Publications by authors named "Hiroaki Nakamura"

595 Publications

Correction to: An analysis of tumor-related skin temperature differences in malignant soft-tissue tumors.

Int J Clin Oncol 2021 Oct 17. Epub 2021 Oct 17.

Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-ku, Osaka, 545-8585, Japan.

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http://dx.doi.org/10.1007/s10147-021-02055-yDOI Listing
October 2021

Evaluation of regenerated cartilage using T2 mapping methods after opening-wedge high tibial osteotomy with microfracture at the cartilage defect: a preliminary study.

J Exp Orthop 2021 Oct 16;8(1):91. Epub 2021 Oct 16.

Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.

Purpose: This study evaluated the regenerated cartilage after opening-wedge high tibial osteotomy (OWHTO) with concomitant microfracture by second-look arthroscopy, Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score and magnetic resonance imaging (MRI) T2 mapping. It was hypothesised that cartilage regeneration can be achieved by HTO, but the quality of regenerated cartilage is not normal cartilage.

Methods: OWHTO was performed in eight knees of seven patients (mean age, 57.6 ± 5.2 years). Microfracture for the cartilage defect was performed followed by OWHTO, and second-look arthroscopy was performed at the time of plate removal (14.1 ± 4.5 months after OWHTO). MRI was assessed at three months and one year after surgery. The status of articular cartilage regeneration was assessed by the ICRS grade, MOCART score and T2 value.

Results: The number of subjects in ICRS grade 1/2/3/4 changed significantly from 0/0/4/4 preoperatively to 0/2/6/0 postoperatively in the medial femoral condyle (MFC) (P < 0.05) and 0/0/0/8 preoperatively to 0/0/7/1 postoperatively in the medial tibial plateau (MTP) (P < 0.05). Mean MOCART scores for MFC and MTP at one year after surgery exhibited significant increases compared with the results at three months after surgery. Mean T2 values for MFC and MTP did not differ at three months and one year after surgery.

Conclusion: The appearance and morphological evaluation by ICRS grade and MOCART score of regenerated cartilage were improved after OWHTO with concomitant microfracture. However, there were no significant qualitative differences in T2 values. This suggests that the regenerated cartilage tissue was likely to be insufficient cartilage.

Level Of Evidence: Level IV, therapeutic case series.
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http://dx.doi.org/10.1186/s40634-021-00413-3DOI Listing
October 2021

Prognostic value of psoas major muscle density in patients with breast cancer metastases to bone: a retrospective single-center cohort study.

Jpn J Clin Oncol 2021 Oct 13. Epub 2021 Oct 13.

Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.

Objective: Although sarcopenia is associated with poor prognosis for cancer patients, the relationship between muscle quantity and quality, and prognosis of breast cancer patients with bone metastases is unclear. This study aims to evaluate the association of muscle parameters, muscle area and density, and overall survival (OS) from the diagnosis of bone metastases in breast cancer patients with bone metastases.

Methods: This study retrospectively investigated the prognostic value of muscle area and density in 90 women who were diagnosed with breast cancer with bone metastases between September 2005 and June 2018. We measured psoas major muscle and paravertebral muscle area and density on single axial computed tomography images at the L3 level and subgrouped the patients into higher or lower groups for each muscle measurement, using median values as cutoffs. We evaluated associations between OS and muscle parameters, using a Cox proportional hazards model adjusted by age and prognostic score for bone metastases (modified Katagiri score).

Results: Median OS among patients with lower psoas major muscle density (25 months) was significantly shorter than in the higher psoas major muscle density group (61 months; hazard ratio: 1.79, 95% confidence interval: 1.01-3.16, P = 0.045). However, muscle area and paravertebral muscle density were not associated with OS in this setting.

Conclusion: Lower psoas major muscle density was a predictor of poor prognosis in patients with breast cancer metastases to bone. The association between psoas major muscle density and prognosis allows wider research into interventions that can prevent loss of muscle density.
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http://dx.doi.org/10.1093/jjco/hyab166DOI Listing
October 2021

In vivo study on the healing of bone defect treated with non-thermal atmospheric pressure gas discharge plasma.

PLoS One 2021 11;16(10):e0255861. Epub 2021 Oct 11.

Department of Orthopedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan.

Medical treatment using non-thermal atmospheric pressure plasma (NTAPP) is rapidly gaining recognition. NTAPP is thought to be a new therapeutic method because it could generate highly reactive species in an ambient atmosphere which could be exposed to biological targets (e.g., cells and tissues). If plasma-generated reactive species could stimulate bone regeneration, NTAPP can provide a new treatment opportunity in regenerative medicine. Here, we investigated the impact of NTAPP on bone regeneration using a large bone defect in New Zealand White rabbits and a simple atmospheric pressure plasma (helium microplasma jet). We observed the recovery progress of the large bone defects by X-ray imaging over eight weeks after surgery. The X-ray results showed a clear difference in the occupancy of the new bone of the large bone defect among groups with different plasma treatment times, whereas the new bone occupancy was not substantial in the untreated control group. According to the results of micro-computed tomography analysis at eight weeks, the most successful bone regeneration was achieved using a plasma treatment time of 10 min, wherein the new bone volume was 1.51 times larger than that in the plasma untreated control group. Using H&E and Masson trichrome stains, nucleated cells were uniformly observed, and no inclusion was confirmed, respectively, in the groups of plasma treatment. We concluded the critical large bone defect were filled with new bone. Overall, these results suggest that NTAPP is promising for fracture treatment.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0255861PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8504758PMC
October 2021

An analysis of tumor-related skin temperature differences in malignant soft-tissue tumors.

Int J Clin Oncol 2021 Oct 10. Epub 2021 Oct 10.

Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-ku, Osaka, 545-8585, Japan.

Background: Soft tissue tumors are often accompanied with elevated skin temperature; however, studies concerning the relationship between soft-tissue tumors and skin temperature elevation are scarce. We aimed to evaluate the clinical significance of skin temperature elevation in soft-tissue tumors and identify factors related to skin temperature elevation.

Patients And Methods: This study comprised 118 patients at our hospital with soft-tissue tumors, excluding lipomatous tumors, whose pathological diagnosis was surgically confirmed between February 2017 and March 2021. Sixty-one and 57 patients had been diagnosed with benign lesions and malignant tumors, respectively (men, 64; women, 54; median age, 61 [range, 20-92] years). The relationship between skin temperature, monitored using a thermography camera, and the presence of soft-tissue malignancy was investigated. We reviewed clinical data to identify factors related to elevated skin temperature.

Results: Temperature differences ≥ 0.2 °C compared to the unaffected side were significantly associated with the presence of malignant tumors (p < 0.001). Logistic regression analysis indicated that intertumoral blood supply was associated with elevated skin temperature (OR 3.22, 95% CI 2.03-5.13; p < 0.001).

