Publications by authors named "Shuichi Matsuda"

528 Publications

Dynamics of Type I and Type II Interferon Signature Determines Responsiveness to Anti-TNF Therapy in Rheumatoid Arthritis.

Front Immunol 2022 6;13:901437. Epub 2022 Jun 6.

Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan.

The factors influencing long-term responses to a tumor necrosis factor inhibitor (TNFi) in rheumatoid arthritis (RA) patients currently remain unknown. Therefore, we herein conducted a multi-omics analysis of TNFi responses in a Japanese RA cohort. Blood samples were collected from 27 biological disease-modifying antirheumatic drug (DMARD)-naive RA patients at the initiation of and after three months of treatment with TNFi. Treatment responses were evaluated at one year. Differences in gene expression levels in peripheral blood mononuclear cells (PBMCs), plasma protein levels, drug concentrations, and the presence/absence of anti-drug antibodies were investigated, and a cell phenotypic analysis of PBMCs was performed using flow cytometry. After one year of treatment, thirteen patients achieved clinical remission (responders), while the others did not or switched to other biologics (non-responders). Differentially expressed genes related to treatment responses were enriched for the interferon (IFN) pathway. The expression of type I IFN signaling-related genes was higher in non-responders than in responders before and after treatment ( = 0.03, 0.005, respectively). The expression of type II IFN signaling-related genes did not significantly differ before treatment; however, it increased in non-responders and decreased in responders, with a significant difference being observed after three months of treatment ( = 1.2×10). The total number of lymphocytes and C-X-C Motif Chemokine Ligand 10 (CXCL10) protein levels were associated with the type I IFN signature ( = 6.7×10, 6.4×10, respectively). Hepatocyte growth factor (HGF) protein levels before treatment predicted fold increases in type II IFN ( = 0.03). These IFN signature-related indices (the number of lymphocytes, CXCL10, and HGF) significantly differed between responders and non-responders ( = 0.01, 0.01, and 0.04, respectively). A single-cell analysis revealed that the type I IFN signature was more highly enriched in monocytes than in other cell types. A deconvolution analysis of bulk-RNA sequence data identified CD4+ and CD8+ T cells as the main sources of the type II IFN signature in non-responders. Collectively, the present results demonstrated that the dynamics of the type I and II IFN pathways affected long-term responses to TNFi, providing information on its biological background and potential for clinical applications.
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http://dx.doi.org/10.3389/fimmu.2022.901437DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9208293PMC
June 2022

Intramuscular adipose tissue content predicts patient outcomes after allogeneic hematopoietic stem cell transplantation.

Transplant Cell Ther 2022 Jun 19. Epub 2022 Jun 19.

Rehabilitation Unit, Kyoto University Hospital.

During clinical courses involving allogeneic hematopoietic stem cell transplantation (allo-HSCT), multidisciplinary assessments for patients including physical functions are indispensable, and quantitative skeletal muscle loss is a poor prognostic marker. In addition, deteriorating quality of muscle due to intra-muscle adipose tissue degeneration can be important as well, because many patients are cachexic or sarcopenic before allo-HSCT, although this approach has not been employed yet. Therefore, we conducted a retrospective cohort study to evaluate the quality, as well as quantity of skeletal muscle using computed tomography (CT). Psoas muscle mass index (PMI) and radiographic density (RD) calculated by cross-sectional area and averaged CT values of the psoas major muscle at the umbilical level were used to determine the quantity and quality of muscle, respectively. In total, 186 adult patients, aged 17-68 years (median, 49) were included in this study, and 46 (24.7%) and 49 (26.3%) patients were assigned to the lower PMI and RG groups. Low RD was identified as an independent risk factor for poor overall survival after allo-HSCT (adjusted hazard ratio 2.54, p<0.01), while PMI was not significant. Decreased RD along with reduced 6-min walking distance before transplantation was also significant factor for increased non-relapse mortality (hazard ratio, 2.69, p=0.01). This study is the first to suggest the use of a qualitative skeletal muscle index to serve as a prognostic indicator following allo-HSCT. RD should be included in pre-transplant screening parameters, and approaches that include rehabilitation focused on improving both muscle quality and quantity may improve the prognosis of allo-HSCT.
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http://dx.doi.org/10.1016/j.jtct.2022.06.011DOI Listing
June 2022

Diagnostic advantage of thin slice 2D MRI and multiplanar reconstruction of the knee joint using deep learning based denoising approach.

Sci Rep 2022 Jun 20;12(1):10362. Epub 2022 Jun 20.

Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.

The purpose of this study is to evaluate whether thin-slice high-resolution 2D fat-suppressed proton density-weighted image of the knee joint using denoising approach with deep learning-based reconstruction (dDLR) with MPR is more useful than 3D FS-PD multi planar voxel image. Twelve patients who underwent MRI of the knee at 3T and 13 knees were enrolled. Denoising effect was quantitatively evaluated by comparing the coefficient of variation (CV) before and after dDLR. For the qualitative assessment, two radiologists evaluated image quality, artifacts, anatomical structures, and abnormal findings using a 5-point Likert scale between 2D and 3D. All of them were statistically analyzed. Gwet's agreement coefficients were also calculated. For the scores of abnormal findings, we calculated the percentages of the cases with agreement with high confidence. The CV after dDLR was significantly lower than the one before dDLR (p < 0.05). As for image quality, artifacts and anatomical structure, no significant differences were found except for flow artifact (p < 0.05). The agreement was significantly higher in 2D than in 3D in abnormal findings (p < 0.05). In abnormal findings, the percentage with high confidence was higher in 2D than in 3D (p < 0.05). By applying dDLR to 2D, almost equivalent image quality to 3D could be obtained. Furthermore, abnormal findings could be depicted with greater confidence and consistency, indicating that 2D with dDLR can be a promising imaging method for the knee joint disease evaluation.
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http://dx.doi.org/10.1038/s41598-022-14190-1DOI Listing
June 2022

A first view of the effect of a trial of early mobilization on the muscle strength and activities of daily living in mechanically ventilated patients with COVID-19.

Arch Rehabil Res Clin Transl 2022 Jun 10:100201. Epub 2022 Jun 10.

Rehabilitation Unit, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyo-ku Kyoto 606-8507, Japan.

Objective: To retrospectively investigate the effect of early mobilization on the muscle strength and activities of daily living in patients with coronavirus disease 2019 (COVID-19) under mechanical ventilation.

