限を要することの多い開放骨折での使用などに適すると考えられた。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)メジカルビュー社  

＜文献概要＞人工関節周囲感染(periprosthetic joint infection;PJI)の診断における細菌培養検査を中心とした細菌学的検査について概説する。原因菌の同定はPJIの診断,治療において最重要であり,細菌培養検査は必須である。細菌培養の検出率を上げるには,適切な検体採取方法や培養期間に加え,増菌培養や超音波処理などの工夫が必要となる。培養陰性PJIが存在することに注意し,培養陰性症例に対しては,ポリメラーゼ連鎖反応(polymerase chain reaction;PCR)や次世代シーケンシング(next-generation sequencing;NGS)などの分子生物学的診断法が有用である。

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本脊椎脊髄病学会  

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記述言語：日本語   出版者・発行元：(一社)日本脊椎脊髄病学会  

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記述言語：日本語   出版者・発行元：神奈川整形災害外科研究会  

症例は50歳男性で、4ヵ月前からの胸背部痛を主訴とした。胸部CTで右下肺野の胸水貯留とTh8、9での骨破壊像を認め、胸水培養検査ではメチシリン感受性黄色ブドウ球菌(MSSA)が検出された。血液生化学検査では炎症反応マーカーの上昇を認め、胸椎MRIではTh8/9椎間腔に液体貯留を認め、上下椎体にT1強調像で低信号、T2強調像で高信号の信号変化を認めた。Th8/9胸椎化膿性脊椎炎と診断し、胸椎後方進入による病巣掻爬と椎弓根スクリューによる後方固定術を一期的に施行した。術中に病巣の掻爬部よりMSSAが検出され、CLDM点滴静注を開始し、術後9日目に抗生剤をRFP+CLDMによる経口薬に変更した。術後腰背部痛は軽快し、術後18日目に独歩自宅退院し、外来通院後は術後4週で炎症所見が陰性化した。術後6ヵ月で抗菌薬を終了し、CTではTh8/9間の架橋形成を認め骨癒合は良好であった。

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記述言語：日本語   出版者・発行元：(一社)日本リウマチ学会  

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記述言語：日本語   出版者・発行元：(一社)日本リウマチ学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：関東整形災害外科学会  

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記述言語：日本語   出版者・発行元：関東整形災害外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本リウマチ学会  

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記述言語：日本語   出版者・発行元：(一社)日本リウマチ学会  

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記述言語：日本語   出版者・発行元：(一社)日本脊椎脊髄病学会  

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記述言語：日本語   出版者・発行元：(一社)日本脊椎脊髄病学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：神奈川整形災害外科研究会  

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記述言語：日本語   出版者・発行元：神奈川整形災害外科研究会  

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記述言語：日本語   出版者・発行元：金原出版(株)  

＜文献概要＞近年,関節リウマチの手術では手指・足趾関節の手術の割合が高くなり,下肢大関節の割合が減少してきた。当院では2020年特有の傾向として人工膝関節の割合が高く推移しており,COVID-19による社会情勢の変化が影響している可能性がある。足趾では,母趾に対してはDLMO法,外側趾には中足骨骨切り術を行っているが,足趾の過度な直線化を避けるため,最近は骨切り部の固定に吸収性骨片接合材料を使用し,足趾自体は軟部組織の解離と自然な肢位でのテープ固定としている。膝・股関節では手術数が経年的に減少しており,骨棘形成を伴った変形例が経年的に増加している。平均Larsen gradeは股関節では手術の10年前から,膝関節では手術の4〜5年前から両関節とも約0.4/年で直線的に悪化していた。手術に至るような関節炎の持続例では関節破壊が一旦進行を始めると,破壊の程度は一定であることを意味する可能性がある。

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J-GLOBAL

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J-GLOBAL

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記述言語：日本語   出版者・発行元：日本リウマチの外科学会  

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記述言語：日本語   出版者・発行元：日本リウマチの外科学会  

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記述言語：日本語   出版者・発行元：日本リウマチの外科学会  

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記述言語：日本語   出版者・発行元：日本リウマチの外科学会  

