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8-Prenylnaringenin (8-PN), a hop flavonoid, is a promising food substance with health benefits. Compared with nonprenylated naringenin, 8-PN exhibits stronger estrogenic activity and prevents muscle atrophy. Moreover, 8-PN prevents hot flushes and bone loss. Considering that prenylation reportedly improves the bioavailability of flavonoids, we compared the parameters related to the bioavailability [pharmacokinetics and tissue distribution in C57/BL6 mice, binding affinity to human serum albumin (HSA), and cellular uptake in HEK293 cells] of 8-PN and its mother (non-prenylated) compound naringenin. C57/BL6 mice were fed an 8-PN or naringenin mixed diet for 22 days. The amount of 8-PN (nmol/g tissue) in the kidneys (16.8 ± 9.20), liver (14.8 ± 2.58), muscles (3.33 ± 0.60), lungs (2.07 ± 0.68), pancreas (1.80 ± 0.38), heart (1.71 ± 0.27), spleen (1.36 ± 0.29), and brain (0.31 ± 0.09) was higher than that of naringenin. A pharmacokinetic study in mice demonstrated that the Cmax of 8-PN (50 mg/kg body weight) was lower than that of naringenin; however, the plasma concentration of 8-PN 8 h after ingestion was higher than that of naringenin. The binding affinity of 8-PN to HSA and cellular uptake in HEK293 cells were higher than those of naringenin. 8-PN bioavailability features assessed in mouse or human model experiments were obviously different from those of naringenin.

Background There are many therapeutic options for dislocation following total hip arthroplasty (THA). The aim of this study was to evaluate the results of revision surgery for dislocated hips. Methods Between November 2001 and December 2020, 71 consecutive revision hip surgeries were performed at our institution for recurrent dislocation following THA. We conducted a retrospective study of all 65 patients (71 hips), who were followed for a mean of 4.7 years (range, 1–14). The cohort included 48 women and 17 men, with a mean age of 71 years (range, 34–92). The mean number of previous surgeries was 1.6 (range, 1–5). Revision hip surgeries for recurrent dislocation following THA were classified as follows: open reduction and internal fixation, 2 hips; only head change or only liner change, 6 hips; only cup change with head size up, 14 hips; only stem change, 7 hips; cup and stem change, 24 hips; and conversion to constrained cup, 18 hips. Prosthesis survival was analyzed using the Kaplan-Meier method, with repeat revision surgery for re-dislocation or implant failure considered the endpoint. Cox proportional hazards model was performed for risk factors of re-revision surgery. Results Re-dislocation occurred in 5 hips (7.0%) and implant failure occurred in 1 hip (1.4%). The 10-year survival rate was 81.1% (95% confidence interval, 65.5–96.8). A risk factor for re-revision surgery due to re-dislocation was “positional” according to Dorr’s classification. Conclusion It is important to assess the cause of the dislocation to determine the most appropriate procedure.

We retrospectively evaluated the cases of 169 hip fracture patients, their previous fractures, and the contralateral hip joint's morphology. A history of contralateral hip fracture was present in 23 patients (Contra group). The other patients had a unilateral hip fracture: a trochanteric fracture (Troch group, n=73) or a femoral neck fracture (Neck group, n=73). In the Troch and Neck groups, we used anteroposterior and cross-table axialview radiographs of the contralateral hip to evaluate the proximal femur's anatomy. In the Contra group, the concordance rate between the first and second types of hip fracture was 65.2%, and the second hip fracture's morphology indicated that the trochanteric fracture had a cam deformity in terms of the femoral head-neck ratio. The average alpha angle and femoral head-neck offset in the Troch group were significantly larger than those in the Neck group. In the Neck group, pistol-grip deformities of Arbeitsgemeinschaft für Osteosynthesefragen types B1 (subcapital), B2 (transcervical), and B3 (displaced) were observed in 42.1%, 75%, and 6% of cases, respectively. There was a smaller alpha angle and a larger femoral head-neck offset in the contralateral hip of femoral neck fractures; thus, the "cam deformity" may protect against femoral neck fractures.

