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Longitudinal magnetic resonance imaging study on whiplash injury patients: minimum 10-year follow-up

Abstract Background We conducted a prospective long-term follow-up study to assess associations between magnetic resonance imaging (MRI) findings and changes in clinical symptoms, as well as factors relating to the prognosis of symptoms. Methods A total of 133 patients with acute whiplash injury between 1993 and 1996 participated in this follow-up study. They underwent neurological examinations by spine surgeons and second MRI scans of the cervical spine were obtained. They also filled out a questionnaire regarding cervical symptoms and the accident details. The items evaluated by MRI were (1) a decrease in the signal intensity of the intervertebral disc; (2) anterior compression of the dura and the spinal cord; (3) posterior disc protrusion; (4) disc space narrowing; and (5) foraminal stenosis. Relations between the presence/absence of degenerative changes on MRI, accident details, and patients’ symptoms were assessed by calculating the adjusted odds ratio (OR). Results Progression of some degenerative changes was recognized on MRI in 98.5% of the 133 whiplash injury patients, and clinical symptoms diminished in more than a half of the 133 patients. There were no statistically significant associations between MRI findings and changes in clinical symptoms. The prognosis for neck pain tended to be poor after accidents with double collisions (rear-end collision followed by frontend collision) [adjusted OR 5.83, 95% confidence interval (CI) 1.15-29.71] and accidents with serious car damage (2.87, 1.03–7.99). The prognosis for stiff shoulders tended to be poor in women (2.83, 1.23–6.51); and the prognosis for numbness in the upper extremities tended to be poor after accidents with serious car damage (3.39, 1.14–10.06). Conclusions This study demonstrated that progression of degenerative changes of the cervical spine on MRI was not associated with clinical symptoms during the 10-year period after whiplash injury. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1378-zAuthors Daisuke Ichihara, Keio University Department of Orthopaedic Surgery, School of Medicine 35 Shinanomachi, Shinjukuku Tokyo 160-8582 JapanEijiro Okada, Keio University Department of Orthopaedic Surgery, School of Medicine 35 Shinanomachi, Shinjukuku Tokyo 160-8582 JapanKazuhiro Chiba, Keio University Department of Orthopaedic Surgery, School of Medicine 35 Shinanomachi, Shinjukuku Tokyo 160-8582 JapanYoshiaki Toyama, Keio University Department of Orthopaedic Surgery, School of Medicine 35 Shinanomachi, Shinjukuku Tokyo 160-8582 JapanHirokazu Fujiwara, Keio University Department of Diagnostic Radiology, School of Medicine Tokyo JapanSuketaka Momoshima, Keio University Department of Diagnostic Radiology, School of Medicine Tokyo JapanYuji Nishiwaki, Keio University Department of Preventive Medicine and Public Health, School of Medicine Tokyo JapanTakeshi Hashimoto, Keio University Tsukigase Rehabilitation Center Department of Orthopaedic Surgery Shizuoka JapanJun Ogawa, Kyorin University Department of Orthopaedic Surgery Tokyo JapanMasahiko Watanabe, Tokai University Department of Orthopaedic Surgery Kanagawa JapanTakeshi Takahata, Isehara Kyodo Hospital Department of Orthopaedic Surgery Kanagawa JapanMorio Matsumoto, Keio University Department of Orthopaedic Surgery, School of Medicine 35 Shinanomachi, Shinjukuku Tokyo 160-8582 Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 5 / September, 2009

Regulation of prostaglandin E2 synthesis in cells derived from chondrocytes of patients with osteoarthritis

Abstract Background Osteoarthritis (OA) is a disorder that causes pain and degeneration of the joint over a chronic time course. Chondrocytes in OA play important roles in maintaining the homeostasis of the joint while they produce many cytokines and pathological mediators, including interleukin-1β (IL-1β), cyclooxygenases (COX), and prostaglandin E2 (PGE2). To elucidate the mechanisms of pain due to OA, the pathway of PGE2 synthesis was analyzed using cells derived from chondrocytes obtained from patients with OA. Methods Chondrocytes were isolated from cartilage samples obtained at the time of joint replacement surgery from patients with OA. The chondrocytes at the second passage were cultured with or without IL-1β, dexamethasone (DEX), or COX inhibitors such as NS-398, meloxicam, and indomethacin. Reverse transcription-polymerase chain reaction and Western blotting analysis were performed to study the levels of mRNA and protein, respectively. An enzyme-linked immunosorbent assay was performed to investigate the translocation of nuclear factor-κB (NF-κB) to the nucleus, and Western blotting analysis was performed to study the phosphorylation of mitogen-activated protein kinases. Results IL-1β markedly enhanced the expression of COX-2 and microsomal prostaglandin E synthase-1 (mPGES-1) at both the mRNA and protein levels. The up-regulation was suppressed by DEX or COX inhibitors. IL-1β strongly increased the translocation of NF-κB to the nucleus and the phosphorylation of extracellular-signal-regulated kinase, p38, and c-Jun amino-terminal kinase; but the up-regulation was not inhibited by DEX or COX inhibitors. Interestingly, in a dose-dependent manner, PGE2 recovered mPGES-1 expression from suppression by DEX, whereas it did not restore the expression of COX-2 in the presence of DEX and IL-1β. Conclusions These results suggested that in cells derived from OA chondrocytes different mechanisms of regulation exist between mPGES-1 and COX-2, and the expression of mPGES-1 was, at least partially, regulated through the autocrine positive feedback by PGE2. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1370-7Authors Hisashi Shimpo, Tokoname Municipal Hospital Department of Orthopedic Surgery 4-5 Koiehonmachi, Tokoname Aichi 479-8510 JapanTadahiro Sakai, Nagoya University Department of Orthopedic Surgery Nagoya JapanSeiji Kondo, Chukyo Women’s University Department of Physical Education, Junior College Nagoya JapanShinji Mishima, Tokyo Kosei Nenkin Hospital Department of Orthopedic Surgery Tokyo JapanMasaki Yoda, Nagoya University Department of Orthopedic Surgery Nagoya JapanHideki Hiraiwa, Nagoya University Department of Orthopedic Surgery Nagoya JapanNaoki Ishiguro, Nagoya University Department of Orthopedic Surgery Nagoya Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 5 / September, 2009

Atelocollagen-associated autologous chondrocyte implantation for the repair of chondral defects of the knee: a prospective multicenter clinical trial in Japan