Conclusions: Elevated skin temperature, influenced by intertumoral blood supply, may be an important adjunct to physical findings when diagnosing malignant soft-tissue tumors.

Clinical Relevance: Intertumoral blood supply influenced elevated skin temperature in malignant soft-tissue tumors. A skin temperature difference ≥ 0.2 °C compared to the unaffected side can help differentiate between benign and malignant tumors. Skin temperature differences may help in diagnosing malignant soft-tissue tumors.
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http://dx.doi.org/10.1007/s10147-021-02044-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8502238PMC
October 2021

Pathological fracture of a solitary bone cyst in the calcaneus: a case series and literature review.

Arch Orthop Trauma Surg 2021 Oct 8. Epub 2021 Oct 8.

Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-ku, Osaka, 545-8585, Japan.

Introduction: Solitary bone cysts in the calcaneus (calcaneal bone cysts) are often asymptomatic. Pathological fractures are rare, and few reports are available concerning its risk assessment. Therefore, the indication for operative interventions remains debatable, and further discussion on the treatment of symptomatic cysts and pathological fractures in calcaneal bone cysts is necessary.

Materials And Methods: Clinical data of 21 patients with calcaneal bone cysts (16 men and five women) was retrospectively reviewed. The average age was 13.3 (range, 7-23) years. Clinical data, such as concerning symptoms, radiological findings, pathological findings and outcomes, were investigated, and the pathogenesis of symptomatic cysts was studied.

Results: Thirteen cysts were symptomatic, and eight were incidentally discovered. Computed tomography revealed no fracture in 12 cases, microfracture in eight and complete fracture in one. The areas under the curves of the receiver operating characteristic curves calculated to establish an association between cyst size and symptoms and cyst size and pathological fractures (microfracture and complete fracture) were 0.78 and 0.71, respectively. Symptomatic cysts and pathological fractures were associated with the cyst ratio (cyst size/calcaneus ≥ 0.20). On magnetic resonance imaging (MRI), fluid levels were observed in 11 of 21 (52%) patients. At the time of surgery, blood from the haemorrhage was aspirated from 15 of 21 (71%) cysts.

Conclusions: Orthopaedic surgeons should be aware that the cyst ratio is associated with clinical symptoms and pathological fractures. MRI and gross findings revealed haemorrhage in the cystic fluid. In calcaneal bone cysts, repeated microfractures and spontaneous healing might occur.
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http://dx.doi.org/10.1007/s00402-021-04202-6DOI Listing
October 2021

Facet Joint Opening on Computed Tomography is a Predictor of Poor Clinical Outcomes After Minimally Invasive Decompression Surgery for Lumbar Spinal Stenosis.

Spine (Phila Pa 1976) 2021 Oct 5. Epub 2021 Oct 5.

Department of Orthopaedic Surgery, PL Hospital, Tondabayashi City, Osaka, Japan Department of Orthopaedic Surgery, Osaka City University, Osaka City, Osaka, Japan.

Study Design: Retrospective longitudinal cohort study.

Objective: To investigate the impact of facet joint opening (FJO) on clinical outcomes after minimally invasive decompression surgery for lumbar spinal stenosis.

Summary Of Background Data: Although FJOs have previously been identified as indicators of segmental spinal instability, their impact on clinical outcomes after decompression alone surgery has yet to be investigated.

Methods: This study included 296 patients from a single institution who underwent minimally invasive surgery for lumbar spinal stenosis and were followed up for ≥5 years. Our analysis focused on identifying FJOs at the index decompression level (d-FJO) and at multiple levels (m-FJO) (i.e., ≥3 levels within the lumbar segment) using preoperative computed tomography. Clinical outcomes including reoperations, improvement ratio for Japanese Orthopaedic Association (JOA) score, and achievement of a minimal clinically important difference (MCID) in visual analogue scale (VAS) scores for low back pain (LBP) or leg pain at 5 years were compared between patients with and without d-FJO or m-FJO.

Results: There were 129 (44%) and 62 (21%) patients with d-FJO (more common with lateral olisthesis) and m-FJO (less common with spondylolisthesis), respectively. Reoperations were more common in patients with d-FJO than in those without (16% vs. 5%). On Cox proportional hazards analysis, d-FJO was identified as a predictor for revision at the index decompression level [hazard ratio (HR) 4.04, p = 0.03], whereas m-FJO was a predictor for revision at other lumbar levels (HR 3.71, p = 0.03). Patients with m-FJO had slightly lower rates of achieving MCID in VAS scores for LBP (34% vs. 52%, p = 0.03) and poorer improvement ratio forJOA scores (74% vs. 80%, p = 0.03) than those without.

Conclusion: FJO at both index decompression level and multiple level were predictors of poor outcomes; patients with FJOs require careful surgical planning or special follow-up.Level of Evidence: 3.
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http://dx.doi.org/10.1097/BRS.0000000000004262DOI Listing
October 2021

Delayed aortic injury after thoracic corrective osteotomy: a case report.

Eur Spine J 2021 Oct 5. Epub 2021 Oct 5.

Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-Ku, Osaka, 545-8585, Japan.

Purpose: To present a case of delayed aortic perforation due to a nondisplaced fracture of the 9th rib after vertebral osteotomy for degenerative kyphoscoliosis in patients with osteoporosis.

Methods: A 78-year-old female patient with osteoporosis had undergone T9-iliac correction surgery for degenerative kyphoscoliosis. After 2 years, the patient underwent T10 pedicle subtraction osteotomy for a T10 vertebral fracture and progression of kyphosis. Postoperatively, the patient had been doing well for 3 weeks; however, just before the day of discharge, she died following a cardiopulmonary arrest. An autopsy was performed with the consent of her family.

Results: Autopsy revealed a large amount of blood and a clot in the left thoracic cavity. Aortic perforation was found just in front of a nondisplaced fracture of the left 9th rib.

Conclusion: This report describes a new critical complication after spinal correction surgery. Even without pedicle screw malposition, aortic injuries can happen to patients with osteoporosis after corrective osteotomy for degenerative kyphoscoliosis due to positional change of aorta and fragility of the ribs. The spine surgeon should be aware of this type of complication, and rib fractures around the aorta after vertebral osteotomy should not be neglected even when there is no displacement.
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http://dx.doi.org/10.1007/s00586-021-07014-9DOI Listing
October 2021

Clinical outcomes of laminoplasty for patients with lysosomal storage disease including mucopolysaccharidosis and mucolipidoses: a retrospective cohort study.

Orphanet J Rare Dis 2021 09 28;16(1):401. Epub 2021 Sep 28.

Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-5-7, Asahimachi, Abenoku, Osaka, Osaka, 545-8585, Japan.