Background: Fixation of greater trochanteric fractures or osteotomy in total hip arthroplasty pose technical challenges. This study aimed to evaluate the results of trochanteric claw plate fixation.Methods: This study retrospectively evaluated 41 consecutive open reductions and internal fixations following primary or revised total hip arthroplasty, which required trochanteric claw plate fixation for greater trochanteric fracture or osteotomy between January 2008 and December 2020. The mean duration of clinical follow-up was 4.2 years (range, 1–13 years). The patients included 13 men and 28 women, with a mean age of 68 years (range, 32–87 years). The indications for intervention included trochanteric osteotomy, intraoperative fracture, and non-union including postoperative fracture in 6, 9, and 26 cases, respectively.Results: The mean Merle d'Aubigné clinical score improved from 9.4 points (range, 5−15 points) pre-operatively, to 14.3 points (range, 9−18 points) at the last follow-up. Bone union occurred in 35 cases (85%), while implant breakage occurred in 4 cases. At the last follow-up, the mean Merle d’Aubigné Clinical Score of bone union and non-union were 15.3 and 14.1 points, respectively (p = 0.48). The Kaplan-Meier survival rate, with the endpoint being revision surgery for pain, non-union, dislocation, or implant breakage, at 10 years was 80.0% (95% confidence interval: 62.6−97.4%).Conclusions: Greater trochanteric fixation using a trochanteric claw plate yielded successful results.

Background We assessed whether combining the conventional culture and implant sonicate fluid culture (SFC) methods increased the diagnostic accuracy of orthopedic implant-associated infection (OIAI). Methods Consecutive patients (n = 66) undergoing implant removal (OIAI, 17; non-OIAI, 49) were evaluated prospectively. We analyzed 493 samples (39 preoperative joint aspirates, 243 peri-implant tissue specimens, 124 implant sonication, 67 controls, and 20 water bath samples). OIAI was preoperatively evaluated based on clinical evidence of infection or aspirate culture (AC). Conventional methods required positive results in either preoperative ACs or intraoperative tissue cultures (TCs), whereas the combination method required at least 1 positive culture among 3 sources (AC, TC, or SFC). The application of SFC and the detection rate, sensitivity, and specificity of the diagnostic methods were assessed. Results No controls or water bath samples harbored bacteria. Three patients (18%) were detected by SFC only and Peptostreptococcus and Corynebacterium species were isolated by SFC only. The OIAI detection rate attributable to SFC was significantly higher than that of TC (61% vs 36%; P = .02). The sensitivities of AC, TC, and SFC at a cutoff point of 1 colony-forming unit/plate and 1 positive culture were 60%, 59%, and 71%, respectively. At a cutoff point of 2 positive cultures, the combination (vs conventional) method showed significantly greater sensitivity (71% vs 47%; P = .008). Conclusion By incorporating SFCs into conventional culture methods, the diagnostic accuracy in the context of OIAI was significantly improved.

Introduction Management of periprosthetic hip infections (PHIs) generally consists of implant removal and thorough debridement, accompanied by appropriate antibiotic therapy. Daptomycin (DAP) is a novel antibiotic, which allowed for implant retention in several patients after treating their infected joints. However, there is no consensus about implant retention or removal during the treatment of PHIs. The aim of this study was to examine the effect of DAP and to determine a surgical treatment strategy. Methods This study retrospectively evaluated 20 patients between August 2014 and December 2018, divided into implant retention (n=9) and implant removal groups (n=11). Infection control and risk of recurrent infection were evaluated. Infection control was defined as not requiring implant removal after the final treatment. Results Infection control rates in implant retention and implant removal groups were 67% and 90%, respectively. All late chronic infections resulted in failure cases within the implant retention group. In the implant retention group, mean preoperative risk scores for successful cases were significantly higher than those for failure cases (p

