Publications by authors named "Hiroyuki Tsuchiya"

687 Publications

Change in leg length after open-wedge high tibial osteotomy can be predicted from the opening width: A three-dimensional analysis.

Knee 2021 Apr 30;30:185-194. Epub 2021 Apr 30.

Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan.

Background: The purpose of this study was to evaluate true change in leg length after open-wedge high tibial osteotomy (OWHTO) using three-dimensional (3D) assessments, examine the factors that influence leg lengthening and verify their validity in clinical practice.

Methods: Study 1: a retrospective case series simulation study, included 46 patients (55 knees) that underwent knee arthroplasty or HTO. OWHTO was simulated from preoperative computed tomography using 3D preoperative planning software. Uni- and multivariate regression analyses were conducted to identify predictors related to change in leg length. Study 2: a retrospective case series study, included 53 patients (55 knees) that underwent OWHTO in another institution. Change in leg length was measured preoperatively and 1 year postoperatively and was compared with the predicted change in leg length calculated using the formula obtained from Study 1.

Results: Study 1: the true change in leg length significantly increased and showed a strong correlation with the opening width. The change in leg length was predicted using the formula "change in leg length = opening width × 0.75-1.5." Study 2: the predicted change in leg length showed no significant difference from the change in leg length 1 year postoperatively and a strong correlation with the measured change.

Conclusions: The true change in leg length after OWHTO was predicted using the formula obtained from the 3D model. Predicting the change in leg length preoperatively can be a basis to consider other HTOs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.knee.2021.04.010DOI Listing
April 2021

Perioperative complications of total en bloc spondylectomy for spinal tumours.

Bone Joint J 2021 May;103-B(5):976-983

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.

Aims: To evaluate the perioperative complications associated with total en bloc spondylectomy (TES) in patients with spinal tumours, based on the extent and level of tumour resection.

Methods: In total, 307 patients who underwent TES in a single centre were reviewed retrospectively. There were 164 male and 143 female patients with a mean age at the time of surgery of 52.9 years (SD 13.3). A total of 225 patients were operated on for spinal metastases, 34 for a malignant primary tumour, 41 for an aggressive benign tumour, and seven with a primary of unknown origin. The main lesion was located in the thoracic spine in 213, and in the lumbar spine in 94 patients. There were 97 patients who underwent TES for more than two consecutive vertebrae.

Results: Major and minor perioperative complications were observed in 122 (39.7%) and 84 (27.4%) patients respectively. The breakdown of complications was as follows: bleeding more than 2,000 ml in 60 (19.5%) patients, hardware failure in 82 (26.7%), neurological in 46 (15.0%), surgical site infection in 23 (7.5%), wound dehiscence in 16 (5.2%), cerebrospinal fluid leakage in 45 (14.7%), respiratory in 52 (16.9%), cardiovascular in 11 (3.6%), digestive in 19 (6.2%)/ The mortality within two months of surgery was four (1.3%). The total number of complications per operation were 1.01 (SD 1.0) in the single vertebral resection group and 1.56 (SD 1.2) in the group with more than two vertebral resections. Cardiovascular and respiratory complications, along with hardware failure were statistically higher in the group who had more than two vertebrae resected. Also, in this group the amount of bleeding in patients with a lumbar lesion or respiratory complication in patients with a thoracic lesion, were statistically higher. Multivariate analysis showed that using a combined anterior and posterior approach, when more than two vertebral resections were significant independent factors.

Conclusion: The characteristics of perioperative complications after TES were different depending on the extent and level of the tumour resection. In addition to preoperative clinical and pathological factors, it is therefore important to consider these factors in patients who undergo en bloc resection for spinal tumours. Cite this article:  2021;103-B(5):976-983.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1302/0301-620X.103B5.BJJ-2020-1777.R1DOI Listing
May 2021

Bone and Soft Tissue Tumors: New Treatment Approaches.

Cancers (Basel) 2021 Apr 12;13(8). Epub 2021 Apr 12.

Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8640, Japan.

Bone and soft tissue sarcomas require intensive treatments, including chemotherapy, surgical resection with safe margin, and radiotherapy [...].
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/cancers13081832DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8069035PMC
April 2021

Total en bloc spondylectomy is worth doing in complete paralysis spinal giant cell tumor, a minimum 1-year follow-up.

J Orthop Surg (Hong Kong) 2021 Jan-Apr;29(1):23094990211005900

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.

Objective: To investigate the neurological recovery of Frankel A spinal giant cell tumor (GCT) patients after they had received a Total En Bloc Spondylectomy (TES).

Materials And Methods: We retrospectively recorded data of three patients (two females) with mobile spine GCT (T6, T10, and L2) Enneking stage III with complete paralysis before surgery, who had undergone TES in our institute from January 2018 to September 2020. The duration of neurologic recovery to Frankel E was the primary outcome. The intra-operative blood loss, operative time, operative-related complications, and the local recurrence were the secondary outcomes.

Results: The duration of suffering from Frankel A to TES surgery was 2 months for the T6 patient, 3 weeks for the T10 patient, and 1 month for the L2 patient. Three patients had achieved full neurological recovery to Frankel E within 6 months after TES (T6 for 5 months, T10 for 3 months, and L2 for 3 months). The average blood loss was 2833.33 ml and the mean operative time was 400 min. Up until the last follow-up (13-25 months), no evidence of local recurrences had been found in any of the three patients.

Conclusion: Frankel A spinal GCT patients can achieve full neurological recovery after TES, if the procedure is performed within 3 months after complete paraplegia. TES can effectively control any local recurrences.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/23094990211005900DOI Listing
April 2021

Antibacterial Activity in Iodine-coated Implants Under Conditions of Iodine Loss: Study in a Rat Model Plus In Vitro Analysis.

Clin Orthop Relat Res 2021 Apr 11. Epub 2021 Apr 11.

K. Ueoka, T. Kabata, Y. Kajino, D. Inoue, T. Takagi, T. Ohmori, J. Yoshitani, T. Ueno, Y. Yamamuro, A. Taninaka, H. Tsuchiya, Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.