Background: Although the clinical efficacy of laminoplasty in adult cervical spondylotic myelopathy or ossification of posterior longitudinal ligament has been frequently reported, there are only few reports of laminoplasty for patients with lysosome storage diseases (LSDs). Therefore, this study aimed to report the midterm clinical and radiological outcomes of patients with LSDs after cervical laminoplasty.

Methods: Six patients with LSD who underwent laminoplasty with/without C1 laminectomy for cervical myelopathy were enrolled. Clinical evaluations, including the cervical Japanese Orthopedic Association (cJOA) score and visual analog scale (VAS) scores for upper extremity numbness, and radiographic parameters, including C2-C7 lordotic angle, atlanto-dens interval (ADI), and ⊿ADI, were evaluated preoperatively, at 2 years postoperatively, and at the final follow-up.

Results: Five patients had mucopolysaccharidoses (type I: n = 1, II: n = 3, VII: n = 1) and one patient had mucolipidoses type III. The mean age of patients at surgery was 27.5 years, and the mean postoperative follow-up period was 61 months. All mucopolysaccharidoses cases required C1 posterior arch resection with C2-C7 laminoplasty. No critical complications were observed postoperatively. There were no significant differences in C2-C7 angle (p = 0.724) and ⊿ADI (p = 0.592) between the preoperative and final follow-ups. The cJOA score and VAS for numbness significantly improved at the final follow-up (p = 0.004 and p = 0.007, respectively).

Conclusions: The cervical myelopathy in patients with LSD could be safely and effectively treated with laminoplasty with/without C1 posterior arch resection after excluding patients with atlantoaxial instability. Atlantoaxial stability and symptom improvement could be maintained at an average of 5 years postoperatively.
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http://dx.doi.org/10.1186/s13023-021-02031-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8480100PMC
September 2021

An adult case of spontaneous healing of concurrent osteochondritis dissecans of the lateral femoral condyle after saucerization with meniscal repair for discoid lateral meniscus: A case report.

Int J Surg Case Rep 2021 Oct 23;87:106427. Epub 2021 Sep 23.

Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.

Background: The treatment strategy for osteochondritis dissecans (OCD) with discoid lateral meniscus (DLM) in adults remains unclear.

Case Presentation: A 22-year-old man presented with left knee pain after spraining his knee. Physical examination revealed lateral joint line tenderness and a positive McMurray test. Radiographic imaging showed OCD of the lateral femoral condyle classified as stage 3 on Brückl's classification. Magnetic resonance imaging showed complete DLM with anterocentral shift based on Ahn's classification and an OCD of 11 mm × 8 mm, grade 2 based on Nelson's classification. On computed tomography (CT), a demarcated fragment was observed in the lesion. Based on these findings, saucerization with meniscal repair was performed for unstable DLM. The OCD lesion presented with softening without any fissure and was diagnosed as grade 1. No surgical procedure was added. One year after surgery, the union of the fragment was confirmed on radiograph and CT. At the final follow-up five years after surgery, the Lysholm score had improved from 58 to 100 points.

Conclusions: We experienced an adult case of stable OCD with concurrent DLM that achieved spontaneous healing after undergoing reshaping surgery for DLM, mimicking normal meniscal morphology, without additional treatment for the stable OCD lesion.
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http://dx.doi.org/10.1016/j.ijscr.2021.106427DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8476636PMC
October 2021

[A Long-Term Survival Case of Liver Metastasis from Remnant Gastric Cancer Treated by CapeOX, S-1, and Surgery].

Gan To Kagaku Ryoho 2021 Sep;48(9):1173-1175

Dept. of Surgery, Yuaikai Foundation and Oda Hospital.

A 70-year-old man, who had undergone distal gastrectomy for early gastric cancer at 63-year-old, had multiple liver metastases from remnant gastric cancer, which was diagnosed as cT3(SS), N0, M1, cStage Ⅳ. After a regimen consisting of 8 courses of capecitabine plus oxaliplatin and 2 courses of S-1 was administered, clinical CR was confirmed for the remnant gastric cancer and multiple liver metastases. Chemotherapy was administered for 10 months and discontinued for side effects and the needs of the patient. Anticoagulant drugs were administered for the onset of cerebral infarction after he vomited blood. A gastric ulcer in the oral side of the anastomotic portion was detected and diagnosed as poorly differentiated adenocarcinoma. Multiple liver metastases could not be detected by PET-CT, and we performed a total gastrectomy of the remnant stomach. The patient remains relapse-free 4 years and 10 months after chemotherapy(3 years and 10 months after discontinuing chemotherapy).
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September 2021

Direct Lateral Corpectomy and Reconstruction Using an Expandable Cage Improves Local Kyphosis but Not Global Sagittal Alignment.

J Clin Med 2021 Sep 5;10(17). Epub 2021 Sep 5.

Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan.

Recently, an expandable cage equipped with rectangular footplates has been used for anterior vertebral replacement in osteoporotic vertebral fracture (OVF). However, the postoperative changes in global alignment have not been elucidated. The purpose of this study was to evaluate local and global spinal alignment after anterior and posterior spinal fixation (APSF) using an expandable cage in elderly OVF patients. This retrospective multicenter review assessed 54 consecutive patients who underwent APSF for OVF. Clinical outcomes were compared between postoperative sagittal vertical axis (SVA) > 95 mm and ≤95 mm groups to investigate the impact of malalignment. SVA improved by only 18.7 mm (from 111.8 mm to 93.1 mm). VAS score of back pain at final follow-up was significantly higher in patients with SVA > 95 mm than SVA ≤ 95 mm (42.4 vs. 22.6, = 0.007). Adjacent vertebral fracture after surgery was significantly more frequent in the SVA > 95 mm (37% vs. 11%, = 0.038). Multiple logistic regression showed significantly increased OR for developing adjacent vertebral fracture (OR = 4.76, 95% CI 1.10-20.58). APSF using the newly developed cage improves local kyphotic angle but not SVA. The main cause for the spinal malalignment after surgery was postoperative development of adjacent vertebral fractures.
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http://dx.doi.org/10.3390/jcm10174012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8432512PMC
September 2021

Nerve capping treatment using a bioabsorbable nerve conduit with open or closed end for rat sciatic neuroma.

Clin Neurol Neurosurg 2021 Oct 28;209:106920. Epub 2021 Aug 28.

Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.

Background And Aims: Nerve capping treatment using bioabsorbable nerve conduits has recently been introduced for painful amputation neuroma. However, no clinical or experimental data are available for comparing nerve conduits with open distal ends and closed distal ends. Here, we investigated the nerve conduit with open or closed distal ends as the superior capping device, using a commercially available polyglycolic acid (PGA) nerve conduit in a rat sciatic nerve amputation model.