Although antibiotic-loaded acrylic cement (ALAC) is used to prevent and treat periprosthetic hip infection, it is unknown how much antibiotic is deposited in the body in vivo, how high the serum concentration rises, or how long its effects last. The aim of this study was firstly to determine the amount of vancomycin (VCM) deposited as ALAC in the body, and secondly to assess the safety and drug elution profile of VCM in ALAC.We administered VCM to prevent infection after total hip arthroplasty (THA) or to treat patients with methicillin-resistant Staphylococcus aureus. Patients were classified into two groups: a low-dose group (21 hips) that received primary THA for high-risk cases, revision THA without infection, or one-staged revision THA for infection; and a high-dose group (6 hips) that received cement beads during a two-staged revision THA. The amount of VCM placed as ALAC into the hip was calculated using the remaining ALAC. The serum concentrations of VCM and creatinine were evaluated at postoperative days 1, 4, 7, 14, and 28, and at 3 and 6 months.The mean amount of VCM placed as ALAC into the hip was 0.9 g and 3.4 g for cemented THA and cement beads, respectively (P 0.0001). The mean serum concentration of VCM from ALAC in the high-dose group was significantly increased compared with that in the low-dose group on postoperative days 1, 4, 7, 14, and 28 (P 0.0001), but it remained within a clinically safe range. No significant differences were observed between the preoperative and postoperative serum creatinine levels of either group.The average serum concentrations of VCM from ALAC were always less than the effective blood concentration, and were detectable until 6 months after surgery.

Background The purpose of this study was to identify the long-term durability of the Kerboull-type reinforcement device (KT plate) in acetabular reconstruction for massive bone defects, assessing the remodeling of structural bone grafts. Methods This study retrospectively evaluated 106 hips that underwent acetabular reconstruction using a KT plate between November 2000 and December 2010. Thirty-eight primary total hip arthoplasties (THAs) and 68 revised THAs were performed, and the mean duration of clinical follow-up was 8 years (5-14 years). Regarding reconstructing the acetabular bone defects, autografts were used in 37 hips, allografts in 68 hips, and A-W glass ceramics in 2 hips. Results One hip exhibited radiological migration and no revision for aseptic loosening. The mean Merle d'Aubigne Clinical Score improved from 7.5 points (4-12 points) preoperatively to 10.9 points (9-18 points) at the last follow-up. The Kaplan–Meier survival rate for radiological migration of primary and revised THAs at 10 years was 100% and 97% (95% confidence interval: 96%-100%), respectively. Bone remodeling was evaluated using the radiological demarcation at the bone-to-bone interface, and an improvement of 100% in primary THAs and 94% in revised THAs was observed. Conclusion For massive bone defects, acetabular reconstruction using the KT plate with a structural bone grafting can yield successful results.

Background: Management of periprosthetic hip infections (PHIs) generally consists of implant removal and thorough debridement, accompanied by appropriate antibiotic therapy. Daptomycin (DAP) is a novel antibiotic, which allowed for implant retention in several patients after treating their infected joints. However, there is no consensus about implant retention or removal during treatment of PHIs. The aim of this study was to examine the effect of DAP, and to determine a surgical treatment strategy. Methods: This study retrospectively evaluated 20 patients between August 2014 and December 2018, divided into implant retention (n = 9) and implant removal groups (n = 11). Infection control and risk of recurrent infection were evaluated. Infection control was defined as not requiring implant removal after the final treatment. Results: Infection control rates in implant retention and implant removal groups were 67% and 90%, respectively. All late chronic infections resulted in failure cases within the implant retention group. In the implant retention group, mean preoperative risk scores for successful cases were significantly higher than those for failure cases (P < 0.05). Conclusions: Patients with low-risk did not require implant removal, suggesting that DAP may be a breakthrough alternative to traditional PHI management.