関節リウマチの外反母趾変形に対するDLMO(Distal Lineal Metatarsal Osteotomy)法後の外反母趾再発のリスク因子を明らかにすることを目的に、2015年11月以降にDLMO法による関節温存手術を行った40例のうち、術後1年以上経過観察できた25例35足(女性20例30足、男性5例5足、手術時平均年齢67.0±8.6歳)を対象に検討した。DLMO法は、中足骨遠位部骨切り術に分類される関節温存手術で、術前・術直後・術後1ヵ月・3ヵ月・6ヵ月・1年後の単純X線写真から、外反母趾角(HVA)、第1第2中足骨間角(M1M2角)、第1第5中足骨間角(M1M5角)を調査した。その結果、術後1年時のHVAが、至適角度である20度を超えた再発例は35足中3足(8.6%)であった。また、術直後のM1M5角が術後HVAの変化量に影響を及ぼしており、術後の外反母趾変形の再発要因である可能性が示唆された。

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本関節病学会  

当院で2014〜2018年に変股症に対して両側同時TKAを施行した191例を対象とし、術後入院期間が21日以内であった群(132例)と22日以上群(59例)に分け、術前諸因子の群間比較および多重ロジスティック回帰分析を行った。調査項目は「年齢」「性別」「BMI」「独居か否か」「KSS functional score」「ASA class」「Hb値」「Alb値」「膝可動域」「K-L grade」とした。多重ロジスティック回帰分析の結果、入院期間に有意な影響を与える因子として「年齢」と「Hb値」が抽出された。調査項目のうち下記6項目を用いて入院期間を予測するスコアリングシステムを構築したので提示した。1)年齢。2)BMI。3)独居か否か。4)KSS functional score。5)ASA class。6)Hb値。

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記述言語：日本語   出版者・発行元：(一社)日本骨・関節感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本骨・関節感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本骨・関節感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本骨折治療学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本骨折治療学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本骨折治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本骨折治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本リウマチ学会  

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記述言語：日本語   出版者・発行元：(一社)日本リウマチ学会  

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記述言語：日本語   出版者・発行元：日本股関節学会  

過去14年間に、人工股関節(THA)再置換術を行った32例(男性7例、女性25例:平均年齢68歳)を対象に、機能的なステム前捻角の変化が及ぼすステム、大腿骨、カップ、骨盤とのインピンジメントへの影響について検討した。対照は初回THA症例32例とし、術前後のCT横断面像における解剖学的ステム前捻角、大腿骨回旋角、機能的ステム前捻角を比較した。その結果、術後大腿骨回旋角は初回THAでは内旋する傾向であったが、THA再置換術症例は27例(84%)が外旋していた。術後ステム前捻角は大腿骨の外旋に伴って有意に増加した。THA再置換術症例では機能的ステム前捻角はステムまたは大腿骨、カップまたは骨盤とのインピンジメントまでの距離と有意な負の相関を認め、機能的ステム前捻角の増加がインピンジメントのリスク増加に関与することを確認した。特に二期的再置換術症例では術後早期に強い大腿骨外旋傾向を認めるため、機能的ステム前捻角の増加によるインピンジメントに注意を払う必要がある。

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記述言語：日本語   出版者・発行元：東日本整形災害外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本リウマチ学会  

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記述言語：日本語   出版者・発行元：(一社)日本リウマチ学会  

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記述言語：日本語   出版者・発行元：日本リウマチの外科学会  

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記述言語：日本語   出版者・発行元：日本リウマチの外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本リウマチ学会  

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記述言語：日本語   出版者・発行元：(一社)日本リウマチ学会  

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記述言語：日本語   出版者・発行元：南江堂  

CiNii Books

CiNii Research

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記述言語：日本語   出版者・発行元：(株)メジカルビュー社  

＜文献概要＞はじめに 人工関節周囲感染(periprosthetic joint infection;PJI)に関する諸問題は,この十数年で大きく取り上げられるようになった。特に2013年に第1回,2018年に第2回が開催された国際コンセンサス会議(International Consensus Meeting;ICM)の意義は大きく,診断,予防,治療に関して広く議論が行われた。また,近年のさまざまな診断ツールの発達に伴い,これまでは診断が困難であった例も診断することが可能となっている。一方で,治療に関しては明確なエビデンスが不足している部分も多い。本稿では,PJIの診断から治療に関して,現段階で筆者らが行っている診療のコツについて概説する。

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記述言語：日本語   出版者・発行元：(一社)日本手外科学会  

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