Methods: Ninety-one rats were assigned to three groups: no-capping (n = 30), capping the resected nerve stump with open ends (n = 31), and closed-end nerve conduits (n = 30). Twelve weeks after sciatic neurectomy, with or without capping, the evaluation of neuropathic pain using the autotomy score was performed. Stump neuromas with perineural scars and neuroinflammation were evaluated histologically.

Results: The mean autotomy scores in the closed-end nerve conduit group were significantly lower than those in the no-capping group. However, the difference between the open-end nerve conduit and the closed-end nerve conduit groups was insignificant. Histologically, distal axonal fibers expanded radially and formed neuromas in the no-capping group while they were terminated within the PGA conduit in both capping groups. In particular, the closed-end version of the PGA nerve conduit blocked scarring from intruding through the open end and protected the nerve stump with less neuroinflammation. Nerve capping with the closed-end version of the PGA nerve conduit most effectively suppressed perineural neuroinflammation and scar formation around the resected nerve stump.

Interpretation: Nerve capping with the PGA nerve conduit, particularly those with closed ends, after rat sciatic neurectomy prevented amputation neuroma and relieved neuropathic pain.
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http://dx.doi.org/10.1016/j.clineuro.2021.106920DOI Listing
October 2021

Two positioned MRI can visualize and detect the location of peripheral rim instability with snapping knee in the no-shift-type of complete discoid lateral meniscus.

Arch Orthop Trauma Surg 2021 Sep 6. Epub 2021 Sep 6.

Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.

Introduction: We evaluated the efficacy of two positioned magnetic resonance imaging (MRI) for visualizing the snapping phenomenon and detecting peripheral rim instability (PRI) in no-shift-type complete discoid lateral meniscus (CDLM).

Materials And Methods: The records of 39 patients diagnosed with no-shift-type CDLM under routine MRI who underwent arthroscopic surgery were reviewed. The snapping phenomenon and meniscal shift on two positioned MRI in full extension and deep flexion were evaluated and calculated the agreement between these findings. The positive predictive value (PPV), sensitivity, and specificity of meniscal shift on two positioned MRI for predicting PRI were calculated; PRI was further investigated according to anterior and posterior location. The hypotheses of this study were asfollows: (1) Two positioned MRI can visualize the snapping phenomenon and (2) Meniscal shift on two positioned MRI is an important predictive sign of detecting the instability site in no-shift-type CDLM.

Results: The κ values between the snapping phenomenon and meniscal shift on two positioned MRI were 0.84. The snapping and two positioned MRI findings had high PPV (1.0, 0.96), sensitivity (0.82, 0.85), and specificity (1.0, 0.91) for predicting overall PRI. For anterior PRI, the snapping and posterior shift on two positioned MRI had moderate and high PPV (0.78, 0.9), high sensitivity (0.9, 0.9), and specificity (0.8, 0.89). The anterior shift on two positioned MRI findings predicted posterior PRI with high PPV (1.0) and specificity (1.0).

Conclusions: Two positioned MRI visualized the snapping phenomenon. Meniscal shift on two positioned MRI was an important predictive sign of overall PRI, anterior PRI, and posterior PRI in no-shift-type CDLM.
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http://dx.doi.org/10.1007/s00402-021-04148-9DOI Listing
September 2021

Clinical Outcomes of Minimally Invasive Posterior Decompression for Lumbar Spinal Stenosis with Degenerative Spondylolisthesis.

Spine (Phila Pa 1976) 2021 Sep;46(18):1218-1225

Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.

Study Design: Retrospective cohort study.

Objective: To compare the clinical outcomes 5 years after minimally invasive posterior decompression for lumber spinal stenosis (LSS) between patients with and without degenerative spondylolisthesis (DS).

Summary Of Background Data: Indications for surgical procedures for patients with LSS and DS are still under investigation. Since minimally invasive surgery does not affect most anatomical structures, preoperative DS may not negatively affect the clinical outcomes of minimally invasive posterior decompression.

Methods: Overall, 198 patients with LSS who underwent microendoscopic or microscopic decompression and were followed up for more than 5 years postoperatively were included in the present study. Patients who showed a segmental kyphosis >5° at the surgical level during flexion were treated with fusion surgery. However, other patients, including those with DS, were treated with posterior decompression. The patients were divided into two groups: the DS group included 82 patients with >3-mm slip and the non-DS group included 112 patients with ≤3-mm slip or without slip. A mixed-effects model adjusted for age and sex was used to compare the improvements in the visual analog scale score for low-back pain and the Japanese Orthopaedic Association score of the two groups. For subgroup analysis (n = 53), the changes in the preoperative physical component summary and the mental component summary of Short Form-36 of the two groups at 5 years after surgery were evaluated.

Results: There was no significant difference in the improvement of preoperative low-back pain visual analog scale score and Japanese Orthopaedic Association score 5 years after surgery between the two groups. Subgroup analysis showed no significant difference between the two groups in the improvement of preoperative physical component summary and mental component summary 5 years after surgery.

Conclusion: After carefully eliminating patients with segmental instability, DS did not affect the clinical outcomes of minimally invasive decompression surgery.Level of Evidence: 3.
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http://dx.doi.org/10.1097/BRS.0000000000003997DOI Listing
September 2021

Comparison of Occurrence of Bone Tunnel Laceration, Clinical Results, and Cuff Repair Integrity of Transosseous Arthroscopic Rotator Cuff Repair With and Without Lateral Cortical Augmentation.

Arthrosc Sports Med Rehabil 2021 Aug 14;3(4):e981-e988. Epub 2021 Jun 14.

Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.

Purpose: To compare the occurrence of bone tunnel laceration, the short-term clinical results, and cuff repair integrity of transosseous arthroscopic rotator cuff repair (ARCR) using a tunneling device, with and without lateral cortical augmentation.

Methods: A retrospective review of patients who underwent transosseous ARCR from May 2012 to December 2017 was conducted. The inclusion criterion was repairable medium- to massive-sized full-thickness rotator cuff tear. This study included 2 consecutive series of patients undergoing transosseous ARCR with and without lateral cortical augmentation, called the ITO method and AT method, respectively. The incidence of bone tunnel laceration was evaluated intraoperatively. Patients were assessed through a range of motion and Constant scores preoperatively and at final follow-up. Further, magnetic resonance imaging was performed at 24 months postoperatively to examine the repaired rotator cuff integrity.

Results: A total of 121 subjects were included: 33 in the AT group and 88 in the ITO group. The intraoperative bone tunnel laceration occurrence rate was 67% and 4% for the AT and ITO methods, respectively; the difference was significant ( = .001). Anatomic failure rate (Sugaya Ⅲ, Ⅳ, and Ⅴ) rate for medium- to large-sized tears was significantly lower for the ITO than for the AT method (29% vs 65%,  = .004), but not for massive tears (61% vs 69%,  = .515). The mean forward elevation, abduction, external rotation, internal rotation, and Constant score were significantly improved at final follow-up from preoperative values. There were no significant differences between the 2 methods.

