Publications by authors named "Ken Okazaki"

188 Publications

Comparison of in vivo knee kinematics before and after bicruciate-stabilized total knee arthroplasty during squatting.

BMC Musculoskelet Disord 2021 Sep 12;22(1):772. Epub 2021 Sep 12.

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.

Background: No studies have directly evaluated kinematic changes during squatting before and after bicruciate-stabilized total knee arthroplasty (BCS-TKA) with the dual cam-post mechanism and asymmetric surfaces. This study investigated the effect of BCS-TKA on changes to pre- and postoperative skeletal knee kinematics, to identify factors associated with postoperative skeletal kinematic parameters.

Methods: Seventeen knees in 17 patients were prospectively recruited before primary TKA for advanced medial knee osteoarthritis. Subjects underwent BCS-TKA and were evaluated more than 1 year postoperatively. In vivo dynamic skeletal knee kinematics were evaluated using periodic radiographic images collected during squatting to quantify the tibiofemoral functional extension/flexion angle, anteroposterior (AP) translation, and axial rotation angle using image-matching techniques. Rotational alignments of femoral and tibial components were measured postoperatively using computed tomography images.

Results: The pre- and postoperative tibiofemoral functional extension/flexion angles during squatting were 12.2° ± 6.7°/100.1° ± 16.8° and 9.6° ± 8.6°/109.4° ± 16.8°, respectively, with a significant difference in flexion angle (p < .05). Total AP translation was significantly larger postoperatively than preoperatively (10.8 mm ± 3.7 mm vs. 14.4 mm ± 4.2 mm, respectively; p < .05). The pre- and postoperative total rotation angles were 6.6° ± 3.0° and 6.4° ± 3.7°, respectively, indicating no significant difference. The pre- and postoperative tibiofemoral functional flexion angles were significantly associated with each other (p = .0434, r = .49). The postoperative total rotation angle was significantly smaller when the total component rotational mismatch angle between the femoral and tibial components was above 5° vs. below 5° (4.6° ± 2.7° vs. 8.3° ± 3.9°, respectively; p < .05).

Conclusions: BCS-TKA significantly increased the tibiofemoral functional flexion angles, with larger AP translation postoperatively. Both preoperative skeletal kinematics and surgical techniques affected the skeletal kinematics of the replaced knee. A total component rotational mismatch angle greater than 5° significantly decreased postoperative total knee rotation during squatting.
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http://dx.doi.org/10.1186/s12891-021-04669-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8436441PMC
September 2021

Anterior prominence of the femoral condyle varies among prosthesis designs and surgical techniques in total knee arthroplasty.

BMC Musculoskelet Disord 2021 Sep 12;22(1):784. Epub 2021 Sep 12.

Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, 162-8666, Tokyo, Japan.

Background: Patellofemoral overstuffing after total knee arthroplasty (TKA) can cause limited range of motion and anterior knee pain. This study compared anterior prominence of femoral components among different prothesis designs in surgical simulation models utilizing the anterior reference (AR) and posterior reference (PR) techniques.

Methods: Surgical simulations were performed using on a three-dimensional planning system preoperative computed tomography data of consecutive 30 patients with knee osteoarthritis scheduled to undergo TKA. Four implant models were used: Attune, Persona, Journey II, and Legion. Rotational alignment was set parallel to the transepicondylar axis and size was selected based on the absence of notch formation in the femoral anterior cortex and the best fit with the shape of the medial posterior femoral condyle. For each combination of surgical technique (AR or PR method) and implant model, measurements were taken of the maximum medial, central, and lateral prominence of the implant from the anterior femoral cortex.

Results: Using either the AR or PR method, the medial and central prominences were significantly lower with Journey II than with the other models. The lateral prominence was the lowest with Attune in the AR method. The AR method was associated with significantly less prominence compared with the PR method, regardless of implant model.

Conclusions: The degree of anterior prominence of the femoral implant is affected by the implant design when the AR method is used. The PR method is associated with greater anterior prominence compared with the AR method, and the pitch size is an additional factor in the PR method. Surgeons should be familiar with implant designs, including the thickness of the anterior flange and the available size selections.
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http://dx.doi.org/10.1186/s12891-021-04670-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8436424PMC
September 2021

Full-Endoscopic Lumbar Discectomy for Recurrent Lumbar Disc Herniation: A Retrospective Study with Patient-Reported Outcome Measures.

Spine Surg Relat Res 2021 20;5(4):272-277. Epub 2020 Nov 20.

Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan.

Introduction: Revision surgery for recurrent lumbar disc herniation after surgical treatment is at times challenging due to epidural adhesions and scar. This study aimed to review the clinical results and safety of full-endoscopic lumbar discectomy via interlaminar (FELD-IL) and transforaminal (FELD-TF) approaches for revision surgery.

Methods: We conducted a retrospective study including 52 lumbar disc herniation revision patients (mean age, 51.8 years; male/female, 13/39), with 17 FELD-IL and 35 FELD-TF cases. Complication incidences were assessed by reviewing surgical videos and postoperative magnetic resonance images of nerve decompression outcomes. Patients' responses to Japan Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and numerical rating scales (NRS) for lumbar pain, leg pain, and leg numbness were recorded before and during follow-up. The Wilcoxon-signed rank tests were utilized to compare pre- and postoperative group variables.

Results: The average operation time was 33.0 min in FELD-IL and 31.7 min in FELD-TF. Seven FELD-IL cases required lamina excavation with high-speed drill bars for scar tissue dissection from the lamina. Dura injury occurred during the excavation in one case. No complication was noted in the FELD-TF group. Successful decompression of the nerve was achieved in all cases. Complete sets of JOABPEQ and NRS were obtained in 64.5% of FELD-IL and in 82.9% of FELD-TF. The mean follow-up period was 18.6 months. All the subdomain of JOABPEQ and NRS improved significantly postoperative in both groups. There was no difference regarding the improvement of scores between the procedures except NRS for lumbar pain, which was more favorable in FELD-IL. Recurrence of herniation occurred in one patient (6%) after FELD-IL and two patients (6%) after FELD-TF.

Conclusions: Both FELD-IL and FELD-TF are safe and effective revision procedures for recurrent lumbar disc herniation. FELD-TF could be performed employing the same procedure as primary surgery in revisions, regardless of the previous surgical approach.
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http://dx.doi.org/10.22603/ssrr.2020-0159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8356243PMC
November 2020

Safety and Efficacy of Zoledronic Acid Treatment with and without Acetaminophen and Eldecalcitol for Osteoporosis.