Abstract Background New tissue-engineering technology was developed to create a cartilage-like tissue in a three-dimensional culture using atelocollagen gel. The minimum 2-year followup outcome of transplanting autologous chondrocytes cultured in atelocollagen gel for the treatment of full-thickness defects of cartilage in knees was reported from the single institution. The present multicenter study was conducted to determine clinical and arthroscopic outcomes in patients who underwent atelocollagen-associated autologous chondrocyte implantation for the repair of chondral defects of the knees. Methods At six medical institutes in Japan, we prospectively evaluated the clinical and arthroscopic outcomes of transplanting autologous chondrocytes cultured in atelocollagen gel for the treatment of full-thickness defects of cartilage in 27 patients (27 knees) with cartilage lesions on a femoral condyle or on a patellar facet over 24 months. Results The Lysholm score significantly increased from 60.0 ± 13.7 points to 89.8 ± 9.5 points (P = 0.001). Concerning the ICRS grade for arthroscopic appearance, 6 knees (24%) were assessed as grade I (normal) and 17 knees (68%) as grade II (nearly normal). There were few adverse features, except for detachment of the graft in two cases. Conclusions We concluded that transplanting chondrocytes in a newly formed matrix of atelocollagen gel can promote restoration of the articular cartilage of the knee. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1384-1Authors H. Tohyama, Hokkaido University School of Medicine Department of Sports Medicine Kita-15 Nishi-7 Sapporo 060-8638 JapanK. Yasuda, Hokkaido University School of Medicine Department of Sports Medicine Kita-15 Nishi-7 Sapporo 060-8638 JapanA. Minami, Hokkaido University School of Medicine Department of Orthopaedic Surgery Sapporo, Hokkaido JapanT. Majima, Hokkaido University School of Medicine Department of Orthopaedic Surgery Sapporo, Hokkaido JapanN. Iwasaki, Hokkaido University School of Medicine Department of Orthopaedic Surgery Sapporo, Hokkaido JapanT. Muneta, Tokyo Medical and Dental University Department of Orthopaedic Surgery Tokyo JapanI. Sekiya, Tokyo Medical and Dental University Department of Orthopaedic Surgery Tokyo JapanK. Yagishita, Tokyo Medical and Dental University Department of Orthopaedic Surgery Tokyo JapanS. Takahashi, Mitsubishi Nagoya Hospital Department of Orthopedic Surgery Nagoya JapanK. Kurokouchi, Mitsubishi Nagoya Hospital Department of Orthopedic Surgery Nagoya JapanY. Uchio, Shimane University School of Medicine Department of Orthopaedic Surgery Izumo, Shimane JapanJ. Iwasa, Shimane University School of Medicine Department of Orthopaedic Surgery Izumo, Shimane JapanM. Deie, Hiroshima University Department of Orthopedics Hiroshima JapanN. Adachi, Hiroshima University Department of Orthopedics Hiroshima JapanK. Sugawara, Japan Tissue Engineering Co., Ltd. Gamagori JapanM. Ochi, Hiroshima University Department of Orthopedics Hiroshima Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 5 / September, 2009

Direct detection of pathogens in osteoarticular infections by polymerase chain reaction amplification and microarray hybridization

Abstract Background Molecular biological techniques such as the polymerase chain reaction (PCR) and DNA microarray are used for the detection/identification of microorganisms; however, few reports have discussed the clinical utility of microarray analysis for identification of causative organisms of osteoarticular infections. It is important to examine the utility of PCR amplification followed by analysis of DNA microarray carrying specific oligonucleotides. Methods This study included 101 biological samples obtained from 96 patients who underwent conservative and/or surgical treatment for osteoarticular infections. In this double-blind comparative study, routine conventional testing and the research groups were unaware of each other’s interpretation until identical specimens were identified by culture and microarray analysis. Results Results of PCR microarray analysis were positive for 25 samples and negative for the remaining 76 samples within 24 h, and the results of the cultures (available after a mean of 3.54 days) were positive in 26 samples and negative for the remaining 75 samples. The sensitivity of microarray analysis was 84.6% (22/26) and specificity was 88.0% (22/25). Discrepant results were identified in seven samples, including a negative culture and a positive microarray in three cases and a positive culture and a negative microarray in four other cases. Conclusions The PCR microarray analysis is complementary to routine cultures in identifying causative microorganisms and should be used in patients with highly suspected infections and negative bacterial culture and in patients who require prompt diagnosis and early initiation of antibiotic therapy. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1373-4Authors Kenzo Uchida, Fukui University Faculty of Medical Sciences Department of Orthopaedics and Rehabilitation Medicine Matsuoka Shimoaizuki 23 Eiheiji, Fukui 910-1193 JapanTakafumi Yayama, Fukui University Faculty of Medical Sciences Department of Orthopaedics and Rehabilitation Medicine Matsuoka Shimoaizuki 23 Eiheiji, Fukui 910-1193 JapanYasuo Kokubo, Fukui University Faculty of Medical Sciences Department of Orthopaedics and Rehabilitation Medicine Matsuoka Shimoaizuki 23 Eiheiji, Fukui 910-1193 JapanTsuyoshi Miyazaki, Fukui University Faculty of Medical Sciences Department of Orthopaedics and Rehabilitation Medicine Matsuoka Shimoaizuki 23 Eiheiji, Fukui 910-1193 JapanHideaki Nakajima, Fukui University Faculty of Medical Sciences Department of Orthopaedics and Rehabilitation Medicine Matsuoka Shimoaizuki 23 Eiheiji, Fukui 910-1193 JapanKohei Negoro, Fukui University Faculty of Medical Sciences Department of Orthopaedics and Rehabilitation Medicine Matsuoka Shimoaizuki 23 Eiheiji, Fukui 910-1193 JapanKenichi Takeno, Fukui University Faculty of Medical Sciences Department of Orthopaedics and Rehabilitation Medicine Matsuoka Shimoaizuki 23 Eiheiji, Fukui 910-1193 JapanElisa S. Mwaka, Fukui University Faculty of Medical Sciences Department of Orthopaedics and Rehabilitation Medicine Matsuoka Shimoaizuki 23 Eiheiji, Fukui 910-1193 JapanNorbert T. Orwotho, Fukui University Faculty of Medical Sciences Department of Orthopaedics and Rehabilitation Medicine Matsuoka Shimoaizuki 23 Eiheiji, Fukui 910-1193 JapanMitsunobu Shimadzu, Mitsubishi Chemical Medience Corporation R&D and Business Planning Department Tokyo JapanShigeru Kobayashi, Fukui University Faculty of Medical Sciences Department of Orthopaedics and Rehabilitation Medicine Matsuoka Shimoaizuki 23 Eiheiji, Fukui 910-1193 JapanHisatoshi Baba, Fukui University Faculty of Medical Sciences Department of Orthopaedics and Rehabilitation Medicine Matsuoka Shimoaizuki 23 Eiheiji, Fukui 910-1193 Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 5 / September, 2009

Increased p21 expression in chondrocytes of achondroplasic children independently from the presence of the G380R FGFR3 mutation

Abstract Background Achondroplasia (ACH) represents the major cause of dwarfism and is due to mutations in the fibroblast growth factor receptor 3 (FGFR3) gene. The cellular mechanisms involved in the reduced growth have been mainly described for in vitro or in vivo models, but few data have been obtained for humans. Methods Thirteen children with ACH were enrolled in the study; the presence of FGFR3 mutations was determined by restriction fragment length polymorphism analysis and sequencing, whereas protein expression in cartilage biopsy was assessed by immunohistochemistry. Results Chondrocytes in cartilage biopsies of ACH children were characterized by the presence of growth arrest mediated by STAT activation (both STAT1 and STAT5) and increased expression of p21 and cyclin D1, whereas no expression of either p53 or cyclin D3 could be detected. This mechanism was present in ACH children carrying the G380R mutation but also in a patient in whom no mutation could be detected in the entire coding region of the FGFR3 gene. Conclusions These data thus demonstrate the presence of a common final mechanism involving p21 and possibly leading to a block in chondrocyte proliferation. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1355-6Authors Antonina Parafioriti, Orthopaedic Institute Gaetano Pini Pathology Department piazza Cardinal Ferrari 1 20122 Milan ItalySilvia del Bianco, Orthopaedic Institute Gaetano Pini Pathology Department piazza Cardinal Ferrari 1 20122 Milan ItalyDonatella Barisani, University of Milano Bicocca Department of Experimental Medicine, Faculty of Medicine via Cadore 48 20052 Monza (MI) ItalyElisabetta Armiraglio, Orthopaedic Institute Gaetano Pini Pathology Department piazza Cardinal Ferrari 1 20122 Milan ItalyGiovanni Peretti, University of Milano and Orthopaedic Institute Gaetano Pini Orthopaedic Division, Faculty of Medicine Milan ItalyWalter Albisetti, University of Milano and Orthopaedic Institute Gaetano Pini Orthopaedic Division, Faculty of Medicine Milan Italy Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 5 / September, 2009

