記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Orthopedic infections, including fracture-related infection and periprosthetic joint infection (PJI), remain difficult to eradicate because bacteria within biofilms exhibit high tolerance to systemic antibiotics. Conventional antibacterial strategies based on minimum inhibitory concentration often fail in the biofilm environment, where substantially higher antimicrobial concentrations are required. Continuous local antibiotic perfusion (CLAP) has emerged as a technique that enables sustained delivery of high local antibiotic concentrations directly to the infected site while providing continuous drainage using negative pressure wound therapy. METHODS: This narrative review summarizes the principles, technical aspects, clinical indications, and reported outcomes of CLAP. A literature search of the MEDLINE database was conducted up to July 2025 using the term "continuous local antibiotic perfusion." Clinical studies describing the use of CLAP in orthopedic infections, including case reports, case series, and retrospective studies, were reviewed. Perfusion strategies (iMAP, iSAP, iJAP, and TRAP), antibiotic regimens, safety considerations, and current limitations were analyzed. RESULTS: CLAP enabled delivery of high local antibiotic concentrations exceeding the minimum biofilm eradication concentration while maintaining relatively low systemic exposure. Favorable outcomes for infection control, implant retention, and fracture union, were reported across various intractable infections, including fungal PJI. Complications such as transient elevations in serum antibiotic levels and renal dysfunction were reported but appeared to be infrequent. Although CLAP has shown potential utility in refractory infections, further high-quality studies with rigorous safety evaluations are required to strengthen the evidence base. CONCLUSION: CLAP is a promising adjunctive strategy for challenging orthopedic infections, offering targeted high-concentration antibiotic delivery with effective drainage. However, current evidence is limited to low-level studies. Prospective trials, standardized protocols, and long-term safety evaluations are needed to define its role in clinical practice.

DOI： 10.2106/JBJS.OA.25.00212

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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.jos.2025.10.006

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00586-025-09709-9

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Vertebral compression fractures (VCFs) can impair posture, gait, and daily activities in patients undergoing total hip arthroplasty (THA). However, limited data are available regarding the incidence, risk factors, and impact of VCFs on sagittal spinal alignment following THA. Therefore, the purpose of this study was to investigate the incidence and risk factors of VCFs after THA, and to evaluate their impact on sagittal spinal alignment and clinical outcomes. METHODS: This retrospective cohort study included 220 patients (243 hips) who underwent primary THA, with a mean follow-up period of 6.1 years. Data collected included patient demographics, Fracture Risk Assessment Tool (FRAX) scores, lumbar bone mineral density measured before THA, sagittal spinal alignment parameters, Harris Hip Score (HHS), and the occurrence of new VCFs. We analyzed changes in spinal alignment and identified risk factors associated with incident VCFs. RESULTS: VCFs occurred in 20% of hips during the follow-up period. Patients who developed VCFs demonstrated a significantly increased sagittal vertical axis, reduced lumbar lordosis angle, and lower postoperative HHS compared to those without VCFs. Preexisting VCF and higher preoperative FRAX scores were significantly associated with the development of new VCFs. Multivariate logistic regression analysis identified the FRAX score as an independent predictor of incident VCFs. CONCLUSIONS: In this 6.1-year retrospective cohort study, 20% of hips developed new VCFs after THA, which were associated with worsened spinal alignment and hip function. The higher FRAX score, calculated prior to THA surgery, is a useful predictor of VCF risk and may help identify individuals who require closer monitoring or preventive interventions during follow-up after surgery. Video Abstract.

DOI： 10.1186/s42836-025-00345-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.arth.2025.08.042

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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 the achievement of the preoperative plan and clinical outcomes in patients with cam- or combined-type femoroacetabular impingement syndrome undergoing computer navigation-assisted arthroscopic osteochondroplasty compared with freehand techniques. METHODS: This retrospective study included patients treated between 2020 and 2024 who met the following criteria: (1) primary hip arthroscopic surgery for cam- or combined-type femoroacetabular impingement syndrome, (2) availability of pre- and postoperative computed tomography imaging, and (3) minimum 12-month follow-up. Patients were divided into a navigation-assisted group and a freehand group. In the navigation group, a computed tomography-based system was used, enabling real-time tracking of the abrader burr during resection. Achievement of the preoperative plan was assessed by comparing postoperative 3-dimensional range of motion simulations to preoperative targets at 90°, 70°, and 45° of hip flexion. Clinical outcomes included the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS). RESULTS: Fifty-five hips were included (25 in the navigation-assisted group and 30 in the freehand group). Mean follow-up was 14.7 ± 4.4 months (range, 12-25 months) in the navigation group and 31.3 ± 11.2 months (range, 12-58 months) in the freehand group. The navigation group had greater achievement rates of the preoperative range of motion plan at 90° (92.0% vs 46.7%, P < .001) and 70° (80.0% vs 50.0%, P = .027). At 1 year, NAHS was greater in the navigation group (88.6 ± 9.2 vs 79.8 ± 18.9, P = .037), with more patients achieving the minimal clinically important difference (76.0% vs 46.7%, P = .032). There were no significant differences in mHHS, revision arthroscopy, or conversion to total hip arthroplasty. CONCLUSIONS: Computer navigation-assisted osteochondroplasty may improve the accuracy of cam resection and contribute to better short-term outcomes such as the NAHS at 1 year. However, clinical benefits over freehand technique were limited in other measures such as mHHS, revision, or conversion rates. LEVEL OF EVIDENCE: Level Ⅲ, retrospective comparative study.

DOI： 10.1016/j.arthro.2025.07.048

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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.2025.08.062

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

ObjectiveThis study aimed to evaluate clinical outcomes and cartilage repair following autologous chondrocyte implantation (ACI) combined with high tibial osteotomy (HTO) in elderly patients with spontaneous osteonecrosis of the knee (SONK) presenting with large cartilage defects.DesignEleven knees of 11 patients with SONK (lesion size ≥4 cm2) aged 60 years or older underwent ACI and concomitant opening-wedge HTO. Patients were followed for at least 1 year. Clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS). Cartilage repair was evaluated arthroscopically using the International Cartilage Repair Society (ICRS) grade and histologically using the ICRS II score at second-look arthroscopy.ResultsThe overall KOOS improved significantly from a preoperative value of 38.4 ± 8.5 to a 1-year postoperative value of 77.8 ± 10.9 (P < 0.01). Arthroscopy showed cartilage repair to normal or nearly normal in 91% of cases. The mean histological ICRS II score was 67.5 ± 16.2. No postoperative complications or need for additional surgical interventions was observed.ConclusionsACI combined with HTO provides good clinical and histological outcomes in elderly patients with SONK and large cartilage defects. This approach represents an effective joint-preserving treatment option, even in patients aged 60 years or older.

DOI： 10.1177/19476035251392531

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background/Objective: Endoprosthetic proximal femoral replacement is a reconstructive procedure for preserving ambulatory function following tumor resection. Different prosthetic systems for endoprosthetic proximal femoral replacement may result in different stem placement techniques, especially regarding the anteversion angle of the stem. The aim of this study was to evaluate femoral rotation and stem anteversion following endoprosthetic proximal femoral replacement using two different prosthetic systems, and to investigate their influence on postoperative quality of life. Methods: We retrospectively reviewed 30 patients who underwent endoprosthetic proximal femoral replacement at our institution between 2008 and 2022. The evaluated parameters included patient demographics, anatomical and functional stem anteversion, femoral rotation, femoral resection length, implant type, and Musculoskeletal Tumor Society score. Results: The cohort comprised 16 males and 14 females with a mean age of 65.2 ± 13.5 years. Twenty patients received the Global Modular Replacement System implants and 10 received the Kyocera Modular Limb Salvage System implants. The mean anatomical stem anteversion was 17.0 ± 17.7°, and the mean femoral rotation was 14.4 ± 22.6°. The Global Modular Replacement System implants demonstrated less variability in anatomical stem anteversion (11.7 ± 15.2°) compared to the Kyocera Modular Limb Salvage System (27.6 ± 18.4°, p = 0.02). A significant negative correlation was found between anatomical stem anteversion and femoral rotation (r = -0.78, p < 0.01), and a positive correlation between femoral rotation and functional stem anteversion (r = 0.62, p < 0.01). Musculoskeletal Tumor Society scores were available in 14 patients and correlated significantly with functional stem anteversion (r = -0.62, p = 0.02) and femoral resection length (r = -0.61, p = 0.02), but not with anatomical stem anteversion or femoral rotation alone. Conclusions: This study demonstrated that stem placement angles differ between prosthetic systems. These differences are attributable to variations in surgical implantation techniques and prosthesis design philosophies. In particular, the Global Modular Replacement System incorporates built-in anteversion, and when using such prostheses, referencing the linea aspera enables more stable restoration of the anatomical stem anteversion. Excessive reduction in anatomical stem anteversion is not recommended to avoid excessive external femoral rotation.