Background: We developed iodine-coated titanium implants to suppress microbial activity and prevent periprosthetic joint infection (PJI); their efficacy was demonstrated in animal and in vitro models. The iodine content in iodine-coated implants naturally decreases in vivo. However, to our knowledge, the effect of reduced iodine content on the implant's antimicrobial activity has not been evaluated to date.

Questions/purposes: (1) How much does the iodine content on the implant surface decrease after 4 and 8 weeks in vivo in a rat model? (2) What effect does the reduced iodine content have on the antimicrobial effect of the implant against multiple bacteria in an in vitro model?

Methods: This experiment was performed in two parts: an in vivo experiment to determine attenuation of iodine levels over time in rats, and an in vitro experiment in which we sought to assess whether the reduced iodine content observed in the in vivo experiment was still sufficient to deliver antimicrobial activity against common pathogens seen in PJI. For the in vivo experiment, three types of titanium alloy washers were implanted in rats: untreated (Ti), surface-anodized to produce an oxide film (Ti-O), and with an iodine layer on the oxidation film (Ti-I). The attenuation of iodine levels in rats was measured over time using inductively coupled plasma-mass spectrometry. Herein, only the Ti-I washer was used, with five implanted in each rat that were removed after 4 or 8 weeks. For the 4- and 8-week models, two rats and 15 washers were used. For the in vitro study, to determine the antibacterial effect, three types of washers (Ti, Ti-O, and Ti-I) (nine washers in total) were implanted in each rat. Then, the washers were removed and the antibacterial effect of each washer was examined on multiple bacterial species using the spread plate method and fluorescence microscopy. For the spread plate method, six rats were used, and five rats were used for the observation using fluorescence microscopy; further, 4- and 8-week models were made for each method. Thus, a total of 22 rats and 198 washers were used. Live and dead bacteria in the biofilm were stained, and the biofilm coverage percentage for quantitative analysis was determined using fluorescence microscopy in a nonblinded manner. Ti-I was used as the experimental group, and Ti and Ti-O were used as control groups. The total number of rats and washers used throughout this study was 24 and 213, respectively.

Results: Iodine content in rats implanted with Ti-I samples decreased to 72% and 65% after the in vivo period of 4 and 8 weeks, respectively (p = 0.001 and p < 0.001, respectively). In the in vitro experiment, the Ti-I implants demonstrated a stronger antimicrobial activity than Ti and Ti-O implants in the 4- and 8-week models. Both the median number of bacterial colonies and the median biofilm coverage percentage with live bacteria on Ti-I were lower than those on Ti or Ti-O implants for each bacterial species in the 4- and 8-week models. There was no difference in the median biofilm coverage percentage of dead bacteria. In the 8-week model, the antibacterial activity using the spread plate method had median (interquartile range) numbers of bacteria on the Ti, Ti-O, and Ti-I implants of 112 (104 to 165) × 105, 147 (111 to 162) × 105, and 55 (37 to 67) × 105 of methicillin-sensitive Staphylococcus aureus (Ti-I versus Ti, p = 0.026; Ti-I versus Ti-O, p = 0.009); 71 (39 to 111) × 105, 50 (44 to 62) × 105, and 26 (9 to 31)× 105 CFU of methicillin-resistant S. aureus (Ti-I versus Ti, p = 0.026; Ti-I versus Ti-O, p = 0.034); and 77 (74 to 83) × 106, 111 (95 to 117) × 106, and 30 (21 to 45) × 106 CFU of Pseudomonas aeruginosa (Ti-I versus Ti, p = 0.004; Ti-I versus Ti-O, p = 0.009). Despite the decrease in the iodine content of Ti-I after 8 weeks, it demonstrated better antibacterial activity against all tested bacteria than the Ti and Ti-O implants.

Conclusion: Iodine-coated implants retained their iodine content and antibacterial activity against methicillin-sensitive S. aureus, methicillin-resistant S. aureus, and P. aeruginosa for 8 weeks in vivo in rats. To evaluate the longer-lasting antibacterial efficacy, further research using larger infected animal PJI models with implants in the joints of both males and females is desirable.

Clinical Relevance: Iodine-coated titanium implants displayed an antibacterial activity for 8 weeks in rats in vivo. Although the findings in a rat model do not guarantee efficacy in humans, they represent an important step toward clinical application.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/CORR.0000000000001753DOI Listing
April 2021

Benefit of surgical resection of distant metastasis in soft tissue sarcoma: a systematic review.

Jpn J Clin Oncol 2021 Apr 6. Epub 2021 Apr 6.

Division of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan.

Objective: The aim of this systematic review was to evaluate the efficacy of metastasectomy for patients with advanced soft tissue sarcoma and to develop a recommendation outlining clinical guidelines for soft tissue sarcoma.

Methods: We searched the pertinent literature from January 1985 to December 2017. Two reviewers evaluated and screened the literature independently for eligibility and extracted data. We evaluated the quality of body of evidence and made a recommendation according to the Grading of Recommendations Development and Evaluation methodology.

Results: Among 244 identified studies, only 10 were finally included in this review and no randomized controlled trial reports were present. The median survival period after metastasectomy ranged from 9.6 to 39.6 months, and the 5-year survival rate ranged from 8 to 52%. The complication rate ranged from 7.3 to 25%, and the perioperative mortality rate was 0-1%. The guidelines committee proposed 'Metastasectomy can be offered for malignant soft tissue tumours with distant metastases'. This recommendation gained 100% consensus among the members of the guidelines group.

Conclusions: Although the level of evidence is very low, many retrospective studies support a clinical advantage for metastasectomy, and surgical indications should be carefully considered for patients with metastasis from soft tissue sarcoma. Metastasectomy is an option for patients with metastasis and should be done only if it can be performed safely and if potential advantages outweigh disadvantages.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/jjco/hyab049DOI Listing
April 2021

The effect of gracilis tendon harvesting in addition to semitendinosus tendon harvesting on knee extensor and flexor strength after anterior cruciate ligament reconstruction.

Arch Orthop Trauma Surg 2021 Apr 2. Epub 2021 Apr 2.

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.