Assessment of thrombotic risk factors predisposing to thromboembolic complications in prosthetic orthopedic surgery

Abstract Background Congenital thrombophilia is responsible for thromboembolic complications despite prolonged low-molecular-weight heparin (LMWH) prophylaxis following hip and knee endoprosthesis surgery. Methods A series of 86 patients with hip or knee endoprosthesis surgery were assessed 1 year after operation. Antithrombin III, protein C, and protein S were determined, and the activated protein C sensitivity ratio was measured. We screened for the presence of lupus anticoagulant, factor V Leiden mutation, and polymorphism of prothrombin G20210A. The lower limb venous circulation was monitored by color Doppler ultrasonography. Pulmonary embolism (PE) was diagnosed using ventilation and perfusion scintigraphy. Results In all, 33 patients had thromboembolic complications, 18 with thrombophilia (7 with combined form). Of the 53 patients without complications 12 had thrombophilia (2 with combined form). The differences were statistically significant. The risk score, the prevalence of FV Leiden and prothrombin G20210A mutations, and lupus anticoagulant were also significantly higher in the symptomatic group. Deep vein thrombosis (DVT) developed preoperatively in 15 patients; DVT and PE in 4 patients; thrombophilia was diagnosed in 53% and 75% of these cases. In all, 17 patients had postoperative thromboembolic complications: DVT developed in nine and PE in one patient (all with thrombophilia); DVT + PE developed in seven patients (all but one had thrombophilia). Conclusions Significant differences were found in the incidence (P ≤ 0.01) of thrombophilia and the risk score (P ≤ 0.02) between symptomatic and asymptomatic patients. We recommend preoperative thrombophilia screening for patients with a history or familial prevalence of thromboembolism and/or with a high risk score (≥15). In cases of thrombophilia, the form and duration of anticoagulant treatment must be decided individually. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1368-1Authors Gabriella Szücs, University of Debrecen, Health and Medical Science Centre Department of Anesthesiology and Intensive Care H-4032, Debrecen, Nagyerdei krt. 98 Debrecen 4032 HungaryÉva Ajzner, University of Debrecen, Health and Medical Science Centre Clinical Research Center Debrecen HungaryLászló Muszbek, University of Debrecen, Health and Medical Science Centre Clinical Research Center Debrecen HungaryTünde Simon, University of Debrecen, Health and Medical Science Centre Department of Anesthesiology and Intensive Care H-4032, Debrecen, Nagyerdei krt. 98 Debrecen 4032 HungaryKálmán Szepesi, University of Debrecen, Health and Medical Science Centre Department of Orthopedics Debrecen HungaryBéla Fülesdi, University of Debrecen, Health and Medical Science Centre Department of Anesthesiology and Intensive Care H-4032, Debrecen, Nagyerdei krt. 98 Debrecen 4032 Hungary Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 5 / September, 2009

High revision rate of hydroxyapatite-coated ABG-I prosthesis

Abstract Background The aim of this study was to investigate the causes of the high revision rate of the hydroxyapatite-coated Anatomique Benoist Girard (ABG-I) prosthesis. Methods We performed 204 total hip arthroplasties (THAs) at our hospital between March 1992 and December 1996. Of the 204 THA patients, 129 were followed up; the mean duration of follow-up was 12.2 years (range 10.0–14.5 years). There were 113 male patients and 16 female patients, with an average age of 53 years (30–83 years) at the time of surgery. The reasons for THA were avascular necrosis in 119 hips, acetabular dysplasia in 8 hips, and traumatic arthritis in 2 hips. Results The Harris hip score was 47.3 preoperatively and 86.4 at the last follow-up. The linear polyethylene wear was an average of 0.29 mm/year. Acetabular osteolysis was seen in 113 cases (88%). Altogether, 61 (47.2%) acetabular cups were revised for aseptic loosening in 38 hips, polyethylene wear and osteolysis in 20 hips, recurrent dislocation in 2 hips, and deep infection in 1 hip. Femoral osteolysis was observed in 100 cases (77.5%). The femoral stem was revised in 4 hips (3.1%). Conclusion We observed that the fatal detriment to ABG-I acetabular cup survival in long-term follow-up was periacetabular osteolysis followed by aseptic loosening. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1367-2Authors Young-Yool Chung, Gwangju Christian Hospital Department of Orthopedic Surgery Gwangju Republic of KoreaSung-Chan Ki, Gwangju Christian Hospital Department of Orthopedic Surgery Gwangju Republic of KoreaKwang-Young So, Gwangju Christian Hospital Department of Orthopedic Surgery Gwangju Republic of KoreaDae-Hee Kim, Gwangju Christian Hospital Department of Orthopedic Surgery Gwangju Republic of KoreaKyung Ho Park, Gwangju Christian Hospital Department of Orthopedic Surgery Gwangju Republic of KoreaYeon Soo Lee, Gwangju Institute of Science and Technology School of Information and Mechatronics 1 Oryong-dong, Buk-gu Gwangju 500-712 Republic of Korea Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 5 / September, 2009

One-leg standing test for elderly populations

Abstract Background The one-leg standing (OLS) test is one of the balance tests used to diagnose musculoskeletal ambulation disability symptom complex (MARS), a condition newly defined by three professional Japanese medical societies in 2006 to help identify the symptoms of motor organ deterioration and establish preventive strategies. Although many studies have used the OLS test, none has shown conclusively that the test can be used as a practical marker of frailty among elderly people, especially in community settings. Based on the type of epidemiological study — i.e., descriptive epidemiology and analytical epidemiology (observational and intervention studies) — we reviewed evidence on three fundamental issues related to the OLS test: (1) testing procedures and reference values; (2) the associations between the OLS time and negative events; (3) improvement of the OLS time by intervention. These issues are key to any discussion of whether the OLS test can be used as a practical marker for predicting frailty in community-dwelling elderly populations. Methods Articles were collected from MEDLINE databases using the search terms “one- leg standing” and the other names included in the same category. Results Because various procedures are used to carry out the OLS test, the measured values for the OLS time varied widely from study to study. Some observational studies showed that the OLS time is related to negative events such as falls, declines in activity of daily living, and other morbidity. OLS times could be improved by several interventions. Conclusions This review suggests that the OLS test can be a tool for predicting frailty in community-dwelling elderly populations. However, our review should be interpreted with caution because we did not confirm the evidence level of each of the studies we selected. Further research on this topic is needed. Content Type Journal ArticleCategory Review ArticleDOI 10.1007/s00776-009-1371-6Authors Takehiro Michikawa, Keio University Department of Preventive Medicine and Public Health, School of Medicine 35 Shinanomachi, Shinjuku-ku Tokyo 160-8582 JapanYuji Nishiwaki, Keio University Department of Preventive Medicine and Public Health, School of Medicine 35 Shinanomachi, Shinjuku-ku Tokyo 160-8582 JapanToru Takebayashi, Keio University Department of Preventive Medicine and Public Health, School of Medicine 35 Shinanomachi, Shinjuku-ku Tokyo 160-8582 JapanYoshiaki Toyama, Keio University Department of Orthopaedic Surgery, School of Medicine Tokyo Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 5 / September, 2009