Design: This was a single-center, retrospective, observational study.

Setting: Inpatient rehabilitation care in Japan.

Participants: The study subjects were divided based on the onset of mobilization: under mechanical ventilation (n =17; aged 68.5 ± 11.9, 13 male) and after extubation (n =11; aged 59.7 ± 7.1, 6 male).

Interventions: Mobilization, including dangle sitting, standing, walking, and muscle strengthening exercises.

Main Outcome Measures: The outcome measures were Barthel Index, Medical Research Council Manual Muscle Test (MRC), and intensive care unit (ICU) Mobility Scale.

Results: The difference in the Barthel Index, MRC, and ICU Mobility Scale scores pre- and post-intervention were not statistically significant between the two groups, but all significantly improved after the intervention.

Conclusion: This small sample size study found no difference in the functional recovery of patients with severe COVID-19 who underwent early mobilization under mechanical ventilation relative to when it was begun after extubation.
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http://dx.doi.org/10.1016/j.arrct.2022.100201DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9186404PMC
June 2022

High Subsidence Rate After Primary Total Hip Arthroplasty Using a Zweymüller-type Noncemented Implant With a Matte Surface.

J Am Acad Orthop Surg Glob Res Rev 2022 Jun 7;6(6). Epub 2022 Jun 7.

From the Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan.

Introduction: The surface topography is one key factor that affects the initial fixation of prosthesis in total hip arthroplasty (THA). We aimed to evaluate the mid-term results of a Zweymüller-type noncemented femoral implant (Elance stem) that had a matte surface with a target average roughness of 1.0 to 2.5 μm. The prosthesis was subjected to alkali and heat treatments to enhance its bone-bonding property.

Methods: In this retrospective study, 30 THAs (27 patients) done using an Elance stem from September 2012 to October 2014 were evaluated clinically and radiographically for a mean follow-up of 6.3 ± 1.7 years after the index THA.

Results: Stem revision was indicated for six hips (20%). The survival rate with stem revision for any reason was 86.4% (95% confidence interval, 68.9%-94.8%) at 5 years. Stem subsidence >5 mm was noted in 17 hips (56.7%). The survival rate with stem subsidence >5 mm as the end point was 46.6% (95% confidence interval, 29.9%-64.2%) at 5 years.

Conclusion: The Zweymüller-type noncemented stem with a low-roughness matte surface demonstrated a high subsidence rate, although the bone-bonding property was potentially enhanced by the alkali and heat treatments. Surgeons should be aware that an insufficient surface roughness could lead to poor mechanical fixation of the noncemented stem, even with an appropriate stem geometry and surface chemistry.
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http://dx.doi.org/10.5435/JAAOSGlobal-D-21-00126DOI Listing
June 2022

Reproducibility, criterion-related validity, and minimal clinically important difference of the stair negotiation test after total Hip arthroplasty.

Physiother Theory Pract 2022 May 17:1-8. Epub 2022 May 17.

Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan.

Objective: To determine the reproducibility, criterion-related validity, and minimal clinically important difference (MCID) of the stair negotiation test (SNT) after total hip arthroplasty (THA).

Methods: Sixty patients who underwent THA were included in this study. They performed the SNT and rated their difficulty in stair negotiation (question 7 of the Oxford Hip Score [OHSQ7]) before and 6 months after surgery. The SNT determined the time taken by a patient to ascend, turn around, and descend the stairs (15 cm × 4 steps) and was measured twice each time. As a measure of reproducibility, the intraclass correlation coefficient (ICC) was calculated using the preoperative SNT. As an index of criterion-related validity, Spearman's rank correlation coefficient was used to evaluate the relationship between the better score of two trials in the preoperative SNT and the OHSQ7. The MCID of the SNT was calculated using the distribution-based method and the anchor-based method. The change in the OHSQ7 between before and after surgery was used as an anchor in the latter method.

Results: The ICC of the SNT was 0.97. The SNT was significantly correlated with the OHSQ7 (r = 0.40, p < .05). Moreover, the anchor-based MCID of the SNT was 1.98 seconds.

Conclusion: The SNT is an objective assessable test of stair negotiation ability in post-THA patients that has good reproducibility and moderate criterion-related validity. Changes in the SNT beyond the MCID (1.98 seconds) represent clinically important changes in stair negotiation ability.
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http://dx.doi.org/10.1080/09593985.2022.2078255DOI Listing
May 2022

Systemic Chronic Diseases Coexist with and Affect Locomotive Syndrome: The Nagahama Study.

Mod Rheumatol 2022 May 12. Epub 2022 May 12.

Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Objectives: The concept of locomotive syndrome was proposed to highlight older adults who require nursing care services due to the malfunctioning of their locomotive organs. With the coming of a super-aging society, there is a growing need to understand relation between systemic chronic diseases and locomotive syndrome.

Methods: We analyzed the second-visit dataset of the Nagahama Study. The association analysis was performed to identify the chronic diseases that were risk factors associated with the occurrence and the progression of locomotive syndrome in both the cross-sectional and longitudinal studies.

Results: Hypertension, stroke, coronary heart disease, rheumatoid arthritis, chronic renal failure, osteoporosis, anemia, and gastroesophageal reflux disease were independently correlated with locomotive syndrome through the deterioration of body pain, social activity, and cognitive function in the cross-sectional study. Multiple chronic diseases had additive effects and significantly increased the risk of locomotive syndrome. In the longitudinal study, osteoporosis and kidney disease were significantly correlated with the worsening of the total GLFS-25 score.

Conclusions: Locomotive syndrome coexisted with various systemic chronic diseases, especially cardiovascular diseases. Osteoporosis and kidney disease were significantly correlated with the progression of locomotive dysfunction. The management of various chronic diseases may be useful to prevent locomotive syndrome and vice versa.
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http://dx.doi.org/10.1093/mr/roac039DOI Listing
May 2022

Comparative Study of Circumferential Decompression and Posterior Decompression in Palliative Surgery for Metastatic Thoracic Spinal Tumors.

Clin Spine Surg 2022 May 9. Epub 2022 May 9.

Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto Prefecture.

Study Design: This was a case-control study.

Objective: The present study aimed to evaluate the significance of circumferential tumor resection around the spinal cord in palliative decompression surgery for patients with metastatic spinal cord compression (MSCC) in the thoracic spine.