DOI： 10.3390/jcm14217786

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Surgical site infection (SSI) following spinal surgery, although rare, is a serious complication that affects patient outcomes. Identifying risk factors such as patient background, preoperative serum markers, and surgical factors is essential for effective screening and prevention measures. Therefore, this study aimed to verify whether preoperative patient conditions serve as predictors of post-spinal surgery infections and to determine the association between preoperative serum markers and infecting pathogen species. METHODS: This single center retrospective study analyzed 427 patients who underwent spinal surgery at our hospital between November 2019 and September 2022. Data on patient demographics, comorbidities, preoperative blood tests, surgical factors, SSI occurrence, and causative organisms were collected. Logistic regression analysis was performed to identify independent predictors of SSI, and a subgroup analysis compared preoperative serum markers between superficial and intra-abdominal bacterial infections. RESULTS: SSI occurred in 33 patients (7.7 %). Several factors showed significant differences between the SSI and non-SSI groups, including albumin (ALB), Albumin-Globulin Ratio (AGR), Prognostic Nutritional Index (PNI), C-Reactive Protein (CRP), CAR, D-dimer, and blood loss. Logistic regression analysis identified ALB as the only independent predictor of SSI (OR = 0.23, 95 % CI: 0.11-0.48, P < 0.001), with a cutoff value of <4.0 g/dL. Among SSI cases with identified pathogens, 17 were caused by skin commensal bacteria, while 7 were attributed to intra-abdominal comm-ensal bacteria. Subgroup analysis revealed that AGR and Lympocyte to Monocyte Ratio (LMR) were significantly higher in the intra-abdominal infection group than in the superficial infection group (P = 0.028 and P = 0.045, respectively). CONCLUSION: Preoperative ALB levels serve as a crucial predictor of postoperative SSI in spinal surgery, with a cutoff value of <4.0 g/dL. Additionally, the type of bacterial infection (superficial vs. intra-abdominal) may be influenced by preoperative patient factors.

DOI： 10.1016/j.jos.2025.03.012

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/jhps/hnaf064

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

This study aimed to identify the optimal timing for starting mobilization after enthesis repair surgery. A total of 28 8-week-old male Wistar rats underwent bilateral Achilles tendon detachment and repair. We randomized animals into four groups based on the duration of immobilization: no cast group, no immobilization; 7 days group, immobilization for 7 days; 14 days group, immobilization for 14 days; or 30 days group, immobilization for 30 days. Samples were harvested for biomechanical and histological analyses following euthanasia at 30 days after surgery. Histological findings showed abundant fibrocartilage formation in 7 days group, limited fibrocartilage formation in 14 days group, and no fibrocartilage formation in no cast or 30 days group. Histological score was significantly higher in 7 days group than in no cast and 30 days groups (p < 0.05 each). Biomechanical analysis showed that the mean load to failure was significantly higher in 7 days and 14 days groups than in no cast and 30 days groups (p < 0.05). These findings suggest that starting mobilization following short-term (1 week) immobilization is the optimal timing to improve structural and mechanical properties of healing enthesis. This provides insight into the optimization of rehabilitation protocols following enthesis repair surgery.

DOI： 10.1002/jor.70002

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Serum markers are commonly used to diagnose bone and joint infections; however, their accuracy for diagnosing pyogenic spondylitis remains unproven. This study aimed to validate the diagnostic accuracy of inflammatory, nutritional, and immunological serum markers for spinal infections and identify the most effective combinations. Methods: The retrospective cohort study analyzed 656 patients who visited the hospital for spinal diseases between 1 January 2004 and 31 March 2021; a total of 76 were diagnosed with pyogenic spondylitis. Blood samples were analyzed for serum albumin (Alb), total protein (TP), globulin (Glb), C-reactive protein (CRP), platelet count, white blood cell count, neutrophil count, lymphocyte count, and monocyte count. Combination markers, including albumin-globulin ratio (AGR), CRP-albumin ratio (CAR), CRP-AGR (CAGR), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR), were also evaluated. Receiver operating characteristic curves were used to determine each marker's diagnostic performance. Furthermore, multivariate analysis was performed to examine the odds ratios. Results: Patients with pyogenic spondylitis showed significantly different levels in Alb (p < 0.0001), Glb (p < 0.0001), CRP (p < 0.0001), platelet count (p < 0.0001), WBC count (p < 0.0006), neutrophil count (p = 0.0019), lymphocyte count (p = 0.0085), AGR (p < 0.0001), CAR (p < 0.0001), CAGR (p < 0.0001), NLR (p < 0.0001), and PLR (p < 0.0001). CRP (AUC = 0.80) showed good diagnostic accuracy, while combination markers CAR (AUC = 0.82) and CAGR (AUC = 0.83) had the highest areas under the curve (AUC). Multivariate analysis indicated that decreased age and the presence of comorbidities (including chronic kidney disease, chronic liver disease, malignancy, or diabetes), were independent predictors of early pyogenic spondylitis (OR_age = 0.93, OR_comorbidities = 16.98, p_age = 0.0005, and p_comorbidities = 0.0001). In patients with low-inflammatory pyogenic spondylitis, significant differences were observed in TP (p = 0.0293), Glb (p = 0.0012), CRP (p = 0.0023), platelet count (p = 0.0108), AGR (p = 0.0044), CAR (p = 0.0006), CAGR (p = 0.0004), PLR (p = 0.0192), and NLR (p = 0.0027), with CAGR showing the highest AUC (AUC = 0.70) among them. Conclusions: Serum combination markers (AGR, CAGR, CAR, PLR, and NLR) showed diagnostic value for pyogenic spondylitis, with CAGR achieving the highest accuracy. In low-inflammatory pyogenic spondylitis patients (CRP ≤ 1.0 mg/dL), these markers may aid diagnosis.

DOI： 10.3390/jcm14176001

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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 requiring rapid diagnosis for effective treatment. The BIOFIRE® Joint Infection (JI) Panel, a fully automated multiplex PCR system, enables the identification of 31 organisms and 8 antimicrobial resistance (AMR) genes within 1 h, offering a promising diagnostic method. However, its diagnostic performance, particularly in Asian populations, remains underexplored. METHODS: This retrospective study analyzed 60 cases of suspected PJI between 2022 and 2023. Synovial fluid samples were evaluated using the JI Panel and microbiological culture, with PJI diagnoses based on the International Consensus Meeting 2018 criteria. Diagnostic accuracy, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), was assessed by comparing JI Panel results with microbiological culture findings or PJI diagnosis. RESULTS: Among 60 cases, 33 were diagnosed with PJI. The JI Panel demonstrated a sensitivity of 45.5 % and a specificity of 100 % for detecting PJI, while microbiological culture showed a sensitivity of 63.6 % and specificity of 100 %. Combined use of the JI Panel and culture improved diagnostic sensitivity to 69.7 %. Notably, the JI Panel identified pathogens in two culture-negative PJI cases. Limitations of the JI Panel included its inability to detect coagulase-negative staphylococci (CNS), such as Staphylococcus epidermidis. However, the JI Panel successfully identified Candida species, a pathogen often undetected by conventional methods. DISCUSSION: The JI Panel facilitates rapid and accurate diagnosis of PJI with high specificity. Although limited by its low sensitivity for CNS-associated infections, the ability to rapidly identify causative organisms and detect fungal pathogens supports its clinical utility. Implementation of the JI Panel in diagnostic laboratories may expedite diagnosis, reduce unnecessary antibiotic use, and alleviate the burden of multidrug-resistant infections. CONCLUSION: The BIOFIRE® JI Panel offers a highly specific, fully automated method for the rapid diagnosis of PJI. Its adoption in clinical practice may enhance diagnostic accuracy, particularly for culture-negative cases, although improvements in detecting CNS pathogens are necessary.