Analysis of early failure of the locking compression plate in osteoporotic proximal humerus fractures

Abstract Background Although there has been continuous evolution in the management of fracture fixation, treatment for osteoporotic proximal humerus fractures is still challenging to trauma surgeons. The purpose of this study was to report early failure of the locking compression plate (LCP) in the treatment of osteoporotic proximal humerus fracture and characterize the mode of failure. Methods Nine patients, older than 65 years, underwent internal fixation with the use of a locking compression plate and had early failure within 4 weeks postoperatively. According to Neer’s classification, five were included in a two-part surgical neck fracture, three in a three-part fracture, and one in a four-part fracture. Results All failures occurred with back-out of the plate—screw construct, leading to varus displacement in eight patients and plate breakage in one. Revision surgery was performed in six patients using replating and tension band wiring with a bone graft, and three patients underwent hemiarthroplasty. The average UCLA score was 25 points for the hemiarthroplasty group and 30 points for the reconstruction group. Conclusions Early postoperative failure of the LCP developed within 4 weeks with a presentation of en bloc back-out of the plate-screw construct and plate breakage. Possible risk factors included malreduction, loss of medial support, and negligence of tension band sutures on the tuberosities. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1382-3Authors Ivan D. Micic, Faculty of Medicine Department of Orthopaedic Surgery and Traumatology, Clinical Center Nis SerbiaKyung-Chun Kim, Chung-Nam National University Department of Orthopedic Surgery Daegu KoreaDong-Ju Shin, Daegu Fatima Hospital Daegu KoreaSang-Jin Shin, Ewha Woman’s University Seoul KoreaPoong-Taek Kim, Kyungpook National University Hospital Department of Orthopedic Surgery 50 Samduk 2, Chung-gu Daegu 700-721 KoreaIl-Hyung Park, Kyungpook National University Hospital Department of Orthopedic Surgery 50 Samduk 2, Chung-gu Daegu 700-721 KoreaIn-Ho Jeon, Kyungpook National University Hospital Department of Orthopedic Surgery 50 Samduk 2, Chung-gu Daegu 700-721 Korea Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 5 / September, 2009

Evaluation of instability after transtrochanteric anterior rotational osteotomy for nontraumatic osteonecrosis of the femoral head

Abstract Background Transtrochanteric anterior rotational osteotomy results in improvement of joint congruity and prevention of progressive collapse and osteoarthritic changes in patients with femoral head osteonecrosis. However, this procedure remains controversial for patients with extensive collapse due to potential osteoarthritis caused by postoperative instability. The purpose of this study was to evaluate hip instability after osteotomy and determine the relation between instability and radiological and clinical outcomes. Methods In all, 27 hips of 24 patients that were followed up for a mean period of 3.8 years were included. Instability was defined as more than 1 mm translation of the femoral head in transverse computed tomography scans obtained at 0° and 45° flexion of the hip joint. Hips were divided into instability and stability groups. Results Eleven hips (40%) developed instability after surgery. Osteophytes on the femoral head in 10 hips of the instability group and 2 hips of the stability group had increased in size at follow-up. There was a significant relation between postoperative instability and osteophyte formation. Joint space narrowing was not seen in any of the cases. There was no significant difference between the groups in either the postoperative intact ratio of the femoral head or the Japanese Orthopaedic Association hip score. Conclusions Neither instability nor osteophyte formation on the femoral head after transtrochanteric anterior rotational osteotomy correlated with progressive osteoarthritic changes or clinical outcome in the presence of an adequate femoral head intact ratio facing the weight-bearing area. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1363-6Authors Yasunari Hiranuma, Showa University School of Medicine Department of Orthopaedic Surgery, Fujigaoka Hospital 1-30 Fujigaoka, Aoba-ku Yokohama 227-8053 JapanTakashi Atsumi, Showa University School of Medicine Department of Orthopaedic Surgery, Fujigaoka Hospital 1-30 Fujigaoka, Aoba-ku Yokohama 227-8053 JapanToshihisa Kajiwara, Showa University School of Medicine Department of Orthopaedic Surgery, Fujigaoka Hospital 1-30 Fujigaoka, Aoba-ku Yokohama 227-8053 JapanSatoshi Tamaoki, Showa University School of Medicine Department of Orthopaedic Surgery, Fujigaoka Hospital 1-30 Fujigaoka, Aoba-ku Yokohama 227-8053 JapanYasuhiro Asakura, Showa University School of Medicine Department of Orthopaedic Surgery, Fujigaoka Hospital 1-30 Fujigaoka, Aoba-ku Yokohama 227-8053 Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 5 / September, 2009

Evolutional patterns of articular cartilage following growth plate injury in rats

Abstract Background No study to date has analyzed the damage of the articular cartilage and its relation to growth plate injury. The purpose of this study was to test whether primary injury to the growth plate contributes to secondary damage to the articular cartilage in rats. Methods A total of 109 two-week-old male Wistar rats were allocated to four lesional groups. In group I (controls) no surgery took place. In the remaining animals, an injury was caused in the proximal physis of the left tibia: group II, perichondrial ring injury; group III, direct injury to the growth plate; group IV, traumatic separation of the epiphysis where a Salter-Harris II-type injury was created. The results were assessed at 1 week, 6 weeks, and 6 months. A growth plate score was used. The stereological and histological changes in the articular cartilage were analyzed, and the results were subjected to statistical analysis. Results Histological studies showed discrete degenerative changes in the articular cartilage in the injured growth plate. Changes in the cell density, mean cell volume, and articular cartilage occurred in the injured growth plate. The changes appeared to be transient in groups II and III. Conclusions Primary injury to the growth plate contributes to secondary damage to the articular cartilage in young rats. Our data — extrapolated to the clinical view — suggests that a Salter-Harris type II injury does not seem to have impunity to subsequent joint degeneration. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1377-0Authors M. B. Quintana-Villamandos, University Hospital “Gregorio Marañón” Department of Anesthesiology Madrid SpainJ. J. Sánchez-Hernández, Universidad Autónoma de Madrid Department of Preventive Medicine and Public Health, Faculty of Medicine Madrid SpainM. J. Delgado-Martos, Universidad Autónoma de Madrid Orthopaedic Research Laboratory, Histology Unit, Faculty of Medicine Madrid SpainE. Delgado-Baeza, Universidad Autónoma de Madrid, Hospital “La Paz” Orthopaedic Research Laboratory, Histology Unit, Faculty of Medicine Madrid Spain Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 5 / September, 2009

Influence of the timing of surgery on mortality and activity of hip fracture in elderly patients