Summary Of Background Data: Although the benefits of palliative surgery for MSCC are well known, the significance of circumferential tumor resection with cord compression has not yet been clarified.

Materials And Methods: We retrospectively compared the outcomes of 45 and 34 patients with incomplete paralysis of modified Frankel grade B-D caused by MSCC with anterior cord compression (epidural spinal cord compression grade ≥2) treated at 2 different university hospitals (H1 and H2, respectively). All patients in H1 hospital underwent posterior decompression only, while all patients in H2 hospital underwent full circumferential decompression. We analyzed factors that affect the postoperative ambulatory status. evaluated by the modified Frankel classification.

Results: No significant differences were observed in the epidural spinal cord compression grade, spinal instability neoplastic score, new Katagiri score, revised Tokuhashi score, or postoperative survival between patients in H1 and H2 hospitals. A multivariable logistic regression analysis identified preoperative radiotherapy [odds ratio (OR): 0.23, 95% confidential interval (CI): 0.056-0.94] as a negative risk factor and postoperative chemotherapy (OR: 5.9, 95% CI: 1.3-27.0) as a positive risk factor for an improved ambulatory status. Five and 6 patients in H1 and H2 hospitals, respectively, showed deterioration in the ambulatory status. An older age (OR: 1.1, 95% CI: 1.0-1.2) and preoperative radiotherapy (OR: 10.3, 95% CI: 1.9-55.4) were extracted as significant independent risk factors for deterioration in the ambulatory status. Circumferential decompression did not improve the clinical results of patients regardless of the degree of paralysis.

Conclusions: Preoperative radiotherapy interfered with the recovery of paralysis, and postoperative chemotherapy improved the ambulatory status. Clinical outcomes did not significantly differ between total circumferential decompression and posterior decompression, although further validation in a small number of cases is needed, such as patients with Frankel grade D.
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http://dx.doi.org/10.1097/BSD.0000000000001342DOI Listing
May 2022

Clinical Features and Surgical Outcomes of Lower Lumbar Osteoporotic Vertebral Collapse with Symptomatic Stenosis: A Surgical Strategy from a Multicenter Case Series.

Asian Spine J 2022 May 10. Epub 2022 May 10.

Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Study Design: A retrospective multicenter case series was conducted.

Purpose: This study was designed to investigate the clinical features and surgical outcomes of lower lumbar osteoporotic vertebral collapse (LL-OVC) with symptomatic stenosis based on various surgical procedures and classify them using the newly developed collapse severity criteria.

Overview Of Literature: The surgical outcomes of LL-OVC with symptomatic stenosis remain unclear.

Methods: We investigated patients who underwent surgical intervention for LL-OVC (L3, L4, and/or L5) with symptomatic foraminal and/or central stenosis from eight spine centers. Only patients with a minimum follow-up duration of 1 year were included. We developed new criteria to grade vertebral collapse severity (grade 1, 0%-25%; grade 2, 25%-50%; grade 3, 50%-75%; and grade 4, 75%-100%). The clinical features and outcomes were compared based on the collapse grade and surgical procedures performed (i.e., decompression alone, posterior lateral fusion [PLF], lateral interbody fusion [LIF], posterior/transforaminal interbody fusion [PLIF/TLIF], or vertebral column resection [VCR]).

Results: In this study, 59 patients (average age, 77.4 years) were included. The average follow-up period was 24.6 months. The clinical outcome score (Japanese Orthopaedic Association score) was more favorable in the LIF and PLIF/TLIF groups than in the decompression alone, PLF, and VCR groups. The use of VCR was associated with a high rate of revision surgery (57.1%). No significant difference in clinical outcomes was observed between the collapse grades; however, grade 4 collapse was associated with a high rate of revision surgery (40.0%).

Conclusions: When treating LL-OVC, appropriate instrumented reconstruction with rigid intervertebral stability is necessary. According to our newly developed criteria, LIF may be a surgical option for any collapse grade. The use of VCR for grade 4 collapse is associated with a high rate of revision.
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http://dx.doi.org/10.31616/asj.2021.0421DOI Listing
May 2022

Alignment and ligament balance of total knee arthroplasty.

Authors:
Shuichi Matsuda

Knee 2022 03;35:A1

Kyoto University, Japan.

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http://dx.doi.org/10.1016/j.knee.2022.04.001DOI Listing
March 2022

Development of a Clinical Prediction Rule to Identify Physical Activity After Total Hip Arthroplasty.

Arch Phys Med Rehabil 2022 Apr 11. Epub 2022 Apr 11.

Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan; Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Objective: To develop clinical prediction rule (CPR) of physical activity 1 year after total hip arthroplasty (THA).

Design: Retrospective cohort study.

Setting: University hospital with orthopedic surgery.

Participants: The study group included 321 patients (56 men) who underwent primary THA (N=321).

Intervention: Not applicable.

Main Outcomes Measures: The data collected included age, body mass index, clinical score from the questionnaires, hip pain, range of motion, muscle strength, and Physical functions (10-meter walk test [10MWT], timed Up and Go test, sit-to-stand test). Patients were classified into sufficient and insufficient activity groups based on their University of California, Los Angeles (UCLA) activity score 1 year after THA. Variables measured preoperatively and 3 weeks postoperatively were analyzed using univariate and multivariate methods to derive CPR for physical activity.

Results: A CPR was developed using the following 5 factors and cutoffs: age 70.5 years or younger, preoperative UCLA activity score ≥3.5, preoperative hip abduction strength ≥0.54 Nm/kg, preoperative knee extension strength ≥1.04 Nm/kg, and 10MWT ≤8.49 seconds 3 weeks after surgery. The presence of 4 of the 5 factors predicted a sufficient physical activity level at 1 year, with a positive likelihood ratio of 5.94 and probability of 85.4%. The presence of 5 predictor variables increased the probability of sufficient physical activity after THA to 94.7%.

Conclusions: This study developed a CPR for physical activity 1 year after THA. Having 4 or more of the 5 measurements were useful indicators for predicting of physical activity 1 year postoperatively.
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http://dx.doi.org/10.1016/j.apmr.2022.03.015DOI Listing
April 2022

Early Breakage of All Proximal Locking Compression Screws under Non-weight-bearing Conditions after Derotational Femoral Osteotomy in a Child with Cerebral Palsy: A Case Report.

