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Background: The modified Glasgow prognostic score (mGPS) is a reliable system for identifying patients at high risk of death among patients with soft tissue sarcoma (STS). The scoring systems use a combination of C-reactive protein (CRP) and albumin levels. Although patients with high-grade STS are at risk of metastasis and death, even if their mGPS is 0, the prognostic indicators in these patients are unknown. Therefore, we investigated useful prognostic indicators for survival and the development of metastasis in patients with high-grade STS and an mGPS of 0., Methods: One hundred and four patients with CRP and albumin levels of <1.0 mg/dl and >3.5 g/dl, respectively, indicating an mGPS of 0, were included. The mean follow-up period was 79 months., Results: The 5-year disease-specific survival (DSS) rate was 79.2%. Cox proportional analysis showed that tumor size and absolute neutrophil count (ANC) were prognostic variables in multivariate analyses. Patients with higher ANC (ANC>3370/μl) had a worse DSS than those with lower ANC. The 5-year DSS was 74.7% vs. 91.7%, respectively (p = 0.0207). The 5-year metastasis-free survival was 67.2%. Tumor size and ANC remained significant variables for predicting the development of metastasis in the multivariate analysis. Patients with higher ANC had a worse metastasis-free survival than those with lower ANC. The 5-year metastasis-free survival was 59.5% vs. 87.3%, respectively (p = 0.00269)., Conclusions: When patients with high-grade STS have an mGPS of 0, the ANC and tumor size should be carefully evaluated. A higher neutrophil count and larger tumor size may increase the risk of metastasis development., Competing Interests: Declaration of competing interest There was no conflict of interest in the present study., (Copyright © 2023 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Background: Recently, we identified artifactual hypoglycemia in patients with soft tissue sarcoma (STS) who received pegfilgrastim-supported chemotherapy. In the present study, we measured white blood cell count and fasting blood glucose levels after the administration of pegfilgrastim in patients with STS and showed the relationship between artifactual hypoglycemia and white blood cell count., Patients: A total of 19 patients were included in this study. The mean age of the patients was 54 years. They received chemotherapy and administration of pegfilgrastim. Pegfilgrastim was injected subcutaneously 48 h after chemotherapy. No patient had a history of diabetes mellitus., Results: Fifty-nine cycles were administered to 19 patients. One hundred and twenty-eight samples were obtained within one week after the of pegfilgrastim administration. Hypoglycemia was observed in 38 of the 13 patients. There were no symptoms of hypoglycemia in any patient. The white blood cell count in samples from patients with hypoglycemia was significantly higher than that in samples without hypoglycemia (p < 0.001). The median white blood cell count in samples with hypoglycemia was 29,415 and 3420 in samples without hypoglycemia. Age, sex, body mass index, performance status, and red blood cell count were not associated with hypoglycemia. White blood cell count was strongly negatively correlated with fasting blood glucose levels (Pearson's r: 0.786, 95% confidence interval: 0.844-0.709, p < 0.001). Of the 38 samples with hypoglycemia, 32 were measured within 2 days after pegfilgrastim administration., Conclusion: If a lack of symptoms due to hypoglycemia and leukocytes is confirmed, physicians should wait and identify the normalization of the level of glucose according to the neutrophil nadir following temporal leukocytes, which prevents further invasive examination for hypoglycemia., Competing Interests: Declaration of competing interest There was no conflict of interest in the present study., (Copyright © 2023 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Background: Psychological stress response refers to the negative emotional states generated when an individual perceives that they do not have the resources to cope with or respond to a threat. Low back pain (LBP) is a complex condition with multiple contributors, including psychological factors. However, whether LBP is a stressor that causes a psychological stress response remains unknown. This study aimed to investigate the association between LBP and psychological stress response in a Japanese population-based cohort., Methods: Participants aged >50 years were recruited from inhabitants of a mountain village in Japan. The participants completed the following patient-reported outcome measures. The extent of the psychological stress response was measured using the Stress response scale (SRS)-18, which includes the subscales "Depression/Anxiety", "Irritability/Anger", and "Helplessness". LBP intensity in several situations/positions was measured using a numerical rating scale (NRS). Quality of life (QOL) was measured using the Oswestry Disability Index, EuroQol 5-dimension, and EuroQol visual analog scales. The association between SRS-18 and each parameter was statistically evaluated., Results: A total of 282 participants (72.1 years old) were analyzed in this study, and 29.1% had chronic LBP. The SRS-18 total score of all participants ranged from 0 to 43, and the average SRS-18 total score was 7.7 ± 8.8 (depression/anxiety: 2.3 ± 3.2, irritability/anger: 2.4 ± 3.3, helplessness: 2.9 ± 3.2). SRS-18 scores of participants with LBP were significantly higher than those of participants without LBP. SRS-18 scores were significantly correlated with QOL scores (P < 0.01, correlation coefficient = 0.22-0.46). Multiple regression analysis showed that the NRS score of LBP during morning awakening was significantly associated with the SRS-18 total, depression/anxiety, and helplessness scores., Conclusions: Psychological stress responses were associated with LBP and LBP-related QOL among residents of a Japanese mountain village., Competing Interests: Declaration of competing interest None., (Copyright © 2023 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Background: Locomotive syndrome is closely related to the state of long-term care. This study aimed to longitudinally evaluate long-term care certification occurrence in locomotive syndrome using data from the Miyagawa study., Methods: The study included 470 individuals (168 males, 302 females; mean age, 70.7 years) with no long-term care certification at the time of participation in the study. Locomotive syndrome was classified into three stages (stages 1-3) according to the 25-question Geriatric Locomotive Function Scale. Analysis was performed with long-term care certification occurrence as the endpoint and locomotive syndrome stage as the explanatory variable., Results: The median observation period was 6.3 years, and long-term care certification occurred in 69 (34.2%) and 30 (11.2%) of the participants in the locomotive syndrome and no-locomotive syndrome groups, respectively. Independent risk factors of long-term care certification occurrence were locomotive syndrome stage-3 (hazard ratio: 2.27) in the total number of studies, and locomotive syndrome stages 2 (hazard ratio: 2.49) and 3 (hazard ratio: 2.79) in females. Locomotive syndrome stage-3 was an independent risk factor in long-term care certification occurrence due to musculoskeletal disorders (hazard ratio: 3.89)., Conclusions: The higher the locomotive syndrome stage, especially in females, the higher the risk of long-term care certification occurrence., Competing Interests: Declaration of competing interest None., (Copyright © 2022 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Backgrounds: Preoperative widespread pain sensitization or pain catastrophizing could be associated with chronic pain after total knee arthroplasty (TKA). The aim of the present study was to examine the association between postoperative pain in patients undergoing TKA and preoperative factors, including patient characteristics and preoperative central sensitization as well as pain catastrophizing., Methods: Preoperative TKA patients were evaluated using the Central Sensitization Inventory (CSI)-9 and Pain Catastrophizing Scale (PCS). Postoperative knee pain was evaluated using a numerical rating scale (NRS) 6 months after TKA. Statistical analyses were performed to assess the relationship between NRS 6 months after TKA and preoperative factors, including patient characteristics, CSI-9, and PCS., Results: We enrolled 58 consecutive patients with osteoarthritis who underwent TKA. Using cutoff of 14, postoperative NRS was higher in the patients with ≥14 than the patients with <14 in CSI (p = 0.025). Postoperative NRS was higher in the patients with ≥30 than the patients with <30 in PCS (p = 0.043). Preoperative PCS was a significant risk factor of postoperative pain using a multivariate analysis., Conclusions: Surgeon should recognize preoperative PCS could affect postoperative pain 6 months after TKA., Competing Interests: Declaration of competing interest None., (Copyright © 2021 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Peroneal tendon dislocation (PTD) is sometimes diagnosed as a sports-related injury, of which many cases lead to recurrent PTD (RPTD). Superior retinaculum repair is the major operative treatment of RPTD. The technique described herein comprises 8 steps: (1) Standard tendoscopic examination, (2) debridement of the pseudo-pouch base, (3) first anchor insertion, (4) suture relay, (5) second anchor insertion and suture relay, (6) third anchor insertion and suture relay, (7) suture tightening, and (8) suture bridge. Although this tendoscopic peroneal retinaculum repair technique is complicated, expensive, and requires a longer operation time, it incorporates a double-row suture bridge. Therefore, it has a wider contact surface between the superior retinaculum repair and fibula bone and tighter fixation than does a single-row technique. Moreover, our technique is knotless and thereby avoids knot-related complications. Tendoscopy has additional advantages in terms of less postoperative pain, fewer complications, and better cosmesis. In conclusion, this knotless tendoscopic peroneal retinaculum repair technique for RPTD is a patient-friendly surgery compared with previous procedures., (© 2022 The Authors.)