Conclusions: Transosseous ARCR using a tunneling device with and without lateral cortical augmentation is a reliable method of improving clinical results at a minimum follow-up of 2 years. The intraoperative occurrence rate of bone tunnel laceration occurrence rate and the anatomic failure rate of medium- to large-sized cuff tear were lower with lateral cortical augmentation than without it.

Level Of Evidence: Level Ⅳ, therapeutic cases series.
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http://dx.doi.org/10.1016/j.asmr.2021.02.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8365204PMC
August 2021

Incidence of and risk factors for spondylolisthesis, scoliosis, and vertebral fracture in rheumatoid arthritis.

J Bone Miner Metab 2021 Aug 23. Epub 2021 Aug 23.

Department of Orthopaedic Surgery, Osaka City University, Osaka City, Osaka, Japan.

Introduction: Although lumbar lesions such as spondylolisthesis, scoliosis, and vertebral fracture are not specific to rheumatoid arthritis (RA), the prevalence is high in RA patients. However, no longitudinal study has evaluated lumbar lesions in RA. This study aimed to investigate the incidence of and risk factors for lumbar lesions in RA by a prospective longitudinal cohort study.

Materials And Methods: The study cohort comprised 110 patients with RA from the 'analysis of factors for RA spinal disorders (AFFORD)' study who completed the secondary survey at a single orthopaedic outpatient RA clinic. Radiological examination included standing radiographs and magnetic resonance imaging (MRI) of the lumbar spine. New development of spondylolisthesis, scoliosis, and vertebral fracture were assessed between baseline and secondary survey.

Results: The incidences of spondylolisthesis, scoliosis, and vertebral fracture were 42%, 16%, and 12%, respectively, during a mean follow-up of 7 years. The independent risk factor for de novo scoliosis was poor control of RA (adjusted odds ratio [aOR] 4.81, p = 0.011), while the independent risk factors for new vertebral fracture was use of glucocorticoid at secondary survey (aOR 14.87, p = 0.012). Patients with de novo scoliosis exhibited more severe low back pain and lower quality of life than those without.

Conclusion: The incidence of scoliosis was related in patients with poor control of RA, while new vertebral fracture was more common in patients with use of glucocorticoid. Control of disease activity might be important in preventing radiological lumbar disorders in RA.
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http://dx.doi.org/10.1007/s00774-021-01261-yDOI Listing
August 2021

Morphological Changes in the Residual Meniscus After Reshaping Surgery for a Discoid Lateral Meniscus.

Am J Sports Med 2021 10 20;49(12):3270-3278. Epub 2021 Aug 20.

Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan.

Background: Arthroscopic reshaping surgery is the first treatment option for a symptomatic discoid lateral meniscus (DLM) to preserve the peripheral rim. However, the degree of postoperative morphological change in the residual meniscus is unclear.

Purpose/hypothesis: The purpose of this study was to measure the meniscus after reshaping surgery for a DLM, to verify when the morphological change occurred, and to examine the related risk factors. The hypothesis was that the residual meniscal width would decrease throughout the postoperative course.

Study Design: Case-control study; Level of evidence, 3.

Methods: We retrospectively reviewed the medical records of patients who underwent reshaping surgery for a symptomatic DLM and had undergone follow-up for ≥2 years. Magnetic resonance imaging (MRI) was routinely performed preoperatively and at 3, 6, 12, and 24 months postoperatively, and the width, height, and extrusion of the residual meniscus were measured. According to the width of the midbody on final MRI scans, we compared the preoperative and postoperative data for the preserved group (≥5 mm) and decreased group (<5 mm). The associated risk factors for a decreased meniscal width (<5 mm) of the midbody were analyzed on final MRI scans.

Results: We included 61 knees of 54 patients in this study. The mean age at the time of surgery was 11.7 years. The intraobserver and interobserver reliabilities of the midbody width were 0.937 and 0.921, respectively. The width of the anterior horn, midbody, and posterior horn decreased significantly from 3 to 24 months after surgery (from 9.1 to 8.6 mm [ < .001], from 7.5 to 6.1 mm [ < .001], and from 9.5 to 8.9 mm [ = .001], respectively). Meniscal extrusion of the midbody did not change significantly (from 1.2 to 1.5 mm; = .062). Overall, 46 knees (n = 20/32 in the preserved group and n = 26/29 in the decreased group) had longitudinal tears that required meniscal repair. Clinical outcomes did not differ significantly between the 2 groups. Multivariate logistic analysis showed that intrameniscal degeneration (odds ratio, 4.36; = .023) significantly increased the risk of a decreased meniscal width.

Conclusion: The width of the anterior horn, midbody, and posterior horn decreased significantly from 3 to 24 months after surgery. In particular, the average decrease rate of the midbody was 19%. No clinical difference was seen in patients with a decreased width and height or with peripheral extrusion. Increased intrameniscal signals on preoperative MRI scans were associated with an increased risk of a decreased meniscal width. Surgeons should consider this result to determine the amount of resection.
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http://dx.doi.org/10.1177/03635465211033586DOI Listing
October 2021

A comparison of accuracy and safety between stem-first and cup-first total hip arthroplasty: a prospective randomised controlled trial.

Hip Int 2021 Aug 16:11207000211039767. Epub 2021 Aug 16.

Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.

Background: The combined anteversion theory to prevent impingement in total hip arthroplasty (THA) has been proposed. However, because stem-anteversion is influenced by the native femoral anteversion and the stem flexion/extension angle, it is often difficult to adjust stem anteversion during surgery. Therefore, the stem-first (combined anteversion) technique may be useful to adjust and achieve appropriate cup anteversion during surgery with respect to the implanted stem anteversion angle. However, the technique may adversely affect cup or stem angle accuracy and result in intra-operative bleeding, post-operative adverse events, and prolonged operative time. It is inconclusive whether either the stem-first or cup-first technique is safe or accurate. Therefore, this study assessed the accuracy and safety of stem-first THA compared to those of cup-first THA.

Materials And Methods: This prospective randomised controlled trial analysed 114 patients who were randomly divided into 2 groups (stem-first group:  57, cup-first group (control group):  57). Primary outcomes included cup and stem angle, the discrepancies from the targeted angle and combined anteversion (evaluated via CT at 3 months postoperatively). Secondary outcomes included intraoperative blood loss, operative time, WOMAC, and adverse events.

Results: There were no significant differences in age, gender, BMI or in the primary and secondary outcomes between the 2 groups.