Intern Med 2021 15;60(16):2585-2591. Epub 2021 Aug 15.

Department of Orthopaedic Surgery, Tokyo Women's Medical University, Japan.

Objectives We aimed to investigate the safety of zoledronic acid (ZOL) combined with acetaminophen (APAP) regarding both the adverse events and the efficacy of ZOL combined with an eldecalcitol (ELD) in a randomized clinical trial conducted in patients with primary osteoporosis. Methods A total of 109 patients were administered ZOL 5 mg and then were randomly assigned to the following groups (3:2:1): those treated with ZOL, those treated with ZOL combined with APAP and ELD, and those treated with ZOL combined with ELD. For the analyses, the groups were classified into four treatment groups: patients treated with APAP (APAP group) and without APAP (non-APAP group), and those treated with ELD (ELD group) and without ELD (non-ELD group). The incidence rates of symptomatic adverse events were compared between the APAP and non-APAP groups, and the efficacy was compared between the ELD and non-ELD groups. Results In the APAP and non-APAP groups, the incidence rates of symptomatic adverse events were 20.6% and 44.6% (p=0.009), respectively. Age and APAP use were found to be significant factors associated with adverse events. The percent changes in the bone mineral density values from baseline (ΔBMD) in the ELD and non-ELD groups at 12 months were 8.2% and 6.2% for the lumbar spine, 4.2% and 4.0% for the total hip, and 3.9% and 2.2% for the femoral neck, respectively. The ΔBMD of all sites did not differ significantly between the ELD and non-ELD groups. Conclusion In ZOL treatment, the co-administration of APAP should thus be considered as a therapeutic option to reduce the occurrence of symptomatic adverse events stemming from ZOL treatment in Japanese patients with primary osteoporosis, particularly in younger patients.
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http://dx.doi.org/10.2169/internalmedicine.6607-20DOI Listing
August 2021

Efficacy of Intra-Articular Injection of 10 mg and 20 mg Triamcinolone for Rheumatoid Arthritis of the Wrist: A Prospective, Randomized, Pilot Study.

J Hand Surg Asian Pac Vol 2021 Sep;26(3):490-493

Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan.

To compare the efficacy of intra-articular injection (IA) with 10 mg and 20 mg triamcinolone for treatment of rheumatoid arthritis (RA) of the wrist joint. We enrolled 20 patients with swelling and pain in wrist due to RA in the present prospective, randomized, pilot study. Patients were randomly assigned in a 1:1 ratio to either the 20 mg or 10 mg group, and received IA of the appropriate dose of triamcinolone. Efficacy was assessed by recording Numerical Rating Scale (NRS) for pain and improvement in power doppler (PD) scale score at weeks 1, 4, and 12 of treatment compared with baseline. The shortened Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) was recorded at baseline and week 12. The NRS was found to be significantly improved at weeks 4 ( = 0.006) and 12 ( = 0.036) among the total study population. Neither the change in NRS nor the improvement PD scale score from baseline were significantly different between the two groups at any week (NRS: week 1, = 0.617; week 4, = 0.727; and week 12, = 0.878; PD scale score: week 1, = 0.370; week 4, = 1.000; and week 12, = 0.179). Among the entire study population, the QuickDASH was not significantly improved at week 12 nor was the change from baseline significantly different between the two groups at week 12 ( = 0.592). IA of triamcinolone was effective for pain relief in context of RA in the wrist joint. However, in terms of NRS, improvement of PD scale score, and QuickDASH score, the efficacies of 10 mg and 20 mg triamcinolone were not significantly different. Thus, IA of 10 mg triamcinolone may be sufficient for the treatment of RA in the wrist joint.
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http://dx.doi.org/10.1142/S2424835521200046DOI Listing
September 2021

Clinical Outcomes of Selective Single-Level Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression of Multilevel Lumbar Spinal Stenosis and Risk Factors of Reoperation.

Global Spine J 2021 Jul 19:21925682211033575. Epub 2021 Jul 19.

Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan.

Study Design: Retrospective cohort study.

Objectives: To investigate the usefulness of selective single-level lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) in patients with radiological multilevel lumbar spinal stenosis (LSS) and clarify the predictive factors of reoperation.

Methods: A total of 128 patients who underwent LE-ULBD of radiological multilevel LSS were retrospectively examined. Single-level decompression was selected clinically and supplemented radiologically. Clinical outcomes were assessed with the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), numeric rating scale (NRS), and Macnab criteria (mean follow-up period, 28.6 months [range, 24-63 months]). Stenosis severity was classified as grades M (moderate) and S (severe) based magnetic resonance imaging findings. Multilevel LSS was classified as SS, SM, and MM according to the number of grade S levels.

Results: The follow-up rate was 74.2%. All domains of the JOABPEQ and NRS significantly improved during follow-up. The Macnab outcome classification was "excellent" or "good" in 77.9% of the patients. The reoperation rate was 10.2%. None of the patients with unilateral symptoms required reoperation. The SS type was a significant risk factor of reoperation for multilevel LSS with bilateral symptoms. Additional LE-ULBD was performed for all the reoperation with the "excellent" or "good" results of the Macnab criteria in 69% of the patients.

Conclusions: Selective single-level LE-ULBD provided favorable results for multilevel LSS. However, information about the risks of reoperation for multilevel severe stenosis with bilateral symptoms should be shared between surgeons and patients.
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http://dx.doi.org/10.1177/21925682211033575DOI Listing
July 2021

Alcohol consumption induces murine osteoporosis by downregulation of natural killer T-like cell activity.

Immun Inflamm Dis 2021 Jul 2. Epub 2021 Jul 2.

Department of Microbiology and Immunology, Nippon Medical School, Tokyo, Japan.

Introduction: Chronic alcohol consumption (CAC) can induce several deleterious effects on the body, including the promotion of osteoporosis; however, the immunological mechanism underlying alcohol-induced osteoporosis is still unclear.

Methods: We administered alcohol to mice for 4 weeks as the experimental CAC model and analyzed the bone and immune cells that are located in the vicinity of a bone.

