Search

Background: Dislocation is a major complication of total hip arthroplasty (THA). The modular femoral neck system has some practical advantages in that it permits adjustment neck version and length, if intraoperative instability is present. Anatomical studies have identified morphological differences in the hip joint between men and women. Although sex-based differences exist in hip morphology, it is unclear whether sex-based differences exist in femoral neck selection when the hip is anatomically reconstructed with THA using a modular femoral neck system. This retrospective study aimed to investigate sex-based differences in femoral neck selectivity in THA using a modular neck system. Hypothesis: We hypothesised that sex-based differences exist in neck selectivity in THA using a modular neck system. Patients and Methods: Between July 2007 and March 2013, 163 THAs using a modular femoral neck system were performed in 149 patients at Teikyo University Chiba Medical Center. Data on the type of modular neck were retrieved from patient records. Fisher’s exact test was used to investigate sex-based differences in femoral neck selectivity in THA using a modular neck system. Results: Neck selectivity did not significantly differ between men and women. Discussion: This retrospective study on THA with a modular femoral neck system revealed no sex-based difference in neck selectivity; however, more than half of the series used varus or version-controlled neck, indicating that a changeable neck may play a role in preventing postoperative dislocation.

Background The adherence to home exercise is generally low despite its well-known effect on knee osteoarthritis. Therefore, we developed a home exercise application, LongLifeSupport, to provide patients with daily basic exercise videos and an automatic recording calendar. We hypothesized that this application would encourage patients to exercise and help maintain their motivation; this pilot study aimed to determine their exercise adherence rates. Using outcome measures, we also aimed to determine the effect of home exercise using this application and the factors for its continuation. Methods Twenty patients with knee osteoarthritis were included. The participants exercised for 12 weeks. Using pre- and post-tests, we examined their satisfaction with continuation (only in the post-test), Japanese knee osteoarthritis measure score, short physical performance battery score, bilateral knee extension muscle strength, and short test battery for locomotive syndrome. Furthermore, we investigated correlations between adherence rates and pre-test scores of Japanese knee osteoarthritis measure and short test battery, and between pre-test scores and variations in Japanese knee osteoarthritis measure and short test battery. Results The mean adherence rate was 82.4%. The participants showed ease of continuation (100%) and significant improvements in the degree of knee pain, pain and stiffness, and daily life conditions using the Japanese knee osteoarthritis measure score, total score, walk seconds and chair stand seconds of the short physical performance battery, as well as the extension muscle strength of the right- and pain-side knee. No significant correlations were identified between the adherence rate and the pre-test or variation. Conclusions The adherence rate to the application was over 80%. Participants with knee osteoarthritis showed almost full satisfaction, reduced pain, and improved physical ability. Therefore, the use of this application provided a safe exercise program and maintained the exercise motivation of participants. Thus, it may be useful for unsupervised home exercise. Trial registration: WHO Registry Network jRCT1030210102. Registered on 19/05/2021

The effects of the type of anesthesia (spinal (SA) vs. general (GA)) used for transurethral resection of bladder tumor (TURBT) on non-muscle invasive bladder cancer (NMIBC) recurrence and progression are controversial and our aim is to investigate their associations. We identified 300 NMIBC patients who underwent initial TURBT with SA or GA. Cox’s regression analysis was performed to examine the effects of anesthesia on tumor recurrence. Among 300 patients, 153 (51.0%) received GA and 147 (49.0%) SA. The 5-year recurrence-free survival (RFS) rate was 59.9% in the GA group, which was significantly lower than that in the SA group (74.4%, p = 0.029). GA (HR 1.57, p = 0.048), male sex (HR 2.72, p = 0.012), and tumor multiplicity (HR 1.96, p = 0.006) were independently associated with tumor recurrence. In a subgroup of 137 patients with high-risk NMIBC, the 5-year RFS rate was 50.3% in the GA group, which was significantly lower than that in the SA group (77.6%, p = 0.020), and GA remained an independent indicator of tumor recurrence (HR 2.35, p = 0.016). However, no significant differences were observed in the RFS rates of low- to intermediate-risk NMIBC patients between the GA and SA groups. The RFS rate was lower in NMIBC patients who received GA during TURBT than in those who received SA. Volatile anesthesia may increase tumor recurrence, particularly in high-risk NMIBC patients, which may be due to the inhibition of the immune response system during surgery.

The PR approach combines the advantages of the second window of the ilioinguinal approach and the medial view of the modified Stoppa approach. However, it is unclear whether the PR approach is more effective or safer than the other approaches, as few clinical studies have compared the PR approach with the other approaches. The aim of this study was to provide a systematic review and meta-analysis comparing the PR approach with the other approaches for the treatment of acetabular fractures and to answer the following question: Are the results of the PR approach superior to those of the other approaches in terms of reduction quality, operative time, operative blood loss, complications, and clinical outcomes for treatment of acetabular fractures?A systematic literature review was conducted using relevant original studies from various databases. Pooling of data was performed using RevMan software (version 5.3, Cochrane Collaboration, Oxford, UK). A p-value of0.05 was considered to be significant. We calculated the mean differences (MDs) for continuous data and odds ratio (OR) for dichotomous data with 95% confidence intervals (CIs) for each outcome. Statistical heterogeneity was assessed based on IFive studies were included in this meta-analysis. The findings demonstrated that operative blood loss was significantly lower in the PR approach than in the other approaches (p = 0.04). There was no significant difference in the rate of anatomical reduction, the operative time, the rate of complications, and the rate of excellent or good clinical score between the PR approach and the other approaches.The PR approach provided lower operative blood loss, although there was no significant difference in operative time, reduction quality, complications, and excellent or good clinical score between the PR approach and the other approaches.Ⅲ.