Study Design: Biomechanical study.Purpose: To assess the correlation between the computed tomography (CT) values of the pedicle screw path and screw pull-out strength.Overview of Literature: The correlation between pedicle screw pull-out strength and bone mineral density has been well established. In addition, several reports have demonstrated a correlation between bone mineral density and CT values. However, no previous biomechanical studies investigated the correlation between CT values and pedicle screw pull-out strength.Methods: Sixty fresh-frozen lumbar vertebrae from 6-month-old pigs were used. Before screw insertion, the CT values of the screw path were obtained for each sample. Specimens were then randomly divided into three equal groups. Each group had one of three pedicle screws inserted: 4.0-mm LEGACY (4.0-LEG), 4.5-mm LEGACY (4.5-LEG), or 4.5-mm SOLERA (4.5-SOL) (all from Medtronic Sofamor Danek Inc., Memphis, TN, USA). Each screw had a consistent 30-mm thread length. Axial pull-out testing was performed at a rate of 1.0 mm/min. Correlations between the CT values and pedicle screw pull-out strength were evaluated using Pearson’s correlation coefficient analysis.Results: The correlation coefficients between the CT values of the screw path and pedicle screw pull-out strength for the 4.0-LEG, 4.5-LEG, and 4.5-SOL groups were 0.836 (p p p

Although some reports suggest that taper-slip cemented stems may be associated with a higher periprosthetic femoral fractures rate than composite-beam cemented stems, few studies have focused on the biomaterial effect of the polished material on the stem–cement interface. The purpose of this study was to investigate the relationship between surface roughness of materials and bone cement. Four types of metal discs—cobalt-chromium-molybdenum alloy (CoCr), stainless steel alloy 316 (SUS), and two titanium alloys (Ti-6Al-4V and Ti-15Mo-5Zr-3Al)—were prepared. Five discs of each material were produced with varying degrees of surface roughness. In order to evaluate surface wettability, the contact angle was measured using the sessile drop method. A pin was made using two bone cements and the frictional coefficient was assessed with a pin-on-disc test. The contact angle of each metal increased with decreasing surface roughness and the surface wettability of metal decreased with higher degrees of polishing. With a surface roughness of Ra = 0.06 μm and moderate viscosity bone cement, the frictional coefficient was significantly lower in CoCr than in SUS (p = 0.0073). In CoCr, the low adhesion effect with low frictional coefficient may result in excessive taper-slip, especially with the use of moderate viscosity bone cement.

The optimum approach in total hip arthroplasty (THA) should reduce the risk of postoperative dislocation or limping, be applicable in every case, and be reusable in the future. The purpose of this study was to introduce our transgluteal approach for THA and to evaluate the type and frequency of complications around the greater trochanter.This study retrospectively evaluated 892 THA cases between January 2010 and March 2015 performed using our transgluteal approach that osteotomized only the lateral anteroinferior greater trochanter. The trochanteric fragment was reattached using one of three different protocols: Group A, three non-absorbable polyester sutures; Group B, two non-absorbable polyester sutures and one ultra-high molecular weight polyethylene (UHMWPE) fiber cable; or Group C, two UHMWPE fiber cables. Postoperative complications were assessed and recorded, and univariate logistic regression analyses were performed to determine whether risk factors and radiological complications around the greater trochanter were correlated.None of the hips required revision for infection, dislocation, or limping. The rate of radiological complications around the greater trochanter at 1 year was 19.2% in Group A, 16.3% in Group B, and 7.9% in Group C (p 0.001). Risk factors for radiological complications included the patient's disease or the surgeon's experience in Group A and the patient's age or the surgeon's experience in Group C. In the relationship between postoperative pain around the greater trochanter and radiological complications, there were no significant differences in all groups; no group interaction was observed (p= 0.3875).The UHMWPE fiber cable was effective to reduce complications of the reattached osteotomized greater trochanter in THA.