DOI： 10.1016/j.jos.2025.07.008

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Shelf acetabuloplasty for acetabular dysplasia is being reevaluated as a less invasive, joint preservation surgery. However, there are few reports on validation of the proper placement of the grafting shelf. In this study, finite element analysis was performed to examine the optimal location of shelves from the perspective of stress reduction by simulating various shelf installation patterns. MATERIALS AND METHODS: Fifteen patients scheduled for shelf acetabuloplasty were included. Using preoperative computed tomography, we created a total of 81 shelf installation models per case. The equivalent stress at loading area of the acetabulum was analyzed, and the stress reduction ratio was calculated based on the preoperative values. RESULTS: Among the 1215 shelf models across 15 cases, 284 (23.3%) demonstrated a stress reduction exceeding 10%. Multiple regression analysis showed that the center-edge angle was the strongest factor associated with postoperative stress reductio n (p < 0.001). Moreover, the equivalent stress values on the acetabulum were significantly lower for lateral shelf placement than the anterior position (p < 0.05). The reduction rate of acetabular stress exhibited a significant correlation with the equivalent stress on the “inner shelf”, the part implanted in the pelvis, (p < 0.0001). The stress on the inner shelf was significantly greater in the lateral position than the anterior position (p < 0.001). CONCLUSIONS: Considering load dispersion, lateral installation is advantageous for effective load dispersion. Additionally, stress changes in the acetabulum are influenced by the stresses applied to the inner shelf.

DOI： 10.1186/s12891-025-09014-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Iatrogenic deep femoral artery (DFA) injury is a serious complication of hip surgery, often resulting from screw or wire placement in the femur owing to the limited visibility of the DFA and its branches during femoral penetration. We aimed to identify the course and location of DFA perforating branches using an imaging-based approach to improve surgical planning and prevent vascular injury during hip procedures, which has not been thoroughly evaluated in prior anatomical studies. We consecutively enrolled 20 female and 20 male participants with unilateral hip osteoarthritis. Contrast-enhanced computed tomography images of the unaffected side were used to identify the DFA. Associations between participant demographics and DFA branch location and trajectory were analyzed. The distance from the apex of the greater trochanter (GTR) to the first DFA perforating branch was significantly shorter in females than in males (mean: 100 (range, 77-122) vs. 113 (range, 99-131) mm, P < 0.001), whereas no significant difference was found for the second branch (mean: 154 (range, 108-242) vs. 160 (range, 128-235) mm, P = 0.73]. The DFA ran within 5 mm of the femur on the medial-posterior aspect at 140 mm and 200 mm distal to the apex of the greater trochanter, typical insertion sites for distal cortical screws in intramedullary nailing for hip fractures. In females, the first DFA perforating branch occurs more proximally than in males, necessitating caution during femoral wiring at this level. These findings help refine anatomical understanding of the DFA course, supporting safer surgical planning for intramedullary fixation. The small sample size (n = 40) is one of the limitations and may affect generalizability.

DOI： 10.7759/cureus.89803

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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 a complication of peri-implant biofilm-based treatments and confers resistance to antimicrobial therapy. Integrating continuous local antibiotic perfusion (CLAP) with conventional surgery for PJI facilitates the local delivery of low-flow, high-concentration antimicrobials. This study aimed to evaluate the efficacy and safety of CLAP for treating PJI. This study included patients diagnosed with hip PJI who underwent debridement, antibiotics, and implant retention (DAIR) augmented by CLAP. Gentamicin was administered at a high concentration (1.2 mg/mL) and low flow rate (2.0 mL/h for 24 h). We evaluated implant survival and complication rates associated with adding CLAP to conventional DAIR surgery. Of the 22 patients, including 11 with chronic infection, DAIR surgery supplemented with CLAP resulted in implant survival in 20 patients (90.9%). In contrast, among 10 patients treated with DAIR without CLAP (non-CLAP group), implant survival was 70%. The mean follow-up period was 42.6 ± 31.5 (range, 12-161) months in the CLAP group and 56.8 ± 28.8 (range, 28-114) months in the non-CLAP group. During CLAP treatment, renal function worsened in two patients; however, it improved rapidly after CLAP completion and device removal. No major complications were observed. CLAP demonstrated promising results in treating acute and chronic PJI. However, monitoring and regulating blood antimicrobial levels is crucial to avoiding renal dysfunction. CLAP is a treatment option for PJI that can destroy bacterial biofilms.

DOI： 10.1038/s41598-025-11808-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Surgical treatment of proximal femoral fractures typically involves fixation with intramedullary nailing or sliding hip screws, where screws inserted into the femoral head stabilize the fracture site. However, few studies have quantitatively assessed the distribution of bone density and quality within the femoral head. We investigated the distribution of bone mineral density (BMD) within the proximal femoral head, evaluated inter-patient variability, and examined associated factors based on computed tomography (CT) values. METHODS: This multicenter prospective observational study included 100 patients with femoral trochanteric fractures. Preoperative CT images were obtained from the first lumbar vertebra to the distal end of the femur. Using 3D Slicer (version 7), the proximal uninjured femur was segmented and reconstructed into a 3D model. The volume and CT values (Hounsfield units [HU]) of the proximal femur and femoral head were measured. Additionally, CT values were used to assess the bone volume and distribution of low bone-density areas (0-100 HU) and high bone-density areas (≥300 HU) in the femoral head. RESULTS: The average bone volume and CT values of proximal femur and femoral head were 90,641 mm3 and 94 HU, and 32,316 mm3 and 131 HU, respectively. The volume of the femoral head with CT values ≥300 HU was 2967 mm3, accounting for 9.1% of the total volume (range: 0.1%-32.6%), with a distribution observed along the central region of the femoral head, particularly along the principal compressive trabeculae. Additionally, the average CT value of the femoral head (<100 HU, ≥300 HU) correlated with bone volume. CONCLUSION: A distribution of CT values within the femoral head is characteristic of patients with femoral trochanteric fractures. Using HU values from CT imaging to predict bone fragility preoperatively may aid in assessing the risk of postoperative complications.

DOI： 10.1177/21514593251361803

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Patients with femoral neck fractures (FNF) have reduced walking ability owing to muscle weakness. Preoperative muscle volume and quality may have an association with prolonged rehabilitation and can be useful to predict the postoperative walking ability in patients with FNF. This study aimed to compare the muscle volume and computed tomography (CT)-assessed density around the hip joint in patients with FNF with patients having hip osteoarthritis (HOA) and assess the association of these measurement with postoperative walking ability. MATERIALS AND METHODS: This retrospective observational study included 15 patients with FNF and 15 with unilateral HOA who were matched for age, sex, and osteoporosis medication. Muscle volume and CT-assessed density of the gluteus maximus, gluteus medius, gluteus minimus, iliacus, psoas major, rectus femoris, and rectus abdominis on the unaffected side were measured three-dimensionally using 3D Slicer software with preoperative CT data. The associations of muscle measurement with patient background, load to FNF (measured using the finite element method), and pre- or postoperative walking ability were assessed. RESULTS: Muscle volume of gluteus maximus, CT-assessed density of all muscles, and femoral strength were significantly lower in the FNF group than in the OA group (P < .01, P < .01, and P = .04, respectively). Muscle volume showed a moderate-to-strong correlation with body mass index (r = 0.66-0.81) and FNF load (r = 0.51-0.70), and CT-assessed density showed a moderate correlation with serum nutritional markers (r = 0.33-0.60). Postoperative walking ability was significantly correlated with the muscle volumes of iliacus and gluteus maximus (r = 0.40 and 0.49) and CT-assessed density of all muscles (r = 0.47-0.64). CONCLUSION: Muscle volume and CT-assessed density significantly correlated with femoral bone strength, serum total protein levels, and pre- and postoperative walking ability. These findings suggest that muscle CT analysis around the hip joint may serve as a valuable tool for assessing musculoskeletal status in patients with FNF.

DOI： 10.1177/21514593251336626

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Bipolar hemiarthroplasty (BHA) and total hip arthroplasty (THA) are standard treatments for hip disorders in the elderly. However, a rare postoperative complication known as periprosthetic acetabular fracture (PPAF) can occur, potentially affecting hip joint stability and implant longevity. The management of PPAF is guided by the Della Valle and Paprosky classifications, which assess implant stability and the extent of bone loss. In this study, we report two cases of PPAF occurring after BHA and THA. In Case 1, early open reduction and internal fixation were performed, successfully avoiding stem revision and achieving a favorable clinical outcome. In contrast, Case 2 was initially managed conservatively; however, due to fracture displacement progression and subsequent reinjury from a fall, surgical intervention became necessary, requiring acetabular reconstruction and implant revision. Treatment options for PPAF include conservative management, plate fixation, and implant revision. In many cases, early surgical intervention yields better outcomes. Therefore, close collaboration between orthopedic trauma surgeons and hip reconstruction specialists is essential. Given the limited number of reported cases, further accumulation of case data and evaluation of long-term outcomes are needed. Early classification and appropriate management are crucial for optimal treatment of PPAF.