Results: IL-4 is known to be a suppressive factor for osteoclastogenesis, and we found that natural killer T (NKT)-like cells, which showed NK1.1-positive, CD3-positive, and α-galactosylceramide-loaded CD1d tetramer-negative, produced IL-4 more effectively than CD4 T and natural killer (NK) cells. The alcohol consumption facilitated a significant decrease of bone mineral density with the upregulation of nuclear factor of activated T cells 1 and receptor activator of NF-κB ligand expression. Meanwhile, we confirmed that alcohol consumption suppressed the activity of antigen-presenting cells (APCs) and NKT-like cells, leading to decreased IL-4 secretion. Moreover, these harmful effects of alcohol consumption were reduced by simultaneous treatment with a glycolipid antigen OCH.

Conclusions: Our results indicate that the inactivation of innate immune cells, APCs, and NKT-like cells are likely to be crucial for alcohol-induced osteoporosis and provide a new therapeutic approach for preventing osteoporosis.
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http://dx.doi.org/10.1002/iid3.485DOI Listing
July 2021

Using peer role-playing to improve students' clinical skills for musculoskeletal physical examinations.

BMC Med Educ 2021 Jun 5;21(1):322. Epub 2021 Jun 5.

Department of Medical Education, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.

Background: The traditional curriculum for medical students in Japan does not include sufficient opportunities for students to develop their skills for musculoskeletal (MSK) examination and clinical reasoning and diagnosis. Therefore, an effective programme is required to help medical students and residents improve their clinical skills in MSK. This paper aims to assess the clinical skills of medical students who have participated in a peer role-playing simulation programme using a mini clinical evaluation exercise (mini-CEX).

Methods: Participants were 90 female medical students who were completing their first orthopaedic clinical clerkship. They were divided into two groups. The simulation group participated in a role-play focussed on MSK cases as low-fidelity simulation, a structured debriefing with the course supervisor, and a self-reflection on Day 1 (n = 64). The control group did not participate in the role-play due to randomised clerkship schedules (n = 26). On Day 2 of the intervention, we observed and assessed all participants' performances during MSK outpatient encounters using the mini-CEX. We compared the mini-CEX score between the simulation group and the control group; the Wilcoxon rank-sum test was used for statistical analysis.

Results: The mini-CEX scores for physical examination, clinical reasoning and diagnosis, and overall clinical competency were significantly higher in the simulation group than in the control group (p < .05, physical examination: p = .014, clinical reasoning: p = .042, overall: p = .016). These findings suggest that medical students who partake in a peer role-playing simulation programme could experience improved clinical skills for physical examination, clinical reasoning and diagnosis, and overall clinical competency in real-life MSK outpatient encounters.

Conclusions: Through a mini-CEX assessment, our findings indicate that medical students who participated in our peer role-playing simulation programme have improved clinical skills. Peer role-playing as a low-fidelity simulation and practical educational opportunity will enable educators to polish the competency of medical students in musculoskeletal physical examinations and clinical reasoning and diagnosis in a clinical setting.
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http://dx.doi.org/10.1186/s12909-021-02742-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8179699PMC
June 2021

Change of ARASHI scores for large joints in rheumatoid arthritis patients treated with abatacept for three years: A clinical observational study.

Arch Rheumatol 2021 Mar 25;36(1):10-18. Epub 2020 Jun 25.

Department of Orthopedic Surgery, Tokyo Women's Medical University, Shinjyuku, Japan.

Objectives: This study aims to investigate large joint damage progression using the assessment of rheumatoid arthritis by scoring of large joint destruction and healing in radiographic imaging (ARASHI) score in patients with rheumatoid arthritis (RA) treated with abatacept for three years.

Patients And Methods: A total of 71 consecutive patients with RA (7 males, 64 females; median age 68 years; range, 41 to 81 years) and joint lesions (141 shoulders, 139 elbows, 141 hips, 134 knees, and 142 ankles) treated with abatacept for three years were examined. Radiographic changes were assessed using the ARASHI score, and factors associated with radiographic progressive damage of large joints were analyzed using multivariate logistic regression.

Results: The three-year radiographic progressive damage rates for the upper and lower limb large joints were 18.3% and 22.5%, respectively. Rates for the shoulder and knee decreased significantly (p=0.025 and 0.039, respectively), whereas rate for the ankle increased significantly (p=0.043). Multivariate logistic regression analysis identified the baseline ARASHI status score as an independent predictor of progressive damage of upper limb large joints within three years (p=0.004; odds ratio, 1.17). The cutoff value of the ARASHI status score for the upper limb large joints was 4, as determined from the receiver operating characteristics curve. No significant predictors of progressive damage were identified in the lower limb large joints within three years.

Conclusion: The greatest suppression of the radiographic progressive damage of large joints was achieved for the shoulders and knees. Meanwhile, ankle damage progressed. Therefore, ankle joint damage should be monitored even in patients treated with abatacept. In the upper limbs, prescribing abatacept to patients with RA depending on their state of upper limb large joint damage may suppress damage progression.
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http://dx.doi.org/10.46497/ArchRheumatol.2021.7727DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8140878PMC
March 2021

Interlocking Closed-Wedge High Tibial Osteotomy Modified With Oblique Osteotomy Lines and a Locking Plate Fixation.

Authors:
Ken Okazaki

Arthrosc Tech 2021 Apr 12;10(4):e1061-e1066. Epub 2021 Mar 12.

Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan.

Closed-wedge high tibial osteotomy (CWHTO) is more advantageous over open-wedge high tibial osteotomy in the following viewpoints: (1) compression force from the patellar tendon to the osteotomy site contribute to its stability, (2) patellar baja less likely occurs, and (3) hardware implant is placed under the thick muscle, which could prevent risk of irritation and infection. Although conventional CWHTO resects the wedge bone, including the anterior and posterior cortices, interlocking CWHTO preserves them while performing osteotomy for the anterior or posterior cortex with only the proximal or distal osteotomy line, respectively. When the wedge is being closed, the distal fragment is internally rotated overlying the anterior and posterior cortices on the proximal and distal cortices, respectively. As a result, good rotational stability and anterior advancement of the tibial tubercle are obtained. Interlocking CWHTO can be applied for patients with moderate patellofemoral osteoarthritis. Adopting an oblique osteotomy line enables secure multiple screw fixations for a long locking plate with a good fitting, allowing early postoperative weightbearing.
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http://dx.doi.org/10.1016/j.eats.2020.12.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8085353PMC
April 2021

Gradual-radius femoral component with s-curve post-cam provides stable kinematics at mid-flexion after total knee arthroplasty.