SKG/Jcl (SKG) mice spontaneously develop T cell-mediated autoimmune arthritis and may be an effective model for studying human rheumatoid arthritis. We sought to confirm that arthritis in SKG mice was caused by stem cell disorders. We induced systemic arthritis in normal C57/BL6 (B6) mice (H-2(b) type) by injecting lineage-negative (lin(-)) immature cells isolated from bone marrow cells (BMCs) of SKG mice (H-2(d) type) directly into bone cavities. Twenty weeks later, we analyzed arthritis scores, hematoxylin-eosin (H-E) staining and tartrate-resistant acid phosphatase (TRAP) staining in ankle joints, H-2 type of hematolymphoid and osteoblast-like cells, serum levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) and percentages of CD4(+) T cells and osteoblast-like cells expressing receptor activator of nuclear factor kappa-B ligand (RANKL) in recipient mice. Donor-derived hematolymphoid cells and osteoblast-like cells had completely replaced donor-derived cells in the recipients (H-2(b) to H-2(d)). All recipients showed severe joint swelling with hyperemia and developed hypertrophic synovitis with lymphocytes accumulated around joints. All recipients also had higher TNF-α and IL-6 levels than untreated B6 controls. Furthermore, the percentages of CD4(+) T cells and osteoblast-like cells expressing RANKL and the number of TRAP(+) cells were greater in treated animals. Donor-derived hematolymphoid cells and osteoblast-like cells persisted in these recipients and promoted autoimmune arthritis and an increase in osteoclasts. Because autoimmune arthritis may be associated with abnormal lin(-) immature cells, patients with intractable autoimmune arthritis may be treated by replacing these cells with direct injection of lin(-) immature cells isolated from normal BMCs.

The purpose of this multicenter study was to evaluate the clinical performance of an ultrahigh molecular weight polyethylene (UHMWPE) fiber cable for re-attachment of the osteotomized greater trochanter in hip surgery. Included in the study were 85 hips that had undergone surgery with greater trochanter osteotomy, including 50 hip arthroplasty procedures and 35 hip osteotomies. The osteotomized greater trochanter was reattached using one or more UHMWPE fiber cables. The bone union and displacement of the greater trochanter were assessed in radiographs for up to 12 months after surgery. Non-union of the osteotomy site occurred in 4.7% of the cases. In approximately 90% of the cases, displacement was less than 2 mm at up to 12 months after surgery. The UHMWPE fiber cable was a good biomaterial for reattaching the osteotomized greater trochanter and may also be an option for osteosynthesis procedures.

The purpose of this study was to assess the removability and biological reactivity of an ultrahigh molecular weight polyethylene (UHMWPE) fiber cable as a new biomaterial for osteosynthesis. We used a pull-out test and an implantation test to analyze the performance of the UHMWPE fiber cable using a dog model, and compared its characteristics with those of a wire cable and a soft wire. In the pull-out test, the UHMWPE fiber cable was as easy to remove as the soft wire, and both the UHMWPE fiber cable and the soft wire were significantly easier to remove than the wire cable. The fixation capability and the biological reactivity of the UHMWPE fiber cable were examined in an osteosynthesis model of the dog greater trochanter, and were compared with those of the soft wire. The bone union rate, assessed radiographically, was very similar when using the UHMWPE fiber cable and the soft wire. However, in the soft wire group, both the surface of the greater trochanter under the fixation material and the penetration area around the fixation material showed an increased tendency toward a biological reaction, including inflammation and granulation tissue formation, as compared to the UHMWPE fiber cable group. The UHMWPE fiber cable was as easily removed from the bone tissue as the soft wire, and was easier to remove than the wire cable. Additionally, the UHMWPE fiber cable caused reduced biological reactivity with the surrounding tissue, as compared with the soft wire. In conclusion, the UHMWPE fiber cable appeared to be a suitable fixation material for osteosynthesis.

The treatment of rheumatoid arthritis (RA) has recently seen a paradigm shift with the introduction of biological therapy, but there is concern that this will result in an increased incidence of infection. Postoperative infection is always a potentially problematic complication, even though a large review by the British Society for Rheumatology has shown that anti-tumor necrosis factor (TNF) therapy is not associated with an increased risk of overall serious infection in comparison with disease-modifying antirheumatic drugs [1]. It is well known that Staphylococcus aureus and Staphylococcus epidermidis are common pathogens of postoperative infection, although Salmonella infection after joint replacement is quite rare in the English literature [2–19], accounting for