Background: This study aimed to elucidate the clinical outcomes of patients with small (≤5 cm) high-grade soft tissue sarcoma, who underwent unplanned excision with positive surgical margin, using data from the Bone and Soft Tissue Tumor registry in Japan., Methods: We examined 174 patients (101 males and 73 females; mean age, 59 years) with primary non-metastatic soft tissue sarcoma. The tumor size was ≤5 cm, and tumor histological grade was high in all patients. The mean follow-up duration was 50 months., Results: Unplanned excision with R1 and R2 margins was reported in 115 (66%) and 59 patients (34%), respectively. After unplanned excision, immediate additional excision was performed in 154 patients, whereas no additional excision was performed in the remaining 20. Of the 154 patients who underwent additional excision, wide surgical margin resection was achieved in 140 patients, while marginal and intralesional resections were achieved in 10 and 3 patients, respectively. Additionally, 93 patients (60%) underwent reconstruction after additional excision. During the last follow-up, 8 patients died of the disease, 22 developed distant metastasis, and 14 reported local recurrence. The 5-year disease-specific survival rate and 5-year metastasis-free survival rate was 93.5% and 85%, respectively. Tumor depth and additional excision after unplanned excision showed statistical significance in the multivariate analysis. The 5-year metastasis-free survival rate was 89.1% in patients with additional excision and 39.2% in those without. Univariate analysis showed an association between additional excision and local control. The 5-year local recurrence-free survival was significantly worse in patients without additional excision after unplanned excision (52.6%) than in those with additional excision (92.8%)., Conclusion: If unplanned excision is performed in patients with small high-grade soft tissue sarcoma, additional excision is recommended for preventing metastasis, along with necessary preparations for reconstruction., Competing Interests: Conflict of interest There was no conflict of interest in the present study., (Copyright © 2021 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Background: Due to their rarity, soft tissue sarcomas (STS)s are often treated surgically as unplanned excisions (UE)s before referral to specialists. The Bone and Soft Tissue Tumor (BSTT) registry is a nationwide, organ-specific cancer registry for bone and soft-tissue tumors in Japan. The aim of this study was to elucidate the incidence and risk factors for UEs using data from the BSTT registry., Methods: Our study comprised 8761 patients with STS including 4826 males and 3935 females, with a mean age of 59 years (range, 0-105 years). Patients were classified into primary STS and UE groups., Results: Superficial and deep tumors were found in 2533 and 6120 patients, respectively. The mean STS size was 8.6 cm (range, 0.2-49 cm). We identified 6610 patients with high-grade, and 1758 patients with low-grade STS. Of the total 8761 patients, 7770 patients had primary STSs, whereas 991 patients were referred after undergoing UE. The UE mean incidence rate over 11 years was 11.3%. The UE incidence rates for leiomyosarcoma (LMS) (odds ratio [OR] = 1.75, p < 0.0001), fibrosarcoma (FS) (OR = 2.28, p < 0.0001), and epithelioid sarcoma (OR = 1.82, p = 0.01) were higher than the mean UE incidence rate (11.3%). Of 757 patients who underwent UE, 354 (47%) patients had superficial (≤5 cm) STSs, whereas 156 (20.6%) of patients had deep STSs (>5 cm) (p < 0.0001). Logistic regression analysis revealed that UE was frequently associated with males and small, superficial, and trunk STSs., Conclusions: In the present study, the mean UE incidence rate (11.3%) was significantly different from the individual UE incidence rates of histological diagnoses suggesting that surgeons should consider STS, even with small tumors. Continuous education during training for medical students and surgeons is essential to ensure awareness and correct diagnostic procedures for STS., Competing Interests: Declaration of competing interest None., (Copyright © 2021 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Lateral ankle sprains are very common injuries that sometimes lead to chronic lateral ankle instability. The modified Broström operation is the gold standard procedure for treatment of chronic lateral ankle instability. Currently, this operation is performed arthroscopically. Broström repair depends on the quality of the remnant ligament. In cases with an insufficient remnant ligament, Gould augmentation or reconstruction using the gracilis tendon is generally performed. Recently, tape augmentation (internal brace) also has been used to support an insufficient ligament. This article introduces arthroscopic tape augmentation with arthroscopic modified Broström operation. This technique consists of creation of a talar anchor hole and fibular anchor hole, reattachment of the remnant ligament to the fibula with tape, and tape fixation to the talus. This technique uses only one knotless anchor screwed to the fibula for both the modified Broström operation and fixation of the tape. This technique is relatively simple and produces similar results as an open procedure., (© 2020 by the Arthroscopy Association of North America. Published by Elsevier.)

Background: Patellar tendon rupture is a devastating complication after total knee arthroplasty (TKA). Different strategies have been used to reconstruct or augment direct repairs., Methods: Acute patellar tendon ruptures after TKA were treated using ultra-high molecular weight polyethylene cable (Nesplon cable) for augmentation in four patients. Nesplon cables were inserted anteriorly through the quadriceps just above the patella, and drill holes were placed in the tibial tubercle with one in figure-of-eight fashion and the other in cerclage configuration. Clinical evaluations were performed using range of motion and Knee Society Score at the time of last follow-up. Mean follow-up was 3.5 years., Results: Postoperatively, mean flexion was 119° and mean extension was 0° in all cases. No knees showed extension lag. Mean knee score was 93.8 and mean function score was 63.8. Infection occurred in one case., Conclusion: Patellar tendon reconstruction with Nesplon cable was favorable with good clinical outcomes., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: The locomotive syndrome risk test was developed to quantify the decrease in mobility among adults, which could eventually lead to disability. The purpose of this study was to establish reference values for the locomotive syndrome risk test for adults and investigate the influence of age and sex., Methods: We analyzed 8681 independent community dwellers (3607 men, 5074 women). Data pertaining to locomotive syndrome risk test (the two-step test, the stand-up test, and the 25-question geriatric locomotive function scale [GLFS-25]) scores were collected from seven administrative areas of Japan., Results: The reference values of the three test scores were generated and all three test scores gradually decreased among young-to-middle-aged individuals and rapidly decreased in individuals aged over 60 years. The stand-up test score began decreasing significantly from the age of 30 years. The trajectories of decrease in the two-step test score with age was slightly different between men and women especially among the middle-aged individuals. The two physical test scores were more sensitive to aging than the self-reported test score., Conclusion: The reference values generated in this study could be employed to determine whether an individual has mobility comparable to independent community dwellers of the same age and sex., Competing Interests: Declaration of Competing Interest There are no conflicts of interest to declare., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)