Intrapelvic prosthesis migration is a rare but serious complication of bipolar hemiarthroplasty in femoral neck fractures. The external iliac artery is one of the most frequently damaged arteries during the removal of a migrated implant from the pelvic region. This report describes a case in which prophylactic placement of an external iliac artery balloon catheter was performed to reduce blood loss in the event of vascular injury during implant removal surgery in the pelvic region.

Traumatic hip dislocations should be reduced gently and promptly to prevent complications such as osteonecrosis of the femoral head, heterotopic ossification, incomplete recovery of sciatic nerve injury, and fractures of the femoral neck. Many closed reduction manoeuvres have been reported; however, these manoeuvres require forceful and sustained traction, which places an enormous physical burden on surgeons. The aim of the present technical note is to describe a new reduction manoeuvre that uses a traction table to decrease the physical burden experienced by surgeons.

Stepladders are used to work at heights in daily life, but their structure and usage differs from that of a ladder; stepladders can fold and stand without support, whereas ladders cannot fold and, thus, require support from other objects. We hypothesised that this difference made ladder and stepladder fall injuries to differ in characteristics. To clarify this hypothesis, we performed a retrospective cohort study on the stepladder fall injuries and compared their characteristics with that of ladder fall injuries. We conducted a retrospective cohort study of injuries sustained from either ladder or stepladder falls. In this study, data were retrieved from the computerised database of Teikyo University Chiba Medical Center. Patients admitted to the orthopaedic department because of injury from ladder or stepladder fall were included. The following data were retrieved from the patient records: sex, age, height, body weight, body mass index (BMI), injury severity score (ISS), season, number of injury sites, details of injury and treatment option. One hundred thirty-two patients were included in this study. 101 patients were injured from stepladder falls, and 31 patients were injured from ladder falls. The number of females sustaining injuries due to a stepladder fall was significantly higher than those due to a ladder fall. The most frequent type of injury after fall from stepladder was fracture (48.9%), whereas the most frequent type of injury after fall from ladder was contusion/sprain (56.4%). The most frequently injured body part from stepladder fall was lower extremity (32.6%). In contrast, the most frequently injured body part due to a ladder fall was spine (27.3%). The current study found that the number of females sustaining injuries due to a stepladder fall was significantly higher than those due to a ladder fall. Furthermore, the most frequent body parts that needed surgery following a ladder fall injury were spine and upper extremity, whereas the most frequent body parts that needed surgery following a stepladder fall injury was lower extremity. Our study indicated that stepladder falls cause severe injuries and physical disability and can be a huge financial burden.

Introduction: The purpose of this study was to investigate the incidence of necrosis and insufficiency fracture of the hip and knee using magnetic resonance imaging (MRI) in renal transplant patients. Methods: We examined 300 consecutive renal transplant patients using MRI of the hips and knees (T1-weighted coronal MRI) preoperatively and at 3 and 6 months postoperatively. Oblique axial-plane T1-weighted MRI and short-tau inversion-recovery T2-weighted MRI were performed parallel to the femoral neck when distinguishing the osteonecrosis of the femoral head (ONFH) from subchondral insufficiency fracture (SIF) of the femoral head was difficult. Results: ONFH was observed in 3 hips (3 cases, 1.0%). Osteonecrosis of the knee was observed in 2 knees (1 case, 0.3%). SIF of the femoral head was observed in 5 hips (3 cases, 1.0%). Bilateral simultaneous onset of SIF of the femoral head was observed in 2 cases (0.7%). Insufficiency fracture of the knee was observed in 2 knees (1 case, 0.3%). Conclusions: When it was difficult to distinguish ONFH from SIF of the femoral head, oblique axial-plane T1-weighted MRI and the short-tau inversion-recovery T2-weighted MRI parallel to the femoral neck were useful to establish the correct diagnosis.

BACKGROUND Total hip arthroplasty (THA) using a minimally invasive (MI) approach is a commonly performed procedure, and several approaches are now being used clinically. The MI anterolateral (MIAL) approach is one of the MI approaches used in clinical practice. Whether the MIAL approach is superior to non-MI approaches remains controversial. To resolve this controversy, we performed a systematic review and a meta-analysis of results of THA procedures that used the MIAL approach. We assessed whether the MIAL approach was superior to the lateral transmuscular (LT) approach in terms of operative time, operative blood loss, radiological parameters, and clinical outcomes. METHODS We performed a methodical search for all literature published on PubMed, Web of Science, and the Cochrane Library, and pooled data using the RevMan software. A p value

Background Precise implant alignment is a crucial prognostic factor for successful outcomes following total hip arthroplasty (THA). A portable accelerometer-based navigation (PN) device may achieve the same accuracy as that achieved by the computer-assisted navigation surgery technique, with the convenience of a conventional technique. Although the usefulness of PN in THA (PN-THA) has been reported, whether it is more accurate than performing THA with a conventional technique (CON-THA) remains controversial. The difference in surgical time between PN-THA and CON-THA is also unclear. Therefore, we conducted a systematic review and meta-analysis of studies comparing results of PN-THA with those of CON-THA. We focused on the following question: is PN-THA superior to CON-THA in terms of radiological parameters and surgical time? Patients and Methods A literature search was conducted in PubMed, Web of Science, and Cochrane Library, to identify studies that met the following inclusion criteria: randomised controlled trials (RCT) or non-RCT, studies involving patients who underwent PN-THA and patients who underwent CON-THA, studies including data on radiological parameters and surgical outcomes. Author names, publication year, country, study design, surgical approach, demographic characteristics of the participants (diagnosis, gender, age, and body mass index), and surgical outcomes (the radiological parameters and the surgical time) were extracted. We calculated the mean differences (MDs) for continuous data with 95% confidence intervals (CIs) for each outcome. p Results Three studies were included in this meta-analysis. The meta-analysis showed that absolute deviation of the postoperative measured angles from the target position for the cup anteversion was significantly smaller in PN-THA than in CON-THA (MD = −1.70, 95% CI = −2.91 to −0.50, [p = 0.005]). There was no significant difference in the absolute deviation of the postoperative measured angles from the target position for cup abduction between the groups (MD = −1.82, 95% CI = −4.32–0.67, [p = 0.15]). The surgical time was significantly longer in PN-THA than in CON-THA (MD = 8.58, 95% CI = 4.05–13.10, [p = 0.0002]). Discussion This systematic review and meta-analysis of studies comparing the results of PN-THA with those of CON-THA showed that the PN-THA is advantageous for precise cup implantation compared to CON-THA, although PN-THA has a longer surgical time compared to CON-THA. Level of evidence III.