DOI： 10.7759/cureus.82890

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

In patients with ankylosed hips, activities of daily living (ADL) are often restricted because of the limited range of hip motion and adjacent joint disorders that cause severe low back and knee pain. Total hip arthroplasty (THA) can improve hip mobility and reduce adjacent joint pain; however, muscle atrophy around the hip joint potentially interferes with ADL improvement. Herein, we describe the seven-year clinical outcomes of computed tomography (CT)-based navigation THA in three patients with ankylosed hips. Additionally, we report the longitudinal changes in muscle atrophy; the muscle volume around the hip joint was measured using CT analysis. The three patients include one woman and two men, aged 75, 65, and 73, respectively, who underwent THA using a CT-based navigation system. None of the patients experienced THA post-operative complications, and all were able to walk with a cane and sit freely in a chair. The hip function of the Harris Hip Score improved from a mean of 71.0 points to 86.6 points at seven years postoperatively. The volume of the gluteus maximus muscle increased in all patients (mean +10.1%); however, the gluteus medius and minimus decreased in all patients (mean, -42.2% and -51.0%). THA with CT-based navigation for ankylosed hips improves ADL, hip joint function, and muscle volume of the gluteus maximus in mid-term clinical results; however, muscle volume recovery in the gluteus medius and minimus can be insufficient.

DOI： 10.7759/cureus.82654

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Scapular fractures are rare injuries, whereas rib fractures are more common. Scapular fractures are frequently associated with rib fractures, which may lead to significant respiratory compromise. While surgical fixation has demonstrated benefits for both scapular and rib fractures, simultaneous fixation using a single surgical approach is not widely practiced. A 54-year-old male sustained a right scapular body fracture (AO 14B1) and multiple right rib fractures following a crush injury. Due to severe respiratory pain and prolonged mechanical ventilation, surgical fixation was performed on post-injury day three using a video-assisted thoracoscopic surgery (VATS)-aided modified Judet approach. The third to fifth rib fractures were stabilized with the Matrix RIB™ Fixation System (Johnson & Johnson, New Brunswick, NJ) and the scapular body fracture was fixed with locking compression plates. Postoperatively, the patient was extubated on day eight and discharged to rehabilitation on day 29. At the follow-up at one year and six months, complete bone union was confirmed with no residual functional impairment. The VATS-aided modified Judet approach enabled simultaneous fixation of scapular and rib fractures, potentially reducing surgical invasiveness, improving postoperative respiratory function, and expediting rehabilitation. This technique presents a viable option for managing complex thoracic fractures, warranting further investigation to evaluate its long-term efficacy.

DOI： 10.7759/cureus.81013

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: The purpose of this study was to investigate the distribution of the change of leg length (LL) after closed wedge high tibial osteotomy (CWHTO) and to identify the factors associated with the magnitude of postoperative change of LL. METHODS: A total of 70 consecutive knees of 58 patients with knee osteoarthritis who underwent CWHTO were retrospectively investigated. LL, hip-knee-ankle angle (HKAA), mechanical axis deviation (MAD), joint line convergence angle (JLCA), mechanical medial proximal tibial angle (mMPTA), and mechanical lateral distal femoral angle (mLDFA) were measured using the anteroposterior whole leg radiograph, and posterior tibial slope (PTS) and flexion contracture (FC) were measured using the lateral knee radiograph. The amount of change from preoperative to postoperative in each parameter was defined as Δ. RESULTS: Patients had a mean correction angle of 18.3 ± 6.6°, with a mean ΔLL of -0.8 ± 10.2 mm, ranging from - 22 mm to 24 mm. There were significant differences between the preoperative and postoperative mean values of HKAA, MAD, JLCA, mMPTA, and FC, whereas no significant differences were found in LL, mLDFA, and PTS. A significant correlation was found between ΔLL and postoperative FC (ρ=-0.28, P = 0.03). Moderate correlations were found between postoperative FC and preoperative FC (ρ = 0.61, P < 0.01) or postoperative PTS (ρ = 0.44, P < 0.01) and between ΔFC and postoperative FC (ρ = 0.54, P < 0.01), postoperative PTS (ρ = 0.60, P < 0.01) or ΔPTS (ρ = 0.55, P < 0.01). CONCLUSIONS: The mean change of LL after CWHTO was only - 0.8 mm, but it ranged widely, from - 22 mm to 24 mm. This variability highlights the importance of addressing factors such as FC and PTS, which are associated with LL changes. Surgeons should carefully control PTS during surgery and address FC to minimize LL change. However, these findings should be interpreted with caution due to the limited methodologies in the assessment of variables including LL and FC.

DOI： 10.1186/s13018-025-05582-w

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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.2024.10.041

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Secondary femoroacetabular impingement (FAI) is a severe complication observed after acetabular osteotomy; however, the diagnostic and treatment strategies of FAI have not been well established, especially with respect to arthroscopic techniques. We here describe hip arthroscopic osteochondroplasty for secondary FAI using computer-assisted techniques. The main features and tips of our technique are preoperative computed tomography (CT)-based surgical planning and the intraoperative capsule takedown method. Computer modeling produces a patient-specific 3-dimensional CT bone model. Subsequently, we identify the impingement point between the acetabulum and the femoral neck using dynamic simulation. The excess bony bumps are resected through computer surgical simulation, and pre- and postoperative 3-dimensional CT bone models are combined to identify the appropriate resection area. For the surgical technique, it is important to detach the capsule to visualize the acetabulum bony excess. Once the resection area has been sufficiently visualized, the bone resection is performed. Finally, the capsule is reattached to the excavated acetabulum, and the delaminated labrum is sewn up with the capsule in a round bale shape.

DOI： 10.1016/j.eats.2024.103193

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: The purpose of this study was to assess whether an excessively increased medial proximal tibial angle (MPTA) resulted in the deterioration of long-term clinical outcomes after opening wedge high tibial osteotomy (OWHTO) for patients with knee osteoarthritis (OA). METHODS: A total of 69 OA knees that underwent OWHTO, with follow-up for a minimum of 10 years, were retrospectively reviewed. The knee and function scores of the Knee Society Score were assessed separately, and cases with a score decline greater than or equal to the minimal clinically important difference from postoperative 1 to 10 years were defined as showing clinical deterioration. Cartilage status was assessed with arthroscopy at the time of osteotomy (first-look) and plate removal (second-look) according to the International Cartilage Repair Society grading system. The outcomes were compared between knees with MPTA ≤ 95° (n = 27) and MPTA > 95° (n = 42). RESULTS: The mean knee and function scores at postoperative 10 years in MPTA ≤ 95° knees (86.8 ± 9.6 and 90.4 ± 13.1) were not significantly different from those in MPTA > 95° knees (85.8 ± 11.5 and 86.9 ± 14.2). The rate of clinical deterioration in knee and function scores was not significantly different between MPTA ≤ 95° knees (26% and 26%) and MPTA > 95° knees (21% and 36%). No significant differences were found between the MPTA ≤ 95° and MPTA > 95° groups in the cartilage status of all compartments at both first-look and second-look (postoperative 21 months) arthroscopies. CONCLUSIONS: Increased MPTA > 95° after OWHTO is not associated with deterioration of minimum 10-year clinical outcomes.

DOI： 10.1007/s00402-024-05696-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: This study aimed to investigate the expression of vascular endothelial growth factor (VEGF) in cruciate ligaments from patients with osteoarthritis (OA). It was hypothesized that the expression level of VEGF is associated with the extent of degeneration of the cruciate ligaments. METHODS: Remnants of anterior cruciate ligaments (ACLs) from patients with acute ACL injury due to trauma, and ACLs and posterior cruciate ligaments (PCLs) from patients with primary OA were assessed histologically. Samples were immunohistochemically stained with VEGF and tenomodulin, and immunopositive cells were quantitatively assessed by the histological grades of ligament degeneration. RESULTS: Histological analysis showed significant degeneration of the ACLs from OA patients compared with trauma patients, with increased expression of VEGF correlating with higher grades of degeneration. Conversely, tenomodulin expression was lower in more degenerated cruciate ligaments. The percentage of VEGF-positive cells was correlated inversely with that of tenomodulin-positive cells. CONCLUSIONS: Increased VEGF expression is associated with degeneration of cruciate ligaments in patients with osteoarthritis of the knee.