We measured wear and creep in conventional tibial inserts retrieved after total knee arthroplasty by using Raman spectroscopy. The Raman spectra of thirteen tibial inserts retrieved after total knee arthroplasty with a mean in vivo time of 34.3 months were confocally measured along their bearing subsurface, and then from bearing surface to backside after cutting. The amounts of creep, wear, and wear rate in the medial and lateral load zone were computed from the full-width at half-maximum of a selected Raman band as a characteristic parameter related to strain. In all retrievals, the strain was higher than that of pristine samples at the bearing subsurface, and we observed a correlation between full-width at half-maximum and body weight/body mass index in both load zones. The amount of total penetration, creep, and wear were 0.27 ± 0.21, 0.082 ± 0.031, 0.19 ± 0.18 mm in the medial load zone and 0.22 ± 0.18, 0.080 ± 0.040, 0.14 ± 0.14 mm in the lateral load zone, respectively. The amount of wear in both load zones was strongly correlated with the in vivo time. The wear rate in eleven retrievals excluding an extremely short excised sample was 0.055 ± 0.020 mm/year in the medial load zone and 0.041 ± 0.020 mm/year in the lateral load zone. Raman spectroscopy proved very useful in separating creep and wear components of thickness reduction, thus revealing the wear rate of the UHMWPE material., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: We reported a new technique for arthroscopic ligamentoplasty for the thumb carpometacarpal osteoarthritis (CMC-OA) along with a minimum of 2 years of results., Methods: Twenty-nine thumbs with CMC-OA in stages II and III according to the Eaton and Glickel classification, were treated by arthroscopic ligamentoplasty. The procedure included partial trapeziectomy followed by ligamentoplasty similar to the Thompson technique. We evaluated pain VAS; DASH; grip and pinch strength; thumb abduction range of motion, and radiographic examination preoperatively and every 3 months until 1 year after surgery, and every 6 months thereafter. The mean duration of the follow-up was 3.2 years with a range of 2.0-6.0 years., Results: Pain, VAS, and DASH were significantly improved at 3 months after surgery than those preoperatively. Further, the strength of grip, tip, and key pinch significantly increased at 9, 9, and 12 months after surgery, respectively. Additionally, these improvements were maintained until the final follow-up. The range of motion tended to decrease in both palmar and radial abduction, although the differences were not significant. Radiographic examination after surgery showed that the ratio of trapezial space was significantly reduced because of surgical excision of the trapezium. However, there were no significant differences in the results between each follow-up time and the final follow-up. Moreover, the ratio of subluxation on the plain X-ray was significantly improved and maintained until the final follow-up. The parameters of clinical and radiographic outcomes, except motion, were significantly improved, even in patients with including those in stage III and with greater than 1/3 subluxation of the 1st metacarpal base on plain radiography., Conclusion: Arthroscopic ligamentoplasty was effective for pain relief and improvement of grip and pinch strength for the patients with symptomatic CMC-OA., Level of Evidence: Therapeutic study/Level IV., (Copyright © 2019 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Background: The effects of tenascin-C (TNC) on cartilage repair were examined in cartilage defect model mice. An in vitro study was also performed to determine the mechanism of cartilage repair with TNC., Methods: Full-thickness osteochondral defects were filled with TNC (group A: 100 μg/ml, group B: 10 μg/ml, group C: empty). Mice were sacrificed at 1, 2, 3, and 6 weeks postoperatively. Cartilage repair was histologically evaluated using the modified WAKITANI score. Chondrocytes were isolated and cultured, and they were treated with TNC. The expressions of various mRNAs including TNC, inflammatory cytokines, and anabolic and catabolic factors for cartilage were compared by real-time polymerase chain reaction., Results: The defects in group A were covered with hyaline-like cartilage after 3 weeks. Average modified WAKITANI scores were significantly better in group A than in groups B and C at 3 and 6 weeks. TNC upregulated the expressions of endogenous TNC, inflammatory cytokines, and anabolic and catabolic factors for cartilage. TNC downregulated the expression of a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) 5., Conclusions: Intra-articular injection of full-length TNC repaired cartilage in murine models of full-thickness osteochondral defects. TNC upregulated the expression of ADAMTS4, but downregulated the expression of ADAMTS5 that contributed to cartilage degradation., (Copyright © 2019 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Objective: The aim of this study was to evaluate skeletal pain associated with immobility-induced osteoporosis and to examine the inhibitory effect of bisphosphonate (BP) administration on pain in hindlimb-unloaded (HU) mice., Methods: The mechanism of osteoporotic pain in HU mice was evaluated through an examination of pain-related behavior, as well as immunohistochemical findings. In addition, the effects of alendronate (ALN), a potent osteoclast inhibitor, on these parameters were assessed., Results: HU mice with tail suspension developed bone loss and mechanical hyperalgesia in the hindlimbs. The HU mice showed an increase in the number of calcitonin gene-related peptide (CGRP)-immunoreactive neurons and in transient receptor potential channel vanilloid subfamily member 1 (TRPV1)-immunoreactive neurons in the dorsal root ganglions (DRGs) innervating the hindlimbs. Furthermore, administration of ALN prevented HU-induced bone loss, mechanical hyperalgesia, and upregulation of CGRP and TRPV1 expressions in DRG neurons of immobility-induced osteoporotic animal models., Conclusions: HU mice appear to be a useful model for immobility-induced osteoporotic pain and hindlimb-unloading-induced bone loss, as well as upregulation of CGRP and TRPV1 expressions in DRG neurons, and BP treatment prevented bone loss and mechanical hyperalgesia. The inhibitory effect of BP on osteoclast function might contribute to improving osteoporosis-related pain., (Copyright © 2018 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Background: We investigated the long-term clinical efficacy of acridine orange (AO) therapy on the inhibition of local recurrence after marginal or intra-lesional tumor resection in high-grade soft tissue sarcomas (STSs)., Methods: Our study consisted of 48 patients with STSs who received AO therapy after marginal or intra-lesional resection. The median and mean follow-up durations were 76 and 78 months, respectively. Our AO therapy procedure was combined with photodynamic surgery, photodynamic therapy, and radiodynamic therapy., Results: There were 25 men and 23 women, with a mean age of 46 years. The average tumor size at surgery was 8.5 cm. At the last follow-up, 11 patients developed local recurrence. The 5- and 10-year local recurrence-free rates were 78.9% and 73.3%, respectively. In multivariate analysis, tumor size remained significant for local control. None of the patients developed systemic or local complications. All patients recovered activities of daily life before AO therapy., Conclusion: AO therapy can be performed in safety and may be a useful therapy for acquiring long-term local control in patients with high-grade STSs. Tumor size is an important factor for the indication of AO therapy., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Highly cross-linked polyethylene (HXLPE) hip liners grafted with 2-methacryloyloxyethyl phosphorylcholine (MPC) on their bearing surfaces have recently been commercialized as components of a new generation of artificial hip joints, while improvements in wear resistance and biocompatibility were reported based on in vitro studies. The present study aimed at evaluating the surface modification and oxidative degradation in short-term retrieved MPC-grafted liners by X-ray photoelectron spectroscopy (XPS), Fourier-transform infrared spectroscopy (FT-IR) with attenuated total reflection (ATR) equipment and Raman spectroscopy. In none of 3 samples of retrieved MPC-grafted liners, detectable MPC graft remained on the bearing surfaces although 2 samples yet contained remains of MPC polymer in their rim zone. These results revealed that the MPC polymer might have quickly disappeared from the bearing surface under in vivo loading, which is more severe than the in vitro one. Furthermore, a detectable oxidation index (OI) value (>0.1) was not only observed in any zone of any sample investigated, but also in the rim zones of Samples 1 and 2, which surprisingly experienced the most remarkable increase in OI value detected in this study. We thus confirmed that: (i) annealing of HXLPE cannot completely remove free radicals; (ii) the MPC graft has no beneficial effect in protecting HXLPE against oxidation and wear; and, (iii) lipid absorption occurred even in the rim zone where the MPC layer remained. Based on these evidences we consider that the declaimed advanced MPC technology is not a suitable one to elongate the in vivo lifetime of hip joints., Statement of Significance: Several studies reported that highly crosslinked polyethylene (HXLPE) have resulted in reduced wear in total hip arthroplasty. Beyond those studies, HXLPE hip liners grafted with 2-methacryloyloxyethyl phosphorylcholine (MPC) on their bearing surface were extensively studied in vitro and then commercialized as a new generation of artificial hip joints. The present study reports for the first time results about the evaluation of surface modification and oxidative degradation in retrieved the MPC grafted liners. The findings of this investigation clearly show that the MPC layer has been peeled off on the bearing surface of the liner main wear zone although the MPC layer remained on the surface of the rim zones. Furthermore, we assessed the microstructural modifications and the oxidation drifts that occurred in vivo in the hip joints despite the presence of the MPC layer., (Copyright © 2017 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.)