We have developed a simple method for analysing gravity data to define 3D subsurface structures consistent with geological maps and reflection seismic survey results. This new method makes it possible to automatically separate gravity anomalies caused by structures that are the target of analysis (residual gravity) and not subject to gravity anomaly analysis (trend surfaces or regional gravity variations). This separation is achieved by assuming that the gravity anomaly trend surface is extremely smooth prior to analysis. In addition, this analysis can be carried out automatically, so it is possible to use a boot-strap simulation to evaluate the effect that gravity data accuracy and survey point distribution have on the analysis results. Using this newly developed method, we conducted a 3D subsurface structural analysis based on newly obtained gravity survey data in an area around Iwaki City, Fukushima Prefecture. The results of the 3D structural analysis revealed sharp depressions in the basement rock and basin-shaped underground structures along the Yunodake and Yamada faults. Finally, we were able to estimate the influence of survey point distribution and abrupt changes in the structure on the analysis results using a boot-strap simulation of the 3D analysis.

Background There are several reports regarding total hip arthroplasty (THA) after a previous pelvic osteotomy (PO). However, to our knowledge, until now there has been no formal systematic review and meta-analysis published to summarize the clinical results of THA after a previous PO. Therefore, we conducted a systematic review and meta-analysis of results of THA after a previous PO. We focus on these questions as follows: does a previous PO affect the results of subsequent THA, such as clinical outcomes, operative time, operative blood loss, and radiological parameters. Methods Using PubMed, Web of Science, and Cochrane Library, we searched for relevant original papers. The pooling of data was performed using RevMan software (version 5.3, Cochrane Collaboration, Oxford, UK). A p-value 50%, significant heterogeneity was assumed and a random-effects model was applied for the meta-analysis. A fixed-effects model was applied in the absence of significant heterogeneity. Results Eleven studies were included in this meta-analysis. The pooled results indicated that there was no significant difference in postoperative Merle D’Aubigne-Postel score (I2 = 0%, SMD = −0.15, 95% CI: −0.36 to 0.06, p = 0.17), postoperative Harris hip score (I2 = 60%, SMD = −0.23, 95% CI: −0.50 to 0.05, p = 0.10), operative time (I2 = 86%, SMD = 0.37, 95% CI: −0.09 to 0.82, p = 0.11), operative blood loss (I2 = 82%, SMD = 0.23, 95% CI: −0.17 to 0.63, p = 0.25), and cup abduction angle (I2 = 43%, SMD = −0.08, 95% CI: −0.25 to 0.09, p = 0.38) between THA with and without a previous PO. However, cup anteversion angle of THA with a previous PO was significantly smaller than that of without a previous PO (I2 = 77%, SMD = −0.63, 95% CI: −1.13 to −0.13, p = 0.01). Conclusion Systematic review and meta-analysis of results of THA after a previous PO was performed. A previous PO did not affect the results of subsequent THA, except for cup anteversion. Because of the low quality evidence currently available, high-quality randomized controlled trials are required. Level of evidence Level III, meta-analysis of case-control studies.

Study DesignRetrospective review of prospectively collected outcome data.PurposeTo compare 5-year outcomes following decompression with fusion (FU) and microendoscopic decompression (MED) in patients with degenerative lumbar spondylolisthesis (DLS) and to define surgical indication limitations regarding the use of MED for this condition.Overview of LiteratureThere have been no comparative studies on mid- or long-term outcomes following FU and MED for patients with DLS.MethodsForty-one consecutive patients with DLS were surgically treated. Sixteen patients first underwent FU (FU group), and 25 then underwent MED (MED group). The 5-year clinical outcomes following the two surgical methods were compared using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire.ResultsThe degree of improvement (DOI) for social life function was significantly greater in the MED group than in the FU group. Although not statistically significant, DOIs for the other four functional scores were also greater in the MED group than in the FU group. However, patients with a large percentage of slippage in the neutral position might experience limited improvement in low back pain, those with a large percentage of slippage at maximal extension might experience limited improvement in three functional scores, and those with a small intervertebral angle at maximal flexion might have limited improvement in three functional scores after MED for DLS. Therefore, we statistically compared the DOIs between the FU and MED groups regarding the preoperative percentage of slippage in the neutral position among patients with greater than 20% slippage, the preoperative percentage of slippage at maximal extension among patients with greater than 15% slippage, and the intervertebral angle at flexion among patients with angles lesser than −5°; however, there were no statistically significant differences between the two groups.ConclusionsMED is a useful minimally invasive surgical procedure that possibly offers better clinical outcomes than FU for DLS.