J Orthop Sci 2021 Apr 28. Epub 2021 Apr 28.

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.

Background: Mid-flexion instability is the one of the reasons for patient dissatisfaction after total knee arthroplasty (TKA). The purposes of this study were to evaluate in vivo knee kinematics and clinical outcomes using a novel TKA design with a gradual femoral radius component and s-curve post-cam, which are intended to prevent the instability initiated by sudden reductions in the femoral radius observed with conventional components.

Methods: We used radiographic-based, image-matching techniques to analyze femorotibial anteroposterior translation, axial rotation, and anterior/posterior cam-post contact during two dynamic movements, squatting and stair climbing, in 20 knees that had undergone posterior-stabilized fixed-bearing TKA with an improved sagittal profiles of the femoral component and post-cam mechanism. We also evaluated patient-reported outcomes assessed by the 2011 Knee Society Score (KSS 2011).

Results: Squatting and stair climbing produced a similar trend in anteroposterior translation and a relatively small standard deviation at mid-flexion. Although the rotation angles varied widely during squatting and stair climbing, the femoral component was consistently externally rotated. Anterior/posterior cam-post contact during squatting and stair climbing were observed in 0/17 knees and 0/0 knees, respectively. The "Symptoms", "Satisfaction", and "Functional activities" subscales of the KSS 2011 were significantly (P < 0.05) improved postoperatively compared to preoperatively ("Symptoms", 10 to 21; "Satisfaction", 15 to 26; "Functional activities", 25 to 71).

Conclusion: A gradual femoral radius component with an s-curve post-cam provided stable kinematics and favorable clinical results during squatting and stair climbing at 1 year after surgery.
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http://dx.doi.org/10.1016/j.jos.2021.02.015DOI Listing
April 2021

Joint-Preserving Surgery for Forefoot Deformities in Patients with Rheumatoid Arthritis: A Literature Review.

Int J Environ Res Public Health 2021 04 13;18(8). Epub 2021 Apr 13.

Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo 162-8666, Japan.

The combination of first metatarsophalangeal joint arthrodesis and resection arthroplasty of all lesser metatarsal heads has been historically considered the golden standard treatment for rheumatoid forefoot deformities. However, as recent improved management of rheumatoid arthritis have reduced progression of joint destruction, the surgical treatments for rheumatoid forefoot deformities have gradually changed from joint-sacrificing surgery, such as arthrodesis and resection arthroplasty, to joint-preserving surgery. The aim of this literature review was to provide current evidence for joint-preserving surgery for rheumatoid forefoot deformities. We focused on the indications, specific outcomes, and postsurgical complications of joint-preserving surgery in this review.
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http://dx.doi.org/10.3390/ijerph18084093DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8068870PMC
April 2021

Comparison of radiographic changes in rectangular curved short stem with thin versus thick porous coating for cementless total hip arthroplasty: a retrospective study with a propensity score matching.

J Orthop Surg Res 2021 Apr 13;16(1):247. Epub 2021 Apr 13.

Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.

Background: Radiographic changes that appear relatively quickly after fixation of cementless stem in total hip arthroplasty (THA) vary depending on the stem design and fixation style. The present study compared radiographic changes between two types of rectangular curved short stems of similar shape.

Methods: This retrospective study included 118 hips that underwent primary cementless THA with an anterolateral supine approach using a rectangular, curved, short stem performed by the same surgeon between June 2015 and June 2019. Among the examined hips, 39 had a thicker porous coating stem (thicker group) and 66 had a thinner porous coating and reduced tip stem (thinner group) and at least 12-month follow-up. Radiographs taken during the final course observation were assessed. Propensity score matching was performed based on demographic data and comparisons were made using pairs of 25 hips each. Statistical analysis was performed using chi-square test and p values ≤ 0.05 indicated statistical significance.

Results: The pattern of the radiolucent lines showed a significant difference after matching (p = 0.0044). A "proximal and distal" pattern was most common in the thicker group and a "distal only" pattern was most common in the thinner group. There was notable and significant difference in cortical hypertrophy in the thicker group after matching (p = 0.024).

Conclusions: Although the two short stems were similar shapes, the short-term radiographic changes were different. The thinner group showed fewer radiographic changes than the thicker group, making it a more "silent" stem.
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http://dx.doi.org/10.1186/s13018-021-02397-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8042942PMC
April 2021

Good Validity and High Internal Consistency of the Forgotten Joint Score-12 in Patients After Medial Opening Wedge High Tibial Osteotomy.

J Arthroplasty 2021 08 13;36(8):2691-2697. Epub 2021 Mar 13.

Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan.

Background: The Forgotten Joint Score-12 (FJS-12) was originally developed to assess awareness of an artificial joint. Medial opening wedge high tibial osteotomy (MOWHTO), an alternative surgical method of knee replacement, is a joint-preservation surgery; therefore, joint awareness should be used to evaluate its clinical results. However, FJS-12 has not been validated as a tool to evaluate the postoperative results of MOWHTO. This study aimed to validate FJS-12 in MOWHTO.

Methods: Patients with bilateral knee surgery, previous knee surgery, flexion contracture >15°, varus alignment >20°, and patients without plate removal surgery were excluded. Finally, 71 knees of 71 patients were analyzed, with a mean follow-up of 34.5 months. The FJS-12 score and Knee Injury and Osteoarthritis Outcome Score (KOOS) were obtained, and the floor and ceiling effect of each score was investigated. Cronbach's α was calculated to determine the internal consistency of FJS-12. Spearman's correlation coefficients between FJS-12 and KOOS were calculated to assess convergent validity.

Results: There were ceiling effects in 3 KOOS subscales (symptoms [25.4%], pain [15.5%], and activities of daily living [25.4%]) but not in FJS-12 (8.5%). No floor effect was noted in any patient-reported outcome measures. The total Cronbach's α was 0.9457 in FJS-12. FJS-12 showed moderate-to-strong positive correlations with all KOOS subscales (r = 0.64-0.72).

Conclusion: FJS-12 showed a lower ceiling effect than KOOS and high internal consistency and convergent validity in patients following MOWHTO. With its low ceiling effect, FJS-12 was found to be useful for evaluating patients following MOWHTO.
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http://dx.doi.org/10.1016/j.arth.2021.03.028DOI Listing
August 2021

Effect of osteoarthritis severity on survival and clinical outcomes after high tibial osteotomy.

Knee 2021 Mar 17;29:441-447. Epub 2021 Mar 17.

Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.

Background: This study aimed to evaluate the effect of osteoarthritis severity on clinical outcomes using the 2011 Knee Society Score (KSS2011) and survival rates after closed wedge high tibial osteotomy (CWHTO).

Methods: In this retrospective study, KSS2011 questionnaires were mailed to patients who had undergone CWHTO between January 1991 and December 2011. The completed questionnaires returned by the patients were analyzed. Preoperative osteoarthritis severity was evaluated by Kellgren-Lawrence (K-L) grade. KSS2011 was compared between the K-L grade groups. To determine the effect of K-L grade for revision surgery, Kaplan-Meier survival curves were created using the need for total knee arthroplasty (TKA) as the endpoint to estimate the probability of failure.

Results: There were 16, 81, and 47 knees with preoperative K-L 2, 3, and 4, respectively. Among the KSS2011 sub-scores, the symptom score showed significant differences between the groups (p = 0.006). However, no significant difference was found regarding satisfaction, expectation, and functional activity scores. No significant difference in the symptom score was found between the K-L 2 and 3 groups (p > 0.05). Eighteen knees were treated with TKA at a mean of 9 years after CWHTO. Using the Kaplan-Meier survival estimates, the K-L 4 group showed a significantly higher rate of total knee arthroplasty conversion than the K-L 2 and 3 groups (p < 0.001).

Conclusions: Osteoarthritis severity affects clinical outcomes and survival rates during long-term follow-up after CWHTO. Surgeons should consider the preoperative osteoarthritis grade for long-term outcomes when considering CWHTO for patients with varus knees.
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http://dx.doi.org/10.1016/j.knee.2021.02.031DOI Listing
March 2021

Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression for Lumbar Spinal Stenosis Provides Comparable Clinical Outcomes in Patients with and without Degenerative Spondylolisthesis.

World Neurosurg 2021 06 17;150:e361-e371. Epub 2021 Mar 17.

Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan. Electronic address:

Objective: To investigate and compare the clinical and radiological outcomes of lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) for lumbar spinal stenosis (LSS) patients with and without degenerative spondylolisthesis (DS).

Methods: A total of 129 patients who underwent LE-ULBD for single-level LSS were retrospectively reviewed. The patients were classified into 2 groups based on the presence of DS. Clinical outcomes were assessed with the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire and numeric rating scale (NRS) for low back pain, lower limb pain, and lower limb numbness. Scores were obtained at baseline and final follow-up (mean follow-up, 28.6 months [range, 24-63 months]).

Results: The follow-up rate was 77.5% (103 patients). All domains of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire and NRS evaluations significantly improved during the follow-up period in both groups; group differences were not significant except for the postoperative NRS limb numbness score, which was higher in patients with DS. The Macnab outcome classification was excellent or good in 80% of patients without DS and 77.1% of patients with DS. During the follow-up period, the increase of vertebral slip was observed in 31% of the patients with DS that includes vertebral slip progression defined as percent slip >5% in 4% of the patients. The increase of vertebral slip was not related to a clinical outcome. Segmental motion of the affected intervertebral disc did not increase after surgery.

Conclusions: LE-ULBD provides a comparably favorable outcome in LSS patients with and without DS. Postoperative segmental instability did not occur in patients with DS.
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http://dx.doi.org/10.1016/j.wneu.2021.03.018DOI Listing
June 2021

Difference in patient-reported outcomes of various patellar component designs in total knee arthroplasty: A randomized clinical study.

J Orthop Surg (Hong Kong) 2021 Jan-Apr;29(1):2309499021996068

Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan.

Purpose: This study investigated the clinical effects of different patellar components without being affected by the femoral component design in total knee arthritis (TKA) for patients with knee osteoarthritis (OA).

Methods: In total, 48 patients with OA who met the criteria of the American College of Rheumatology for OA were enrolled and randomly assigned in a 1:1 ratio to two groups according to the usage of patellar component design for TKA (medialized dome type [dome group] or medialized anatomic type [anatomic group]). To evaluate the clinical outcomes for TKA, knee range of motion (ROM), pain intensity of 0-100 mm visual analog scale (pain VAS), and the Japanese Knee Osteoarthritis Measure (JKOM) score were obtained at baseline and year 1.

Results: The difference in knee ROM, pain VAS, or total JKOM score at year 1 was not significant between the dome and anatomic groups ( = 0.398, 0.733 and 0.536, respectively). Moreover, similar results were obtained for changes in knee ROM, pain VAS, or total JKOM scores from baseline. In both groups, the pain VAS and total JKOM scores were significantly improved at year 1.

Conclusion: Both dome and anatomic groups in TKA are significantly effective for pain and function using the JKOM score. However, their efficacy did not differ, according to the JKOM score. Results of this study are rare information focusing on the patellar component design and provide one of the insights into the TKA clinical management.
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http://dx.doi.org/10.1177/2309499021996068DOI Listing
June 2021

Monocortical fixation for locking plate distal screws does not impair mechanical properties in open-wedge high tibial osteotomy.

BMC Musculoskelet Disord 2021 Feb 8;22(1):157. Epub 2021 Feb 8.

Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.

Background: The neurovascular bundle containing the deep peroneal nerve has a potential risk of injury during open-wedge high tibial osteotomy (OWHTO), particularly due to drilling for bicortical fixation at distal screw holes. Therefore, monocortical fixation is recommended for distal fixation of a long locking plate as long as good stability is ensured. The purpose of this study was to analyse the biomechanical properties of monocortical fixation of distal locking screws for OWHTO.

Methods: Three-dimensional models of bone and fixation materials simulating OWHTO were created using computed tomographic data of patients and material data of a T-shaped long locking plate and screws. Three of the four distal screws of the locking plate were chosen for a bicortical fixation or monocortical fixation procedure. In addition, loss of correction was assessed by measuring the medial proximal tibial angle (MPTA) in patients who underwent OWHTO with two bicortical and two monocortical distal fixation screws at 1 month and 1 year after surgery.

Results: No significant differences in stress were observed in either the normal or osteoporotic bone model between the monocortical and bicortical fixation models, including in the area of the lateral hinge at the osteotomy site. Furthermore, there were no significant differences in MPTA between the early post-operative period and 1-year follow-up.