Longitudinal flexor hallucis longus (FHL) tendon tears are sometimes complicated by posterior ankle impingement syndrome (PAIS), especially in ballet dancers. In recent years, PAIS has been treated endoscopically, but it is difficult to suture FHL tendon tears endoscopically. In this report, we describe how to suture the FHL tendon endoscopically with the Meniscal Viper Repair system (Arthrex, Naples, FL). Without our endoscopic technique, when a patient is found to have a longitudinal tear of the FHL under endoscopy, we must choose to either neglect the tear or convert to an open repair. Open tendon suture techniques have reportedly had relatively good results but require a longer skin incision than endoscopic surgery for PAIS. Compared with the open repair, the advantages of our technique include earlier recovery, less pain, a lower rate of soft tissue complications, and improved healing through better preservation of the blood supply. This technique is an attractive and useful option because it is an easy and safe method for longitudinal FHL tendon tears.

Objectives: The objective of this retrospective study was to investigate the prevalence of asymptomatic deep vein thrombosis (DVT) and the risk of DVT in patients admitted to hospital for total knee arthroplasty (TKA)., Methods: From September of 2003 to December of 2013, 322 patients admitted for TKA were eligible for this retrospective study. A diagnosis of DVT was confirmed by Doppler ultrasonography. The prevalence of silent DVT in the lower limbs in patients before TKA was assessed. The risk factors for preoperative DVT were investigated, as well as the correlation of DVT in the patient's background and medical history., Results: Preoperative DVT was diagnosed in 56 patients (17.4%) including 3 patients with proximal DVT. Significantly elevated risks of DVT were found in patients undergoing revision TKA (p < 0.01), patients with rheumatoid arthritis (RA) (p < 0.005), patients with connective tissue diseases (CTDs) (p < 0.05), and female patients (p < 0.05) on univariate analyses. Multiple linear regression analysis showed that RA, CTDs and admission for revision TKA were independent risk factors for preoperative DVT., Conclusions: A high prevalence of preoperative DVT was found in patients admitted to hospital for TKA. Admission to the hospital for RA, CTDs and revision TKA were risk factors for preoperative DVT., (Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Background: Chronic back pain is one of the most important complications of postmenopausal osteoporosis. The aim of this study was to evaluate skeletal pain associated with osteoporosis and to examine the inhibitory effect of bisphosphonates (BPs) on pain in ovariectomized (OVX) mice. The mechanism of osteoporotic pain in OVX mice was evaluated through an examination of pain-related behavior, as well as immunohistochemical findings. In addition, the effects of alendronate (ALN), a potent osteoclast inhibitor, on these parameters were assessed., Methods: 8-week-old female ddY mice were ovariectomized and assigned to 3 groups: SHAM-operated mice treated with vehicle (SHAM; n = 8); OVX mice treated with vehicle (OVX-V; n = 8); and OVX mice treated with ALN (OVX-ALN; n = 8). Starting immediately after surgery, vehicle or 40 μg/kg ALN was injected subcutaneously twice a week for 4 weeks. The bilateral distal femoral metaphyses and proximal tibial metaphyses were analyzed three-dimensionally by μCT. Mechanical sensitivity was tested using von Frey filaments. Transient receptor potential channel vanilloid 1 (TRPV1) and calcitonin gene-related peptide (CGRP) expressions in L3-5 dorsal root ganglion (DRG) neurons were examined immunohistochemically., Results: Ovariectomy induced bone loss and mechanical hyperalgesia in hindlimbs with upregulation of TRPV1 and CGRP expressions in DRG neurons innervating hindlimbs. ALN prevented bone loss and mechanical hyperalgesia in ovariectomized mouse hindlimbs, and it suppressed upregulation of pain markers., Conclusions: ALN prevented ovariectomy-induced bone loss and mechanical hyperalgesia in hindlimbs, and it suppressed TRPV1 and CGRP expressions in DRG neurons. The results suggest that bone resorption with upregulation of TRPV1 and CGRP expressions is one of the causes of postmenopausal osteoporotic pain., (Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Although the introduction of highly cross-linked polyethylene is effective in reducing the amount of wear, there are still major concerns regarding the use of this material in total knee arthroplasty (TKA), essentially due to the reduction of fatigue resistance and toughness. Monitoring the in vivo performance of different types of UHMWPE is a much needed task to tackle the lack of information on which should be the most reliable choice for TKA. The present study was aimed at investigating the mid-term degradation of electron beam sterilized conventional UHMWPE tibial plates. Visual inspection enabled to grade the surface damage of 12 retrievals according to the Hood's score: the total wear damage correlates to the in vivo time (Spearman's ρ=0.681, p<0.05) and BMI (ρ=0.834, p<0.001). Surface degradation was less severe than that quantified in similar studies on γ-sterilized UHMWPE. Raman and infra-red spectroscopies were utilized to unfold the microstructural modifications. In the load zone, polyethylene whitened damage regions were noticed in the inserts implanted longer than 1year, in which oxidation index (OI) is clearly higher than 1 (max 8). The maximum OI (ρ=0.802, p<0.005) and α c (ρ=0.816, p<0.005) correlate to the implantation time in the load zone. The crystallinity increased along with the extent of oxidation. Concentration of absorbed species from synovial fluid is higher in the contact zone and correlates to maximum OI (Spearman's ρ=0.699, p=0.011). Absorption was promoted in the contact area by the mechanical action of the femoral counterpart and it exacerbated the oxidative degradation in retrievals with high concentration of absorbed species. In the non-load zone, mild but detectable oxidation was observed, probably due to free radicals trapped after sterilization., Statement of Significance: Although several clinical studies on retrieved tibial bearings have been published so far, monitoring and comparing the in vivo performance of different types of UHMWPE is still a much needed task. The present study reports for the first time results on the effect of sterilization by electron beam on the mid-term in vivo performance of conventional UHMWPE tibial plates. In the present investigation, visual inspection of wear damage based on the Hood's scoring method, Raman micro-spectroscopy and Fourier-transformed infrared spectroscopy were utilized to unveil the damage, the microstructural modifications and the oxidation occurred during implantation. The findings of this investigation have been discussed and compared to previous clinical studies on γ-air sterilized, γ-inert sterilized tibial bearings., (Copyright © 2017 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.)