Introduction: Anterior cruciate ligament (ACL) reconstruction using hamstring tendons may involve harvesting of the gracilis tendon in addition to the semitendinosus tendon (ST) depending on the size of the ST graft. However, the effect of gracilis harvesting in addition to ST harvesting on muscle strength, such as the hamstring-to-quadriceps (HQ) ratio, remains unclear. Hence, this study aimed to investigate the effect of gracilis harvesting on subsequent knee muscle strength.

Materials And Methods: Eighty-two patients who underwent ACL reconstruction were included in this retrospective study. They were divided into the following two groups depending on the tendon graft used for ACL reconstruction: the ST group (41 patients) and the semitendinosus tendon/gracilis tendon (STG) group (41 patients). The isokinetic peak torque of the knee extensor and flexor was measured using a BIODEX dynamometer at a velocity of 60°/s and 180°/s, respectively, 3 and 6 months after ACL reconstruction. The groups were compared in terms of the limb symmetry index (LSI) and HQ ratio.

Results: The significant difference in the knee flexor of the LSI at 6 months after ACL reconstruction was as follows: ST group, 120.3 ± 28.3 vs STG group, 105.6 ± 19.0 (p < 0.01) at 60°/s and ST group, 122.9 ± 35.2 vs STG group, 106.2 ± 24.6 (p = 0.02) at 180°/s. There were significant differences in the HQ ratio at 180°/s as follows: ST group, 0.67 ± 0.15 vs STG group, 0.60 ± 0.13 (p < 0.01) at 3 months and ST group, 0.67 ± 0.13 vs STG group, and 0.59 ± 0.12 (p < 0.01) at 6 months after ACL reconstruction.

Conclusions: Gracilis tendon harvesting may contribute to a decrease in knee flexor strength and HQ ratio with fast contraction. Thus, the need for gracilis tendon harvesting in ACL reconstruction should be carefully considered.

Level Of Evidence: III.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00402-021-03877-1DOI Listing
April 2021

Complete Response of Bone Metastasis in Non-small Cell Lung Cancer With Pembrolizumab: Two Case Reports.

Anticancer Res 2021 Mar;41(3):1693-1699

Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan.

Aim: To report two cases in which treatment with pembrolizumab for advanced non-small cell lung cancer (NSCLC) with bone metastasis of the long bone of the lower extremity in a state of impending fracture significantly ameliorated both lung tumor and bone metastasis.

Case Report: Case 1 was a 74-year-old woman diagnosed with metastasis of NSCLC in the left tibia and case 2 was a 71-year-old man diagnosed with metastasis of NSCLC in the right femur; their bone metastases were in a state of impending fracture. Disease in both cases was already in stage IVB and they received systemic therapy using pembrolizumab, whilst the bone metastases were treated conservatively. After 3 months, both patients showed a complete response with remarkable osteosclerotic changes in bone metastases and the size of lung tumors was reduced.

Conclusion: These results might imply a novel strategy for systemic treatment with pembrolizumab is required, even in case of impending fracture in advanced NSCLC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21873/anticanres.14933DOI Listing
March 2021

Spontaneous extensor tendon rupture due to scaphoid osteophyte: A case report and literature review.

JPRAS Open 2021 Jun 5;28:66-71. Epub 2021 Mar 5.

Department of Orthopaedic Surgery, Kanazawa University Hospital, Kanazawa, Japan.

Spontaneous attritional extensor tendon ruptures of the index finger due to carpal bone lesions are uncommon. Here, we report the case of a patient with a spontaneous rupture of the extensor indicis proprius (EIP) and index extensor digitorum communis (EDC2) tendons due to a previously symptomatic dorsal scaphoid osteophyte. A healthy 60-year-old man with right-hand dominance experienced mild pain over the dorsum of his left hand for no particular cause. He was a maker of tatami mats. Nine months later, he noted a sudden snap on the dorsum of his right hand while he was making tatami mats and he became unable to extend his index finger. Plain radiography revealed an osteophyte on the dorsal side of the scaphoid. Computed tomography revealed a bone fragment on the dorsal side between the scaphoid and lunate, which seemed to be derived from the scaphoid osteophyte. He underwent surgery 24 days after the incident. First, the fragment was excised; then tendon transfer was performed. EIP and EDC2 tendons were bundled using a side-to-side suture and connected to the middle extensor digitorum communis tendon using interlacing sutures. Histopathological findings of the resected bone were compatible with osteoarthritic change. Tatami mat making requires repeated radioulnar deviation, which could be a risk factor for scaphoid osteophytes. To our knowledge, the present case is the first to report extensor tendon rupture due to a scaphoid osteophyte in a healthy person. Although there is no consensus on the appropriate management of symptomatic scaphoid osteophytes, early intervention at the first sign of tenosynovitis might be necessary to prevent extensor tendon ruptures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpra.2021.02.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7994726PMC
June 2021

Clinical outcomes and prognostic factors following the surgical resection of renal cell carcinoma spinal metastases.

Cancer Sci 2021 Mar 29. Epub 2021 Mar 29.

Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan.

The efficacy of surgical resection in metastatic renal cell carcinoma is an active and important research field in the postcytokine era. Bone metastases, especially in the spine, compromise patient performance status. Metastasectomy is indicated, if feasible, because it helps to achieve the best clinical outcomes possible compared with other treatments. This study examined the postoperative survival and prognostic factors in patients who underwent metastasectomy of spinal lesions. The retrospective study included 65 consecutive patients with metastatic renal cell carcinomas who were operated on by spinal metastasectomy between 1995 and 2017 at our institution. The cancer-specific survival times from the first spinal metastasectomy to death or the last follow-up (≥3 years) were determined using Kaplan-Meier analysis. Potential factors influencing survival were analyzed using Cox proportional hazard models. Planned surgical resection of all the spine tumors was achieved in all patients. Of these, 38 had complete metastasectomy of all visible metastases, including extraspinal lesions. In all patients, the estimated median cancer-specific survival time was 100 months. The 3-, 5-, and 10-year cancer-specific survival rates were 77%, 62%, and 48%, respectively. The survival times after spinal metastasectomy were similar in both cytokine and postcytokine groups. In multivariate analyses, postoperative disability, the coexistence of liver metastases, multiple spinal metastases, and incomplete metastasectomy were significant risk factors associated with short-term survival. Complete metastasectomy, including extraspinal metastases, was associated with improved cancer-specific survival. Proper patient selection and complete metastasectomy provide a better prognosis in metastatic renal cell carcinoma patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/cas.14902DOI Listing
March 2021

Contralateral Lower-Limb Functional Status Before Total Hip Arthroplasty: An Important Indicator for Postoperative Gait Speed.