Background: Bone marrow cells possess multipotentiality and have been used for several treatments. We hypothesized that bone marrow cells might differentiate into regenerated tendon and that several cytokines within bone marrow cells might accelerate tendon healing. Therefore, we treated Achilles tendon ruptures in a rat model with transplantation of whole bone marrow cells. Methods: Nine F344/Nslc (Fisher) rats were the source of bone marrow cells and mesenchymal stem cells as well as normal Achilles tendons. Eighty-seven Fisher rats were used for the experiments. The rats were divided into three groups: the BMC group (bone marrow cells injected around the tendon), the MSC group (mesenchymal stem cells injected around the tendon), and the non-treated control group (incision only). Outcome measures included mechanical testing, collagen immunohistochemistry, histological analysis, and reverse transcription-polymerase chain reaction to detect expression of transforming growth factor-β (TGF-β) and vascular endothelial growth factor (VEGF). Results: The ultimate failure load in the BMC group was significantly greater than that in the non-treated or the MSC group at seven days after incision (3.8 N vs. 0.9 N or 2.1 N, p < 0.016) and at fourteen days after incision (10.2 N vs. 6.1 N or 8.2 N, p < 0.016). The ultimate failure load in the BMC group at twenty-eight days after incision (33.8 N) was the same as that of normal tendon (34.8 N). The BMC group demonstrated stronger staining for type-III collagen at seven days after incision and stronger staining for type-I collagen at twenty-eight days than did the MSC group. Expression of TGF-β and VEGF in the BMC group was significantly increased compared with that in the other groups at four days after incision (TGF-β: 1.6 vs. 1.3 or 0.6, p < 0.01; VEGF: 1.7 vs. 1.1 or 0.9, p < 0.01). Conclusions: Transplantation of whole bone marrow cells may be a better and more readily available treatment for Achilles tendon rupture than cultured mesenchymal stem cells. Clinical Relevance: The present study provides evidence that transplantation of bone marrow cells may be a promising therapy for the treatment of Achilles tendon rupture.

The treatment of autoimmune diseases by allogeneic bone marrow transplantation remains a promising therapeutic avenue. However, more intensive studies on murine models are essential before application to a large number of human patients. In particular, the use of bone marrow transplantation to treat rheumatoid arthritis has been problematic. We have taken advantage of the SKG/Jcl mouse that develops a chronic T cell-mediated autoimmune disease that mimics rheumatoid arthritis which attempted to prevent the development of immunopathology in these mice by allogeneic bone marrow transplantation (BMT). In particular, we utilized our unique technology in which bone marrow cells (BMCs) of control C57BL/6J mice are directly injected into the bone marrow cavity in the tibia of SKG mice (intra-bone marrow [IBM]-BMT). As controls, SKG/Jcl mice were transplanted with whole BMCs from syngeneic SKG mice. Importantly, 12 months after IBM-BMT [B6-->SKG] demonstrated no evidence of arthritis, whereas the control [SKG-->SKG] mice demonstrated, the expected immunopathology of a rheumatoid arthritis-like condition. Further, hematolymphoid cells in [B6-->SKG] mice were reconstituted by donor-derived cells and the percentages of Treg (Foxp3+/CD4+) cells, the percentages of receptor activator of nuclear factor-kappaB ligand (RANKL)+ cells on the CD4+ T cells and the serum levels of tumor necrosis factor-alpha, interleukin-1 and interleukin-6 were normalized in the [B6-->SKG] mice. These data suggest that IBM-BMT is a viable method of immunological manipulation that suppresses the severe joint destruction and bone absorption in SKG/Jcl mice and lends further credence to the use of this methodology in humans with intractable rheumatoid arthritis.

Cell proliferation and matrix synthesis were compared for rat nucleus pulposus cells cocultured with mesenchymal stem cells (MSCs) or fresh whole bone marrow cells (BMCs), harvested by the perfusion or aspiration methods. Nucleus pulposus cells were isolated from tail intervertebral discs of F344/slc rats, and BMCs were obtained from femora. Proteoglycan synthesis, DNA synthesis, and aggrecan mRNA expression were measured. The level of transforming growth factor-beta in supernatants from the culture system was also measured. Cell number, aggrecan mRNA expression, and uptake of [(35)S]-sulfate and [(3)H]-thymidine by nucleus pulposus cells cocultured with fresh whole BMCs all increased significantly compared with nucleus pulposus cells cocultured with MSCs. TGF-beta secreted by nucleus pulposus cells cocultured with fresh whole BMCs also significantly increased when compared with cocultures with MSCs. The perfusion method was superior to the aspiration method for preventing contamination of BMCs with peripheral red blood cells and lymphocytes, which may cause an autoimmune response in the disc. In conclusion, we suggest that fresh whole BMCs harvested by the perfusion method are more effective for increasing the proliferative and matrix synthesis capacity of nucleus pulposus cells.