DOI： 10.1186/s12891-024-07886-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Polymerase chain reaction (PCR)-based genetic diagnosis is a rapid and sensitive method to diagnose periprosthetic joint infection (PJI). DNA extraction using bead beating is an effective method for collecting bacterial genes in Gram-positive bacteria. We compared the detection accuracy between the conventional and bead-beating DNA extraction assay. The detection rate improved from 86.7% using the conventional method to 95.6% using the bead-beating. Our results suggest that bead-beating during DNA extraction can improve the accuracy of PCR-based genetic diagnosis of PJI.

DOI： 10.1002/jor.25871

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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

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: It is known that preoperative Prognostic Nutritional Index (PNI) is useful in predicting prognosis in gastrointestinal diseases and that preoperative improvement of nutritional status improves prognosis. However, there have been few large-scale reports examining the prognostic value of PNI in soft tissue sarcomas. Therefore, the aim of this study is to investigate whether the PNI can be useful for predicting overall survival in soft tissue sarcoma. METHODS: Between January 2006 and March 2022 at our hospital, 111 patients with pathologically diagnosed soft tissue sarcoma were included, retrospectively. Several nutritional or inflammatory biomarkers such as PNI were calculated from the pretreatment blood sample results. The patients were classified into two groups (low and high groups) based on the median value of each parameter. Overall survival was analyzed by the Kaplan‒Meier method and log-rank test. Univariate and multivariate analyses using the Cox proportional hazards model were used to investigate prognostic factors for overall survival. RESULTS: The median overall survival was 24.3 months (mean 37.3 months), and the high PNI group had a significantly longer overall survival than the low PNI group (p < 0.0001). PNI was the most significant univariate factor for overall survival among other nutritional and inflammatory parameters (HR: 5.64, 95% CI: 2.26-14.12, p = 0.0002). The multivariate proportional hazards model was built using variables with prognostic potential as suggested by previous analysis with respect to patient characteristics and PNI. As potential confounding factors, we included PNI, stage, age, and tumor location. PNI was also an independent prognostic factor in multivariate analysis (HR: 7.02, CI: 2.52-19.40, p = 0.0002). CONCLUSION: PNI is a useful prognostic factor among various parameters for overall survival in patients with soft tissue sarcoma.

DOI： 10.1016/j.jos.2024.08.005

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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）  

PURPOSE: Since 2011, we have used computed tomography (CT)-based navigation to perform safe and accurate rotational acetabular osteotomy (RAO) for treating developmental dysplasia of the hip. We developed a new method with four fiducial points to improve the accuracy of a published technique. In this study, we introduced a new method to achieve reorientation in accordance with planning and evaluated its accuracy. METHODS: This study included 40 joints, which underwent RAO used CT-based navigation. In 20 joints, reorientation was confirmed by touching the lateral aspect of the rotated fragment with navigation and checking whether it matched the preoperative plan. A new fiducial point method was adopted for the remaining 20 joints. To assess the accuracy of the position of the rotated fragment in each group, postoperative radial reformatted CT images were obtained around the acetabulum and three-dimensional evaluation was performed. The accuracy of acetabular fragment repositioning was evaluated using the acetabular sector angle (ASA). RESULTS: The absolute value of ΔASA, which represents the error between preoperative planning and the actual postoperative position, was significantly smaller in the new fiducial method group than the previous method group in the area from 11:30 to 13:30 (p < 0.05). The Harris Hip Score at 1 year after surgery did not differ significantly between the previous and new fiducial point methods. CONCLUSION: The new fiducial point method significantly reduced reorientation error in the superior-lateral area of the acetabulum: significantly fewer errors and fewer cases of under-correction of lateral acetabular coverage were recorded. The four-reference fiducial method facilitates reorientation of the acetabulum as planned, with fewer errors. The effect of the improved accuracy of the fiducial point method on clinical outcomes will be investigated in the future work.

DOI： 10.1007/s11548-024-03210-2

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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

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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)日本骨折治療学会  

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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：(一社)日本小児整形外科学会  

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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）  

AIMS: This study was designed to develop a model for predicting bone mineral density (BMD) loss of the femur after total hip arthroplasty (THA) using artificial intelligence (AI), and to identify factors that influence the prediction. Additionally, we virtually examined the efficacy of administration of bisphosphonate for cases with severe BMD loss based on the predictive model. METHODS: The study included 538 joints that underwent primary THA. The patients were divided into groups using unsupervised time series clustering for five-year BMD loss of Gruen zone 7 postoperatively, and a machine-learning model to predict the BMD loss was developed. Additionally, the predictor for BMD loss was extracted using SHapley Additive exPlanations (SHAP). The patient-specific efficacy of bisphosphonate, which is the most important categorical predictor for BMD loss, was examined by calculating the change in predictive probability when hypothetically switching between the inclusion and exclusion of bisphosphonate. RESULTS: Time series clustering allowed us to divide the patients into two groups, and the predictive factors were identified including patient- and operation-related factors. The area under the receiver operating characteristic (ROC) curve (AUC) for the BMD loss prediction averaged 0.734. Virtual administration of bisphosphonate showed on average 14% efficacy in preventing BMD loss of zone 7. Additionally, stem types and preoperative triglyceride (TG), creatinine (Cr), estimated glomerular filtration rate (eGFR), and creatine kinase (CK) showed significant association with the estimated patient-specific efficacy of bisphosphonate. CONCLUSION: Periprosthetic BMD loss after THA is predictable based on patient- and operation-related factors, and optimal prescription of bisphosphonate based on the prediction may prevent BMD loss.

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

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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

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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

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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：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：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：(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：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：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

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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：日本語   出版者・発行元：日本リウマチ学会-関東支部  

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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

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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）  

Knee arthroscopy is a minimally invasive surgical technique that allows surgeons to diagnose and treat various knee conditions using much smaller incisions than open surgery. However, it is difficult to fully visualize the posterior compartment of the knee joint using the usual anterior portal approach because of blind spots. The transseptal portal technique enables surgeons to visualize the surgical field and access instruments in the posterior compartment of the knee during arthroscopic surgery. However, creation of the posterior transseptal portal increases the risk of neurovascular injury. Particular attention should be paid to avoid damaging the saphenous nerve, common peroneal nerve, popliteal artery, and tibial nerve. Here, we describe an ultrasonography-guided surgical method for creating the posterior transseptal portal by confirming the surrounding anatomy.

DOI： 10.1016/j.eats.2023.07.001

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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：(一社)日本骨粗鬆症学会  

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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：(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：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：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

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

Ultrasound-assisted surgery is becoming an established tool in the medical field. The addition of imagery to ultrasound-assisted surgery may enable one to perform a procedure in a safer and more accurate manner. This can be achieved through fusion imaging (fusion), a technology that synchronizes MRI or CT images with ultrasound images. We describe intraoperative CT-ultrasound fusion-guided (or -assisted) hip endoscopy for the removal of an impinging poly L-lactic acid screw, which was difficult to identify on fluoroscopy during surgery. The fusion technology enables merging two advantages of ultrasound: the real-time guidance capabilities and CT or MRI and the bird's eye view that makes minimally invasive arthroscopic and endoscopic surgery less invasive, precise, and safe.

DOI： 10.1016/j.eats.2023.02.009

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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

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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

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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）  

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

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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

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Planning a three-dimensional (3D) osteotomy using computed tomography (CT) data is useful especially in cases with complex deformities. Furthermore, CT-based navigation system allows the preoperative virtual planning to be replicated in actual surgery. However, one disadvantage when using navigation systems is that when osteotomies are performed on tracker-attached bone, the bone fragments on the side that were cut away cannot be tracked. This is especially problematic when performing multiple osteotomies on bones with complex deformities. We solved this problem by creating a 3D printed bone model that can be referenced intraoperatively and used in combination with the navigation system. We applied these techniques to perform segmental corrective osteotomy for a complex tibial deformity with intramedullary nail (IMN) fixation case of hereditary vitamin D-resistant hypophosphatemic rickets (HVDRR) in an adult man. Due to the patient's history of multiple surgeries, the affected tibia had a narrow and partially closed medullary canal. Therefore, we planned to use an IMN for correction and fixation of tibial deformity to protect the thin and stretched skin around the deformed tibia. With the assistance of CT-based navigation, we could perform an accurate three-dimensional tibial osteotomy. Moreover, we could perform accurate preparation of closed medullary canal for the IMN placement by referring to the 3D printed bone models. Six months after the operation, the bone union at the osteotomy sites was confirmed and the patient was able to return to his normal life and work.