Conclusions: Performing stem-first in THA did not adversely affect cup and stem angle accuracy, or result in intraoperative bleeding, prolongation of operative time, or postoperative adverse events. Thus, performing stem-first may be advantageous for achieving combined anteversion theory.

Trial Registration: University Hospital Medical Information Network (UMIN) registration number UMIN000025189.
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http://dx.doi.org/10.1177/11207000211039767DOI Listing
August 2021

Comparison of postoperative knee flexion and patient satisfaction between newly and conventionally designed medial pivot total knee arthroplasty: a 5-year follow-up matched cohort study.

Arch Orthop Trauma Surg 2021 Aug 14. Epub 2021 Aug 14.

Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.

Introduction: The medial pivot total knee arthroplasty (TKA) has good patients' satisfaction; however, there is likely the restriction of postoperative knee flexion. The 2nd generation medial pivot TKA prosthesis was designed to improve postoperative knee flexion. This study aimed to compare the clinical outcomes and patient satisfaction between the 2nd generation and 1st generation medial pivot TKA prostheses.

Materials And Methods: We conducted a retrospective study of 472 consecutive TKAs, performed using either the 2nd generation (EVOLUTION), having smaller posterior femoral condyle and asymmetrical tibial tray, or 1st generation (ADVANCE) prosthesis. The use of each system was historically determined. Patient age, sex and body mass index were matched between the two groups, with 157 cases ultimately included in each group. Measured clinical outcomes included: knee range of motion, the Knee Society Score, the rate of re-operation, and radiological parameters. Patient satisfaction was evaluated using the 12-item Forgotten Joint Score (FJS-12).

Results: The average follow-up period was 5.0 (3.7-6.3) years for the 2nd generation group and 8.7 (6.1-12.8) years for the 1st generation group (p < 0.01). The postoperative knee flexion range was 127° (80°-140°) for the 2nd generation and 118° (90°-135°) for the 1st generation at final follow-up (p < 0.01). On multivariate regression analysis, use of the 2nd generation prosthesis predicted greater postoperative knee flexion. The average FJS-12 score was 64 (0-100) for the 2nd generation and mean 57 (0-100) for the 1st generation (p < 0.01). Other clinical outcomes were similar between the two groups.

Conclusions: Compared to the 1st generation, the 2nd generation medial pivot prosthesis provides greater postoperative knee flexion and patient satisfaction.
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http://dx.doi.org/10.1007/s00402-021-04121-6DOI Listing
August 2021

Open-door laminoplasty with stand-alone autologous bone spacers: evaluation of enlarged laminar arch with CT-multiplanar reconstruction.

J Neurosurg Spine 2021 Aug 6:1-5. Epub 2021 Aug 6.

2Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.

Objective: The authors aimed to determine the efficacy of open-door laminoplasty with stand-alone autologous bone spacer for preserving enlarged lamina in patients with cervical myelopathy.

Methods: Patients who underwent open-door laminoplasty for cervical myelopathy with stand-alone autologous bone spacer and underwent CT 1 week and 1 year after surgery were included in this study. There were 20 men and 13 women, with an average (range) age of 65.0 (37-86) years. Seventeen patients were younger than 70 years, and 16 patients were older than 70 years. Autogenous bone spacers made from spinous processes were used in all patients. Slits were made on both sides of the spacers. The lamina was raised with a curette, and a spacer was inserted without any sutures. Before surgery and 1 week and 1 year after surgery, the anteroposterior diameter (APD) of the spinal canal was measured using midsagittal-plane CT-multiplanar reconstruction. The bone union rate of the hinge side and autogenous bone spacer of each lamina was determined using CT images obtained 1 year after surgery. Results 1 year after surgery were evaluated using Japanese Orthopaedic Association (JOA) score.

Results: The mean ± SD APD increase rate was 56.3% ± 21.3% 1 week after surgery and 51.7% ± 20.6% 1 year later. The average APD decrease rate was 2.9% ± 3.8%. The bone union rate on the hinge side was 100%, and that of autologous bone spacer was 93.8% 1 year after surgery. The mean APD decrease rate was 3.3% in patients younger than 70 years and 2.3% in those older than 70 years. There was no significant difference between the two groups (p > 0.05, nonpaired t-test). The JOA score averaged 10.1 before surgery and 13.3 a year after surgery (total score 17). The average improvement rate was 46.3% ± 26.4%.

Conclusions: The authors devised and implemented a technique for inserting an autologous bone spacer between the opened lamina and lateral mass without sutures. The enlarged spinal canal was maintained 1 year after surgery. This simple method does not require any instrumentation or additional cost to stabilize the opened lamina.
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http://dx.doi.org/10.3171/2021.1.SPINE201633DOI Listing
August 2021

Serum COMP Detects Early OA in Patients With ACL Deficiency.

Arthroscopy 2021 Aug 4. Epub 2021 Aug 4.

Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.

Purpose: To investigate the ability of serum cartilage oligomeric matrix protein (COMP) to detect early osteoarthritis (OA) (International Cartilage Research Society [ICRS] grade 1 or 2 cartilage lesions) in patients with anterior cruciate ligament (ACL)-deficient patients.

Methods: Patients with an ACL injury of Kellgren-Lawrence grade 0 or 1 were enrolled. Serum samples for COMP measurement were obtained before surgery. The cartilage surfaces of 6 compartments were classified using the ICRS grading system. The patients were divided into groups with and without early OA according to the cartilage findings and diagnostic criteria for early OA.

Results: In total, 98 patients (mean age 23.7 years; range 12 to 49) were included, with 30 patients (30.6%) in the early OA group and 68 (69.4%) in the no early OA group. The 2 groups significantly differed in age, body mass index, preoperative Tegner activity scale, and serum COMP level. The cutoff value of serum COMP for the presence of early OA arthroscopic cartilage lesions was 152.0 ng/mL. Multiple logistic regression analysis revealed age (odds ratio 1.09; 95% confidence interval [CI] 1.02 to 1.16; P = .01) and serum COMP (odds ratio 1.02; 95% CI 1.01 to 1.04; P < .001) to be independent factors for the presence of early OA arthroscopic cartilage findings.

Conclusions: The incidence of early OA arthroscopic cartilage findings was ∼30% in patients with ACL deficiency, and serum COMP levels were significantly higher in the early OA group than in the no early OA group. The optimum cutoff value for serum COMP was 152 ng/mL. Serum COMP can be used to detect early cartilage change in patients with ACL deficiency.

Level Of Evidence: Ⅲ, retrospective comparative study.
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http://dx.doi.org/10.1016/j.arthro.2021.06.019DOI Listing
August 2021

Evaluation of the clinical performance of noninvasive prenatal testing at a Japanese laboratory.

J Obstet Gynaecol Res 2021 Oct 5;47(10):3437-3446. Epub 2021 Aug 5.

Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan.