The authors successfully treated a rare case of pigmented villonodular synovitis (PVNS) that originated from the lumbar facet joint (L4-5). A 43-year-old man presented with a complaint of left severe sciatica causing difficulty in walking. Magnetic resonance imaging (MRI) demonstrated an extradural mass on the left side at L4 and the mass compressed the dural tube and was continuous with the left L4-5 facet joint. A computed tomography myelogram revealed an extradural defect of contrast medium at the L4 level and an erosion of the L4 lamina. A total synovectomy with unilateral osteoplastic laminectomy was performed. The histological findings were a diagnosis of PVNS. The patient’s symptoms resolved completely and the MRI at postoperative 3 years demonstrated no recurrence of PVNS. It is important to totally remove the synovium, which is the origin of PVNS in order to prevent the recurrence. We think that our procedure is reasonable and adequate for lumbar PVNS.

Although anterior cruciate ligament reconstruction using a bone–patellar tendon–bone (BPTB) autograft has many advantages (e.g., high strength and solid fixation), there are also several complications (e.g., anterior knee pain or kneeling pain) due to harvest-site morbidity associated with the use of this graft type compared with the use of hamstring tendon. Therefore the ultimate goal of anterior cruciate ligament reconstruction using a BPTB graft is to minimize harvest-site morbidity. We have used a technique for harvesting central-third BPTB grafts that involves only a 3-cm-long, longitudinal, curved incision in the medial tibial tuberosity for both graft harvesting and fixation. The purpose of this report is to describe the technique, which can avoid the harvest-site morbidities associated with BPTB autografts during knee arthroscopy. We believe that this less invasive reconstruction may reduce the harvest-site morbidities associated with BPTB grafts because it allows for BPTB graft harvesting without incising the synovial bursa or paratenon and mitigates scarring and adhesion formation.

The aim of this study was to evaluate the results of one- and two-stage revision total hip arthroplasties (THAs) and to determine a rational surgical treatment strategy for periprosthetic hip infections. We constructed a 12-point preoperative scoring system to suggest either one- or two-stage revision THAs, based on a retrospective analysis of 55 operative procedures. Prosthesis survival was analysed using the Kaplan-Meier method, and the validity of the scoring system was evaluated using receiver-operating characteristic curves. At the end point of implant removal due to recurrent infection, the ten year survival rates were 94 and 87 % for one- and two-stage revision THAs, respectively. One-stage revision THA was recommended for patients scoring >9 points. The risk of recurrent infection in patients scoring 4 points was 83 %. The sensitivity and specificity of a cut-off value of 4 points, determined by the scoring system, were 83 and 100 %, respectively. The novel pre-operative scoring system was useful for the management of periprosthetic hip infections.

The purpose of this study was to compare anterior cruciate ligament (ACL) regeneration between animal groups subjected to intra-articular injection of fresh whole bone marrow cells (BMCs), cultured mesenchymal stem cells (MSCs), or saline. Partially transected ACLs in Fischer 344/Nslc rats were prepared, followed by injection of BMCs, MSCs, or saline into the articular cavity at 1 week after transection. Donor cells expressing green fluorescent protein were detected in the recipient's transected ACLs at 4 weeks in the BMC and MSC groups, and their ACLs appeared almost normal histologically. Further, there were significantly more mature spindle cells in the BMC group than in the saline group at 4 weeks. Biomechanically, the tensile strength in the BMC group reached near normal levels at 4 weeks after injection. The levels of transforming growth factor-β1 in the ACL tissue and knee joint fluid in the BMC group were increased significantly compared with that of the saline group at 4 weeks as detected by immunohistochemical analysis. In conclusion, intra-articular bone marrow transplantation using fresh whole BMCs is an effective treatment for ACL partial rupture. This therapy is easy to apply in a clinical setting because no culture system is required for collecting MSCs.