DOI： 10.1080/24699322.2022.2086485

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BackgroundThe active surveillance (AS) has been suggested for the initial treatment of extra-abdominal desmoid fibromatosis (EADF), the percentage of patients who shifted to invasive secondary treatments was significant. Tranilast, an anti-keloid medication, is frequently used in Japan, but there is no detailed report on its efficacy.MethodsWe retrospectively analyzed the medical records of EADF patients treated with tranilast between January 2009 and March 2021. Since EADF has been reported to shrink spontaneously, the effects of all drugs should be compared to AS. Therefore, we compared its clinical course with that under AS (determined by a systematic review) to assess the effect of tranilast. A systematic literature review of AS outcomes was conducted on July 22, 2021, according to PRISMA guidelines. The primary endpoint was the rate of conversion to secondary treatment. Secondary endpoints were progression-free survival, objective response rate (ORR), disease control rate (DCR), and adverse events. The rates of conversion to secondary treatment, ORRs, and DCRs were compared between the two groups using the Fisher's exact test.ResultsEighteen patients who received tranilast as the initial treatment for EADF were included. Two patients (11.1%) underwent surgical resection due to tumor growth and continuous pain. Compared to the secondary treatment conversion rate from the pure AS approach (40.1%), tranilast was shown to significantly reduce the rate (p = 0.01). The ORR and DCR did not different between the two groups.ConclusionsAs initial treatment for EADF, tranilast is preferred over AS.

DOI： 10.1272/jnms.JNMS.2023_90-113

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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

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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

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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）  

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

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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 Science and Business Media LLC  

BACKGROUND: The severity of bone mineral density (BMD) loss after total hip arthroplasty (THA) depends on both implant- and patient-related factors. While implant fixation type is an important factor, but few studies have considered the effect of material composition on the same implant fixation type. In particular, differences in mechanical stiffness due to material composition are of great interest. Here, we compared changes in periprosthetic BMD after THA using proximal fixation concept stems comprising different titanium alloys, i.e., β titanium alloys stem and α + β titanium alloys stem. METHODS: This retrospective cohort included 122 patients (β titanium alloys stem, 61 cases; α + β titanium alloys stem, 61 cases) who underwent primary THA between January 2009 and December 2019. The primary outcome was the change in periprosthetic BMD from base line. Age, body mass index, diagnosis, stem size, canal flare index, surgical approach, pre-operative lumbar BMD, and pre-operative activity scores were reviewed and changes in periprosthetic BMD between the two groups were compared using analysis of covariance. The secondary outcome was radiographic response after THA. RESULTS: There was significant difference in periprosthetic BMD in zone 6 and 7 at 2 years (p < 0.05) between the two groups. There was no significant difference in other zones. A significant difference in radiographic response was noted only for the Engh classification. CONCLUSION: α + β titanium alloys stem resulted in a significantly higher rate of BMD loss in zones 6 and 7 compared with the β titanium alloys stem. These results may be due to differences in mechanical stiffness due to the different titanium alloy composition of the prosthetics.

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）   出版者・発行元：Oxford University Press (OUP)  

ABSTRACT

Objectives

To evaluate joint orientation angles of the coronal plane in patients with rheumatoid arthritis (RA) in comparison with osteoarthritis (OA).

Methods

In total, 72 patients with RA (90 knees) and 76 patients with OA (90 knees) who underwent total knee arthroplasty were enrolled. The hip–knee–ankle (HKA) angle, mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and joint line convergence angle (JLCA) were measured on preoperative long-leg radiographs in the standing position. Student’s t-test was used to assess differences in radiographic data between patients with RA and OA.

Results

In knees with RA and OA, the mean HKA was −3.4 ± 9.4° and −10.6 ± 8.0°, the mean mLDFA was 86.6 ± 3.7° and 88.2 ± 2.7°, the mean mMPTA was 85.9 ± 4.0° and 84.3 ± 3.7°, and the mean JLCA was 2.7 ± 4.2° and 6.8 ± 4.1°. All parameters in the knees with RA were more valgus than those with OA.

Conclusions

Knees with RA had a great variability in joint orientation angles on the coronal plane; the whole lower limb alignment and the femur, tibia, and joint were more valgus in knees with RA than with OA.

DOI： 10.1093/mr/roab046

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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）  

DOI： 10.1016/j.jos.2022.05.014

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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 BV  

PURPOSE: Spontaneous osteonecrosis of the knee (SONK) causes acute atraumatic knee pain, and meniscus tears may be associated with the pathogenesis of SONK. The purpose of this study was to investigate the relationship of the type of meniscus tear and medial meniscus extrusion with SONK on the medial femoral condyle in patients who underwent surgical treatment with high tibial osteotomy due to severe knee pain. METHODS: We enrolled 98 patients with 102 knees who underwent medial opening wedge high tibial osteotomy (OWHTO) under the diagnosis of medial femoral condyle osteonecrosis at our hospital from December 2003 to January 2020. Based on the Koshino classification, cases of SONK were classified as stage 1-4. The relationships of demographic data, X-rays and MRI images, including femorotibial angle (FTA), meniscus tear type, and medial meniscus extrusion (MME), with the stage and volume of SONK were investigated. RESULTS: Ninety-eight patients (29 males and 69 females), with an average age at surgery of 69.2 ± 9.6 years and Body mass index(BMI) of 61.0 ± 17.6 kg/m2. In 102 cases of SONK, 11 knees, 18 knees, 46 knees, and 27 knees were classified as stage 1-4, respectively. The mean SONK volume was 2161.61 µm (range 95.67-7484.68 µm) on preoperative MRI. The preoperative FTA (mean 180.86°, range 172-187°) was not associated with the stage or volume of SONK. Meniscus tears were found in all cases of SONK and consisted of 2 degenerations, 2 horizontal tears, 0 vertical tears, 40 radial tears, 4 complex tears, and 54 medial meniscus posterior root tears (MMPRTs). In addition, 99% (101/102) of knees showed more than 3 mm of meniscus extrusion. Although the meniscus tear type was not associated with SONK stage, there was a high rate of tears that caused disruption of the hoop strain, such as MMPRTs (52.9%) or radial tears (39.2%). MME was significantly related to SONK volume (r = 0.387, p < 0.001). CONCLUSION: All patients with SONK had coexisting meniscus tears, most menisci had medial extrusion, and a positive correlation was observed between MME and SONK volume.

DOI： 10.1016/j.knee.2022.04.011

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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: Venous thromboembolism (VTE) is a major complication in patients with malignant tumors and orthopedic disorders. Although it is known that patients undergoing surgery for malignant musculoskeletal tumor are at an increased risk of thromboembolic events, only few studies have investigated this risk in detail. Therefore, the aim of this study was to determine the prevalence and risk factors for preoperative VTE in malignant musculoskeletal tumors patients. METHODS: We retrospectively reviewed the medical records of 270 patients who underwent surgical procedures, including biopsy for malignant musculoskeletal tumor, have undergone measurements of preoperative D-dimer levels, and were subsequently screened for VTE by lower extremity venous ultrasonography and/or contrast-enhanced computed tomography scans. Statistical analyses were performed to examine the prevalence and risk factors for VTE. Receiver operating characteristic (ROC) analysis was performed to verify the D-dimer cutoff value for the diagnosis of VTE. RESULTS: Overall, 199 patients (103 with primary soft tissue sarcomas, 38 with primary bone sarcomas, 46 with metastatic tumors, and 12 with hematologic malignancies) were included. D-dimer levels were high in 79 patients; VTE was detected in 19 patients (9.5%). Multivariate analysis indicated that age ≥ 60 years (P = 0.021) and tumor location in the lower limbs (P = 0.048) were independent risk factors for VTE. ROC analysis showed that the D-dimer cutoff value for the diagnosis of VTE was 1.53 µg/mL; the sensitivity and specificity were 89.5% and 79.4%, respectively. CONCLUSIONS: Our study indicated that age and tumor location in the lower limbs were independent risk factors for preoperative VTE in malignant musculoskeletal tumors patients. D-dimer levels were not associated with VTE in the multivariate analysis, likely because they are affected by a wide variety of conditions, such as malignancy and aging. D-dimer is useful for exclusion diagnosis because of its high sensitivity, but patients with high age and tumor location in the lower limbs are a high-risk group and should be considered for imaging evaluation such as ultrasonography regardless of D-dimer levels. TRIAL REGISTRATION: Our study was approved by the institutional review board. The registration number is B200600056 . The registration date was July 13, 2020.