Abstract Background Existing reports describe the decline of the mortality rate by conducting surgery for hip fractures within 24 h; however, the theory is still controversial. We have compared the perioperative mortality rate, improvement of mobility, and duration of hospital stay for early surgery (within 24 h) and delayed surgery (beyond 24 h) between two groups. Methods We studied 536 cases of proximal femoral fracture in patients >60 years who were treated between September 2003 and December 2006. There were 91 men and 445 women, who had a total of 257 femoral neck fractures and 279 trochanteric fractures. In all, 270 patients were operated on within 24 h after injury and were defined as the early group; 266 patients were treated surgically more than 24 hours after injury and were defined as the delayed group. Based on admission laboratory tests, co-morbidity, dementia, preoperative mobility, and residential environment before injury, we compared the duration of hospital stay, mobility at discharge, and mortality rates between the early group and the delayed group. Results There was no significant difference in duration of hospital stay between the two groups. Improvement of mobility was 52% in the early group and 41% in the delayed group, with the difference being significant (P < 0.05). Inpatient mortality rate was 5.6% in the early group and 2.6% in the delayed group, but the difference was not significant. In the early group, men with co-morbidity, dementia, and abnormal laboratory values upon admission showed a significantly higher mortality rate. Conclusions Early surgery was useful for improving mobility, but it showed a higher mortality rate in patients with a compromised somatic condition at the time of the injury. For independent patients with a stabilized somatic condition, surgery should be performed within 24 h. For unstable cases, we believe it is better to provide early surgery after stabilizing the patient’s condition to the greatest possible extent. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1380-5Authors Toshiro Yonezawa, Higashi Totsuka Memorial Hospital Orthopaedic Department 548-7 Shinano-cho, Totsuka-ku Yokohama, Kanagawa 244-0801 JapanKen Yamazaki, Higashi Totsuka Memorial Hospital Orthopaedic Department 548-7 Shinano-cho, Totsuka-ku Yokohama, Kanagawa 244-0801 JapanTakashi Atsumi, Showa University School of Medicine Department of Orthopaedic Surgery, Fujigaoka Hospital Kanagawa JapanShu Obara, Showa University School of Medicine Department of Orthopaedic Surgery, Fujigaoka Hospital Kanagawa Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 5 / September, 2009

Prospective randomized controlled trial on the effect of fondaparinux sodium for prevention of venous thromboembolism after hip fracture surgery

Abstract Background Hip fracture surgery (HFS) carries a high risk of venous thromboembolism (VTE) in the absence of thromboprophylactic treatment. Previous reports have suggested that fondaparinux sodium (FPX) administration decreases the incidence of VTE after HFS and total hip and knee arthroplasties. However, investigations of that effect in Japanese populations remain inadequate. We evaluated the efficacy of FPX after HFS in a prospective randomized controlled trial. Methods Subjects comprised 76 consecutive Japanese patients who underwent HFS and were randomly assigned to the FPX group, who received subcutaneous injections of FPX 2.5 mg/day for 14 days beginning the next after HFS, or the control group (non-FPX group). D-dimer values were measured on admission and 7 and 14 days after HFS. Subjects with D-dimer levels over the cutoff value (> 20 µg/ml on day 7) underwent enhanced computed tomography (CT) to evaluate the possibility of deep vein thrombosis (DVT) of the lower extremities. D-dimer values, the incidence of DVT, and side effects associated with a bleeding tendency (i.e., hematoma or massive bleeding) were compared between groups. Results The FPX group showed significantly lower D-dimer levels than the non-FPX group at 7 and 14 days after HFS (P < 0.05). Only one case in the FPX group exceeded the D-dimer cutoff compared to 12 cases in the non-FPX group (P = 0.001). DVTs were found with enhanced CT in one case in the FPX group and in five cases in the non-FPX group. In the FPX group, symptomatic hematoma at the surgical site and/or decreased hemoglobin > 2 g/dl was noted in four cases (10.5%). Postoperative drainage volumes did not differ significantly between groups. Conclusions FPX administration demonstrated positive effects on the prevention of VTE after HFS. However, careful postoperative observation is warranted to prevent serious side effects after FPX administration. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1365-4Authors Satoshi Sasaki, Yuri-Kumiai General Hospital Department of Orthopedic Surgery 38 Yago Kawaguchi Yuri-Honjo 015-8511 JapanNaohisa Miyakoshi, Akita University School of Medicine Division of Orthopedic Surgery, Department of Neuro and Locomotor Science Akita JapanHiroshi Matsuura, Yuri-Kumiai General Hospital Department of Orthopedic Surgery 38 Yago Kawaguchi Yuri-Honjo 015-8511 JapanHidetomo Saitoh, Yuri-Kumiai General Hospital Department of Orthopedic Surgery 38 Yago Kawaguchi Yuri-Honjo 015-8511 JapanDaisuke Kudoh, Akita Rosai Hospital Department of Orthopedic Surgery Akita JapanYoichi Shimada, Akita University School of Medicine Division of Orthopedic Surgery, Department of Neuro and Locomotor Science Akita Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 5 / September, 2009

How accurate is image-free computer navigation for hip resurfacing arthroplasty? An anatomical investigation

Abstract Background The existing studies concerning image-free navigated implantation of hip resurfacing arthroplasty are based on analysis of the accuracy of conventional biplane radiography. Studies have shown that these measurements in biplane radiography are imprecise and that precision is improved by use of three-dimensional (3D) computer tomography (CT) scans. To date, the accuracy of image-free navigation devices for hip resurfacing has not been investigated using CT scans, and anteversion accuracy has not been assessed at all. Furthermore, no study has tested the reliability of the navigation software concerning the automatically calculated implant position. The purpose of our study was to analyze the accuracy of varus-valgus and anteversion using an image-free hip resurfacing navigation device. The reliability of the software-calculated implant position was also determined. Methods A total of 32 femoral hip resurfacing components were implanted on embalmed human femors using an image-free navigation device. In all, 16 prostheses were implanted with the proposed position generated by the navigation software; the 16 prostheses were inserted in an optimized valgus position. A 3D CT scan was undertaken before and after operation. Results The difference between the measured and planned varus-valgus angle averaged 1° (mean ± SD: group I, 1° ± 2°; group II, 1° ± 1°). The mean ± SD difference between femoral neck anteversion and anteversion of the implant was 4° (group I, 4° ± 4°; group II, 4° ± 3°). The software-calculated implant position differed 7° ± 8° from the measured neck-shaft angle. These measured accuracies did not differ significantly between the two groups. Conclusions Our study proved the high accuracy of the navigation device concerning the most important biomechanical factor: the varus-valgus angle. The software calculation of the proposed implant position has been shown to be inaccurate and needs improvement. Hence, manual adjustment of the implant position in the software-planning step is frequently required. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1356-5Authors C. Schnurr, Rheinische Klinik für Orthopädie Viersen Horionstrasse 2 Viersen 41749 GermanyJ. Nessler, Rheinische Klinik für Orthopädie Viersen Horionstrasse 2 Viersen 41749 GermanyC. Meyer, University of Bonn Department of Radiology Bonn GermanyH. H. Schild, University of Bonn Department of Radiology Bonn GermanyJ. Koebke, University of Cologne Department of Anatomy Cologne GermanyD. P. König, Rheinische Klinik für Orthopädie Viersen Horionstrasse 2 Viersen 41749 Germany Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 5 / September, 2009

Shortening and secondary relengthening for chronically infected tibial pseudarthroses with poor soft tissues