J Orthop Case Rep 2021 Dec;11(12):1-4

Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan.

Introduction: The locking compression plate (LCP) system for pediatric hips has improved fixation and angular stability. Herein, we report a rare case in which all proximal locking compression screws were broken before weight bearing in the early post-operative period after derotational femoral osteotomy in a child with spastic cerebral palsy (CP).

Case Report: Derotational femoral osteotomy was performed using a LCP system for a 9-year-old boy with spastic CP to correct excessive femoral anteversion, causing unstable toe-in gait. Proximal screw breakage was found 2 weeks postoperatively during hip-spica casting under non-weight-bearing conditions. Implant breakage was considered a result of the excessive spasticity of the lower limb. At the time of reoperation, shortening and varus correction of the femur and muscle tendon release were performed in addition to the refixation of the osteotomy. Intensive pain control was ensured, and anti-spastic medication and botulinum toxin injection were administered. Complete bone healing was successfully achieved 6 months after the second surgery.

Conclusion: Surgeons need to consider the spasticity of the lower limb as a cause of implant failure. Management to reduce spasticity and mechanical load to the implant is important for preventing implant failures in patients with spastic CP.
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http://dx.doi.org/10.13107/jocr.2021.v11.i12.2540DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8930382PMC
December 2021

A Transposition Flap Reconstruction after Resection of a Soft-Tissue Sarcoma in the Buttock.

J Orthop Case Rep 2021 Oct;11(10):38-40

Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Introduction: Large defects following resection in the gluteal region are challenging. Of note, there are a limited number of fairly morbid options for reconstruction.

Case Report: A 65-year-old female presented with complaints of an enlarging mass in the left buttock over the past several months. A high-grade sarcoma was diagnosed based on a biopsy. The final diagnosis was an undifferentiated pleomorphic sarcoma based on the resected tumor. An 11-cm tumor with surrounding tissues, including the great gluteal muscle, was resected, which resulted in a 17-cm full thickness defect. The defect was reconstructed with a transposition flap elevated from the lateral thorax. A transposition flap can cover large buttock defects without sacrificing other muscles.

Conclusion: Moreover, a transposition flap is esthetically acceptable because most of the operative scar is within the buttock area. A transposition flap reconstruction is one of the several options for large defects after soft-tissue sarcoma resection in the buttock.
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http://dx.doi.org/10.13107/jocr.2021.v11.i10.2458DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8930294PMC
October 2021

Impact of inspiratory muscle strength on exercise capacity after lung transplantation.

Physiother Res Int 2022 Apr 9:e1951. Epub 2022 Apr 9.

Health Science, Graduate School of Health Science, Kio University, Nara, Japan.

Background And Purpose: Though inspiratory muscle strength is essential for patients with respiratory disease, it is unclear whether the recovery of inspiratory muscle strength contributes to an exemplary achievement of exercise tolerance after lung transplantation (LTx). We aimed to elucidate the inspiratory muscle strength affects the recovery of exercise capacity after LTx.

Methods: Recipients who underwent LTx between June 2017 and September 2018 were enrolled, and 6-min walking distance (6MWD), quadriceps force, inspiratory muscle strength (maximal inspiratory pressure [MIP]), and spirometry were evaluated at 3, 6, and 12 months after LTx. The relationships between inspiratory muscle strength and changes in physical performance were analyzed.

Results: Nineteen recipients (mean age: 44.8 years, male: 32%) who completed all follow-ups were analyzed. At 3 months after LTx, mean MIP (88.4% predicted) and vital capacity (60.9% predicted), quadriceps force (QF; 2.1 N*m/kg), and 6MWD (504 m) were lower than normal values. After LTx, 6MWD significantly improved up to 12 months. From 3 to 6 months after LTx, changes in MIP were significantly associated with increases in 6MWD by univariate (r = 0.55, p = 0.02) and multivariate (β = 0.59, p = 0.01) regression analyses, whereas changes of QF in place of MIP were significantly associated with the recoveries of 6MWD from 6 to 12 months.

Discussion: Improvements in MIP may impact the recovery of exercise capacity in the early phase after LTx. Factors that determine the improvement in exercise capacity following LTx may vary with postoperative time.
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http://dx.doi.org/10.1002/pri.1951DOI Listing
April 2022

Closed suction drainage is not beneficial in hybrid total hip arthroplasty with intra-articular administration of tranexamic acid: a propensity score-matched cohort study.

Int Orthop 2022 Jun 2;46(6):1281-1287. Epub 2022 Apr 2.

Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.

Purpose: This retrospective study aimed to evaluate the benefits of closed suction drainage (CSD) in hybrid total hip arthroplasty (THA) with intra-articular administration of tranexamic acid (TXA).

Methods: We included 369 hips that underwent primary hybrid THA between November 2015 and September 2020. We compared peri-operative blood test results, blood loss, and post-operative complications including transfusion, wound complications, and venous thromboembolism (VTE) with or without CSD. Propensity score matching was performed to balance baseline patient demographics.

Results: Transfusion, wound complications, and VTE were observed in 1.9% (seven), 2.4% (nine), and 2.2% (eight) of hips, respectively. There were no significant differences in transfusion, blood loss, wound complications, and deep venous thrombosis in both overall patients and propensity score-matched patients with or without CSD. The calculated total blood loss was approximately 600 ml and showed no significant difference between the two groups in the matched cohort (p = 0.59).

Conclusion: CSD does not provide any benefits and is not needed in primary hybrid THA with intra-articular administration of TXA.
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http://dx.doi.org/10.1007/s00264-022-05366-5DOI Listing
June 2022

Physical and Financial Impacts Caused by the COVID-19 Pandemic Exacerbate Knee Pain: A Longitudinal Study of a Large-Scale General Population.

Mod Rheumatol 2022 Mar 30. Epub 2022 Mar 30.

Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Objectives: This study aimed to evaluate the changes in knee pain, a dominant cause of physical disability, following the coronavirus disease (COVID-19) pandemic, and to identify factors affecting the changes in knee pain.

Methods: We analyzed the pre- and post-COVID-19 longitudinal dataset of the Nagahama Study. Knee pain was assessed using the Knee Society Score (KSS). The estimated KSS from the age and sex using regression model in the pre- and post-COVID-19 dataset was compared. Factors including the activity score, educational level, and various impacts of COVID-19 were analyzed for correlation analyses with changes in KSS.