Conclusions: The monocortical fixation method for three distal screws of the locking plate did not worsen the mechanical properties of fixation for OWHTO using a long locking plate with four proximal and four distal screws. In actual surgery, the number of distal bicortical screws should be reduced based on the patient's condition, taking into account the risk of lateral hinge fracture and unexpected surgical complications. Using at least two bicortical screws would be practical considering the various factors related to reduced fixing ability.
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http://dx.doi.org/10.1186/s12891-021-03999-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871549PMC
February 2021

How does the postoperative medial arch height influence the patient reported outcomes of stage Ⅱ acquired adult flatfoot deformity?

J Orthop Sci 2021 Jan 25. Epub 2021 Jan 25.

Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-0054, Japan.

Background: This study aimed to assess how the postoperative medial arch height influenced postoperative patient-reported clinical outcomes after surgery for stage Ⅱ acquired adult flatfoot deformity.

Methods: A total of 30 feet of 30 patients (7 males, 23 females) who underwent surgery for stage Ⅱ acquired adult flatfoot deformity and could be followed up for at least 2 years were included. The average age at surgery was 60.0 (standard deviation, 13.0) years, and the average follow-up period was 40 (standard deviation, 15.4) months. Among them, 16 patients underwent lateral column lengthening and 14 patients did not. Patient-reported clinical outcomes were evaluated using the Self-Administered Foot Evaluation Questionnaire. Radiographic alignment was evaluated by the talonavicular coverage angle, lateral talo-1st metatarsal angle, medial cuneiform height, medial cuneiform to 5th metatarsal height, and calcaneal pitch. The correlation between postoperative Self-Administered Foot Evaluation Questionnaire and radiographic alignment was assessed with Pearson's correlation analysis.

Results: Self-Administered Foot Evaluation Questionnaire and radiographic alignment significantly improved postoperatively in all patients (P < 0.0001). In patients with severe deformity who needed lateral column lengthening, lateral talo-1st metatarsal angle was negatively and medial cuneiform to 5th metatarsal height was positively correlated with physical functioning Self-Administered Foot Evaluation Questionnaire subscales (r = -0.56 and 0.55), and medial cuneiform height was positively correlated with physical functioning, social functioning and general health Self-Administered Foot Evaluation Questionnaire subscales (r = 0.70, 0.55 and 0.73, respectively).

Conclusion: Postoperative medial arch height could influence physical functioning, social functioning, and general health in patients with severe stage II adult-acquired flatfoot deformity.
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http://dx.doi.org/10.1016/j.jos.2020.12.018DOI Listing
January 2021

Patient-Reported and Radiographic Outcomes of Joint-Preserving Surgery for Rheumatoid Forefoot Deformities: A Retrospective Case Series with Mean Follow-up of 6 Years.

J Bone Joint Surg Am 2021 03;103(6):506-516

Department of Orthopedic Surgery (K.Y., K.I., H.T., and K.O.) and Institute of Rheumatology (K.Y., K.I., and H.T.), Tokyo Women's Medical University, Tokyo, Japan.

Background: Rheumatoid arthritis (RA) is an autoimmune disorder and a chronic inflammatory disease that can damage joints throughout the body. As dramatic improvements in medical treatment have contributed to reduced progression of joint destruction, surgical methods for the treatment of RA-related forefoot deformities have gradually changed from joint-sacrificing to joint-preserving. The aim of this study was to assess the long-term outcomes, including patient-reported outcomes, of joint-preserving surgery for forefoot deformities associated with RA.

Methods: This retrospective study included 105 feet in 89 patients with RA who were treated during the period of January 2012 to May 2015 and had a minimum of 5 years of follow-up (mean, 6.0 ± 0.9 years). The patient-reported outcome measure used was the Self-Administered Foot Evaluation Questionnaire (SAFE-Q), which was completed preoperatively and at the latest follow-up (n = 53 feet). The hallux valgus angle (HVA), the intermetatarsal angle (IMA), and the position of the medial sesamoid were measured preoperatively, at 3 months postoperatively, and at the latest follow-up. Cases of delayed wound-healing, hallux valgus recurrence, nonunion at the osteotomy sites, and reoperation were recorded. Kaplan-Meier survival curves were used to determine the estimated survivorship, with reoperation as the end point.

Results: Scores of all 5 subscales of the SAFE-Q demonstrated significant improvement at the latest follow-up. The average HVA and IMA decreased significantly 3 months postoperatively, and these measurements remained significantly lower than the preoperative values (p < 0.01). The position of the medial sesamoid at the latest follow-up improved significantly (p < 0.01). Delayed wound-healing was found at the site of surgery in 21 (20.0%) of the 105 feet. Recurrence of hallux valgus was observed in 11 (10.5%) of the feet. There was no case of nonunion at any osteotomy site. Eleven (10.5%) of the feet required reoperation. The estimated survivorship of the studied joint-preserving surgery at 7 years, with reoperation as the end point, was 89.5%.

Conclusions: Satisfactory long-term patient-reported and radiographic outcomes after joint-preserving surgery for forefoot deformities associated with RA can be achieved.

Level Of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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http://dx.doi.org/10.2106/JBJS.20.01144DOI Listing
March 2021

Nonunion of a medial malleolar stress fracture in an adolescent athlete secondary to lateral ankle instability: A case report.

Int J Surg Case Rep 2021 Jan 25;78:235-240. Epub 2020 Dec 25.

Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo 162-0054, Japan.

Introduction: Medial malleolar stress fractures are relatively uncommon. This report describes the successful treatment of nonunion of a medial malleolar stress fracture due to chronic lateral ankle instability.

Presentation Of Case: A 13-year-old middle school student who belonged to a football club presented to our clinic with chronic medial left ankle pain lasting over a year. He had sprained his left ankle several times 6 years earlier. A plain anteroposterior ankle radiograph showed a vertical fracture line in the medial malleolus involving the epiphyseal plate, and computed tomography demonstrated the vertical fracture seen on the plain radiographs and bone sclerosis at the fracture site. We performed internal fixation for nonunion of the medial malleolar stress fracture with arthroscopic modified Broström for lateral ankle instability. Two years after surgery, the Self-Administered Foot Evaluation Questionnaire improved in all parameters, and both the anterior drawer and varus stress tests were negative.

Discussion: Early diagnosis of medial malleolar stress fracture is important for a rapid return to sports. Magnetic resonance imaging is helpful for early diagnosis. Because lateral ankle instability can cause medial malleolar stress fracture, arthroscopic modified Broström procedure is meaningful for medial malleolar stress fracture with lateral ankle instability.