Abstract Background The treatment of chronically infected tibial pseudarthroses with poor soft tissues ends with amputation on many occasions. Aggressive débridement of bone and soft tissue and reconstruction of the extremity, performed as a limb salvage procedure, is an alternative treatment option to amputation. Methods Our patients had a mean age of 42 years. According to the Paley classification, one of the patients had A2 pseudoarthrosis, four had B2, and three had B3. One had localized infection, whereas the other seven had diffuse infection, according to the Cierny-Mader system. The mean duration of the infection was 10.75 years, and the mean number of previous operations was 5.13. The mean shortness was 2.4 cm, and the mean bone defect was 1 cm. Results The mean primary shortening was 8.6 cm, the mean duration of the fixator stay was 9.6 months, and the mean distraction index was 39.1 days/cm. The mean duration of follow-up was 25 months. The bone results were excellent in four cases, good in two, and fair in the other two. The functional results were excellent in one patient, good in six, and fair in one. A total of 11 minor and 3 major complications were seen during the treatment, and one case resulted in amputation. Coclusions Despite the high rate of complications, our treatment method enabled limb salvage for patients who had previously been candidates for amputation. With this treatment, there is less need for a second operation, and an additional operation is not necessary for soft tissue coverage. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1364-5Authors Bilal Demir, Baltalimani Metin Sabanci Bone and Joint Diseases Education and Research Hospital 67. Ada. Kardelen 4/11 D.19 Atasehir Istanbul TurkeySarper Gursu, Baltalimani Metin Sabanci Bone and Joint Diseases Education and Research Hospital 67. Ada. Kardelen 4/11 D.19 Atasehir Istanbul TurkeyRamadan Oke, Baltalimani Metin Sabanci Bone and Joint Diseases Education and Research Hospital 67. Ada. Kardelen 4/11 D.19 Atasehir Istanbul TurkeyNuri M. Konya, Baltalimani Metin Sabanci Bone and Joint Diseases Education and Research Hospital 67. Ada. Kardelen 4/11 D.19 Atasehir Istanbul TurkeyKahraman Ozturk, Baltalimani Metin Sabanci Bone and Joint Diseases Education and Research Hospital 67. Ada. Kardelen 4/11 D.19 Atasehir Istanbul TurkeyVedat Sahin, Baltalimani Metin Sabanci Bone and Joint Diseases Education and Research Hospital 67. Ada. Kardelen 4/11 D.19 Atasehir Istanbul Turkey Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 5 / September, 2009

Caffeine-potentiated chemotherapy for metastatic osteosarcoma

Abstract Background The prognosis for patients with metastatic osteosarcoma is still poor despite the development of effective adjuvant and neoadjuvant chemotherapy regimens. We have developed caffeine-potentiated chemotherapy for treatment of high-grade bone and soft tissue sarcomas based on the ability of caffeine to enhance the cytocidal effects of anticancer drugs. We report results of caffeine-potentiated chemotherapy for patients with osteosarcoma with pulmonary metastases. Methods We analyzed retrospectively overall survival and some prognostic factors for 41 patients with osteosarcoma/pulmonary metastases who were treated with caffeine-potentiated chemotherapy between 1990 and 2006. Results The mean follow-up of all patients was 32.7 months. At the time of the final follow-up, 11 patients were alive and 30 had died of disease. Overall survival rates at 2 and 5 years were 38% and 28%, respectively. We identified the primary tumor site, the histological response to preoperative chemotherapy, the number of pulmonary nodules at initial identification, the timing of pulmonary metastasis identification, and the existence of extrapulmonary metastasis as prognostic factors. Especially, the number of pulmonary nodules at initial identification and the timing of pulmonary metastasis identification were independent, strong prognostic factors. Patients with solitary pulmonary metastasis had good prognoses, and their overall 5-year survival rate was 60%; in contrast, survival was 28% in patients with two to five pulmonary nodules, and no patients with more than six nodules survived 5 years. Patients with pulmonary metastasis identified after completion of treatment had the best prognosis, whereas patients with pulmonary metastases identified during treatment had the worst prognosis. Conclusions Caffeine-potentiated chemotherapy prolonged survival of patients who had osteosarcoma with pulmonary metastasis. Especially, patients with pulmonary metastasis identified after completion of treatment or with a solitary pulmonary nodule had good prognoses. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1372-5Authors Hiroaki Kimura, Kanazawa University Department of Orthopaedic Surgery, Graduate School of Medical Science 13-1 Takaramachi Kanazawa, Ishikawa 920-8641 JapanHiroyuki Tsuchiya, Kanazawa University Department of Orthopaedic Surgery, Graduate School of Medical Science 13-1 Takaramachi Kanazawa, Ishikawa 920-8641 JapanToshiharu Shirai, Kanazawa University Department of Orthopaedic Surgery, Graduate School of Medical Science 13-1 Takaramachi Kanazawa, Ishikawa 920-8641 JapanHideji Nishida, Kanazawa University Department of Orthopaedic Surgery, Graduate School of Medical Science 13-1 Takaramachi Kanazawa, Ishikawa 920-8641 JapanKatsuhiro Hayashi, Kanazawa University Department of Orthopaedic Surgery, Graduate School of Medical Science 13-1 Takaramachi Kanazawa, Ishikawa 920-8641 JapanAkihiko Takeuchi, Kanazawa University Department of Orthopaedic Surgery, Graduate School of Medical Science 13-1 Takaramachi Kanazawa, Ishikawa 920-8641 JapanIssei Ohnari, Kanazawa University Department of Orthopaedic Surgery, Graduate School of Medical Science 13-1 Takaramachi Kanazawa, Ishikawa 920-8641 JapanKatsuro Tomita, Kanazawa University Department of Orthopaedic Surgery, Graduate School of Medical Science 13-1 Takaramachi Kanazawa, Ishikawa 920-8641 Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 5 / September, 2009

Is a minimally invasive approach superior to a conventional approach for total knee arthroplasty? Early outcome and 2- to 4-year follow-up

Abstract Background Total knee arthroplasty (TKA) has been widely applied as an effective treatment for knee arthritis for several decades. More recently, minimally invasive surgery (MIS) has been developed for TKA. The purpose of this study was to clarify the difference in clinical results between MIS and conventional TKA. We hypothesized that knee function would recover earlier with MIS than with conventional TKA without major problems, and hence the middle-term outcome would be better with MIS TKA. Methods We retrospectively reviewed 48 primary TKAs performed using the same model of a posterior stabilized prosthesis by a single surgeon at our institution: 25 knees treated by a mini midvastus approach (MIS group) and 23 knees treated by a conventional midvastus approach (conventional group). Outcomes at the early stage and at the 2- to 4-year follow-up were evaluated and compared between the two groups. Results The average length of the skin incision was 10.9 cm in the MIS group and 17.1 cm in the conventional group. The duration of the surgery did not differ significantly between the two groups. Most of the components were correctly implanted in both groups, and no complications were observed. Active straight-leg raising could be achieved significantly earlier in the MIS group. Knee function at the 2- to 4-year follow-up did not significantly differ between the two groups. Conclusions The early results and the wide indication encourage us to apply the MIS approach instead of the conventional technique. The limitation of this study was the small number of cases in the retrospective point of view. If the number were larger, perhaps other significant differences could be detected. Further investigations on a larger scale are required to solve this problem. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1383-2Authors Toshifumi Watanabe, Tsuchiura Kyodo General Hospital Department of Orthopaedic Surgery 11-7 Manabeshinmachi, Tsuchiura Ibaraki 300-0053 JapanTakeshi Muneta, Tokyo Medical and Dental University Department of Orthopaedic Surgery Tokyo JapanMasafumi Ishizuki, Tsuchiura Kyodo General Hospital Department of Orthopaedic Surgery 11-7 Manabeshinmachi, Tsuchiura Ibaraki 300-0053 Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 5 / September, 2009