Background Precise implant alignment is a crucial prognostic factor for successful outcomes following total hip arthroplasty (THA). A portable accelerometer-based navigation (PN) device may achieve the same accuracy as that achieved by the computer-assisted navigation surgery technique, with the convenience of a conventional technique. Although the usefulness of PN in THA (PN-THA) has been reported, whether it is more accurate than performing THA with a conventional technique (CON-THA) remains controversial. The difference in surgical time between PN-THA and CON-THA is also unclear. Therefore, we conducted a systematic review and meta-analysis of studies comparing results of PN-THA with those of CON-THA. We focused on the following question: Is PN-THA superior to CON-THA in terms of radiological parameters and surgical time? Patients and methods A literature search was conducted in PubMed, Web of Science, and Cochrane Library, to identify studies that met the following inclusion criteria: randomised controlled trials (RCT) or non-RCT, studies involving patients who underwent PN-THA and patients who underwent CON-THA, studies including data on radiological parameters and surgical outcomes. Author names, publication year, country, study design, surgical approach, demographic characteristics of the participants (diagnosis, gender, age, and body mass index), and surgical outcomes (the radiological parameters and the surgical time) were extracted. We calculated the mean differences (MDs) for continuous data with 95 % confidence intervals (CIs) for each outcome. p Results Three studies were included in this meta-analysis. The meta-analysis showed that absolute deviation of the postoperative measured angles from the target position for the cup anteversion was significantly smaller in PN-THA than in CON-THA (MD = −1.70, 95 % CI = −2.91 to −0.50, [p = 0.005]). There was no significant difference in the absolute deviation of the postoperative measured angles from the target position for cup abduction between the groups (MD = −1.82, 95 % CI = −4.32–0.67, [p = 0.15]). The surgical time was significantly longer in PN-THA than in CON-THA (MD = 8.58, 95 % CI = 4.05–13.10, [p = 0.0002]). Discussion This systematic review and meta-analysis of studies comparing the results of PN-THA with those of CON-THA showed that the PN-THA is advantageous for precise cup implantation compared to CON-THA, although PN-THA has a longer surgical time compared to CON-THA. Level of evidence III.

The hip placement with a metal-on-metal (MOM) bearing has been used for both surface replacement and total hip arthroplasty (THA). Use of MOM bearing for hip replacement reduces the wear compared to conventional bearings. We prospectively assessed 30 patients who underwent unilateral MOM THA. A control group of 30 patients who underwent metal-on-polyethylene THA using the implants as the other group, except for bearing, were accessed. Blood samples were collected preoperatively and at 3- , 6- , 9- , 12- , 15- , 18- , and 24-month intervals. Changes in mean blood metal ion concentration were compared between the MOM and metal-on-polyethylene groups. A statistically significant positive correlation was observed between blood cobalt and chromium concentrations in all of the patients. The mean blood ion concentrations of the MOM were significantly higher than those of the metal-on-polyethylene. A statistically significant negative correlation was found between maximum blood cobalt concentration and cup version angle. The maximum blood chromium concentrations in the patients who had larger cup version angles were more likely to decrease. We considered that cup version angle is one of the factors that have the greatest effect on blood metal ion concentration, and the target cup version angle that did not induce an increase in blood metal ion concentrations was approximately 20°.

Purpose The purpose of this study was to compare the usefulness of measuring acetabular anterior coverage by tomosynthesis and false profile (FP) radiography. Methods 70 hips in 35 patients who were diagnosed with early stage osteoarthritis of the hip, and 60 hips from 30 healthy volunteers were analysed. Plain FP radiographs were taken, and vertical-centre-anterior margin (FP-VCA) angles were measured. Acetabular anterior coverage was measured in the natural standing position using a tomosynthesis imaging system in the sagittal plane. As with FP radiography, we measured vertical-centre-anterior margin (TS-VCA) angles. Results The median values of the FP-VCA angle, and TS-VCA angle were 43.8°, 54.4°, respectively. The TS-VCA angle was significantly larger than the FP-VCA angle. For FP radiographs, the intraobserver intraclass correlation coefficient (ICC) was 0.68, and the interobserver ICC was 0.79. For tomosynthesis sagittal images, the intraobserver ICC was 0.85, and the interobserver ICC was 0.92. There was a strong positive correlation between the TS-VCA angle and the FP-VCA angle. When the FP-VCA angle was 25°, the TS-VCA angle was 35° in regression analysis. Conclusions Measuring acetabular anterior coverage using sagittal plane tomosynthesis correlates well with FP radiography. Regardless of the presence of acetabular deformities, tomosynthesis demonstrated high reproducibility, simple posture setting, low effective doses, and high versatility. A cut-off value of 35° was useful for the detection of developmental dysplasia of the hip joint using the TS-VCA angle.

Background Precise implant alignment is a crucial prognostic factor in total knee arthroplasty (TKA). Portable navigation systems (PN-TKA) were reported to be better than the conventional technique (CON-TKA). We hypothesized that PN-TKA offered greater radiologic precision than CON-TKA in mechanically aligning components. We investigated whether (1) it improved global mechanical alignment, and (2) optimized component placement with respect to the tibial and femoral mechanical axes. Patients and methods A systematic literature review compared PN-TKA versus CON-TKA. PubMed, Web of Science and Cochrane Library search retrieved ten studies. Their data were pooled using RevMan 5.3. Odds ratios (OR) for dichotomous data were calculated with 95% confidence intervals (CIs) for each outcome. Statistical heterogeneity was assessed as I2 using a standard χ2 test. I2 > 50% denoted significant heterogeneity requiring a random effects model; otherwise, a fixed effects model was applied. Results There were significantly fewer outliers for mechanical axis (I2 = 24%, OR = 0.62, 95% CI = 0.42–0.91, p = 0.02) and coronal femoral component angle (I2 = 58%, OR = 0.31, 95% CI = 0.13–0.73, p = 0.007) using PN-TKA; however, no significant difference was observed for coronal tibial component angle outliers (I2 = 0%, OR = 0.66, 95% CI = 0.38–1.15, p = 0.14). Discussion Although PN-TKA appeared to improve global alignment, it had no effect on coronal tibial alignment, which is a key factor in predicting the long-term success of component fixation. There thus appeared to be no definite advantage of PN-TKA over CON-TKA. Level of evidence III.