Aim: We aimed to evaluate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of noninvasive prenatal testing (NIPT) in high-risk pregnant women.

Methods: Pregnant women who underwent GeneTech NIPT, the most commonly used NIPT in Japan, between January 2015 and March 2019, at Japan NIPT Consortium medical sites were recruited for this study. The exclusion criteria were as follows: pregnant women with missing survey items, multiple pregnancy/vanishing twins, chromosomal abnormalities in the fetus other than the NIPT target disease, and nonreportable NIPT results. Sensitivity and specificity were calculated from the obtained data, and maternal age-specific PPV and NPV were estimated.

Results: Of the 45 504 cases, 44 263 cases fulfilling the study criteria were included. The mean maternal age and gestational weeks at the time of procedure were 38.5 years and 13.1 weeks, respectively. Sensitivities were 99.78% (95% confidence interval [95% CI]: 98.78-99.96), 99.12% (95% CI: 96.83-99.76), and 100% (95% CI: 88.30-100) for trisomies 21, 18, and 13, respectively. Specificities were more than 99.9% for trisomies 21, 18, and 13, respectively. Maternal age-specific PPVs were more than 93%, 77%, and 43% at the age of 35 years for trisomies 21, 18, and 13, respectively.

Conclusion: The GeneTech NIPT data showed high sensitivity and specificity in the detection of fetal trisomies 21, 18, and 13 in high-risk pregnant women, and maternal age-specific PPVs were obtained. These results could provide more accurate and improved information regarding NIPT for genetic counseling in Japan.
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http://dx.doi.org/10.1111/jog.14954DOI Listing
October 2021

Pain and numbness one month after carpal tunnel release predict patient-reported outcome measures at sixth months.

J Plast Surg Hand Surg 2021 Jul 29:1-5. Epub 2021 Jul 29.

Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.

A number of outcome predictors for carpal tunnel release (CTR) for carpal tunnel syndrome (CTS) have been reported. However, some predictors are controversial, and few studies have referred to the early postoperative outcome prognostic factors after CTR. The aim of this study was to investigate whether pain and numbness at 1 month post-CTR were early postoperative predictors of clinical outcomes 6 months after surgery. Pain and numbness were evaluated using the visual analog scale (VAS) preoperatively and at 1 month post-surgery. Patient-reported outcome measures (PROMs), including the Quick Disabilities of the Arm, Shoulder and Hand (QDASH) measure, the Hand20 questionnaire and the Boston Carpal Tunnel Questionnaire (BCTQ), were recorded for each patient 6 months after surgery. The BCTQ consisted of the Symptom Severity Scale (SSS) and Functional Status Scale (FSS). Multivariable linear regression analysis was performed to investigate the association between the VAS scores and PROMs. We retrospectively identified 93 patients who underwent open carpal tunnel release (OCTR) or endoscopic carpal tunnel release. The mean age of the patients was 67.5 years, and 67 patients (72.0%) were female. Sixty patients were treated by OCTR (65.0%). With multivariable linear regression analysis, we found that pain and numbness, evaluated with VAS 1 month post-surgery had significant correlations with QDASH, Hand20, SSS and FSS 6 months after surgery. In conclusion, pain and numbness 1 month after CTR predict PROMs at 6 months.
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http://dx.doi.org/10.1080/2000656X.2021.1953041DOI Listing
July 2021

Surgical Outcomes of a New Technique Using a Convex Rod Rotation Maneuver for Adolescent Idiopathic Scoliosis.

Spine Surg Relat Res 2021 5;5(3):205-210. Epub 2020 Dec 5.

Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.

Introduction: Because of adolescent idiopathic scoliosis (AIS), most surgeons use rod rotation on the concave side for Lenke types 1 and 2 curves. Nevertheless, the accurate placement of pedicle screws within dysplastic pedicles, especially on the concave side, is sometimes challenging. Conversely, there is a concern that apical rotation might be exacerbated after convex rod rotation maneuver (RRM) because the rod is rotated in the same direction as vertebral rotation. This study aims to demonstrate the surgical technique and outcomes of a convex RRM with direct vertebral rotation (DVR) for the correction of AIS.

Technical Note: Multilevel pedicle screws were inserted into the vertebrae. The pre-bent pure titanium rod was set on the convex side and then derotated to nearly 90°. DVR was conducted for the desired vertebrae. Another pre-bent titanium alloy rod, for placement on the concave side, was contoured the same as the rod on the convex side. Using a reduction tube that allowed easier capture of the rod, the rod was connected to the concave side screws. DVR was again conducted for the desired vertebrae. Among the 59 patients, the correction rate of the main thoracic curve in Lenke types 1 and 2 AIS was 75.1% and 65.0%, respectively. The absolute value of the change in apical vertebral rotation between pre- and post-operative computed tomography (CT) scans in Lenke types 1 and 2 curves was 4.8° and 4.2°, respectively.

Conclusions: The convex RRM improved vertebral rotation in Lenke types 1 and 2 AIS. This procedure should be regarded as one of the surgical options for AIS, especially in patients with a narrow pedicle width on the concave side.
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http://dx.doi.org/10.22603/ssrr.2020-0185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8208944PMC
December 2020

Bilateral locking or triggering fingers due to intratendinous calcium pyrophosphate dihydrate crystal deposition: A case report.

J Orthop Sci 2021 Jun 23. Epub 2021 Jun 23.

Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.

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http://dx.doi.org/10.1016/j.jos.2021.05.008DOI Listing
June 2021

A bone replacement-type calcium phosphate cement that becomes more porous in vivo by incorporating a degradable polymer.

J Mater Sci Mater Med 2021 Jun 22;32(7):77. Epub 2021 Jun 22.

Department of Orthopedic Surgery, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-Machi, Abeno-ku, Osaka, 545-8585, Japan.

This study investigated whether mixing low viscosity alginic acid with calcium phosphate cement (CPC) causes interconnected porosity in the CPC and enhances bone replacement by improving the biological interactions. Furthermore, we hypothesized that low viscosity alginic acid would shorten the setting time of CPC and improve its strength. CPC samples were prepared with 0, 5, 10, and 20% low viscosity alginic acid. After immersion in acetate buffer, possible porosification in CPC was monitored in vitro using scanning electron microscopy (SEM), and the setting times and compressive strengths were measured. In vivo study was conducted by placing CPC in a hole created on the femur of New Zealand white rabbit. Microcomputed tomography and histological examination were performed 6 weeks after implantation. SEM images confirmed that alginic acid enhanced the porosity of CPC compared to the control, and the setting time and compressive strength also improved. When incorporating a maximum amount of alginic acid, the new bone mass was significantly higher than the control group (P = 0.0153). These biological responses are promising for the translation of these biomaterials and their commercialization for clinic applications.
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http://dx.doi.org/10.1007/s10856-021-06555-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8219573PMC
June 2021

Bone healing of distal radius nonunion treated with bridge plating with bone graft substitutes in combination with systemic romosozumab administration: A case report.