Raloxifene: its ossification-promoting effect on female mesenchymal stem cells

Abstract Background Raloxifene acts like estrogen in preventing bone loss in postmenopausal women, but it selectively activates biological responses in bone tissue. It has a direct effect on osteoblasts’ differentiation and bone formation in bone marrow culture. However, the point at which raloxifene has an effect on bone marrow-derived mesenchymal stem cells (MSCs), regardless of sex difference, is not known. The purpose of this study was to examine the osteogenic effect of raloxifene on MSCs derived from female and male rats and to assess the sex difference of raloxifene with or without osteogenic supplements (OSs) in the regulation of bone formation. Methods Female and male rat bone marrow cells were cultured with or without OSs. In each experimental group, 10-6 M or 10-8 M raloxifene was added. As a control, cells were cultured without raloxifene. Histologically, mineralization was assessed by alizarin red S staining. Biochemically, alkaline phosphatase (ALP) activity, calcium content, and osteocalcin content were assessed. Results On histological analysis, mineralized nodules were seen on alizarin red S staining in the groups treated with OS. On the biochemical analysis, OS increased ALP activity, calcium content, and osteocalcin content. Among female groups with OSs, 10-6 M raloxifene significantly increased ALP activity, calcium content, and osteocalcin content compared with the controls. Among male groups, raloxifene had negligible effects. Conclusions 10-6 M Raloxifene had no ossification-inducing effect on female MSCs, but it had an ossification-promoting effect; it had no osteogenic effect on male MSCs. Therefore, raloxifene has a sex difference with regard to its osteogenic effect on MSCs. Moreover, combined treatment with raloxifene plus OS has an effect on female MSCs. These results provide a useful insight into the possible influence of raloxifene after MSC transplantation in clinical practice. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1357-4Authors Hiroaki Matsumori, Nara Medical University Department of Orthopaedic Surgery Kashihara, Nara JapanKoji Hattori, Nara Medical University Department of Orthopaedic Surgery Kashihara, Nara JapanHajime Ohgushi, National Institute of Advanced Industrial Science and Technology Research Institute for Cell Engineering Amagasaki, 3-11-46 Nakoji Amagasaki, Hyogo 661-0974 JapanYoshiko Dohi, Nara Medical University Department of Public Health, Health Management and Policy Nara JapanYurito Ueda, Nara Medical University Department of Orthopaedic Surgery Kashihara, Nara JapanHideki Shigematsu, Nara Medical University Department of Orthopaedic Surgery Kashihara, Nara JapanNobuhisa Satoh, Nara Medical University Department of Orthopaedic Surgery Kashihara, Nara JapanHiroshi Yajima, Nara Medical University Department of Orthopaedic Surgery Kashihara, Nara JapanYoshinori Takakura, Nara Medical University Department of Orthopaedic Surgery Kashihara, Nara Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 5 / September, 2009

Nonbacterial osteitis: a clinical, histopathological, and imaging study with a proposal for protocol-based management of patients with this diagnosis

Abstract Background Nonbacterial osteitis (NBO), a term referring to sterile bone lesions with nonspecific histopathological features of inflammation, may be either unifocal or multifocal, acute (≤6 months) or chronic, and recurrent. Only when the condition is chronic, recurrent, and multifocal is it appropriate to use the term chronic recurrent multifocal osteomyelitis (CRMO). We present our clinical experience as the largest reported series of children with NBO to date. Methods We report a retrospective clinical, histopathological, and radiological study of 41 children with nonbacterial osteitis. Results Of 41 children (2–16 years of age) diagnosed with NBO in our institution over the last 6 years, 21 (51%) had recurrent disease and 18 (44%) had multifocal disease. The most common bones affected were the clavicle, femur, and tibia (in order of decreasing prevalence) accounting for 44 (63%) of a total of 70 lesions. Only one individual had SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis) and no other patients had evidence of bowel or skin disease. In the absence of evidence for an infective etiology, we recommend nonsteroidal anti-inflammatory agents as the firstline therapy and bisphosphonates only in cases of resistant disease. Conclusions On the basis of our findings, we propose using a patient questionnaire and protocol for investigating and managing patients who present with NBO to orthopedic surgeons. We predict that this will benefit patients with this disorder by improving our knowledge of the presenting signs and symptoms and related disorders, rationalizing the therapeutic approach, and allowing us to learn about the natural history of the disease. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1381-4Authors Panagiotis D. Gikas, Bone Tumour Unit, Royal National Orthopaedic Hospital Stanmore, Middlesex UKLily Islam, Royal National Orthopaedic Hospital Department of Histopathology Stanmore, Middlesex UKWilliam Aston, Bone Tumour Unit, Royal National Orthopaedic Hospital Stanmore, Middlesex UKRoberto Tirabosco, Royal National Orthopaedic Hospital Department of Histopathology Stanmore, Middlesex UKAsif Saifuddin, Royal National Orthopaedic Hospital Department of Radiology Stanmore, Middlesex UKTimothy W. R. Briggs, Bone Tumour Unit, Royal National Orthopaedic Hospital Stanmore, Middlesex UKSteve R. Cannon, Bone Tumour Unit, Royal National Orthopaedic Hospital Stanmore, Middlesex UKPaul O’Donnell, Royal National Orthopaedic Hospital Department of Radiology Stanmore, Middlesex UKBenjamin Jacobs, Royal National Orthopaedic Hospital Department of Paediatrics Stanmore, Middlesex UKAdrienne M. Flanagan, Royal National Orthopaedic Hospital Department of Histopathology Stanmore, Middlesex UK Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 5 / September, 2009

Efficacy of clarithromycin plus vancomycin in mice with implant-related infection caused by biofilm-forming Staphylococcus aureus

Abstract Background Staphylococcal biofilms pose an important problem, especially after orthopedic surgery using foreign implants. Clarithromycin (CAM) eliminates the biofilms formed by a wide variety of aerobic and anaerobic bacteria. In a previous in vitro study, we showed that treatment with CAM and vancomycin (VCM) eradicated staphylococcal biofilms from surgical implants. To investigate the efficacy of this eradication therapy, we assessed its effects against Staphylococcus aureus on titanium plates implanted in mice. Methods A titanium washer covered with S. aureus biofilms was implanted in the muscular tissue around the femoral bone. Mice were given intravenous injections of CAM and intraperitoneal injections of VCM twice daily beginning 72 h after implantation. To confirm eradication of biofilms and S. aureus strains, the resected washer was examined by scanning electron microscopy. Results Dense colonization and biofilms were seen on the washer implanted in the control mice that received saline, saline plus CAM, or saline plus VCM. Treatment with CAM plus VCM eliminated the biofilms, indicating an S. aureus eradication effect. Conclusions Staphylococcal biofilms have demonstrated resistance to most antibiotics, including VCM. Our in vivo data support the hypothesis that combined treatment using CAM plus VCM may effectively eradicate staphylococcal biofilms in patients with implant-related infection. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1366-3Authors Shigeru Fujimura, Tohoku University Research Division for Development of Anti-infection Agents, Institute of Development Aging and Cancer 4-1 Seiryo-machi, Aoba-ku Sendai 980-8575 JapanTetsuro Sato, Sendai Orthopedic Hospital Sendai JapanToshiaki Kikuchi, Tohoku University School of Medicine Department of Respiratory Medicine Sendai JapanJamal Zaini, Tohoku University School of Medicine Department of Respiratory Medicine Sendai JapanKazunori Gomi, Tohoku University School of Medicine Department of Respiratory Medicine Sendai JapanAkira Watanabe, Tohoku University Research Division for Development of Anti-infection Agents, Institute of Development Aging and Cancer 4-1 Seiryo-machi, Aoba-ku Sendai 980-8575 Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 5 / September, 2009

Surgery for scapula process fractures.