Objectives. Femoral head osteonecrosis (ON) is a serious complication of steroid administration. We evaluated bone marrow transplantation (BMT) for preventing corticosteroid-induced ON. Methods. Rabbits, injected with methylprednisolone (MPSL; 20mg/kg), were divided into four groups: (i) MPSL alone; MPSL injection only, (ii) MPSL+needling; 2 days after MPSL injection, a hole (1.2 mm diameter) was drilled from the outer cortex 2.5cm distal to the proximal end of the greater trochanter, (iii) MPSL+saline; 2 days after MPSL injection, 2ml saline was injected directly into the bone marrow cavity, and (iv) MPSL+BMT; 2 days after MPSL injection, 1 x 10 7 /2 ml bone marrow cells (BMCs) were injected directly into the bone marrow cavity. Platelets, fibrinogen, prothrombin time and total cholesterol in peripheral blood were measured before and after treatment. Tissues were stained with haematoxylin and eosion and terminal deoxynucleotidyl-mediated deoxyuridine triphosphate nick-end labelling stain and immunostained for VEGF, while cell proliferation and viability of whole BMCs in the femur were analysed by cell cycle analysis and [ 3 H]-thymidine uptake. Results. The ON incidence in rabbits treated with MPSL alone, MPSL+needling and MPSL+saline was 72.7, 70.0 and 66.7%, respectively, while in the MPSL+BMT group, the incidence was 0%. Serological findings in the MPSL+BMT group were almost normalized. VEGF and TUNEL staining were reduced in the MPSL+BMT group compared with all other groups. There were significantly fewer BMCs in G1 phase from the MPSL+BMT group than the other groups, while uptake of [ 3 H]-thymidine was significantly increased. Conclusion. Direct injection of autologous BMCs into femurs prevents corticosteroid-induced ON following treatment with high-dose, short-term steroids.

Background Total hip arthroplasty (THA) is a challenging surgical procedure that can be used to treat severely dislocated hips. There are few reports regarding cemented THAs involving subtrochanteric shortening osteotomy (SSO), even though cemented THAs provide great advantages because the femur is generally hypoplastic with a narrow, deformed canal. Purposes We evaluated the utility of cemented THA with SSO for Crowe group IV hips, and assessed the relationship between leg lengthening and nerve injury. Our goal was to describe surgical techniques for optimizing surgical outcomes while minimizing the risk of nerve injury. Methods We retrospectively reviewed 34 cases of cemented THAs with transverse SSO for Crowe group IV. Prior to surgery, mean hip flexion was 93.1° (40°–130°). The mean follow-up period was 5.2 years (3–10 years). Results Bone union took an average of 7.7 months (3–24 months). Mean leg lengthening was 40.5 mm (15–70 mm) and was greater in patients without hip flexion contracture. None of the patients experienced any nerve injuries associated with leg lengthening, and radiographic evidence of loosening was not observed at the final follow-up. Conclusions SSO combined with cemented THA is an effective treatment for severely dislocated hips. Leg lengthening is not necessarily associated with nerve injuries, and the likelihood of this surgical complication may be related to the presence of hip flexion contracture.

The aims of this retrospective study were to firstly introduce three practical bulk bone graft techniques based on acetabular morphology for dysplasia and secondly evaluate the long-term durability of acetabular reconstruction using those techniques combined with cemented total hip arthroplasty (THA). The study comprised 101 consecutive THAs with a minimum follow-up of ten years; these procedures were categorised as being L shape (n = 58), Wall (n = 33) and D shape (n = 10) types. At the last follow-up, all bone grafts acquired trabecular reorientation, and no evidence of revision for aseptic or radiological loosening was noted. These bone graft techniques will be effective for improving the management of dysplasia in cemented THA by providing both acetabular reconstruction and cement containment.