Unlabelled: As a matter of fact, the in vivo oxidative degradation of highly cross-linked polyethylene (HXLPE) still remains one of the limiting factors that affect the long term survivorship of joint replacements. Recent studies clearly pointed out that also the new generation of highly cross-linked and remelted polyethylene components in total hip and knee replacement underwent unexpected oxidation after 5-10years of implantation. The standard methodology to investigate the oxidation of polyethylene (PE) relies on the use of infrared spectroscopy, which, if from one hand is a reliable technique for the detection of oxidized species containing carbonyl group, on the other hand it is not capable of discriminating the fraction of carboxyl acids that is responsible for chain scission and subsequent deterioration of the mechanical properties of the polymer. In the present study we validate a new protocol based on Raman spectroscopy, which is suitable on assessing the structural degradation of polyethylene induced by oxidation. Following in vitro accelerated aging experiments, the oxidation index (OI) of different commercially available HXLPEs, as calculated by infrared spectroscopy according to ASTM standard, has been univocally correlated to the most severe variation of crystalline phase (αc), as calculated by Raman spectroscopy. In each material, locations with equal values of OI showed different degree of recrystallization induced by chain scission, confirming that infrared spectroscopy might overestimate the effective mechanical degradation of the polymer. In addition, as compared to the standards based on infrared spectroscopy, this new method of assessing oxidation enables to investigate the degradation occurring on the original surface of HXLPE components, due to the nondestructive nature of Raman spectroscopy and its high spatial resolution., Statement of Significance: In the present study we validate a new protocol based on Raman spectroscopy, which is suitable on assessing the structural degradation of polyethylene induced by oxidation. In fact, the standard methodology to investigate the oxidation in polyethylene relies on the use of infrared spectroscopy, which is capable of detecting the presence of oxidized species containing carbonyl group, the main products of oxidation in polyolefins. If from one hand this technique enables quantitative analysis of oxidation, on the other hand it is not capable of discriminating the fraction of species with carbonyl groups responsible for the chain scission. In fact, esters, ketones and carboxyl acids are products of oxidation with carbonyl groups commonly formed on polyethylene at the end of the oxidative cascade initiated by the presence of free radicals, but only the latter are responsible for the chain scission and the subsequent deterioration of the mechanical properties. The oxidation index as obtained according to the ASTM standards is not univocally correlated to a certain degree of mechanical deterioration, but, in simple words, two retrievals with the same amount of carbonyl groups might have had different degradation of the mechanical properties. Recrystallization is a direct consequence of the reduction of molecular weight that occurs after chain scission. Raman spectroscopy (RS) is a viable non-destructive method to assess the fraction of crystalline phase in polyethylene and, due to its high spatial resolution, is perfectly suitable to analyze the microstructural modification at the mesoscopic scale, where the effects of oxidation manifest themselves. The aim of the present paper is twofold: i) to compare the microstructural modifications caused by in vitro oxidation on 5 different types of polyethylene currently available on the market of joint replacements; ii) to establish a protocol based on the comparative analysis of IR and RS results to obtain a phenomenological correlation capable to judge the mechanical deterioration of the material induced by the oxidative degradation., (Copyright © 2016 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.)

Traumatic dislocation of peroneal tendons in the ankle is an uncommon lesion that mainly affects young adults. Unfortunately, most cases lead to recurrent dislocation of the peroneal tendons of the ankle (RPTD). Therefore, most cases need operative treatment. One of the most common operative procedures is superior peroneal retinaculum (SPR) repair. Recently, surgery for RPTD has been achieved with less invasive arthroscopic procedures. In this article, tendoscopic surgery for RPTD using a double-row suture bridge technique is introduced. This technique consists of debridement of the lateral aspect of the fibula under an intrasheath pseudo-cavity, suture anchor insertion into the fibular ridge, and reattachment of the SPR to the fibula using a knotless anchor screwed into the lateral aspect of the fibula. This technique mimics the double-row suture bridge technique for rotator cuff tear repair. The double-row suture bridge technique requires more surgical steps than the single-row technique, but it provides a wider bone-SPR contact surface and tighter fixation than the single-row technique. This procedure is an attractive option because it is less invasive and has achieved results similar to open procedures.

In this study Raman (RS) and Fourier Transform Infrared (FT-IR) spectroscopic techniques were exploited to study 11 retrieved liners made of remelted highly cross-linked polyethylene (HXLPE), with the intent to elucidate their in-vivo mechanical and chemical degradation. The retrievals had different follow-ups, ranging from a few months to 7 years of implantation time and belong to the first generation of highly cross-linked and remelted polyethylene clinically introduced in 1999, but still currently implanted. Raman assessments enabled to discriminate contributes of wear and creep on the total reduction of thickness in different locations of the cup. According to our results, although the most of the viscoelastic deformation occurred during the first year (bedding-in period), it progressed during the steady wear state up to 7 years with much lower but not negligible rate. Overall, the wear rate of this remelted HXLPE liner was low. Preliminary analysis on microtomed sections of the liners after in-vivo and in-vitro accelerated aging (ASTM F2003-02) enabled to obtain a phenomenological correlation between the oxidation index (OI) and the amount of orthorhombic phase fraction (αc), which can be easily non-destructively measured by RS. Profiles of αc obtained from different locations of the cups were used to judge the oxidative degradation of the 11 retrievals, considering also the ex-vivo time elapsed from the revision surgery to the spectroscopic experiments. Low but measurable level of oxidation was detected in all the short-term retrievals, while in the middle-term samples peaks of OI were observed in the subsurface (up to OI=4.5), presumably induced by the combined effect of mechanical stress, lipid absorption and prolonged ex-vivo shelf-aging in air., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