Results: Data collected from 6409 participants showed statistically significant differences in KSS, pre- (mean = 22.0; SD = 4.4) and post-COVID-19 (mean = 19.5; SD = 6.4). Low activity score (p = 0.008), low educational level (p < 0.001) and undesirable financial impact (p = 0.030) were independently associated with knee pain exacerbation.

Conclusion: The harmful effects of the COVID-19 pandemic on knee pain were suggested. People should be encouraged to engage in physical activities, such as walking, even despite the state of emergency. Furthermore, social support for economically disadvantaged groups may improve healthcare access, preventing the acute exacerbations of knee pain.
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http://dx.doi.org/10.1093/mr/roac022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8992315PMC
March 2022

Association of Physical Activity and Nutritional Intake with Muscle Quantity and Quality Changes in Acute Stroke Patients.

J Stroke Cerebrovasc Dis 2022 Jun 16;31(6):106442. Epub 2022 Mar 16.

Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Objectives: To evaluate longitudinally the muscle properties of acute stroke patients and examine the association between physical activity and nutritional intake.

Materials And Methods: This study enrolled 21 stroke patients (72.7±10.4 years). Muscle quantity (fat-free mass, appendicular skeletal muscle mass) and quality (extracellular water/intracellular water ratio, phase angle) were assessed using a bioelectrical impedance device at baseline (within three days) and two weeks after stroke onset. Physical activity and sedentary were calculated from the accelerometer data. Total energy and protein intake were calculated from the dietary surveys as nutritional intake. The association of physical activity, sedentary, and nutritional intake with the rate of changes in muscle properties was examined.

Results: The fat-free mass significantly decreased (from 43.4±8.0 to 42.2±7.6 kg), and the skeletal muscle was unchanged (from 17.8±4.2 to 17.7±4.0 kg) after two weeks. The extracellular water/intracellular water ratio significantly increased (from 0.63±0.02 to 0.65±0.03) and the phase angle significantly decreased (from 5.1±0.6 to 4.9±0.8°), suggesting that the muscle quality have declined. Correlation analysis showed that the extracellular water/intracellular water ratio was significantly associated with physical activity [metabolic equivalents (ρ=-0.61)] and sedentary (ρ=0.67) and that the phase angle was significantly associated with physical activity [metabolic equivalents (ρ=0.69)], sedentary (ρ=-0.68), and nutritional intake [total energy (r=0.45), protein (r=0.45)].

Conclusions: The fat-free mass and muscle quality (extracellular water/intracellular water ratio and phase angle) declined two weeks after stroke. Physical activity and nutritional intake were lower in patients with decreased muscle quality, suggesting the importance of exercise and nutrition in the acute phase.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2022.106442DOI Listing
June 2022

Effect of a Rehabilitation Program After Mesenchymal Stromal Cell Transplantation for Advanced Osteonecrosis of the Femoral Head: A 10-Year Follow-Up Study.

Arch Rehabil Res Clin Transl 2022 Mar 13;4(1):100179. Epub 2022 Jan 13.

Department of Tissue Regeneration, Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan.

Objective: To assess the status of 10 patients with advanced osteonecrosis of the femoral head who underwent mesenchymal stromal cell transplants and a 12-week rehabilitation program 10 years earlier.

Design: Retrospective study.

Setting: University clinical research laboratory.

Participants: Patients (N=10) who had undergone mesenchymal stromal cell transplantation and rehabilitation for a single hip osteonecrosis of the femoral head 10 years prior to the current study were recruited by telephone. The average age was 31.7 years and all participants were men; radiographic stages were 3A in 6 patients and 3B in 4 patients before treatment.

Intervention: A 12-week rehabilitation program with follow-up once every 1 to 2 years was performed after mesenchymal stromal cell transplantation.

Main Outcome Measures: Radiographic analysis, clinical score, timed Up and Go test, hip function (range of motion, muscle strength), and Short Form-36 scores were assessed before treatment and 1 and 10 years after treatment.

Results: Upon imaging, 5 hips were found to be stable (stable group) and 5 had progressed (progressed group); 2 of the latter group required a total hip arthroplasty. The pretreatment radiographic stage of the progressed group was more advanced than that of the stable group. Body mass index was higher in the progressed group than in the stable group. Hip function and clinical score at 1 and 10 years after treatment improved in the hips of 8 patients without total hip arthroplasty. There were no severe adverse events during the rehabilitation.

Conclusions: The 12-week rehabilitation program and annual follow-up after mesenchymal stromal cell transplantation for osteonecrosis of the femoral head was associated with pain reduction, maintaining hip muscle strength, widening range of motion, and improving quality of life. The level and timing of weight-bearing and social activity should be planned according to the individual's lifestyle and body composition.
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http://dx.doi.org/10.1016/j.arrct.2022.100179DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8904865PMC
March 2022

Differential efficacy of TNF inhibitors with or without the immunoglobulin fragment crystallizable (Fc) portion in rheumatoid arthritis: the ANSWER cohort study.

Rheumatol Int 2022 07 10;42(7):1227-1234. Epub 2022 Mar 10.

Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Rheumatoid factor (RF) binds to the fragment crystallizable (Fc) portion of immunoglobulin. It could bind to the Fc portion of anti-TNF inhibitors (TNFi) and attenuate the clinical efficacy. We tried to determine whether the therapeutic efficacy of TNFi with Fc might be lower than that of TNFi without Fc in rheumatoid arthritis (RA) patients with high titres of RF. The Kansai Consortium for Well-being of Rheumatic Disease Patients (ANSWER) cohort is an observational multi-center registry of patients with RA in the Kansai district of Japan. RA patients treated with TNFi were included and divided into two groups based on the structural characteristics between TNFi with Fc (infliximab, adalimumab, golimumab, and etanercept) and TNFi without Fc (certolizumab pegol). Patients were classified into 4 groups according to RF titre quartiles. The sequential disease activity score in 28 joints using erythrocyte sedimentation rate (DAS28-ESR) was compared by Mann-Whitney U test between TNFi with and without Fc in each RF titre group. Multiple linear regression analysis was used to analyze the effect of TNFi without Fc for the change of DAS28-ESR adjusted after potential confounders. A total of 705 RA patients were classified into four groups (RF; RF 0-15.0 IU/mL, RF; 15.0-55.0, RF; 55.0-166, RF; 166-7555). In RF, RA patients treated with TNFi without Fc had a significantly lower DAS28-ESR than those treated with TNFi with Fc [3.2 (2.3-4.2) vs. 2.7 (2.0-3.0)] after 12 months. This effect of TNFi without Fc for the change of DAS28-ESR after 12 months treatment retained in multivariate analysis in RF. TNFi without Fc may be more efficacious than TNFi with Fc in RA patients with high RF titres.
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http://dx.doi.org/10.1007/s00296-021-05086-wDOI Listing
July 2022

Characterizing the neurocognitive profiles of children with moyamoya disease using the Das Naglieri cognitive assessment system.