Conclusion: Internal fixation and the arthroscopic modified Broström procedure could achieve good clinical outcomes for medial malleolar stress fractures with lateral ankle instability.
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http://dx.doi.org/10.1016/j.ijscr.2020.12.043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7772367PMC
January 2021

Posterolateral Transforaminal Full-Endoscopic Lumbar Discectomy for Foraminal or Extraforaminal Lumbar Disc Herniations.

World Neurosurg 2021 02 1;146:e1278-e1286. Epub 2020 Dec 1.

Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan. Electronic address:

Background: Surgical procedures via the posterior median or paramedian approach for lateral lumbar disc herniation require significant bone resection to reach the herniation. In contrast, posterolateral transforaminal full-endoscopic lumbar discectomy (FELD) allows direct access to the lateral disc herniation. This study aimed to determine the efficacy and safety of this procedure.

Methods: A total of 118 patients who underwent posterolateral transforaminal FELD were retrospectively examined. Data on surgical time, perioperative complications, and reoperation rate were reviewed from the medical records. Clinical evaluations were completed in 78 patients using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and numeric rating scale (NRS) for low back pain, lower limb pain, and lower limb numbness obtained at baseline and during a follow-up of more than 12 months.

Results: The mean operative time was 33.9 min. Postoperative transient dysesthesia occurred in 11 of 118 patients (9.3%). No other complications were observed. Reoperation was performed in nine patients (5.9%). All domains of JOABPEQ and NRS significantly improved during the follow-up period. The effectiveness rates of the JOABPEQ for measuring low back pain, lumbar function, walking ability, social life function, and mental health were 70.4%, 46.5%, 62.0%, 59.2%, and 32.4%, respectively. Using the Macnab criteria, excellent or good results were achieved in 52 patients (73%).

Conclusions: Successful clinical results were obtained with a few complications and improvements in the domains of JOABPEQ and NRS. Posterolateral transforaminal FELD for lateral lumbar disc herniations is an effective and safe surgical option with minimal invasiveness and sufficient decompression.
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http://dx.doi.org/10.1016/j.wneu.2020.11.141DOI Listing
February 2021

Triple osteotomy for erosive first metatarsal in a patient with rheumatoid arthritis: a case report.

Mod Rheumatol Case Rep 2021 01 9;5(1):6-10. Epub 2020 Jul 9.

Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan.

Recently, over the half of the patients with rheumatoid arthritis achieved clinical remission with beneficial effects of disease modifying anti-rheumatic drugs, including biological disease modifying anti-rheumatic drugs. Because the patients in remission should have no/reduced progression of joint damage, there is a trend towards joint-preserving surgery in the treatment of rheumatoid forefoot deformities. Here we report a 76-year-old woman with rheumatoid arthritis developed a severe forefoot deformity including a large bony erosion of the first metatarsal head. She showed near remission for rheumatoid arthritis without having clinically active synovitis in her MTP joints. To preserving her metatarsophalangeal joint, a double first metatarsal osteotomy was planned to remove the bony erosion and simultaneously correct the hallux valgus. Thirty-month follow-up demonstrated excellent radiographical and patient-reported outcomes. To the best of our knowledge, this is the first case of a double first metatarsal osteotomy to remove the bony erosion and simultaneously correct the hallux valgus in a patient with rheumatoid arthritis with a large erosion of the first metatarsal head.
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http://dx.doi.org/10.1080/24725625.2020.1789303DOI Listing
January 2021

Osteochondroma of the C2 Vertebral Body Totally Resected Using an Intraoperative O-arm Navigation System: A Case Report.

Spine Surg Relat Res 2020 18;4(4):380-383. Epub 2020 Jun 18.

Department of Orthopaedics, Tokyo Women's Medical University, Tokyo, Japan.

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http://dx.doi.org/10.22603/ssrr.2020-0070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7661022PMC
June 2020

Posterior tibial slope and anterior post-cam contact can change knee kinematics in extension in bi-cruciate stabilized total knee arthroplasty.

Bone Joint Res 2020 Nov;9(11):761-767

Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan.

Aims: This study aims to investigate the effects of posterior tibial slope (PTS) on knee kinematics involved in the post-cam mechanism in bi-cruciate stabilized (BCS) total knee arthroplasty (TKA) using computer simulation.

Methods: In total, 11 different PTS (0° to 10°) values were simulated to evaluate the effect of PTS on anterior post-cam contact conditions and knee kinematics in BCS TKA during weight-bearing stair climbing (from 86° to 6° of knee flexion). Knee kinematics were expressed as the lowest points of the medial and lateral femoral condyles on the surface of the tibial insert, and the anteroposterior translation of the femoral component relative to the tibial insert.

Results: Anterior post-cam contact in BCS TKA was observed with the knee near full extension if PTS was 6° or more. BCS TKA showed a bicondylar roll forward movement from 86° to mid-flexion, and two different patterns from mid-flexion to knee extension: screw home movement without anterior post-cam contact and bicondylar roll forward movement after anterior post-cam contact. Knee kinematics in the simulation showed similar trends to the clinical in vivo data and were almost within the range of inter-specimen variability.

Conclusion: Postoperative knee kinematics in BCS TKA differed according to PTS and anterior post-cam contact; in particular, anterior post-cam contact changed knee kinematics, which may affect the patient's perception of the knee during activities. Cite this article: 2020;9(11):761-767.
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http://dx.doi.org/10.1302/2046-3758.911.BJR-2020-0076.R2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7649504PMC
November 2020

Association between low back pain and quality of life in patients with rheumatoid arthritis according to patient-reported outcomes using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ): A cross-sectional study.

Mod Rheumatol 2021 Sep 6;31(5):992-996. Epub 2020 Nov 6.

Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan.

Objectives: To evaluate factors associated with low back pain (LBP) and effect on quality of life (QOL) using patient-reported outcome in patients with rheumatoid arthritis (RA).

Methods: Overall, 414 patients with RA who answered the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were included in this study. LBP-positive was defined a visual analog scale (VAS) of LBP (LBP VAS) of ≥ 30 mm.