The mechanisms leading to systematic failure in modular acetabular components with a sandwich insertion (alumina/polyethylene/titanium) have been reconsidered in light of the newly collected Raman spectroscopic results. Raman assessments were conducted on the polyethylene shells, which belonged to a series of six failed sandwich implants with in vivo lifetimes ranging between 2 and 9yr. With only one exception, all implants commonly showed dislodgment of the polyethylene shell during radiographic analyses prior to revision surgery. The polyethylene shell slipped out of the backing titanium shell, while always remaining integer to the ceramic liner. Four implants fractured at the ceramic liners, but their fractures occurred according to distinctly different patterns, which could be rationalized and classified. The insertion of the polyethylene layer, originally conceived to reduce the rigidity of the ceramic-on-ceramic bearing and to prevent impingement between the ceramic liner rim and the femoral neck, played a role in implant failure with its initial (asymmetric) thickness reduction due to creep deformation (eventually followed by cup rotation and backside wear). The results of the present spectroscopic investigation suggest that a simplistic failure classification of the sandwich-type implant as a "ceramic fracture failure" could be misleading and might represent a confounding factor in judging about the reliability of modern ceramic implants., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: To investigate the prevalence and severity of radiographically detected hallux valgus (HV) as well as associated risk factors among Japanese residents of Miyagawa, a mountain village located in the center of Mie Prefecture., Methods: The height, weight and body mass index (BMI) of 403 participants (male n = 135, female n = 268) recruited from among the residents of Miyagawa Village, Japan aged ≥65 years were measured, and baseline data, including age, sex and medical history were obtained from interviews and questionnaires. Knee osteoarthritis (KOA) was determined from radiographs of the feet and knees, and osteoporosis was determined by measuring bone mineral density. Hallux valgus, defined as angulation of the big toe at the first metatarsophalangeal joint of >20°, was classified as: mild (20°-30°), moderate (30°-40°) or severe (>40°). Risk factors for HV were calculated using multivariate logistic regression analysis that included age, sex, obesity (BMI ≥25), KOA, osteoporosis, Heberden's nodes and low back pain as variables., Results: The overall prevalence of definite radiographic HV was 22.8 % (184/806), and mild, moderate and severe HV was found in 66.3, 27.2 and 6.5 % of the participants, respectively. Hallux valgus was found in at least one foot in 120 (29.8 %) of the participants and the prevalence significantly differed between females with and without HV and KOA (odds ratios: 2.54 and 1.71, respectively)., Conclusions: The prevalence of definite radiographic HV was 29.8 %. Female sex and KOA were significantly associated with increased risk for radiographic HV.

Introduction: Anaemia is present in more than 30 % of patients with various cancers at the time of initial presentation. Anaemia or a lower level of haemoglobin (Hb) is an indicator of poorer prognosis in many cancers. Several studies have also demonstrated that high levels of proinflammatory cytokines contribute to the development of anaemia. However, no studies have assessed the correlation between anaemia and survival in patients with soft tissue sarcoma. The aim of this study was to elucidate the relationship between anaemia and clinical outcome and to determine whether pretreatment anaemia predicted disease-specific survival in patients with adult soft tissue sarcoma., Methods: A total of 376 patients between 2003 and 2010 were retrospectively reviewed. Patients who presented with metastases or/and local recurrence at diagnosis were excluded from this study., Results: Hb levels varied from 8.0 to 17.3 g/dl in all patients. Pretreatment anaemia was seen in 114 patients. Hb levels were significantly correlated to C-reactive protein levels (Spearman ρ = -0.54, p < 0.0001). The tumour histological grade, age and tumour size were also significantly correlated to Hb levels. Patients with anaemia had a worse disease-specific survival (52.6 % at 5 years) than those without anaemia (79.7 % at 5 years) (p < 0.0001). Patients with anaemia also had a worse event-free rate (44 % at 5 years) than those without anaemia (66.3 % at 5 years) (p < 0.0001). Multivariate analysis showed that anaemia remained an independent predictor of survival (p = 0.002) and events (p = 0.0003)., Conclusion: Pretreatment anaemia may be indicative of an aggressive characteristic in patients with soft tissue sarcoma. We recommend the routine measurement of Hb level to identify patients who are at greater risk of death or an event.

Background: The relationships among the hemostatic markers, the development of deep vein thrombosis (DVT) and the withdrawal of fondaparinux due to a reduction in the hemoglobin levels were examined., Methods: Two-hundred twenty-one Japanese patients who underwent major orthopedic surgery and were treated with 1.5mg of fondaparinux instead of 2.5mg of fondaparinux were studied. Forty-seven of 221 patients discontinued fondaparinux treatment (withdrawal group) and 37 patients developed DVT., Results: The age, frequency of total knee arthroplasty (TKA), withdrawal of fondaparinux, reduction of hemoglobin and the plasma levels of soluble fibrin (SF), D-dimer and fibrinogen and fibrin degradation product (FDP) on day 1 after the operation were significantly higher in the patients with DVT. Elevated SF, D-dimer or FDP levels were associated with the risk for DVT. The age, frequency of TKA or DVT, anti-Xa activity and the creatinine, FDP and D-dimer levels were significantly higher in the withdrawal group. An anti-Xa level >0.33 mg/l and an elevated D-dimer or FDP level were associated with the risk of withdrawal., Conclusion: The age and SF levels, TKA and withdrawal of fondaparinux were related to the risk of DVT, and the anti-Xa activity, creatinine level and DVT were related to the risk of withdrawal of fondaparinux due to a reduction in hemoglobin., (© 2013.)

Background: The purpose of this study was to investigate the prevalence and characteristics of unilateral knee osteoarthritis (KOA), to investigate what percent of contralateral healthy knees in patients with unilateral KOA progress to KOA, and to investigate whether knee fractures influence unilateral KOA., Methods: Studies were performed every two years from 1997 to 2009 in Miyagawa village, for a total of seven studies. A total of 1239 village inhabitants aged ≥65 years participated in these studies at least once. KOA was defined as a Kellgren-Lawrence (K/L) grade ≥2. Based on the knee X-ray at the first examination, participants were divided into three groups: no KOA (N group), unilateral KOA (U group), and bilateral KOA (B group). The U group was divided into two subgroups: K/L grade II-I combination (II-I group), and the U group without the II-I combination (G>2 group). To investigate whether knee fractures influence unilateral KOA, the fracture history was considered., Results: The percentages of participants classified into the N, B, and U groups (II-I and G>2 group) were 68.4, 21.6, and 10.0% (7.8 and 2.1%), respectively. Most of the U group had the II-I combination (78.7%). The percentages of knee fractures in the N, B, II-I, and G>2 groups were 3.3, 5.3, 6.3, and 38.5%, respectively. Overall, 49.2% of the U group proceeded to bilateral KOA over an average of 5.3 years., Conclusions: The prevalences of definite radiographic bilateral and unilateral KOA were 21.6 and 10.0%, respectively. Overall, 49.2% of the participants with unilateral KOA developed KOA in the contralateral knee over an average of 5.3 years. If bilateral KOA advanced simultaneously, the II-I group was considered to represent the midpoint of progression to bilateral KOA. Bilateral KOA advanced simultaneously except in cases with a history of knee trauma, such as fractures.