Tight filum terminale (TFT) is a general term for pathological conditions that result in abnormal tension on the spinal cord, pulling the conus medullaris caudally. Because symptoms can vary, we aim to review the usefulness of Komagata’s criteria in our experience with four patients who had TFT that was missed in prior workups. We performed a retrospective review of the medical records of four patients who underwent resection of the filum terminale for TFT. A total of four patients underwent surgery. The patients’ chief complaints were lower back pain, lower limb pain and numbness. All patients met the Komagata diagnostic criteria for TFT and also had neurological abnormalities of the upper limbs, such as numbness and pathological reflexes. We resected the filum terminale in all patients, and achieved resolution of their preoperative symptoms. Komagata’s diagnostic criteria are seemingly useful for the diagnosis of TFT.

PurposeSeptic arthritis of the hip joint in adults often progresses to recurrent infections that require repeated surgeries for treatment. The purpose of the present study was to assess the risk of a recalcitrant hip infection and the usefulness of musculocutaneous flap transposition.Methods15 adult patients who underwent surgeries for the treatment of hip infections were retrospectively analysed. Patients who recovered from infection by undergoing arthroscopy, open irrigation, debridement, continuous irrigation, resection arthroplasty, and/or the placement of antibiotic-loaded acrylic cement were classified into Group A (n = 10). Patients who showed residual infection after multiple surgeries and ultimately recovered after undergoing musculocutaneous flap transposition were classified into Group B (n = 5). The age at onset, sex, incidence of multi-drug-resistant organisms, incidence of infection at other sites, compromising factors, peak pre-operative C-reactive protein level, and period from onset to initial surgery were compared between groups.ResultsThere was a statistically significant difference in the period from onset to initial surgery (p = 0.024). The infections remained chronic after multiple surgeries in most patients who had complications and/or a poor general or local condition. All of the patients recovered after musculocutaneous flap transposition without the need for additional surgery and did not experience recurrence during the follow-up period in Group B.ConclusionsDelayed diagnosis and/or treatment and compromised host caused recurrent septic arthritis of the hip in adults. Musculocutaneous flap transposition may be a useful method for the treatment of recalcitrant hip infection.

Background With the improvement in postoperative care for renal transplant patients, the number of patients requiring spinal surgery after renal transplantation has been increasing. However, there have been only a few reports describing the results of spinal surgery in renal transplant recipients. In this study, we investigated the results of spine surgery in renal transplant recipients. Methods A total of 37 renal transplant recipients who underwent spinal surgery in our hospital between April 2003 and July 2012 were included in this study. Results Perioperative complications were observed in 6 cases (16.2%). Two of them (5.3%) were general complications including duodenal ulcer and acute renal failure. The other four complications (10.8%) were directly related to surgery, namely, epidural hematoma, neurological deterioration and two surgical site infections. No patient required permanent hemodialysis postoperatively. Twenty-five fusion surgeries were performed and pseudoarthrosis was observed in 3 cases (12.0%). Conclusion Spinal surgery in renal transplant recipients can be performed without major complications or requirement for permanent hemodialysis postoperatively. Our data also showed a high rate of surgical site infection and pseudoarthrosis after fusion surgery.

Traumatic hip dislocations should be reduced gently and promptly to prevent complications such as osteonecrosis of the femoral head, heterotopic ossification, incomplete recovery of sciatic nerve injury, and fractures of the femoral neck. Many closed reduction manoeuvres have been reported; however, these manoeuvres require forceful and sustained traction, which places an enormous physical burden on surgeons. The aim of the present technical note is to describe a new reduction manoeuvre that uses a traction table to decrease the physical burden experienced by surgeons.

Background Several studies have reported regarding total hip arthroplasty (THA) for osteonecrosis of the femoral head after failed transtrochanteric rotational osteotomy (TRO). However, to our knowledge, no formal systematic review and meta-analysis have been published yet summarizing the clinical results of a THA after failed TRO. Therefore, we conducted a systematic review and meta-analysis of the THA outcomes after failed TRO. We focussed on the issue whether a previous TRO affects the results of subsequent THA, including operative time, operative blood loss, radiological parameters, postoperative complications, and clinical outcomes. Methods Literatures published up to January 2018 were searched in the PubMed, Web of Science, and Cochrane Library, and the pooling of data was performed using a RevMan software (version 5.3, Cochrane Collaboration, Oxford, UK). A p-value 50%, significant heterogeneity was assumed, and a random-effects model was applied for the meta-analysis. A fixed-effects model was applied in the absence of significant heterogeneity. Results Five studies were included in this meta-analysis. The results showed that operative time was significantly longer in the THA after the TRO than that for the THA without previous osteotomy (I2 = 92%; MD = 31.62; 95% CI: 5.95 to 57.28; p = 0.02). Operative blood loss was significantly greater in the THA after the TRO than that in the THA without previous osteotomy (I2 = 71%; MD = 123.30; 95% CI: 22.21 to 224.39; p = 0.02). The rate of stem malalignment was significantly higher in the THA after the TRO than that in the THA without previous osteotomy (I2 = 0%; OR = 5.23, 95% CI: 1.95 to 14.06; p = 0.001). There was no significant difference in the dislocation rate (I2 = 0%; OR = 2.12; 95% CI: 0.64 to 6.99; p = 0.22), and the postoperative Harris hip score at the final follow-up (I2 = 75%, MD = −0.46, 95% CI: −3.92 to 3.01, p = 0.80) between the groups. Conclusion The results demonstrate that, performing the THA after the TRO is technically more demanding than the THA without previous osteotomy. TRO does not affect the clinical results of future THA, and is a sufficient therapeutic alternative in younger patients. Level of evidence III, systematic and meta-analysis of case control studies.