J Bone Joint Surg Am 2021 Mar 29. Epub 2021 Mar 29.

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.

Background: Postoperative gait speed, especially comfortable gait speed, is an important factor for predicting function after total hip arthroplasty (THA). In this study, we examined factors related to gait speed, including preoperative lower and upper-limb functional parameters and postoperative lower-limb alignment. In addition, we examined factors related to postoperative good comfortable gait speed (≥1.34 m/s: one indicator of a good clinical outcome). The purpose of this study was to determine if better preoperative functional parameters had a positive effect on postoperative gait speed.

Methods: This prospective case-control study included 91 patients with hip osteoarthritis who underwent unilateral THA. Patients who had undergone a prior hip surgical procedure or had Crowe type-3 and 4 hips, complications after THA, knee osteoarthritis-related pain, and severe lumbar conditions were excluded. The 1-leg standing time (OLST) and knee extensor strength of the operatively treated side and the contralateral side and the functional reach test were examined preoperatively and at 1 year postoperatively. The leg-length discrepancy and global offset compared with the contralateral side and leg lengthening were examined using 3-dimensional models captured through computed tomographic scans.

Results: The preoperative contralateral side OLST was a significant factor (p < 0.001) for postoperative comfortable gait speed, and the preoperative contralateral-side knee extensor strength was a significant factor (p = 0.018) for postoperative maximum gait speed. Leg-length discrepancy and differences in global offset after THA were not significant factors for postoperative gait speed. The preoperative comfortable gait speed with a cutoff value of 1.115 m/s (area under the receiver operating characteristic curve, 0.690 [95% confidence interval, 0.569 to 0.810]; p = 0.003; sensitivity of 65.5% and specificity of 74.2%) was an independent factor associated with a good postoperative comfortable gait speed. Preoperative contralateral-side OLST was a significant factor (p = 0.027) for preoperative comfortable gait speed.

Conclusions: The preoperative contralateral-side, lower-limb functional status is a significant factor for postoperative gait speed. Early surgical intervention before the contralateral-side function declines or a preoperative rehabilitation intervention on the contralateral side may improve THA outcome.

Level Of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2106/JBJS.20.00949DOI Listing
March 2021

Immune evasion by cancer stem cells.

Regen Ther 2021 Jun 11;17:20-33. Epub 2021 Mar 11.

Division of Medical Genetics and Regenerative Medicine, Department of Genomic Medicine and Regenerative Therapy, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, Tottori, 683-8503, Japan.

Tumor immunity represents a new avenue for cancer therapy. Immune checkpoint inhibitors have successfully improved outcomes in several tumor types. In addition, currently, immune cell-based therapy is also attracting significant attention. However, the clinical efficacy of these treatments requires further improvement. The mechanisms through which cancer cells escape the immune response must be identified and clarified. Cancer stem cells (CSCs) play a central role in multiple aspects of malignant tumors. CSCs can initiate tumors in partially immunocompromised mice, whereas non-CSCs fail to form tumors, suggesting that tumor initiation is a definitive function of CSCs. However, the fact that non-CSCs also initiate tumors in more highly immunocompromised mice suggests that the immune evasion property may be a more fundamental feature of CSCs rather than a tumor-initiating property. In this review, we summarize studies that have elucidated how CSCs evade tumor immunity and create an immunosuppressive milieu with a focus on CSC-specific characteristics and functions. These profound mechanisms provide important clues for the development of novel tumor immunotherapies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.reth.2021.02.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7966825PMC
June 2021

The prevalence and impact of sarcopenia in females undergoing total hip arthroplasty: A prospective study.

Mod Rheumatol 2021 Mar 30:1-6. Epub 2021 Mar 30.

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.

Objectives: Although both sarcopenia and hip disease decrease physical function, few studies have investigated the association. We investigated the prevalence of sarcopenia in patients awaiting total hip arthroplasty for osteoarthritis and examined the impact of sarcopenia on pre- and postoperative outcomes.

Methods: This prospective study included 96 females. Participants were classified using two criteria. Cases defined as having sarcopenia by the Asian Working Group for Sarcopenia (AWGS) criteria were categorized as the AWGS-sarcopenia (A-S) group, and others were categorized as the AWGS-non-sarcopenia (A-NS) group. Those classified by hand grip strength (HGS) constituted the lower-HGS (L-H) and normal-HGS (N-H) groups. Patient demographics, physical function, and Japanese Orthopaedic Association (JOA) score were compared between each group.

Results: The prevalence of the AWGS sarcopenia was 33.3%. In the pre- and postoperative analyses, the L-H group had significantly poorer physical function and JOA score than the N-H group. Postoperatively, the A-S group only demonstrated poorer HGS.

Conclusion: Preoperative physical function and JOA score was significantly poorer in the L-H group; physical function was significantly poorer even postoperatively. A HGS test is useful for detecting a decline in the pre- and postoperative physical function in females with hip osteoarthritis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/14397595.2021.1899603DOI Listing
March 2021

Screw fixation without bone grafting for scaphoid fracture nonunion.

J Clin Orthop Trauma 2021 Feb 6;13:19-23. Epub 2020 Sep 6.

Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.

Introduction: We previously reported the classification of the scaphoid fracture nonunions as linear, cystic, and sclerotic or displaced types based on radiographic findings. We have been treating the linear and cystic type fractures via screw fixation without bone grafting and the sclerotic or displaced type fractures via screw fixation with bone grafting. In this retrospective study, we report the treatment outcomes of the linear and cystic types of scaphoid fracture nonunions.

Methods: Nineteen patients with linear and cystic type scaphoid fracture nonunions were included. Two patients had linear type and 17 had cystic type fractures. All the patients were male, their mean age was 29.2 years. All patients were treated with screw fixation alone by a single surgeon.