In the evolution of cancer, tumor necrosis factor-alpha (TNF-α) plays a paradoxical role. High doses induce significant anticancer effects, but conversely, physiologic and pathologic levels of TNF-α may be involved in cancer promotion, tumor growth, and metastasis. Infliximab is a chimeric murine monoclonal antibody that binds with high affinity to soluble and membrane TNF-α and inhibits binding of TNF-α to its receptors. In the present study, we investigated the effect of infliximab, a TNF-α antagonist, on breast cancer aggressiveness and bone metastases. Infliximab greatly reduced cell motility and bone metastases in a metastatic breast cancer cell line, MDA-MB-231. The mechanism of bone metastasis inhibition involved decreased expression of CXC chemokine receptor 4 (CXCR4) and increased expression of decorin, which is the prototype of an expanding family of small leucine-rich proteoglycans. These results suggest a novel role for TNF-α inhibition in the reduction or prevention of bone metastases in this breast cancer model. Our study suggests that inhibition of TNF-α using infliximab may become a preventive therapeutic option for breast cancer., (Copyright © 2011 Elsevier Inc. All rights reserved.)

The aggregation of chondroprogenitor mesenchymal cells into precartilage condensation represents one of the earliest events in chondrogenesis. N-cadherin is a key cell adhesion molecule implicated in chondrogenic differentiation. Recently, ADAM10-mediated cleavage of N-cadherin has been reported to play an important role in cell adhesion, migration, development and signaling. However, the significance of N-cadherin cleavage in chondrocyte differentiation has not been determined. In the present study, we found that the protein turnover of N-cadherin is accelerated during the early phase of chondrogenic differentiation in ATDC5 cells. Therefore, we generated the subclones of ATDC5 cells overexpressing wild-type N-cadherin, and two types of subclones overexpressing a cleavage-defective N-cadherin mutant, and examined the response of these cells to insulin stimulation. The ATDC5 cells overexpressing cleavage-defective mutants severely prevented the formation of cartilage aggregates, proteoglycan production and the induction of chondrocyte marker gene expression, such as type II collagen, aggrecan and type X collagen. These results suggested that the cleavage of N-cadherin is essential for chondrocyte differentiation., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Background: Tenascin-C (TN-C) is expressed in the cartilage of osteoarthritis (OA). We examined whether TN-C was involved in cartilage repair of the diseased joints. Human articular cartilage samples were obtained from patients with OA and those with normal joints., Methods: Immunohistochemistry testing of TN-C, chondroitin sulfate (CS), and proliferating cell nuclear antigen (PCNA) was performed. Chondrocytes were isolated from human cartilage and cultured. After treatment with TN-C, chondrocyte proliferation s was analyzed by bromodeoxyuridine (BrdU) incorporation assay using an enzyme-linked immunosorbent assay kit. Glycosaminoglycan content was determined by dimethylmethylene blue (DMMB) assay. The mRNA expression of aggrecan was also analyzed, by quantitative real-time polymerase chain reaction (PCR)., Results: In osteoarthritic cartilage, increased TN-C staining was observed with the degeneration of articular cartilage in comparison with normal cartilage. TN-C staining was shown in the cartilage surface overlying CS-positive areas. In addition, the expression of PCNA in the positive areas for TN-C was significantly higher than that in the negative areas. Treatment of human articular chondrocytes with 10 μg/ml TN-C accelerated chondrocyte proliferation, increased the proteoglycan amount in culture, and increased the expression of aggrecan mRNA., Conclusions: Our findings indicate that the distribution of TN-C is related to CS production and chondrocyte proliferation in osteoarthritic cartilage and that TN-C has effects on DNA synthesis, proteoglycan content, and aggrecan mRNA expression in vitro. TN-C may be responsible for repair in human osteoarthritic cartilage.

Background: Distal radius fractures in osteoporotic senile female patients often used to be complicated with residual deformity, stiffness, and pain. Recently, however, adequate usage of a palmar locking plate or external fixation has led to fewer subsequent complications. The method proposed here deserves consideration because it is less invasive and more cost-effective., Methods: A total of 11 Colles' type fractures (AO type A2) in 11 patients (all female; mean age 78 years) were treated. After a closed reduction, the fractures were fixed by percutaneous pinning, as Kapandji previously described. Through a 5-mm longitudinal skin incision on the dorsoulnar aspect of the fracture site, the barrel of a disposable 1-ml syringe was inserted into the fracture site as a port. Next, a pediatric uromatic balloon was introduced into the fracture site and inflated by contrast medium. The balloon inflation enlarged the void of the fracture site. A compression bandage around the fracture site was applied before calcium phosphate cement injection with a cement gun through the port under an image intensifier. The functional and radiological results were evaluated. The mean follow-up period was 16 months (range 12-25 months)., Results: All results were graded as good or excellent within 3 months, and all were graded as excellent at the final follow-up. The average duration of immobilization was 4 weeks with a short forearm cast. The overall postoperative correction loss in ulnar variance was 1.7 mm. Radial inclination and volar tilt showed no postoperative correction loss. The final volar tilt, radial inclination, and ulnar variance were comparable to those of the nonaffected side., Conclusions: Calcium phosphate cement-assisted balloon osteoplasty is a less invasive procedure and can be clinically justified as a therapeutic option for a Colles' fracture in osteoporotic senile female patients.

Fibulin-3 is a member of the fibulin family that has been newly recognized as extracellular matrix proteins. We assessed the effects of fibulin-3 overexpression on chondrocyte differentiation using the clonal murine cell line ATDC5. The ATDC5-FBLN3 stably expressing fibulin-3 protein was spindle-shaped cell compared to the ATDC5-mock with plump cell. The cell growth in the ATDC5-FBLN3 was accelerated in comparison to that in the ATDC5-mock. The ATDC5-FBLN3 was not stained by Alcian blue, nor was there any cartilage aggregate formed after the induction of chondrogenic differentiation. The expression of type II collagen, aggrecan, and type X collagen was completely suppressed in ATDC5-FBLN3 even after the induction of differentiation. The overexpression of fibulin-3 reduced the expression of Sox5 and Sox6, while it maintained the expression of Sox9. These findings suggest that fibulin-3 may play an important role as a negative regulator of chondrocyte differentiation., (Copyright 2009 Elsevier Inc. All rights reserved.)

Osteogenesis imperfecta (OI) is a rare congenital disorder of type capital I, Ukrainian collagen production that results in brittle bones and affects body systems containing collagen. The increasing life span of patients with OI has recently revealed a high incidence of osteoarthritis of the knee. A 53 year-old man with OI presented with bilateral knee pain. He had severe deformities of the proximal part of the femur with subsegment post-traumatic osteoarthritis of both sides of the knees. However, the frequency of fracture gradually decreased and he had not experienced a fracture for 17 years. His bone mineral density was extremely low for his age. He underwent cemented total knee arthroplasty (TKA) on the left knee. One year later, the patient had relief of pain and he could walk without assistance. To our knowledge, only three knee replacements in two patients with OI have been reported, so this case is extremely rare. Although whether a patient with OI is a suitable candidate for knee replacement, it was a useful treatment for osteoarthritis in this case.