Sci Rep 2022 03 7;12(1):3638. Epub 2022 Mar 7.

Rehabilitation Unit, Kyoto University Hospital, 54 Kawahara-cho Syogoin Sakyo-ku, Kyoto, Japan.

Although cognitive impairment is well-documented in children with moyamoya disease (MMD), selective decline in specific neurocognitive domains remains controversial. The purpose of this study was to characterize the neurocognitive profile of children with MMD using the Das Naglieri Cognitive Assessment System (CAS) and the Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV). We analyzed the neurocognitive data of 30 children (median age, 7 years) with MMD who were assessed with the CAS and the WISC-IV before surgery. We focused on the comparison of standard scores and intraindividual differences across domains. The CAS scores significantly varied across four measures (standard scores, p < 0.001; intraindividual differences, p < 0.001). Post-hoc analyses revealed that the standard scores and intraindividual differences for successive processing were significantly lower than those for planning and attention. The WISC-IV scores did not significantly vary among the four measures, although the working memory index was the lowest among the four measures. The within-individual weakness in successive processing, a form of working memory function, may be a distinct characteristic of children with MMD. The CAS may be more sensitive than the WISC-IV for detecting this selective neurocognitive weakness in children with MMD.
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http://dx.doi.org/10.1038/s41598-022-07699-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8901907PMC
March 2022

Radiodensity measurement is feasible for evaluating fatty infiltration in hip abductors.

J Orthop 2022 Mar-Apr;30:93-97. Epub 2022 Feb 24.

Department of Orthopaedic Surgery, Kyoto University Hospital, 54kawaharacho, Shogoin, Sakyo-ku, 606-8507, Japan.

Objective: This retrospective study aimed to compare radiodensity measurements and Goutallier grading systems for the evaluation of fatty infiltration in hip abductors.

Methods: The radiodensity of the gluteus minimus and medius muscles was measured in 80 hips of 40 patients. These muscles were graded for fatty infiltration using three five-grade classification systems: the original Goutallier classification on both computed tomography (CT) and magnetic resonance imaging (MRI), and a new objective classification based on the percentage of the functional muscle area (defined as 30-100 Hounsfield units). After measuring and grading the abductors, correlation coefficients between them were analyzed.

Results: Spearman's rank correlation coefficients (ρ) between radiodensity measurements of abductors and the Goutallier classification on CT and MRI were -0.701 and -0.552 for the gluteus minimus and -0.832 and -0.740 for the gluteus medius, respectively. Our new classification had correlation coefficients of -0.844 and -0.926 for the gluteus minimus and gluteus medius, respectively.

Conclusions: Radiodensity measurements showed a strong correlation with the grading systems, particularly with the new classification based on the percentage of the functional muscle area. Considering the subjective nature of the original Goutallier grading systems, we conclude that radiodensity assessment is feasible and more objective for evaluating fatty infiltration in hip abductors.
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http://dx.doi.org/10.1016/j.jor.2022.02.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8885799PMC
February 2022

Enthesopathy of the bicipital tuberosity of the radius treated under intraoperative computed tomography.

Eur J Med Res 2022 Mar 3;27(1):34. Epub 2022 Mar 3.

Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 53 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan.

Background: There is no report of the application of intraoperative computed tomography to the extremities, and its usefulness is not mentioned.

Case Presentation: We present a case of a patient with the elbow pain and loss of the forearm rotation due to the prominent bicipital tuberosity of the radius, which was diagnosed as enthesopathy. Surgical treatment to excise the prominent part of the bicipital tuberosity of the radius was recommended. However, it is difficult to perform the appropriate excision of the abnormal prominent part because of complications such as bicipital tendon rupture. The patient was successfully treated by surgical resection under the control of intraoperative computed tomography.

Conclusions: Intraoperative computed tomography scan is a useful tool to assess the remaining volume of the abnormal bones.
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http://dx.doi.org/10.1186/s40001-022-00659-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8896235PMC
March 2022

Ultrasonographic Changes of the Knee Joint Reflect Symptoms of Early Knee Osteoarthritis in General Population; The Nagahama Study.

Cartilage 2022 Jan-Mar;13(1):19476035221077403

Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Objective: Radiographic changes in knee osteoarthritis (OA) are not always associated with symptoms, especially in its early stages. Ultrasonography (US) can detect early changes in the knee joint, but the changes that reflect symptoms have not been fully elucidated. This study aimed to identify US-detectable changes in the knee that are often associated with knee symptoms and demonstrate the feasibility of early diagnosis in symptomatic knee OA using US.

Design: In this cross-sectional community-based study, 1,667 participants aged ≥60 years (1,103 women [66%]) were included. All participants concurrently underwent US and radiography of the knee and completed the Knee Society Knee Scoring System (KSS) questionnaire. Simple and multiple regression analyses were used to examine the associations between US findings and KSS symptom subscales.

Results: Among all participants, medial meniscus protrusion and medial osteophytes, age, and body mass index showed significant associations with KSS symptom scores. Among 894 participants with Kellgren-Lawrence (KL) grade ≤1, medial osteophytes and age were significantly associated with KSS symptom score. US measures were more related to KSS symptoms than KL grades.

Conclusions: Among the knee US-detectable changes, medial osteophytes were strongly associated with knee symptoms. Osteophytes are reliable predictors of symptomatic early knee OA, even in participants with few radiographic OA changes.
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http://dx.doi.org/10.1177/19476035221077403DOI Listing
April 2022

Association Between the Amount of Limb Lengthening and Hip Range of Motion After Total Hip Arthroplasty.

J Am Acad Orthop Surg 2022 Mar;30(6):e599-e606

From the Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan.