Results: Bone union was achieved in 17 cases. The mean time to bone union was 3.7 months. Bone union was not achieved in one case of linear type and one case of cystic type fracture. The former was thought to be due to misdiagnosis of displaced type as linear type fracture; however, no obvious reason could be found for the latter.

Discussion: Screw fixation alone could help achieve bone union in linear type scaphoid fracture nonunions. However, if the type of the fracture is difficult to diagnose based on plain radiography, evaluation using computed tomography should be performed. The cystic type fractures may need to be subclassified according to the location or size of the cyst as well as the viability of the proximal bone fragment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcot.2020.08.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920016PMC
February 2021

Differences in cellular and microstructural properties of the semitendinosus muscle tendon between young and adult patients.

J Orthop Sci 2021 Mar 10. Epub 2021 Mar 10.

Department of Orthopaedic Surgery, Graduate School of Medical Science Kanazawa University, 13-1 Takara-machi, 920-8641, Kanazawa, Japan.

Background: Poor outcomes associated with anterior cruciate ligament reconstruction in paediatric patients are a major concern. The tendon structure and its cellular characteristics are key factors that affect the mechanical properties of tendons. This study aimed to evaluate the effects of growth on the cellular and microstructural properties of the tendon of the semitendinosus muscle in humans.

Methods: Semitendinosus muscle tendon samples from 76 patients who underwent ligament reconstruction were examined and divided into three groups: immature (10.8 ± 2.7 years old), young (16.5 ± 1.8 years old), and adult (35.2 ± 8.6 years old), based on age and the state of the epiphyseal plate in the distal femur. The number of tendon cells per unit area was assessed, and the major-to-minor-length ratio of the tendon cell nuclei was calculated to evaluate the shape of the nuclei using haematoxylin and eosin staining. The collagen fibril diameter and distribution were determined using electron microscopy.

Results: The major-to-minor-length ratio of the tendon cell nuclei significantly increased with age (p-value; immature vs. young: 0.018, young vs adult: 0.001, immature vs adult: 0.001). The shape of the tendon cell nuclei was rounder in the immature group and more elongated in the adult group. A significant decrease in the number of tendon cells was observed with age (immature: 565 ± 134/mm, young: 356 ± 105/mm, adult: 272 ± 81/mm; p-value: immature vs young: 0.001, young vs adult: 0.012, immature vs adult: 0.001). The mean fibril diameter in the immature group was significantly smaller (p-value: immature vs young: 0.018, young vs adult: 0.001, immature vs adult: 0.001). The distribution of the collagen fibrils changed from right skewed in the immature group to flat in the adult group.

Conclusions: The characteristics of the tendon cells and the microstructure of collagen in muscle tendons significantly changed with age.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jos.2021.01.012DOI Listing
March 2021

Heritage and Invention - Dream, Dare and Do.

J Orthop Sci 2021 Mar 6;26(2):201-202. Epub 2021 Mar 6.

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jos.2021.02.002DOI Listing
March 2021

Skeletal muscle metabolism on whole-body positron emission tomography during pitching.

J Int Soc Sports Nutr 2021 Mar 6;18(1):21. Epub 2021 Mar 6.

Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-0934, Japan.

Background: Electromyography (EMG) has been used for evaluating skeletal muscle activity during pitching. However, it is difficult to observe the influence of movement on skeletal muscle activity in deep-lying regions of the trunk and extremities using EMG. An alternative method that may be used is the measurement of glucose metabolism of skeletal muscle using positron emission tomography-computed tomography (PET-CT). This technique is a reliable measure of muscle metabolism, demonstrating a high correlation with the intensity of muscle activity. This study aimed to evaluate whole-body skeletal muscle metabolism during pitching using PET-CT.

Methods: Ten uninjured, skilled, adult pitchers, who were active at college or professional level, threw 40 baseballs at maximal effort before an intravenous injection of 37 MBq of F-fluorodeoxyglucose (FDG). Subsequently, additional 40 balls were pitched. PET-CT images were obtained 50 min after FDG injection, and regions of interest were defined within 72 muscles. The standardized uptake value (SUV) of FDG by muscle tissue per unit volume was calculated, and the mean SUV of the pitchers was compared with that of a healthy adult control group who did not exercise before the measurements. Statistical analysis was performed using a t-test, and P < 0.05 was considered statistically significant.

Results: Whole-body PET images showed a significant increase in glucose metabolism in the muscle groups of the fingers and toes in both the throwing and non-throwing sides. Additionally, asymmetric increases in glucose metabolism were observed in the muscles of the thigh.

Conclusions: This is the first study to evaluate whole-body muscle metabolism during pitching using PET-CT. Our findings would be useful in determining the training required for pitchers, and can be further applied to other sporting activities that involve throwing.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12970-021-00418-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7937262PMC
March 2021

Abscopal Effect of Frozen Autograft Reconstruction Combined with an Immune Checkpoint Inhibitor Analyzed Using a Metastatic Bone Tumor Model.

Int J Mol Sci 2021 Feb 17;22(4). Epub 2021 Feb 17.

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Japan.

We evaluated the abscopal effect of re-implantation of liquid nitrogen-treated tumor-bearing bone grafts and the synergistic effect of anti-PD-1 (programmed death-1) therapy using a bone metastasis model, created by injecting MMT-060562 cells into the bilateral tibiae of 6-8-week-old female C3H mice. After 2 weeks, the lateral tumors were treated by excision, cryotreatment using liquid nitrogen, excision with anti-PD-1 treatment, and cryotreatment with anti-PD-1 treatment. Anti-mouse PD-1 4H2 was injected on days 1, 6, 12, and 18 post-treatment. The mice were euthanized after 3 weeks; the abscopal effect was evaluated by focusing on growth inhibition of the abscopal tumor. The re-implantation of frozen autografts significantly inhibited the growth of the remaining abscopal tumors. However, a more potent abscopal effect was observed in the anti-PD-1 antibody group. The number of CD8+ T cells infiltrating the abscopal tumor and tumor-specific interferon-γ (IFN-γ)-producing spleen cells increased in the liquid nitrogen-treated group compared with those in the excision group, with no significant difference. The number was significantly higher in the anti-PD-1 antibody-treated group than in the non-treated group. Overall, re-implantation of tumor-bearing frozen autograft has an abscopal effect on abscopal tumor growth, although re-implantation of liquid nitrogen-treated bone grafts did not induce a strong T-cell response or tumor-suppressive effect.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijms22041973DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7922593PMC
February 2021

Reconstruction using a free vascularised medial femoral condyle corticoperiosteal flap for osteomyelitis of the juxta-articular distal radius: A case report and literature review.