Background: The aims of the present study were to examine the prevalence and risk factors for knee osteoarthritis in elderly Japanese men and women., Methods: We examined 598 of the 1513 inhabitants of Miyagawa village aged > or = 65 years (393 women, 205 men). Baseline data, obtained with standard questionnaires, included information on age, past history, sports activity, working, knee pain, smoking, and intakes of alcohol and milk. Bone mineral density of the forearm was measured using dual energy X-ray absorptiometry. Anteroposterior radiographs of both knees were graded for osteoarthritis using the Kellgren-Lawrence grading system. Definite osteoarthritis was defined as a grade of 2 or higher. We used logistic regression analysis by the stepwise method to determine the risk factors for radiographic knee osteoarthritis., Results: The prevalence of definite radiographic knee osteoarthritis was 30.0% overall: 17.7% in men and 36.5% in women. The prevalence of symptomatic knee osteoarthritis was 21.2% overall: 10.7% in men and 26.7% in women. There were significant differences in the risk of radiographic knee osteoarthritis with body mass index (BMI), sex, age, and bone mineral density (BMD)., Conclusions: The prevalence of definite radiographic knee osteoarthritis was 30.0% and that of symptomatic knee osteoarthritis was 21.2%. We found that higher BMI, female sex, older age, and higher BMD were significantly associated with an increased risk for radiographic knee osteoarthritis.

Background: Satisfactory results have been reported from long-term studies on bipolar hemiarthroplasty for femoral neck fracture. However, long-term results of this procedure for osteoarthritis of the hip (OA) and idiopathic necrosis of the femoral head (ION) have given rise to pessimism. These poor results have often reported migration of the bipolar head, but few had described the direction of this migration. The purpose of the present study was to conduct a long-term follow-up analysis of bipolar hemiarthroplasty for OA and ION, including the direction of migration., Methods: We retrospectively reviewed a consecutive series of 64 patients (76 hips) who underwent primary bipolar hemiarthroplasty for symptomatic OA and ION with a cementless femoral component between 1976 and 1995. Of these 64 patients, 35 patients (40 hips) were available for clinical and radiographic review at a minimum follow-up duration of 10 years., Results: The Japanese Orthopaedic Association score significantly improved and pain relief was high following surgery; however, preservation of acetabular bone stock could not be achieved because of migration. The survival rate declined 10 years after surgery. Superomedial migration was found to be a risk factor for revision, and one factor affecting superomedial migration was the postoperative center edge angle., Conclusions: The long-term results of bipolar hemiarthroplasty for OA and ION are not favorable. If a sufficient centripetal position is obtained with reaming, the bipolar head tends to migrate superomedially, subsequently requiring revision.

We report a case of a Colles' fracture on the arteriovenous fistula forearm of a maintenance hemodialysis patient treated with percutaneous pinning with the aid of Chinese finger trap reduction combined with cavity creation using a pediatric uromatic balloon with calcium phosphate cement augmentation. Five months after surgery, the arteriovenous fistula was patent, and the range of motion, grip strength, and radiographic findings were comparable with a non-arteriovenous fistula forearm. Wrist x-rays showed a complete union of the distal radius with progressive absorption of the calcium phosphate cement.

The two osteoclastogenesis pathways, receptor activator nuclear factor (NF)-kappaB ligand (RANKL)-mediated and fusion regulatory protein-1 (FRP-1)-mediated osteoclastogenesis, have recently been reported. There were significant differences in differentiation and activation mechanisms between the two pathways. When monocytes were cultured with FRP-1 without adding M-CSF, essential for the RANKL system, TRAP-positive polykaryocyte formation occurred. FRP-1-mediated osteoclasts formed larger pits on mineralized calcium phosphate plates than RANKL+M-CSF-mediated osteoclasts did. Lacunae on dentin surfaces induced by FRP-1-mediated osteoclasts were inclined to be single and isolated. However, osteoclasts induced by RANKL+M-CSF made many connected pits on dentin surfaces as if they crawled on there. Interestingly, FRP-1 osteoclastogenesis was enhanced by M-CSF/IL-1alpha, while chemotactic behavior to the dentin slices was not effected. There were differences in pH and concentration of HCO3- at culture endpoint and in adherent feature to dentin surfaces. Our findings indicate there are two types of osteoclasts with distinct properties.

Spin-out of mobile-bearing knees is a significant early complication of mobile-bearing total knee arthroplasty. Dislocation of the cam-post mechanism of fixed-bearing posterior-stabilized knees occurs more rarely. We have observed an unusual case of dislocation of posterior-stabilized rotating-platform total knee arthroplasty, which has both a cam-post mechanism and rotating platform. A 65-year-old man with knee osteoarthritis and cervical spondylotic myelopathy underwent total knee arthroplasty using a mobile-bearing prosthesis. The dislocation, which occurred 4 days postoperatively, could not be reduced by closed manipulation. However, spontaneous reduction occurred 6 days after the dislocation, which did not recur. A gap mismatch or trapezoidal-shaped gaps may lead to dislocation or spin-out of the bearing insert. This case illustrates that dislocation of a posterior-stabilized mobile-bearing total knee arthroplasty can occur, and both quadriceps deficiency and ligament laxity may contribute to the risk of dislocation.

Background: In the past, patients admitted for hip fractures had often sustained a contralateral hip fracture. The incidence of bilateral hip fractures has been reported to be 5%-10%, and in the future the number of bilateral hip fractures is expected to increase with the increase of unilateral hip fractures. We believe that bilateral hip fractures can be efficiently prevented if a fracture on the other side could be predicted after unilateral hip fracture. Therefore, this retrospective study of 835 patients with hip fractures investigated the incidence, prognosis, and risk factors of bilateral hip fractures., Methods: We examined 835 hip fractures retrospectively in Japan. Among them, we found 94 patients with bilateral noncontemporary hip fractures. We investigated age, sex, interval between the two fractures, type of fractures, cause, physical functioning, and complications. Differences between the unilateral fracture and bilateral fractures groups were analyzed statistically for age, sex, and complications using Student's t test and the chi-square test., Results: In this study, the mean interval between two fractures was 4.28 years, and the second hip fracture occurred within 5 years in more than 70% of patients. The type of hip fracture was the same in 72.2% of bilateral hip fractures. No difference in age and sex was found between the unilateral and the bilateral groups. However, concerning complications, 22.1% of patients in the unilateral group and 34.8% in the bilateral group had dementia, the difference being significant., Conclusions: These results revealed that the second hip fracture occurred within 5 years of the first in more than 70% of bilateral hip fracture patients and that dementia is a risk factor of bilateral hip fractures.

Our study focuses on the antineoplasmic action of hyperthermia. In this study, use of a heat-generating cement was exploited for the management of pathological and impending fractures in malignancies. The cement contains magnetic powder in ceramic particles and generates well-regulated heat when a magnetic field is applied externally. Eighteen rabbits were inoculated with blocks of VX2 tumor into one of their tibia. One week after the procedure, 9 rabbits were exposed to a magnetic field (HT group) while the remaining 9 rabbits were not (non-HT group). In rabbits killed between 20 and 42 days after the VX2 inoculation, the circumference of the operated leg was 7.9 +/- 0.3 cm and 10.2 +/- 1.0 cm (mean +/- SE) in HT and non-HT groups, respectively ( P < 0.05). Histological findings revealed the regressive change in tumor tissue of the HT group. By radiographs, pathological fractures and cortical bone destruction were seen in 5 and 8 rabbits in the non-HT group, respectively, but in the HT group these effects were absent in all the rabbits except 1 in which a definite diagnosis has not been made. Our findings demonstrate that controlled hyperthermia therapy using a newly developed bone cement suppresses tumor growth and prevents local bone destruction caused by VX2 tumors.