Aims: The relationship between prosthetic position and range of motion (ROM) after total hip arthroplasty (THA) has been rigorously examined. However, the effects of limb lengthening on postoperative hip ROM remain unclarified. We aimed to examine the effect of limb lengthening on hip ROM after THA.

Methods: We retrospectively reviewed the data from 120 patients who underwent unilateral THA. Univariate and multivariate regression models were used to evaluate the effects of the following patient- and surgery-related covariates on hip flexion ROM at 3, 6, and 12 months after THA: age, sex, body mass index, diagnosis, preoperative University of California Los Angeles activity score, preoperative Oxford Hip Score, preoperative flexion ROM, amount of leg lengthening, cup inclination, and cup anteversion.

Results: A large preoperative hip flexion ROM was the strongest predictor of a large hip flexion ROM at 12 months after THA (standardized coefficient: 0.519, P < 0.0001). A larger amount of leg lengthening was associated with a smaller postoperative hip flexion ROM (standardized coefficient: -0.159, P = 0.039), and male sex was another predictor of a smaller postoperative hip flexion ROM (standardized coefficient: -0.204, P = 0.014). Cup inclination (P = 0.99) and anteversion (P = 0.18) were not significantly associated with hip flexion ROM at 12 months after THA.

Discussion: A large amount of limb lengthening was associated with decreased hip flexion ROM after THA. In THA, minimizing the leg length discrepancy is important; however, the postoperative improvement in hip flexion ROM may be limited when a large amount of leg lengthening is needed.
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http://dx.doi.org/10.5435/JAAOS-D-21-00374DOI Listing
March 2022

Clinical Results of Arthroscopic Partial Trapeziectomy With Suture-Button Suspensionplasty for Thumb Carpometacarpal Arthritis.

Hand (N Y) 2022 Feb 12:15589447221075663. Epub 2022 Feb 12.

Rehabilitation Unit, Kyoto University Hospital, Japan.

Background: This study represents the clinical results, especially range of motion (ROM) improvement, of arthroscopic partial trapeziectomy with suture-button suspensionplasty for symptomatic grade II and III thumb carpometacarpal arthritis with a minimum 1-year follow-up.

Methods: Thirty-two patients (mean: 67.5 years) with grade II and III thumb carpometacarpal arthritis treated with arthroscopic partial trapeziectomy with suture-button suspensionplasty were retrospectively followed up for at least 1 year. The physical assessments included ROM, pain visual analogue scale (VAS), strength, and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. The physical variables were retrospectively compared before surgery and at the final follow-up.

Results: Preoperative radial abduction and palmar abduction (45.4 ± 16.4° and 54.3 ± 13.9°, respectively) were significantly increased at the final follow-up (59.7 ± 16.9° and 65.5 ± 14.2°, respectively). Preoperative VAS score, pinch strength, and DASH score (70.5 ± 14.0, 57.2 ± 24.8% and 36.8 ± 14.8, respectively) were also significantly improved at the final follow-up (7.9 ± 9.1, 91.0 ± 39.6%, and 11.7 ± 10.5, respectively). Complications involved 1 case of irritation of the superficial branch of the radial nerve and 1 case of dystonia. Two suture-buttons were removed due to patient discomfort.

Conclusions: A significant increase in ROM and pain relief was obtained after suture-button suspensionplasty with arthroscopic partial trapeziectomy.
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http://dx.doi.org/10.1177/15589447221075663DOI Listing
February 2022

The superior accuracy of a novel method in total hip wear calculations following radiographic measurement.

BMC Musculoskelet Disord 2022 Feb 9;23(1):130. Epub 2022 Feb 9.

Department of Orthopaedic Surgery, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto City, Kyoto, 606-8507, Japan.

Background: Polyethylene wear is one of the major concerns of orthopedic surgeons. However, there is no standardized calculation method for the wear rate following radiographic measurement. The purpose of this study was to propose a novel method of wear calculation and to compare its accuracy with a representative conventional method.

Methods: Relative position of the center of the femoral head to that of the cup progresses in one direction following arthroplasty surgery because of bedding-in and wear. We predetermined the amount of bedding-in, wear rate, and random error in measuring the head center position in a 2-dimensional plane. We calculated the wear rate using the head center coordinates over a certain number of measurement periods using a representative conventional method and our novel method. The conventional method consisted of transforming vector data into scalars and conducting a least-squares method. The least-squares method was directly applied to each component of the vector in the novel method. We evaluated the accuracy of these methods by comparing the expected value for the wear rate with their predetermined true values.

Results: If the error were limited to being random, the novel method could provide the predetermined wear rate as the calculation result. However, the conventional method could not.

Conclusion: We recommend using the novel method for the wear calculation rather than the conventional method because of its mathematical accuracy.
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http://dx.doi.org/10.1186/s12891-021-04964-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8826684PMC
February 2022

The Impact of Spinopelvic Parameters on Hip Degeneration After Spinal Fusion.

Spine (Phila Pa 1976) 2022 Feb 4. Epub 2022 Feb 4.

Department of Orthopedic Surgery, Graduate school of medicine, Kyoto University, Kyoto City, Japan.

Mini: The pelvic incidence (PI), sacral slope (SS), and pelvic incidence-lumbar lordosis (PI-LL) were associated with the progression of hip joint narrowing after spinal fusion, especially after fusion of four or more levels. Surgeons need to be aware of the risk of increased hip joint narrowing in patients with a large PI, SS, and PI-LL after fusion surgery.

Study Design: Retrospective cohort study.

Objective: This study aimed to investigate the effects of spinopelvic alignment parameters after spinal fusion on the rate of joint space narrowing in nonarthritic hips.

Summary Of Background Data: Spinal fusion affects the forces on the adjacent hip joint. Therefore, hip joint narrowing may be increased after spinal fusion surgery. However, the relationship between spinal alignment and hip degeneration remains unclarified.

Methods: We retrospectively reviewed data from patients who underwent lumbar spinal fusion from 2011 to 2018 at our institute. Patients with hip osteoarthritis (Kellgren-Lawrence grade ≥II) or hip dysplasia were excluded. The rate of hip joint space narrowing after spinal fusion was measured in 191 patients (382 hips). We assessed the effects of the following spinopelvic alignment parameters on the joint narrowing rate: pelvic tilt, sacral slope (SS), pelvic incidence (PI), lumbar lordosis (LL), PI-LL, sagittal vertical axis, and distance between the C7 plumb line, and the central sacral vertical line (C7-CSVL).