DOI： 10.1186/s12959-022-00382-2

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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：日本語   出版者・発行元：(株)南江堂  

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2022&ichushi_jid=J04037&link_issn=&doc_id=20220509600015&doc_link_id=10.15106%2Fj_besei81_75&url=https%3A%2F%2Fdoi.org%2F10.15106%2Fj_besei81_75&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：American Society for Microbiology  

Bacterial infections routinely cause inflammation and thereby impair osseointegration of orthopedic implants. Acinetobacter spp., which cause osteomyelitis following trauma, on or off the battlefield, were, however, reported to cause neither osteomyelitis nor osteolysis in rodents. We therefore compared the effects of Acinetobacter strain M2 to those of Staphylococcus aureus in a murine implant infection model. Sterile implants and implants with adherent bacteria were inserted in the femur of mice. Bacterial burden, levels of proinflammatory cytokines, and osseointegration were measured. All infections were localized to the implant site. Infection with either S. aureus or Acinetobacter strain M2 increased the levels of proinflammatory cytokines and the chemokine CCL2 in the surrounding femurs, inhibited bone formation around the implant, and caused loss of the surrounding cortical bone, leading to decreases in both histomorphometric and biomechanical measures of osseointegration. Genetic deletion of TLR2 and TLR4 from the mice partially reduced the effects of Acinetobacter strain M2 on osseointegration but did not alter the effects of S. aureus. This is the first report that Acinetobacter spp. impair osseointegration of orthopedic implants in mice, and the murine model developed for this study will be useful for future efforts to clarify the mechanism of implant failure due to Acinetobacter spp. and to assess novel diagnostic tools or therapeutic agents.

DOI： 10.1128/iai.00669-21

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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

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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：(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：英語   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

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 BV  

BACKGROUND: Total hip arthroplasty decreases hip pain and often reduces knee pain in patients with hip osteoarthritis. Whole-body alignment may be associated with knee pain, but to our knowledge this relationship has not been previously investigated. The purpose of this study was to investigate the effect of changes in whole-body alignment on ipsilateral knee pain in patients after total hip arthroplasty. METHODS: In total, 94 patients with unilateral hip osteoarthritis who underwent total hip arthroplasty were enrolled in this study. A visual analog scale (VAS) was used to investigate perioperative knee pain. An EOS 2D/3D X-ray system was used to quantify the whole-body alignment of the spine, pelvis, and lower extremities in the standing position. The relationship between perioperative changes in knee pain and whole-body alignment was investigated. RESULTS: Among 61 patients who had preoperative ipsilateral knee pain, pain resolved in 30 (50%) and persisted in 31 (50%) after surgery. In these patients, average ipsilateral knee pain decreased significantly after surgery, from 41 mm to 14 mm on the VAS (P < 0.01). Preoperative knee pain was correlated with femorotibial rotation, and postoperative knee pain was correlated with K-L grade, preoperative knee pain visualized analog scale, and preoperative sagittal vertical axis. Multiple linear regression identified preoperative sagittal vertical axis as significantly associated with residual postoperative ipsilateral knee pain. CONCLUSIONS: Ipsilateral knee pain decreased in half of patients after total hip arthroplasty. Patients with a considerable forward-bent posture may have residual ipsilateral knee pain after total hip arthroplasty.

DOI： 10.1016/j.jos.2021.12.006

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Serum tartrate-resistant acid phosphatase 5b is well known to be increased in giant cell tumors of bone. However, there are only a few studies that analyzed the association with tartrate-resistant acid phosphatase 5b expression in those patients. Therefore, we analyzed the characteristics of patients with giant cell tumors of bone and high tartrate-resistant acid phosphatase 5b expression. METHODS: This retrospective study included 26 patients with giant cell tumors of bone. The correlation between tartrate-resistant acid phosphatase 5b before initial treatment and tumor volume was evaluated. Patients were divided into two groups according to tartrate-resistant acid phosphatase 5b level. Statistical analysis was performed between the two groups. RESULTS: Tartrate-resistant acid phosphatase 5b was elevated in 17/26 patients, and the mean value was 852 mU/dL. There was no correlation with tumor volume (r = 0.034, P = 0.86). The mean age of 34.5 years in the HT group was significantly younger than the mean age of 47.4 years in the LT group (P = 0.040). Pathologically, 19/26 cases showed at least one focal area with features of typical giant cell tumor of bone. Although 11/18 patients in the LT group exhibited relatively noticeable secondary changes, all patients in the HT group exhibited typical features (P = 0.0074). CONCLUSIONS: Tartrate-resistant acid phosphatase 5b levels were not elevated in some giant cell tumors of bone. This study suggested that tartrate-resistant acid phosphatase 5b may be elevated in younger patients and in cases with fewer pathological secondary changes, regardless of tumor volume.

DOI： 10.1272/jnms.JNMS.2022_89-611

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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： 10.1186/s43019-021-00100-8

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その他リンク： https://link.springer.com/article/10.1186/s43019-021-00100-8/fulltext.html

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：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：(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：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：(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）  

OBJECTIVE: Although anterior compression factors and cervical alignment affect neural decompression, cervical laminoplasty may be used to achieve indirect posterior decompression. The focal apex (FA) angle of the anterior compression factor of the spine represents the degree of anterior prominence toward the spinal cord. The authors investigated the mechanism underlying the influence of FA angle and cervical alignment on spinal cord alignment (SCA) after laminoplasty, including how high-intensity signal cord change (HISCC) on preoperative T2-weighted MRI (T2-MRI) may affect neurological improvement. METHODS: We performed a retrospective study of patients who underwent laminoplasty for CSM or OPLL at two hospitals (Kanto Rosai Hospital, Kawasaki City, and Yokohama Minami Kyousai Hospital, Yokohama City, Japan) between April 2004 and March 2015. In total, 109 patients (mean age 67.3 years) with cervical compression myelopathy were included. FA angle was defined as the preoperative angle between the lines from the top of the prominence to the upper and lower adjacent vertebrae. Preoperative cervical alignment was measured between the C2 and C7 vertebrae (C2-7 angle). MRI was used to classify SCA as lordosis (type-L SCA), straight (type-S), local kyphosis (type-LK), or kyphosis (type-K). Preoperative HISCC was investigated by using T2-MRI. Neurological status was evaluated by using the Japanese Orthopaedic Association score. RESULTS: The mean preoperative FA and C2-7 angles were 32.1° and 12.4°, respectively. Preoperative SCA was type-L or type-S in 53 patients. The neurological recovery rate (NRR) was significantly higher for patients with preoperative type-L and type-S SCA (51.4% for those with type-L and 45.0% for those with type-S) than for patients with other types (35.3% for those with type-LK and 31.7% for those with type-K). Among patients with preoperative type-L or type-S SCA, 87.3% maintained SCA; however, 5/12 (41.7%) patients with a preoperative average C2-7 angle < 12.4° and an average FA angle > 32.1° had postoperative type-LK or type-K SCA. SCA changed to type-L or type-S in 13.0% of patients with preoperative type-LK or type-K SCA. Moreover, in these patients, FA angle was significantly smaller and NRR was significantly higher than in other patients in whom postoperative SCA remained type-LK or type-K. Preoperative T2-MRI showed 73 patients with HISCC (43 with type-L and type-S, and 30 with type-LK and type-K SCA) and 36 without HISCC (20 with type-L and type-S, and 16 with type-LK and type-K SCA); the NRRs of these patients were 42.6% and 41.2%, respectively. No significant differences in SCA or NRR were observed between patients with and without HISCC. CONCLUSIONS: NRR depends on preoperative SCA type; however, it is possible to change the type of SCA after laminoplasty. Preoperative FA and C2-7 angles influence change in SCA; therefore, they are important parameters for successful decompression with cervical laminoplasty.

DOI： 10.3171/2020.12.SPINE201831

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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）  

OBJECTIVE: In this study, we aimed to elucidate the relationship between the duration from diagnosis to femoral head collapse and the collapse rate among patients with pre-collapse osteonecrosis of the femoral head (ONFH). METHODS: In this retrospective, observational, multicenter study, we analyzed 268 patients diagnosed with ONFH and classified them using the Japanese Investigation Committee classification. The primary endpoint was duration from the time of diagnosis to femoral head collapse for each type of ONFH. RESULTS: The 12-, 24-, and 36-month collapse rates among participants were 0%, 0%, and 0% for type A, respectively; 0%, 2.0%, and 10.8% for type B, respectively; 25.5%, 40.8%, and 48.5% for type C-1, respectively; and 57.4%, 70.3%, and 76.7% for type C-2 ONFH, respectively. A comparison of unilateral and bilateral ONFH, using Kaplan-Meier survival curves demonstrated similar collapse rates. CONCLUSIONS: The lowest collapse rate was observed for ONFH type A, followed by types B, C-1, and C-2. Additionally, a direct association was observed between the collapse rate and location of the osteonecrotic lesion on the weight-bearing surface.