Antibiotic-loaded acrylic cement (ALAC) spacers are useful for treatment of infected prostheses in the course of a two-stage revision. Spacers are handmade or are made using a commercial template, with reportedly good treatment outcomes. This study aimed to confirm the usefulness of custom-made ALAC spacers shaped like bipolar hip prostheses using a dental silicone template for treatment of infected hip prostheses, and described their manufacture. This study evaluated 10 patients who underwent two-stage revision for treatment of infected hip prostheses. Custom-made ALAC spacers were used in all patients. Templates were made with dental silicone. We investigated the following in treatment of the infected hip prostheses: bacterial pathogens; antibiotic-cement mixtures; waiting time to revision; dislocation, breakage, and migration of custom-made ALAC spacers; current hip status; progress during follow-up; presence or absence of recurrence; and walking ability. Dislocation, breakage, and migration were not observed in custom-made ALAC spacers. All patients recovered after two-stage revision without additional surgery and showed no recurrence during the follow-up period. Custom-made ALAC spacers shaped like bipolar hip prostheses using a template made of dental silicone may be useful for treatment of infected hip prostheses.

Purpose To examine the effects of conservative and surgical treatments for nocturnal leg cramps in patients with lumbar spinal stenosis (LSS). Nocturnal leg cramps is frequently observed in patients with peripheral neuropathy. However, there have been few reports on the relationship between nocturnal leg cramps and LSS, and it remains unknown whether conservative or surgical intervention has an impact on leg cramps in patients with LSS. Materials and Methods The subjects were 130 LSS patients with low back and leg pain. Conservative treatment such as exercise, medication, and epidural block was used in 66 patients and surgical treatment such as decompression or decompression and fusion was performed in 64 patients. Pain scores and frequency of nocturnal leg cramps were evaluated based on self-reported questionnaires completed before and 3 months after treatment. Results The severity of low back and leg pain was higher and the incidence of nocturnal leg cramps was significantly higher before treatment in the surgically treated group compared with the conservatively treated group. Pain scores improved in both groups after the intervention. The incidence of nocturnal leg cramps was significantly improved by surgical treatment (p=0.027), but not by conservative treatment (p=0.122). Conclusion The findings of this prospective study indicate that the prevalence of nocturnal leg cramps is associated with LSS and severity of symptoms. Pain symptoms were improved by conservative or surgical treatment, but only surgery improved nocturnal leg cramps in patients with LSS. Thus, these results indicate that the prevalence of nocturnal leg cramps is associated with spinal nerve compression by LSS.

Background Precise implant alignment is a crucial prognostic factor in total knee arthroplasty (TKA). Portable navigation systems (PN-TKA) were reported to be better than the conventional technique (CON-TKA). We hypothesized that PN-TKA offered greater radiologic precision than CON-TKA in mechanically aligning components. We investigated whether (1) it improved global mechanical alignment, and (2) optimized component placement with respect to the tibial and femoral mechanical axes. Patients and methods A systematic literature review compared PN-TKA versus CON-TKA. PubMed, Web of Science and Cochrane Library search retrieved ten studies. Their data were pooled using RevMan 5.3. Odds ratios (OR) for dichotomous data were calculated with 95% confidence intervals (CIs) for each outcome. Statistical heterogeneity was assessed as I2 using a standard χ2 test. I2 > 50% denoted significant heterogeneity requiring a random effects model; otherwise, a fixed effects model was applied. Results There were significantly fewer outliers for mechanical axis (I2 = 24%, OR = 0.62, 95% CI = 0.42–0.91, p = 0.02) and coronal femoral component angle (I2 = 58%, OR = 0.31, 95% CI = 0.13–0.73, p = 0.007) using PN-TKA; however, no significant difference was observed for coronal tibial component angle outliers (I2 = 0%, OR = 0.66, 95% CI = 0.38–1.15, p = 0.14). Discussion Although PN-TKA appeared to improve global alignment, it had no effect on coronal tibial alignment, which is a key factor in predicting the long-term success of component fixation. There thus appeared to be no definite advantage of PN-TKA over CON-TKA. Level of evidence III.

Background Several studies have reported regarding total hip arthroplasty (THA) for osteonecrosis of the femoral head after failed transtrochanteric rotational osteotomy (TRO). However, to our knowledge, no formal systematic review and meta-analysis have been published yet summarizing the clinical results of a THA after failed TRO. Therefore, we conducted a systematic review and meta-analysis of the THA outcomes after failed TRO. We focussed on the issue whether a previous TRO affects the results of subsequent THA, including operative time, operative blood loss, radiological parameters, postoperative complications, and clinical outcomes. Methods Literatures published up to January 2018 were searched in the PubMed, Web of Science, and Cochrane Library, and the pooling of data was performed using a RevMan software (version 5.3, Cochrane Collaboration, Oxford, UK). A p-value 50%, significant heterogeneity was assumed, and a random-effects model was applied for the meta-analysis. A fixed-effects model was applied in the absence of significant heterogeneity. Results Five studies were included in this meta-analysis. The results showed that operative time was significantly longer in the THA after the TRO than that for the THA without previous osteotomy (I2 = 92%; MD = 31.62; 95% CI: 5.95 to 57.28; p = 0.02). Operative blood loss was significantly greater in the THA after the TRO than that in the THA without previous osteotomy (I2 = 71%; MD = 123.30; 95% CI: 22.21 to 224.39; p = 0.02). The rate of stem malalignment was significantly higher in the THA after the TRO than that in the THA without previous osteotomy (I2 = 0%; OR = 5.23, 95% CI: 1.95 to 14.06; p = 0.001). There was no significant difference in the dislocation rate (I2 = 0%; OR = 2.12; 95% CI: 0.64 to 6.99; p = 0.22), and the postoperative Harris hip score at the final follow-up (I2 = 75%, MD = −0.46, 95% CI: −3.92 to 3.01, p = 0.80) between the groups. Conclusion The results demonstrate that, performing the THA after the TRO is technically more demanding than the THA without previous osteotomy. TRO does not affect the clinical results of future THA, and is a sufficient therapeutic alternative in younger patients. Level of evidence III, systematic and meta-analysis of case control studies.