Trauma Case Rep 2021 Apr 10;32:100408. Epub 2021 Feb 10.

Department of Orthopaedic Surgery, Kanazawa University Hospital, Kanazawa, Japan.

Osteomyelitis of the epiphysis after a distal radius fracture is uncommon. If not adequately and promptly treated, the detrimental effects on wrist function can be devastating. However, management of septic bone defects of the epiphysis is significantly challenging. We report the case of a patient with juxta-articular distal radius osteomyelitis successfully treated with a free vascularised corticoperiosteal flap from the medial femoral condyle (MFC corticoperiosteal flap). A 46-year-old right-handed man fell on the grass from a height of 2 m during a demolition. He was diagnosed with a right distal radius and ulnar styloid process fracture. He underwent open reduction and internal fixation. However, he developed a deep infection, resulting in postoperative osteomyelitis. Therefore, thorough debridement was performed and an external fixator was applied. Antibiotics were administered according to the culture results. He underwent reconstruction for bone defect using an MFC corticoperiosteal flap 28 days after re-operation. The patient could resume work without limitations 4 months after the reconstruction. The infection subsided completely, and radiographs confirmed bone union at 5 months after the reconstruction. His wrist range of motion was 40° in dorsal flexion (uninjured side 70°), 50° in palmar flexion (75°), 80° in supination (90°), and 90° in pronation (90°). There was no donor site complication. The patient has reported no pain for 1 year since the injury. The use of the MFC corticoperiosteal flap for reconstruction of the juxta-articular distal radius osteomyelitis decreased the time required for bone union, enabled local antibiotic delivery to control infection, and helped preserve wrist function.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.tcr.2021.100408DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7905069PMC
April 2021

Clinical and Biological Implications of Cancer Stem Cells in Hepatocellular Carcinoma.

Yonago Acta Med 2021 Feb 6;64(1):1-11. Epub 2021 Jan 6.

Division of Medical Genetics and Regenerative Medicine, Department of Genomic Medicine and Regenerative Therapy, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan.

Hepatocellular carcinoma (HCC) is a malignant tumor with poor prognosis, and is one of the leading causes of cancer-related deaths worldwide. Recently, the development of therapeutic drugs via novel mechanisms of action, involving molecular-targeted drugs and immune checkpoint inhibitors, has progressed in the field of HCC. However, the recurrence rate remains high, and further improvement of the prognosis of patients with HCC is urgently needed. Cancer stem cells (CSCs) are a promising target for further development of novel anti-cancer drugs because they are reportedly involved in tumor initiation, maintenance, recurrence, and resistance to conventional therapies. Although several studies have already been conducted, the functions and roles of CSCs in the development and progression of tumors remain to be elucidated. In this review article, we will clarify the fundamental knowledge of CSCs necessary for the understanding of CSCs and will outline so-far identified markers specific to liver CSCs and the pathological and therapeutic implications of CSCs in HCC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.33160/yam.2021.02.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902159PMC
February 2021

Sensory Disturbance of the Lower Extremity after Sural Artery Flap Elevation.

Adv Orthop 2021 13;2021:8886063. Epub 2021 Feb 13.

Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641, Japan.

Purpose: Elevation of the sural artery flap with the sural nerve is associated with donor-site morbidities, such as postoperative sensory disturbance of the lower extremity. We evaluated the sensory disturbance of the lower extremity after elevation of the sural artery flap.

Methods: This study included 7 patients who underwent surgery using the sural artery flap. The sensory disturbances immediately after surgery and at present were evaluated on a 10-point scale. The influences of surgery on activities of daily living and patient satisfaction were also evaluated.

Results: The sensory disturbance was 4.48 immediately after surgery and 2.24 presently, and the difference between the timepoints was not statistically significant. The influence of surgery on activities of daily living was 2.30, and the patient satisfaction was 7.90.

Conclusion: It may be necessary to consider the sural artery flap, which does not include the sural nerve, to avoid unnecessary complications. When it is unavoidable to use the sural artery flap, including the sural nerve, it is important to thoroughly inform patients beforehand about the postsurgery sensory disturbance in the lower extremities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2021/8886063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7896868PMC
February 2021

Combination Methionine-methylation-axis Blockade: A Novel Approach to Target the Methionine Addiction of Cancer.

Cancer Genomics Proteomics 2021 Mar-Apr;18(2):113-120

AntiCancer, Inc., San Diego, CA, U.S.A.;

Background/aim: Cancers are selectively sensitive to methionine (MET) restriction (MR) due to their addiction to MET which is overused for elevated methylation reactions. MET addiction of cancer was discovered by us 45 years ago. MR of cancer results in depletion of S-adenosylmethionine (SAM) for transmethylation reactions, resulting in selective cancer-growth arrest in the late S/G-phase of the cell cycle. The aim of the present study was to determine if blockade of the MET-methylation axis is a highly-effective strategy for cancer chemotherapy.

Materials And Methods: In the present study, we demonstrated the efficacy of MET-methylation-axis blockade using MR by oral-recombinant methioninase (o-rMETase) combined with decitabine (DAC), an inhibitor of DNA methylation, and an inhibitor of SAM synthesis, cycloleucine (CL). We determined a proof-of-concept of the efficacy of the MET-methylation-axis blockade on a recalcitrant undifferentiated/unclassified soft-tissue sarcoma (USTS) patient-derived orthotopic xenograft (PDOX) mouse model.

Results: The o-rMETase-CL-DAC combination regressed the USTS PDOX with extensive cancer necrosis.

Conclusion: The new concept of combination MET-methylation-axis blockade is effective and can now be tested on many types of recalcitrant cancer.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21873/cgp.20246DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7943212PMC
August 2020

Long-term survival in a patient with Hutchinson-Gilford progeria syndrome and osteosarcoma: A case report.