Jt Dis Relat Surg 2021 11;32(2):526-530. Epub 2021 Jun 11.

Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka, Japan.

Romosozumab is a humanized, anti-sclerostin monoclonal antibody used to treat osteoporosis, which increases bone formation and decreases bone resorption. It enhances fracture healing and systemic romosozumab administration may have therapeutic potentials for accelerating bone healing of even nonunion. Herein, a 61-year-old heavy smoker male with distal radius nonunion who achieved successful bone union by combination therapy of romosozumab and spanning distraction plate fixation with bone graft substitutes was presented. Through the dorsal approach, atrophic comminuted nonunion of the distal radius was sufficiently debrided. Reduction of the distal radius was performed using indirect ligamentotaxis, and a 14-hole locking plate was fixed from the third metacarpal to the radial shaft. A beta (β) tricalcium phosphate block was mainly packed into the substantial metaphyseal bone defect with additional bone graft from the resected ulnar head. Postoperatively, systemic administration of monthly romosozumab was continued for six months. Complete bone union was achieved 20 weeks postoperatively and the plate was, then, removed. Wrist extension and flexion improved to 75o and 55o, respectively, without pain, and grip strength increased 52 weeks postoperatively from 5.5 kg to 22.4 kg. During romosozumab treatment, bone formation marker levels increased rapidly and finally returned to baseline, and bone resorption marker levels remained low. In conclusion, combination of systemic romosozumab administration and grafting β-tricalcium phosphate with bridge plating provides an effective treatment option for difficult cases of comminuted distal radius nonunion with risk factors such as smoking, diabetes, and fragility.
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http://dx.doi.org/10.52312/jdrs.2021.82661DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8343859PMC
July 2021

Serum cartilage oligomeric matrix protein is correlated with quantitative magnetic resonance imaging and arthroscopic cartilage findings in anterior cruciate ligament deficient knees without osteoarthritic changes.

Clin Rheumatol 2021 Nov 12;40(11):4629-4638. Epub 2021 Jun 12.

Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.

Introduction/objectives: To investigate the association between serum biomarker [cartilage oligomeric matrix protein (COMP) and matrix metalloproteinase-3 (MMP-3)] levels and clinical, magnetic resonance imaging (MRI), and arthroscopic findings in anterior cruciate ligament (ACL)-deficient knees without osteoarthritic changes on radiographs.

Method: Patients with ACL injury of Kellgren-Lawrence grade 0 or 1 were enrolled. Serum COMP and MMP-3 levels were measured preoperatively. Correlations of serum biomarker levels with age, body mass index (BMI), duration from time of injury, Tegner activity scale (TAS) score, Lysholm knee score, International Knee Documentation Committee score, KT-1000 arthrometer measurements, whole-organ MRI score (WORMS), MRI T2 relaxation time, and arthroscopic International Cartilage Research Society (ICRS) grade were assessed by calculating Spearman correlation coefficients. Associations between intraoperative findings (cartilage, meniscus) and serum biomarker levels were determined using the Mann-Whitney U test. Multiple regression analysis was performed to investigate the correlations between serum biomarker levels and MRI and arthroscopic findings.

Results: Ninety-eight patients with a mean age of 23.7 years were enrolled. Higher serum COMP level was correlated with older age and higher BMI, TAS score, serum MMP-3 level, WORMS, and T2 relaxation times (medial femur, medial tibia). Multivariate analysis showed that the serum COMP level was independently associated with WORMS and ICRS grade.

Conclusions: The serum COMP level was correlated with age, BMI, TAS score, and MMP-3 level in ACL-deficient knees and was independently correlated with WORMS and ICRS grade. Thus, the serum COMP level can help detect cartilage degeneration even in patients without radiographic osteoarthritic changes. Key Points • Serum COMP correlated with WORMS and ICRS grade in ACL deficient knee. • The serum COMP level could help in detecting cartilage degeneration, even in patients with no radiographic osteoarthritic changes.
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http://dx.doi.org/10.1007/s10067-021-05800-wDOI Listing
November 2021

The effect of minimally invasive lumbar decompression surgery on sagittal spinopelvic alignment in patients with lumbar spinal stenosis: a 5-year follow-up study.

J Neurosurg Spine 2021 Jun 11:1-8. Epub 2021 Jun 11.

1Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka; and.

Objective: Several studies have examined the relationship between sagittal spinopelvic alignment and clinical outcomes after spinal surgery. However, the long-term reciprocal changes in sagittal spinopelvic alignment in patients with lumbar spinal stenosis after decompression surgery remain unclear. The aim of this study was to investigate radiographic changes in sagittal spinopelvic alignment and clinical outcomes at the 2-year and 5-year follow-ups after minimally invasive lumbar decompression surgery.

Methods: The authors retrospectively studied the medical records of 110 patients who underwent bilateral decompression via a unilateral approach for lumbar spinal stenosis. Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) scores for low-back pain (LBP), leg pain, leg numbness, and spinopelvic parameters were evaluated before surgery and at the 2-year and 5-year follow-ups. Sagittal malalignment was defined as a sagittal vertical axis (SVA) ≥ 50 mm.

Results: Compared with baseline, lumbar lordosis significantly increased after decompression surgery at the 2-year (30.2° vs 38.5°, respectively; p < 0.001) and 5-year (30.2° vs 35.7°, respectively; p < 0.001) follow-ups. SVA significantly decreased at the 2-year follow-up compared with baseline (36.1 mm vs 51.5 mm, respectively; p < 0.001). However, there was no difference in SVA at the 5-year follow-up compared with baseline (50.6 mm vs 51.5 mm, respectively; p = 0.812). At the 5-year follow-up, 82.5% of patients with preoperative normal alignment maintained normal alignment, whereas 42.6% of patients with preoperative malalignment developed normal alignment. Preoperative sagittal malalignment was associated with the VAS score for LBP at baseline and 2-year and 5-year follow-ups and the JOA score at the 5-year follow-up. Postoperative sagittal malalignment was associated with the VAS score for LBP at the 2-year and 5-year follow-ups and the VAS score for leg pain at the 5-year follow-up. There was a trend toward deterioration in clinical outcomes in patients with persistent postural malalignment compared with other patients.

Conclusions: After minimally invasive surgery, spinal sagittal malalignment can convert to normal alignment at both short-term and long-term follow-ups. Sagittal malalignment has a negative impact on the VAS score for LBP and a weakly negative impact on the JOA score after decompression surgery.
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http://dx.doi.org/10.3171/2020.11.SPINE201552DOI Listing
June 2021
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