Background Although vertebral debridement with interbody fusion is a useful procedure for the treatment of spondylodiscitis, anterior interbody fusion (AIF) is risky to perform on patients in a poor condition since it is highly invasive. Percutaneous nucleotomy and drainage (PND) is less invasive than AIF, but there only have been few reports regarding the outcome. The purpose of this study was to test the efficacy of PND for spondylodiscitis. Patients and Methods To analyze the effectiveness of different surgical treatments, 111 patients with spondylodiscitis were studied retrospectively. The average durations from the start of treatment until the C-reactive protein fell below 1.0 mg/dL or below the baseline value, which was defined as “recovery time” in the present study, were compared among PND, AIF, and posterior decompression. Results PND was performed when conservative treatment has been done for average 2.0 ± 0.9 months. Of the 18 PND patients, 15 (83%) showed recovery; 63 (97%) of the 65 patients who had AIF showed recovery. There was no significant difference of the mean recovery time after PND and AIF. All 10 patients whithout methicillin-resistant Staphylococcus aureus (MRSA) recovered after PND, whereas 3 of 8 patients with MRSA did not recover after PND. Of the 3 unsuccessful PND cases, 1 later had AIF, and 1 repeated PND. One patient could not undergo additional surgery because of a poor general condition. Conclusions Although the results of PND were inferior to AIF, PND is a useful next step after conservative treatment for patients in a poor condition. PND can be the initial procedure for spondylodiscitis before AIF if its limitations are understood.

Background C1 lateral mass screw was widely used for fixation of the upper cervical spine. However, massive bleeding from the C1–2 venous plexus is sometimes encountered. In this study, we proposed an alternate method for C1 lateral mass screw insertion, which involves insertion of the screws caudally from the C2 nerve root to reduce bleeding from C1–2 venous plexus. Methods Seven patients with atlantoaxial lesions were included in this study. The mean age at surgery was 65.9 (34–82) years. The mean follow-up period was 23.1 (12–38) months. All patients underwent atlantoaxial fusion with C1 lateral mass screws, which were inserted caudally from the C2 nerve root. All screws were inserted using O-arm based navigation system. Operative time, blood loss, C2 nerve root injury and perioperative complications were investigated. The accuracy of C1 screws and bone union were evaluated using postoperative computed tomography. Results A total of 13 C1 lateral mass screws were inserted using this method. The mean operative time was 224 (144–305) min. The mean blood loss was 209 (100–357) g. One perioperative complication was observed, which was recurrent laryngeal nerve palsy. There were no vertebral artery or spinal cord injuries. No case of massive bleeding from the C1–2 venous plexus was observed. One patient complained of postoperative occipital neuralgia, which disappeared in 2 weeks. No malposition of C1 lateral mass screws was observed on postoperative computed tomography. Bone union was observed in all patients. Conclusion The C1 lateral mass screw insertion caudally from the C2 nerve root may become an alternate method for insertion of C1 screws.

Background Patients with osteoporosis but no evidence of fracture can sometimes report low back pain. However, few studies have evaluated the nature of osteoporotic low back pain in a clinical situation. Therefore, the aim of this study was to examine the nature of osteoporotic low back pain without fracture, and the analgesic effect of minodronic acid hydrate on such pain. Methods The current study examined 136 patients with osteoporotic low back pain and no lower extremity symptoms. The following factors were evaluated before and after minodronic acid hydrate administration: the nature of osteoporotic low back pain was evaluated using the painDETECT questionnaire, numeric rating scale (NRS) score for low back pain at rest and in motion, bone mineral density (BMD) of the lumbar spine, and the serum concentration of tartrate-resistant acid phosphatase 5b (TRACP-5b) as a bone metabolism marker. Results A total of 113 patients were enrolled. The painDETECT questionnaire revealed the percentage of patients with nociceptive pain and neuropathic or mixed pain was approximately 85% and 15%, respectively. the average NRS scores for low back pain at rest decreased significantly 2 months after treatment (p = 0.01), while those in motion decreased significantly 1 month after treatment (p = 0.04). The average lumbar spine BMD tended to increase after treatment, but not significantly. On the other hand, the changes in the average serum concentration of TRACP-5b did significantly decrease 1 month after treatment. There was a significant positive correlation between the rate of NRS score improvement for low back pain at rest, and the rate of improvement in serum concentration of TRACP-5b (p Conclusions Osteoporotic low back pain consisted of 85% nociceptive pain and 15% neuropathic or mixed pain. The pain is strongly related to pain at rest rather than that in motion.

Dislocation of the hip joint in adults is usually caused by high-energy trauma such as road traffic accidents or falls from heights. Posterior dislocation is observed in most cases. However, atraumatic anterior dislocation of the hip joint is extremely rare. We present a case of atraumatic anterior dislocation of the hip joint that was induced by an activity of daily living. The possible causes of this dislocation were anterior capsule insufficiency due to developmental dysplasia of the hip, posterior pelvic tilt following thoracolumbar kyphosis due to vertebral fracture, and acetabular anterior coverage changes by postural factor. Acetabular anterior coverage changes in the sagittal plane were measured using a tomosynthesis imaging system. This system was useful for elucidation of the dislocation mechanism in the present case.