DOI： 10.1177/03000605211023336

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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: 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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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  

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

PubMed

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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: 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：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）  

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：(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：(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：(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：東日本整形災害外科学会  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J03098&link_issn=&doc_id=20210421550005&doc_link_id=10.24645%2Fjejot.33.1_28&url=https%3A%2F%2Fdoi.org%2F10.24645%2Fjejot.33.1_28&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

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：(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）  

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

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1002/JOR.24683

Web of Science

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1002/JOR.24616

Web of Science

PubMed

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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・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）  

Objective: This study evaluated the effect of surgical intervention on disease activity and factors associated with postoperative disease activity in patients with rheumatoid arthritis (RA).Methods: One hundred and seventy-five patients with RA who underwent a single orthopaedic surgical procedure with 1 year of follow-up were retrospectively reviewed to assess postoperative changes in disease activity using disease activity score in 28 Joints calculated with C-reactive protein (DAS28-CRP). European League against Rheumatology (EULAR) response criteria were used to assess the response to surgical intervention.Results: Overall disease activity was significantly improved after surgery. Therapeutic regimens including biological/targeted-synthetic (b/ts) disease-modifying anti-rheumatic drugs (DMARDs), methotrexate (MTX), and prednisolone (PSL) were not significantly changed 1 year after surgery. Shorter disease duration, surgery of large joints, higher baseline DAS28-CRP, and no use of b/tsDMARDs affected postoperative improvement of disease activity. Multivariate logistic regression analysis revealed that large joint surgery and no preoperative use of b/tsDMARDs were independent factors leading to good response to EULAR criteria after surgery (OR = 2.70; 95% CI, 1.03-7.06; p < .05, OR = 4.09; 95% CI, 1.50-11.14; p < .01, respectively).Conclusion: Significant improvement of disease activity after surgical intervention may be expected in patients with RA with large joint surgeries or no preoperative use of b/tsDMARDs.

DOI： 10.1080/14397595.2019.1702252

PubMed

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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

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：(一社)日本骨粗鬆症学会  

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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：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

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)日本リウマチ学会  

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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：(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  

2013年4月〜2018年3月に寛骨臼形成不全症に対してnavigation支援下寛骨臼回転骨切り術(RAO)を行った女性患者20例(平均年齢38.5歳)を対象に、OSSによるvolume registration法を用いて術前後のCT画像を比較し、三次元的画像解析を行った。放射状再構成断面画像で測定したAcetabular Sector Angle(ASA)を測定平面毎にプロットしたスパイダーチャートからは、術前と比べて術後のASAが大きく、被覆が改善していることが判った。荷重部にあたる9時から3時までの範囲のうち、12時から1時半の位置でのASAは、計画よりも実際の術後寛骨臼で有意に小さく、特に骨頭の上前方にあたる1時および1時半方向では計画と実際の術後ASAの差が大きかった。また、寛骨臼後方よりも前方でASAのデータのばらつきが大きい傾向であった。

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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：(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：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：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：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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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：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：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：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：(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：(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：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

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

DOI： 10.21203/rs.3.rs-17538/v1

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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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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J03098&link_issn=&doc_id=20200703260033&doc_link_id=%2Fdx3eastj%2F2020%2F003201%2F034%2F0167-0172%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdx3eastj%2F2020%2F003201%2F034%2F0167-0172%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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：金原出版(株)  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00767&link_issn=&doc_id=20200313080007&doc_link_id=10.18888%2Fse.0000001207&url=https%3A%2F%2Fdoi.org%2F10.18888%2Fse.0000001207&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：日本語   出版者・発行元：金原出版(株)  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00767&link_issn=&doc_id=20200313080008&doc_link_id=10.18888%2Fse.0000001208&url=https%3A%2F%2Fdoi.org%2F10.18888%2Fse.0000001208&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：日本語   出版者・発行元：日本CAOS研究会・日本最小侵襲整形外科学会  

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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：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 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.

</sec>

DOI： 10.1177/2309499020934201

PubMed

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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）   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

PubMed

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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）  

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：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：神奈川県医師会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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：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：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：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：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1177/2309499019868929

Web of Science

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：(一社)日本骨粗鬆症学会  

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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：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：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：日本運動器科学会  

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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  

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：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/J.ARTH.2018.09.025

Web of Science

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1002/JOR.24229

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PubMed

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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

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.arthro.2018.03.036

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：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/s12891-018-2110-y

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.arthro.2017.10.055

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.eats.2017.10.013

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：Springer London  

DOI： 10.1007/s00198-018-4494-9

Scopus

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掲載種別：研究論文（学術雑誌）  

Web of Science

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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

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1080/14397595.2017.1295825

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/s12891-017-1778-8

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：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/s12969-017-0183-z

PubMed

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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

PubMed

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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

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.arthro.2016.08.018

PubMed

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掲載種別：研究論文（学術雑誌）  

Web of Science

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1136/ANNRHEUMDIS-2017-EULAR.2416

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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：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：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：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：LIPPINCOTT WILLIAMS & WILKINS  

Orthopaedic infections are complex conditions that require immediate diagnosis and accurate identification of the causative organisms to facilitate appropriate management. Conventional methodologies for diagnosis of these infections sometimes lack accuracy or sufficient rapidity. Molecular diagnostics is an emerging area of bench-to-bedside research in orthopaedic infections. Examples of promising molecular diagnostics include measurement of a specific biomarker in the synovial fluid, polymerase chain reaction-based detection of bacterial genes, and metabolomic determination of responses to orthopaedic infection.

DOI： 10.5435/JAAOS-D-14-00409

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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  

Orthopaedic infections are complex conditions that require immediate diagnosis and accurate identification of the causative organisms to facilitate appropriate management. Conventional methodologies for diagnosis of these infections sometimes lack accuracy or sufficient rapidity. Molecular diagnostics is an emerging area of bench-to-bedside research in orthopaedic infections. Examples of promising molecular diagnostics include measurement of a specific biomarker in the synovial fluid, polymerase chain reaction-based detection of bacterial genes, and metabolomic determination of responses to orthopaedic infection.

DOI： 10.5435/JAAOS-D-14-00409

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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：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：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. 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）  

DOI： 10.1007/S11999-015-4301-2

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記述言語：英語  

DOI： 10.3899/jrheum.130924.C1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3899/jrheum.130924

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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：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）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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）  

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：W B SAUNDERS CO-ELSEVIER INC  

Pyoderma gangrenosum (PG) is a rare, noninfectious, neurotrophic dermatosis. We observed a case of PG mimicking cutaneous and osteoarticular infections that presented with a prolonged ulcer on the forearm, severe wrist pain, anemia, substantial local and systemic inflammation as evaluated by serum laboratory data, and carpal osteolysis. Although PG rarely damages joints, the ulcer extended to the joint and destroyed the osteochondral tissues. Advanced ulcerative colitis, which is a most common comorbidity of PG, proved to be an underlying disease. Antibiotic and surgical treatment did not heal the ulcer, which was successfully treated with corticosteroids. This intractable ulcer is often misdiagnosed. Hence when a patient presents with an enlarged, painful, unusual skin lesion, PG should always be considered. (J Hand Surg 2013;38A:357-361. Copyright (C) 2013 by the American Society for Surgery of the Hand. All rights reserved.)

DOI： 10.1016/j.jhsa.2012.10.049

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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-ELSEVIER INC  

Pyoderma gangrenosum (PG) is a rare, noninfectious, neurotrophic dermatosis. We observed a case of PG mimicking cutaneous and osteoarticular infections that presented with a prolonged ulcer on the forearm, severe wrist pain, anemia, substantial local and systemic inflammation as evaluated by serum laboratory data, and carpal osteolysis. Although PG rarely damages joints, the ulcer extended to the joint and destroyed the osteochondral tissues. Advanced ulcerative colitis, which is a most common comorbidity of PG, proved to be an underlying disease. Antibiotic and surgical treatment did not heal the ulcer, which was successfully treated with corticosteroids. This intractable ulcer is often misdiagnosed. Hence when a patient presents with an enlarged, painful, unusual skin lesion, PG should always be considered. (J Hand Surg 2013;38A:357-361. Copyright (C) 2013 by the American Society for Surgery of the Hand. All rights reserved.)

DOI： 10.1016/j.jhsa.2012.10.049

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掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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）  

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）  

DOI： 10.3109/17453674.2011.652886

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00776-011-0153-0

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