Results: The hip joint narrowing rate was greater when four or more levels were fused compared with single-level fusion. After adjusting for the effects of patient-related factors, the alignment parameters significantly associated with the hip joint narrowing rate were the PI (P = 0.0002), SS (P = 0.047), and PI-LL (P = 0.0022). A subgroup analysis of patients who underwent long fusion (four or more levels combined with iliac screws) also indicated that the PI (P = 0.013), SS (P = 0.0054), and PI-LL (P = 0.046) were associated with the hip joint narrowing rate.

Conclusion: The PI, SS, and PI-LL were associated with the progression of hip joint narrowing after spinal fusion, especially after fusion of four or more levels. Surgeons need to be aware of the risk of increased hip joint narrowing in patients with a large PI, SS, and PI-LL after fusion surgery.Level of Evidence: Level III.
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http://dx.doi.org/10.1097/BRS.0000000000004340DOI Listing
February 2022

Discrepancy in the Responsiveness to Hip Range of Motion Between Harris and Oxford Hip Scores.

Arthroplast Today 2022 Feb 20;13:157-164. Epub 2022 Jan 20.

Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Background: The primary objectives of total hip arthroplasty (THA) include mobility improvement and pain relief; however, the correlation between hip range of motion (ROM) and function remains unclear. We aimed to explore how ROM affects hip functions after THA and compare the responsiveness of each component of the modified Harris Hip Score (mHHS) and Oxford Hip Score (OHS) to preoperative and postoperative ROM.

Methods: This prospective observational study involved 120 patients who underwent unilateral THA. Univariate regression analyses were performed using the University of California Los Angeles activity score and mHHS and OHS to determine the effects of preoperative and postoperative flex ROM on clinical scores at 12 months. Multivariate regressions were performed to adjust for the confounding effects of patient factors: age, sex, body mass index, and diagnosis.

Results: A larger preoperative flexion ROM was associated with a higher score in the mHHS socks component (standardized coefficient [SC] = 0.26,  = .0041) at 12 months; the effect on the OHS socks component was not significant ( = .34). A larger flexion ROM at 12 months was associated with higher scores in the mHHS support (SC = 0.21,  = .026), stairs (SC = 0.35,  = .0002), and socks (SC = 0.32,  = .0007) components but had no significant effect on any OHS component. The effects of ROM on University of California Los Angeles activity score were limited.

Conclusions: A discrepancy was noted in the responsiveness to ROM between the two major measurement tools; this difference might be because mHHS and OHS are surgeon- and patient-administered questionnaires, respectively. This discrepancy also suggests that the patients have higher satisfaction than that assumed by the surgeons.
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http://dx.doi.org/10.1016/j.artd.2021.10.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8783107PMC
February 2022

Wear resistance of first-generation highly cross-linked annealed polyethylene in cementless total hip arthroplasty is maintained 20 years after surgery.

Bone Joint J 2022 Feb;104-B(2):200-205

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

Aims: The aim of this study was to evaluate the performance of first-generation annealed highly cross-linked polyethylene (HXLPE) in cementless total hip arthroplasty (THA).

Methods: We retrospectively evaluated 29 patients (35 hips) who underwent THA between December 2000 and February 2002. The survival rate was estimated using the Kaplan-Meier method. Hip joint function was evaluated using the Japanese Orthopaedic Association (JOA) score. Two-dimensional polyethylene wear was estimated using Martell's Hip Analysis Suite. We calculated the wear rates between years 1 and 5, 5 and 10, 10 and 15, and 15 and final follow-up.

Results: The mean follow-up period was 19.1 years (SD 0.6; 17.3 to 20.1). The 19-year overall survival rate with the end point of all-cause revision was 97.0% (95% confidence interval (CI) 91 to 100). The mean JOA score improved from 43.2 (SD 10.6; 30 to 76) before surgery to 90.2 (SD 6.4; 76 to 98) at the final follow-up (p < 0.001). There was no osteolysis or loosening of the acetabular or femoral components. The overall steady-state wear rate was 0.013 mm/year (SD 0.012). There was no hip with a steady-state wear rate of > 0.1 mm/year. There was no significant difference in wear rates for each period. We found no significant correlation between the wear rate and age, body weight, BMI, or cup inclination.

Conclusion: First-generation annealed HXLPE shows excellent wear resistance and no acceleration of wear for approximately 20 years, with low all-cause revision rates. Cite this article:  2022;104-B(2):200-205.
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http://dx.doi.org/10.1302/0301-620X.104B2.BJJ-2021-1079.R1DOI Listing
February 2022

Paraplegia Caused by Multifocal Osteosarcoma With Spinal Lesions.

Int J Spine Surg 2021 Dec;15(6):1234-1237

Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Japan.

Background: Multifocal osteosarcoma is a rare condition that may be either synchronous or metachronous. Spine involvement of multifocal osteosarcoma is very rare. Synchronous multifocal osteosarcoma is typically described as the occurrence of tumors at two or more sites in the absence of pulmonary metastases.

Methods: A 55-year-old man initially presented with low back pain. Multiple osteosclerotic lesions were observed, primarily in the spine and pelvis, as well as in soft tissues. Lung lesions were observed, but they were relatively small at reference. Laboratory tests showed a markedly elevated alkaline phosphatase (ALP) level of 36,416 U/L (normal range, 115-359 U/L). Based upon a diagnosis of osteosarcoma on biopsy, chemotherapy was administered, resulting in a decrease in ALP to 17,833 U/L.

Results: Decompression of the symptomatic compressed spinal cord and posterior spinal stabilization of T8-12 were performed. However, progressive extensions of multiple lesions to the spinal canal led to paraplegia with urinary dysfunction. Eleven months after the first visit to our hospital, the patient died due to multiple organ failure.

Conclusions: Multifocal osteosarcoma accompanied by spinal lesions may lead to paraplegia, a clinical problem that negatively affects the quality of activities of daily living.

Level Of Evidence: 4.

Clinical Relevance: Multifocal osteosarcoma accompanied by spinal lesions may lead to paraplegia, a clinical problem that negatively affects the quality of life and activities of daily living.
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http://dx.doi.org/10.14444/8156DOI Listing
December 2021
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