Background There are several reports regarding total hip arthroplasty (THA) after a previous pelvic osteotomy (PO). However, to our knowledge, until now there has been no formal systematic review and meta-analysis published to summarize the clinical results of THA after a previous PO. Therefore, we conducted a systematic review and meta-analysis of results of THA after a previous PO. We focus on these questions as follows: does a previous PO affect the results of subsequent THA, such as clinical outcomes, operative time, operative blood loss, and radiological parameters. Methods Using PubMed, Web of Science, and Cochrane Library, we searched for relevant original papers. The pooling of data was performed using RevMan software (version 5.3, Cochrane Collaboration, Oxford, UK). A p-value 50%, significant heterogeneity was assumed and a random-effects model was applied for the meta-analysis. A fixed-effects model was applied in the absence of significant heterogeneity. Results Eleven studies were included in this meta-analysis. The pooled results indicated that there was no significant difference in postoperative Merle D’Aubigne-Postel score (I2 = 0%, SMD = −0.15, 95% CI: −0.36 to 0.06, p = 0.17), postoperative Harris hip score (I2 = 60%, SMD = −0.23, 95% CI: −0.50 to 0.05, p = 0.10), operative time (I2 = 86%, SMD = 0.37, 95% CI: −0.09 to 0.82, p = 0.11), operative blood loss (I2 = 82%, SMD = 0.23, 95% CI: −0.17 to 0.63, p = 0.25), and cup abduction angle (I2 = 43%, SMD = −0.08, 95% CI: −0.25 to 0.09, p = 0.38) between THA with and without a previous PO. However, cup anteversion angle of THA with a previous PO was significantly smaller than that of without a previous PO (I2 = 77%, SMD = −0.63, 95% CI: −1.13 to −0.13, p = 0.01). Conclusion Systematic review and meta-analysis of results of THA after a previous PO was performed. A previous PO did not affect the results of subsequent THA, except for cup anteversion. Because of the low quality evidence currently available, high-quality randomized controlled trials are required. Level of evidence Level III, meta-analysis of case control studies.

Elderly postmenopausal women who have osteoporosis sometimes experience low back pain, however, the relationship between low back pain and osteoporosis in the absence of vertebral fractures remains unclear. We examined the relationship between bone mineral density (BMD), bone resorption and low back pain in elderly female patients who did not have osteoporotic vertebral fractures. The average BMD was 0.675 g/cm(2) when assessed by dual-energy X-ray absorptiometry (DEXA). Patients were excluded from the study if they had vertebral fractures revealed by radiography, CT scans or MRI. Bisphosphonate (risedronate) was administered for 4 months. The visual analogue scale (VAS) pain score, Roland Morris Disability Questionnaire (RDQ), Short Form-36 (SF-36) questionnaire, BMD and N-terminal telopeptide of type I collagen (NTx; a marker for bone resorption) were examined before and after treatment. DEXA did not increase significantly, but serum and urinary NTx were decreased (-51.4% and -62.0%, respectively) after 4 months of risedronate treatment (p

The mechanisms of apoptosis underlying a characteristic tissue reaction at the surface of the dorsal root ganglion (DRG) exposed to nucleus pulposus were studied in rats with special reference to the role of tumor necrosis factor-alpha (TNF).To study the characteristic tissue reaction at the surface of the DRG exposed to nucleus pulposus with special reference to the role of TNF.Nucleus pulposus cells are capable of producing TNF. Recently, local application of nucleus pulposus was shown to induce a characteristic tissue reaction at the DRG surface due to apoptosis.Recombinant TNF was applied to the DRG to mimic L4-L5 disc herniation in rats. The DRGs were resected 24 hours after surgery. Sections of the specimens were processed for immunohistochemistry using antisera to single-stranded DNA, Caspase 3, and TNF, and observed by light and electron microscopy.Typical apoptotic changes of the cell nuclei were observed in the DRG after application of TNF. The presence of single-stranded DNA, Caspase 3, and TNF further confirmed the occurrence of DRG cell apoptosis.TNF seemed to play a key role in induction of apoptosis of DRG cells, which resembled that induced by application of nucleus pulposus.

Retrospective study for L5 radiculopathy due to foraminal stenosis with vacuum phenomena (VP) at the L5/S disc.To investigate the influence of the L5/S VP on L5 radiculopathy, due to L5/S foraminal stenosis.Foraminal stenosis has often been detected via images. However, although this condition is well known, it is occasionally overlooked during diagnosis, because spinal nerve compression is not always visible on stationary images.Patients who underwent lumbar spine surgery were examined to determine the presence of foraminal stenosis (n = 194). The presence of VP and the range of motion of the L5/S disc were assessed on radiography with the lumbar spine in the extended and flexed positions. The shapes of the L5/S foramina were confirmed using sagittal magnetic resonance imaging. Patients who showed VP were divided into 2 groups: patients with (group A) and without (group B) symptomatic foraminal stenosis. The relationship between the VP and symptomatic foraminal stenosis was examined.In total, 35 cases of VP at the L5/S disc were noted on lateral radiography. L5 radiculopathy due to L5/S foraminal stenosis was identified in 14 of these 35 cases. The ranges of L5/S angles were 10° ± 4° and 5° ± 3° in groups A and B, respectively, and these values were significantly different (P 0.01). 11 (48%) of 23 L5/S foramina that showed VP of the L5/S disc and were completely occupied by a disc below the caudal edge of the vertebra had symptomatic foraminal stenosis.Our results indicated that VP, which showed a large range of motion angle between flexion and extension, triggered symptoms of foraminal stenosis at the L5/S disc. The dynamic motion of the VP should thus be considered for the diagnosis of L5/S foraminal stenosis.3.