Results: The rate of LBP-positive group was 24.9%. Body mass index (BMI) (odds ratio [OR]: 1.116), tender joint count (TJC) (OR: 1.598), global VAS (OR: 1.016), and Health Assessment Questionnaire Disability Index (HAQ-DI) (OR: 2.392) were found as significant LBP-associated factors. When adjusted for sex and van der Heijde-modified total Sharp score, BMI (OR: 1.120), TJC (OR: 1.619), global VAS (OR: 1.016), pain VAS (OR: 1.015), and HAQ-DI (OR: 2.312) were found to be the significant factors associated with LBP. Moreover, LBP VAS had relatively high correlations in all domains of the JOABPEQ scores (correlation coefficient: LBP, -0.601; lumbar function, -0.624; walking ability, -0.548; social life function, -0.479; and mental health, -0.463).

Conclusions: This study investigated the effect of LBP in patients with RA. The results of this study indicate that LBP is associated with the physical function and QOL in patients with RA. We believe that our results will be useful for physical function and QOL assessments in patients with RA with LBP.
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http://dx.doi.org/10.1080/14397595.2020.1840047DOI Listing
September 2021

Assessing the Validity of a New Prediction Model for Patient Satisfaction After Total Knee Arthroplasty: A Retrospective Cross-Sectional Study.

Orthop Res Rev 2020 9;12:133-137. Epub 2020 Sep 9.

Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Shinjuku-ku 162-8666, Japan.

Purpose: Previously, a simplified model using statistically selected questionnaires from various patients reported outcome measures (PROMs) was proposed to predict patient satisfaction after total knee arthroplasty (TKA). However, this simple and useful model needs to be validated across ethnic and cultural differences. The objective of this study was to evaluate the utility of this predictive model in Japanese patients.

Patients And Methods: Of all knees treated using primary TKA at our institution between August 2017 and June 2018, this study involved 50 knees of 48 patients (11 men, 37 women) to whom the predictive model was applied preoperatively and from whom PROMs were obtained at least 1 year postoperatively. To evaluate PROMs, patients completed the KSS and the Forgotten Joint Score-12. Correlations were analyzed between preoperatively predicted postoperative patient satisfaction and actual postoperative patient satisfaction, as well as each PROM.

Results: KSS satisfaction improved from 15.6 ± 6.1 preoperatively to 27.8 ± 8.3 postoperatively, with satisfaction reported for 41 knees (82%). The preoperatively predicted postoperative patient satisfaction score was 26.3 ± 4.6, with no significant correlation with actual postoperative score (r = 0.05, p = 0.72). The difference between preoperatively predicted patient satisfaction and actual postoperative patient satisfaction was positively correlated with the score for question 9 of the Pain Catastrophizing Scale, among other instruments constituting the predictive model.

Conclusion: Our data suggest that the predictive model had a low predictive value and that it had limited applicability to Japanese patients. The results also suggest that a tendency toward catastrophic thinking is associated with discrepancy between preoperatively predicted postoperative patient satisfaction and actual postoperative patient satisfaction. The predictive model has low utility and needs some modification.
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http://dx.doi.org/10.2147/ORR.S271253DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7490064PMC
September 2020

Surgical Technique and Accuracy of S2 Alar-Iliac Screw Insertion Using Intraoperative O-Arm Navigation: An Analysis of 120 Screws.

World Neurosurg 2020 12 22;144:e326-e330. Epub 2020 Aug 22.

Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan.

Objective: To evaluate the surgical technique and accuracy of S2 alar-iliac (SAI) screw placement using intraoperative O-arm-based 3-dimensional navigation (O-arm).

Methods: This study involved 60 patients who underwent SAI screw placement using the O-arm system between September 2013 and September 2019. These surgeries were performed by 5 different surgeons. For O-arm-based SAI screw insertion, a reference frame was attached to the spinous process of the lower lumbar spine (usually L4) so as not to interfere with SAI screw insertion and to facilitate simultaneous L5-S posterior interbody fusion with navigation. The navigated probe, iliac tap, and screwdriver were used for SAI screw insertion. Screw placement accuracy and screw length were assessed using postoperative computed tomography. Perioperative complications were also evaluated.

Results: Mean age at surgery was 68.1 (range, 30-83) years. In total, 120 screws were inserted. Rate of accurate screw placement was 98.3% (118/120 screws). The 2 misplaced screws breached the anterior cortex of the sacrum. Mean screw length was 85.6 (range, 70-90) mm. There were no significant neurovascular or visceral complications perioperatively.

Conclusions: SAI screw placement can be safely performed using the intraoperative O-arm system and our surgical technique.
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http://dx.doi.org/10.1016/j.wneu.2020.08.123DOI Listing
December 2020

Three-year results of denosumab treatment for osteoporosis in women with rheumatoid arthritis and primary osteoporosis: A clinical observational study.

Mod Rheumatol 2021 May 10;31(3):600-606. Epub 2020 Sep 10.

Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan.

Introduction: This study investigated the results of 3 years of denosumab treatment for osteoporosis in women with rheumatoid arthritis (RA) and primary osteoporosis (PO).

Materials And Methods: This study enrolled 112 women with RA (RA group) and 104 women with a PO group who received 60 mg denosumab for 3 years. Bone mineral densitiy (BMD) of the lumbar spine, total hip and femoral neck as well as levels of bone turnover markers [N-terminal propeptide of type I procollagen (P1NP) and tartrate-resistant acid phosphatase-5b (TRACP-5b)] were measured at years 1, 2, and 3.

Results: The percent changes (Δ) in BMD values at years 1, 2, and 3 were as follows: RA group: 6.7 ± 6.2%, 8.9 ± 6.5%, and 9.8 ± 8.2% and PO group: 6.0 ± 4.8%, 8.9 ± 7.5%, and 12.6 ± 8.7% for the lumbar spine; RA group: 4.5 ± 4.6%, 5.2 ± 5.1%, and 6.8 ± 5.9% and PO group: 3.8 ± 4.5%, 4.6 ± 7.4%, and 6.8 ± 4.6% for the total hip; and RA group: 2.7 ± 5.1%, 4.1 ± 6.8%, and 4.3 ± 6.7% and PO group: 3.6 ± 8.0%, 4.5 ± 10.9%, and 5.7 ± 10.5% for the femoral neck, respectively. The ΔBMD for the lumbar spine, total hip, and femoral neck as well as ΔP1NP and ΔTRACP-5b did not differ significantly between the two groups at any time points.

Conclusion: Denosumab treatment for osteoporosis had a similar efficacy over 3 years among women with RA and PO. A better understanding of denosumab treatment for this patient population is important in clinical practice.
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http://dx.doi.org/10.1080/14397595.2020.1812793DOI Listing
May 2021
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