World J Clin Cases 2021 Feb;9(4):854-863

Department of Orthopaedic Surgery, Kanazawa University, Kanazawa 9208641, Japan.

Background: Hutchinson-Gilford progeria syndrome (HGPS) is an extremely rare disease characterized by the rapid appearance of aging with an onset in childhood. Serious cardiovascular complications can be life-threatening events for affected patients and the cause of early death. Herein we report a HGPS patient with osteosarcoma hat was successfully managed and is alive 13 years after the diagnosis. This is the first report describing the detailed surgical procedure and long-term follow-up of osteosarcoma in a patient with HGPS.

Case Summary: The patient was diagnosed with HGPS at 5 years of age with typical features and was referred to our department with a suspected bone tumor of the left proximal tibia at the age of 18. Open biopsy of the tibial bone tumor revealed a conventional fibroblastic osteosarcoma. We have developed and performed a freezing technique using liquid nitrogen for tumor reconstruction. This technique overcame the small size of the tibia for megaprosthesis and avoided amputation and limb salvage was achieved 13 years post-operatively. Although the patient had a number of surgical site complications, such as wound dehiscence, and superficial and deep infections due to vulnerable skin in HGPS, no recurrence or metastases were detected for 13 years, and she walks assisted by crutches. Her general health was good at the latest follow-up at 31 years of age.

Conclusion: A HGPS patient with osteosarcoma was successfully managed and she was alive 13 years after the diagnosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.12998/wjcc.v9.i4.854DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7852653PMC
February 2021

In Vivo Kinematics of the Thumb Carpometacarpal Joint During Flexion and Abduction.

J Hand Surg Asian Pac Vol 2021 Mar;26(1):31-35

Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.

Despite the movement of the thumb carpometacarpal joint has been studied, many unclarified points remain regarding the movement of this joint. The purpose of this study was to evaluate the in vivo kinematics of the thumb carpometacarpal joint during flexion and abduction using computed tomography images. The subjects were 9 healthy males. Computed tomography images were obtained in 4 equally-divided positions from maximum extension to maximum flexion, and maximum adduction to maximum abduction of the thumb. A three-dimensional model was constructed from these images, and the models of each position were superimposed with reference to the trapezium. The amount of angular change around the bone axes of first metacarpal bone and rotation axes were evaluated. We found that the first metacarpal bone showed relatively simple behavior during abduction. However, during flexion, it exhibited a particular movement in which the amount of angular change of the metacarpal bone with respect to the trapezium rapidly increased with deep flexion. These results suggest that the thumb carpometacarpal joint exhibits a special movement during flexion, especially deep flexion.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1142/S2424835521500041DOI Listing
March 2021

Significant Improvement After Surgery for a Symptomatic Osteoblastoma in a Patient with Camurati-Engelmann Disease: Case Report and Literature Review.

Calcif Tissue Int 2021 Feb 8. Epub 2021 Feb 8.

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.

Camurati-Engelmann disease (CED) is a rare, progressive diaphyseal dysplasia characterized as diaphyseal hyperostosis and sclerosis of the long bones. Corticosteroids, bisphosphonates, and losartan have been reported to be effective systemic medications used to reduce CED symptoms. There are no reports of osteoblastoma in patients with CED, and osteoblastoma in the distal radius is rare. We present a patient diagnosed with CED, based on radiological and histological examinations, at 11 years old. At 22 years old, she experienced severe pain in her right forearm and was treated with bisphosphonate, losartan, and prednisolone; however, the pain continued. An expansive and sclerotic lesion at the distal radius was observed on radiography. A follow-up plain radiograph indicated that the lesion was growing. Fluorodeoxyglucose positron emission tomography revealed solitary, intense radiotracer uptake, and a biopsy and surgical resection were performed due to suspected malignancy. Pathologic analysis showed anastomosing bony trabeculae rimmed by osteoblasts observed in a loose fibrovascular stroma. The lesion was diagnosed as an osteoblastoma. Following bone excision and artificial bone grafting, the patient's severe pain almost completely disappeared. At final follow-up, no evidence of osteoblastoma recurrence was noted. To our knowledge, this is the first case report of osteoblastoma arising in a patient with CED. Bone excision and artificial bone grafting may be a treatment option for local symptomatic osteoblastoma in patients with CED.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00223-021-00813-8DOI Listing
February 2021

Association of low back pain with muscle weakness, decreased mobility function, and malnutrition in older women: A cross-sectional study.

PLoS One 2021 25;16(1):e0245879. Epub 2021 Jan 25.

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.

Background: Low back pain (LBP) and decreased mobility function are common problem among older people. Muscle weakness has been reported as a risk factor for these conditions, and exercise therapy can improve them. We created a novel exercise device that also measures abdominal trunk muscle strength. Malnutrition has also emerged as a major problem among older people. Muscle is a direct key linking decreased mobility function and malnutrition. This study aimed to examine the associations of LBP with not only decreased physical function and muscle weakness but also nutritional status of older people.

Methods: We examined the associations of LBP with muscle weakness, decreased mobility function (locomotive syndrome [LS]), and malnutrition among older women. The study included 101 female patients aged 60 years or older scheduled to undergo surgery for degenerative lower extremity diseases. Preoperatively, physical tests including abdominal trunk muscle strength assessment using the device and laboratory tests were conducted. Subjects with LBP (numerical rating scale ≥2; range, 0-4) during the preceding month were allocated to the LBP group (n = 36). Other subjects were allocated to the non-LBP group (n = 65).

Results: The LBP group had lower abdominal trunk and knee extensor muscle strength, lower serum albumin, and hemoglobin levels as blood biomarkers associated with malnutrition risk, and higher LS test scores than the non-LBP group. A multivariate analysis showed that abdominal trunk muscle weakness and advanced LS were associated with LBP. LBP intensity was negatively correlated with abdominal trunk and knee extensor muscle strength and positively correlated with the LS test score. The serum hemoglobin level was negatively correlated with the LS test score.

Conclusion: Abdominal trunk muscle weakness and decreased mobility function were associated with LBP among older women.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0245879PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7833166PMC
January 2021

Comparison of mid-term clinical results between cementless and cemented femoral stems in total hip arthroplasty with femoral shortening osteotomy for Crowe type IV hips.

Arch Orthop Trauma Surg 2021 Jan 23. Epub 2021 Jan 23.

Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.

Introduction: This report is the first study to compare the clinical outcomes between cementless and cemented femoral prostheses in total hip arthroplasty (THA) with subtrochanteric femoral shortening osteotomy for Crowe type IV hips.

Materials And Methods: We identified 26 hips in 20 patients who had undergone cemented (n = 13) or cementless (n = 13) THA with subtrochanteric femoral shortening osteotomy for Crowe type IV hips with a minimum follow-up period of 2 years. The mean follow-up period was 60.8 ± 33.9 months (24-120 months). We compared radiological findings, postoperative clinical recoveries, postoperative complications, and implant survival rates.

Results: In both groups, there were no cases of aseptic loosening for the acetabular and femoral implant. In terms of bone union at the osteotomy site, the mean duration was significantly longer in the cemented group (9.8 ± 4.2 months) than in the cementless group (5.0 ± 1.9 months). The clinical hip score in gait and pain at 3 months postoperatively was significantly higher in the cemented group than in the cementless group, while there were no significant changes at other timepoints between two groups. The number of postoperative complications was not significantly different between the two groups. The implant survival rate was 92% in the cementless group and 100% in the cemented group at 5 years postoperatively (P = 0.31).

Conclusions: The cemented femoral prosthesis is superior to the cementless femoral prosthesis for early clinical recovery, while the duration required to achieve bone union at the osteotomy site is longer in the cemented femoral prostheses. It is possible for surgeons to perform successful hip reconstructions, regardless of the fixation method used for THA with shortening femoral osteotomy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00402-020-03749-0DOI Listing
January 2021

Reconstruction using a frozen autograft for a skull and humeral lesion of synchronous multicentric osteosarcoma after undergoing successful neoadjuvant chemotherapy: a case report and review of the literature.

BMC Surg 2021 Jan 22;21(1):56. Epub 2021 Jan 22.

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.

Background: Synchronous multicentric osteosarcoma (SMOS) is a rare disease characterized by simultaneous multicentricity of intraosseous osteosarcoma without visceral involvement. SMOS, including a skull lesion, which occurs relatively rarely, and reconstruction using a frozen autograft after the excision of a lesion of SMOS has been infrequently reported previously.

Case Presentation: We report an 18-year-old girl with SMOS, with lesions located in the left distal femur, right proximal humerus, and left occipital bone. Her major complaint was pain and swelling around the left knee joint. Asymptomatic lesions of the humerus and skull bone were detected on a systemic bone scan. No visceral organ metastasis was observed. A biopsy of the distal femoral lesion revealed osteosarcoma. Based on the histological findings, multiple bone lesions, and absence of visceral lesion, the clinical diagnosis of SMOS was made. After five courses of neoadjuvant chemotherapy with a regimen of doxorubicin and cisplatin, reconstruction using a tumor prosthesis following wide excision of the left distal femur was performed, and total necrosis was histologically observed in the retracted specimen. Following three cycles of adjuvant chemotherapy, tumor excision and reconstruction with a frozen autograft treated with liquid nitrogen was conducted for both lesions of the humerus and skull, rather than tumor prosthesis or synthetics, in order to retain a normal shoulder function, and to obtain a good cosmetic and functional outcome after treatment of the skull lesion. Further adjuvant chemotherapy could not be administered after the completion of the surgical treatment for all lesions because the adverse events due to chemotherapy were observed. At over 5 years after the diagnosis, she remains clinically disease-free.

Conclusions: An early correct diagnosis, the proper management of chemotherapy, and surgical treatment for all lesions are essential for achieving a good clinical outcome, even in SMOS including a skull lesion. By performing reconstruction using a frozen autograft for a proximal humeral lesion and a skull lesion after confirming the good histological efficacy of neoadjuvant chemotherapy for the primary lesion, the excellent function of the shoulder joint and a good cosmetic outcome at the site of the skull lesion was acquired without complications or recurrence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12893-020-01018-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7825174PMC
January 2021

The number of osteoclasts in a biopsy specimen can predict the efficacy of neoadjuvant chemotherapy for primary osteosarcoma.

Sci Rep 2021 Jan 21;11(1):1989. Epub 2021 Jan 21.

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takaramachi, Kanazawa-city, Ishikawa, 920-8641, Japan.

Osteosarcoma is the most common primary malignant bone tumor, and its standard treatment is a combination of surgery and chemotherapy. A poor response to chemotherapy causes unfavorable oncological outcomes. We investigated the correlation between osteoclast differentiation in biopsy specimens and the efficacy of neoadjuvant chemotherapy in resected specimens. Forty-nine patients who underwent neoadjuvant chemotherapy and subsequent surgical treatment at our institution between 1999 and 2018 were enrolled. Using medical records, we investigated the age, sex, tumor size, location, subtype, staging, chemotherapy agents (doxorubicin, cisplatin, ifosfamide, and methotrexate), number of neoadjuvant chemotherapy courses, number of osteoclasts in biopsy specimens, and efficacy of neoadjuvant chemotherapy according to the Rosen and Huvos classification (Grade I-IV) in resected specimens. Univariate and multivariate analyses were performed to identify factors predictive of a good response in resected specimens after neoadjuvant chemotherapy. A good response (Grade III/IV) was detected in 25, while a poor response (Grade I/II) was detected in 24. According to the multivariate analysis, ≥ 46 years old (odds ratio [OR], 0.05; 95% confidence interval [CI], 0.01-0.45; p < 0.01) and ≥ 5 mature osteoclasts in a biopsy specimen (OR, 36.9; 95% CI, 6.03-225; p < 0.01) were significantly associated with the neoadjuvant chemotherapy efficacy. The accuracy for predicting a good response to chemotherapy based on ≥ 5 osteoclasts in a biopsy specimen in patients < 46 years old was 85%. The number of mature osteoclasts in biopsy specimens is a simple factor for predicting the efficacy of chemotherapy before treatment, although further studies will be required to determine the underlying mechanism.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-020-80504-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7820005PMC
January 2021