Related Articles Surgery for scapula process fractures. Acta Orthop. 2009;80(3):344-350 Authors: Anavian J, Wijdicks CA, Schroder LK, Vang S, Cole PA Background Generally, scapula process fractures (coracoid and acromion) have been treated nonoperatively with favorable outcome, with the exception of widely displaced fractures. Very little has been published, however, regarding the operative management of such fractures and the literature that is available involves very few patients. Our hypothesis was that operative treatment of displaced acromion and coracoid fractures is a safe and effective treatment that yields favorable surgical results. Methods We reviewed 26 consecutive patients (27 fractures) treated between 1998 and 2007. Operative indications for these process fractures included either a painful nonunion, a concomitant ipsilateral operative scapula fracture, >/= 1 cm of displacement on X-ray, or a multiple disruption of the superior shoulder suspensory complex. All patients were followed until they were asymptomatic, displayed radiographic fracture union, and had recovered full motion with no pain. Patients and results 21 males and 5 females, mean age 36 (18-67) years, were included in the study. 18 patients had more than one indication for surgery. Of the 27 fractures, there were 13 acromion fractures and 14 coracoid fractures. 1 patient was treated for both a coracoid and an acromion fracture. Fracture patterns for the acromion included 6 acromion base fractures and 7 fractures distal to the base. Coracoid fracture patterns included 11 coracoid base fractures and 3 fractures distal to the base. Mean follow-up was 11 (2-42) months. All fractures united and all patients had recovered full motion with no pain at the time of final follow-up. 3 patients underwent removal of hardware due to irritation from hardware components that were too prominent. There were no other complications. Interpretation While most acromion and coracoid fractures can be treated nonoperatively with satisfactory results, operative management may be indicated for displaced fractures and double lesions of the superior shoulder suspensory complex. PMID: 19857183 [PubMed - as supplied by publisher]

Growth rate after limb deformity correction by the Ilizarov method with or without knee joint distraction.

Related Articles Growth rate after limb deformity correction by the Ilizarov method with or without knee joint distraction. Acta Orthop. 2009;80(3):338-343 Authors: Oostenbroek HJ, Brand R, van Roermund PM Background and purpose Growth inhibition and stimulation have both been reported after juvenile limb lengthening. Distraction of a joint usually suspends and unloads the growth plate and may stimulate growth. We investigated the influence of knee joint distraction on the speed of growth after limb lengthening. Methods In a retrospective study, growth patterns were analyzed in 30 children mean 61 (24-109) months after limb lengthening with the Ilizarov method, each child having more than 2 years of remaining growth. In 14 patients with knee joint instability, the knee was bridged over during lengthening for joint stabilization. Whether or not joint bridging and distraction would affect patterns of growth of the lengthened limb by unloading the growth plate was evaluated with a repeated measurements analysis of variance. Results After lengthening procedures, the proportionate leg-length discrepancy was found to decrease in 16 children, suggesting increased growth rate in the lengthened limbs. A statistically significantly faster growth rate was seen in 8 of 14 patients with knee distraction as compared to patients with single bone frame configurations. Interpretation Further research is required to investigate whether growth stimulation is due to the surgical technique and whether joint distraction should be recommended during limb lengthening in growing children. PMID: 19857182 [PubMed - as supplied by publisher]

The osteogenic response of undifferentiated human mesenchymal stem cells (hMSCs) to mechanical strain is inversely related to body mass index of the donor.

Related Articles The osteogenic response of undifferentiated human mesenchymal stem cells (hMSCs) to mechanical strain is inversely related to body mass index of the donor. Acta Orthop. 2009;80(4):491-498 Authors: Friedl G, Windhager R, Schmidt H, Aigner R Background While the importance of physical factors in the maintenance and regeneration of bone tissue has been recognized for many years and the mechano-sensitivity of bone cells is well established, there is increasing evidence that body fat constitutes an independent risk factor for complications in bone fracture healing and aseptic loosening of implants. Although mechanical causes have been widely suggested, we hypothesized that the osteogenic mechano-response of human mesenchymal stem cells (hMSCs) may be altered in obese patients. Methods We determined the phenotypic and genotypic response of undifferentiated hMSCs of 10 donors to cyclic tensile strain (CTS) under controlled in vitro conditions and analyzed the potential relationship relevant to the donor's anthropomorphometric and biochemical parameters related to donor's fat and bone metabolism. Results and interpretation The osteogenic marker genes were all statistically significantly upregulated by CTS, which was accompanied by a significant increase in cell-based ALP activity. Linear correlation analysis revealed that there was a significant correlation between phenotypic CTS response and the body mass index of the donor (r = -0.91, p < 0.001) and phenotypic CTS response was also significantly related to leptin levels (r = -0.68) and estradiol levels (r = 0.67) within the bone marrow microenvironment of the donor. Such an upstream imprinting process mediated by factors tightly related to the donor's fat metabolism, which hampers the mechanosensitivity of hMSCs in obese patients, may be of pathogenetic relevance for the complications associated with obesity that are seen in orthopedic surgery. PMID: 19857181 [PubMed - as supplied by publisher]

Open reduction and internal fixation compared to closed reduction and external fixation in distal radial fractures.

Related Articles Open reduction and internal fixation compared to closed reduction and external fixation in distal radial fractures. Acta Orthop. 2009;80(4):478-485 Authors: Abramo A, Kopylov P, Geijer M, Tägil M Background and purpose In unstable distal radial fractures that are impossible to reduce or to maintain in reduced position, the treatment of choice is operation. The type of operation and the choice of implant, however, is a matter of discussion. Our aim was to investigate whether open reduction and internal fixation would produce a better result than traditional external fixation. Methods 50 patients with an unstable or comminute distal radius fracture were randomized to either closed reduction and bridging external fixation, or open reduction and internal fixation using the TriMed system. The primary outcome parameter was grip strength, but the patients were followed for 1 year with objective clinical assessment, subjective outcome using DASH, and radiographic examination. Results At 1 year postoperatively, grip strength was 90% (SD 16) of the uninjured side in the internal fixation group and 78% (17) in the external fixation group. Pronation/supination was 150 degrees (15) in the internal fixation group and 136 degrees (20) in the external fixation group at 1 year. There were no differences in DASH scores or in radiographic parameters. 5 patients in the external fixation group were reoperated due to malunion, as compared to 1 in the internal fixation group. 7 other cases were classified as radiographic malunion: 5 in the external fixation group and 2 in the internal fixation group. Interpretation Internal fixation gave better grip strength and a better range of motion at 1 year, and tended to have less malunions than external fixation. No difference could be found regarding subjective outcome. PMID: 19857180 [PubMed - as supplied by publisher]

Shoulder rhythm in patients with impingement and in controls.

Related Articles Shoulder rhythm in patients with impingement and in controls. Acta Orthop. 2009;80(4):456-464 Authors: Hallström E, Kärrholm J Background and purpose Impingement syndrome is probably the most common cause of shoulder pain. Abnormal abduction and proximal humeral translation are associated with this condition. We evaluated whether the relative distribution between glenohumeral and scapular-trunk motions (the scapulohumeral rhythm) and the speed of motion of the arm differed between patients with impingement and a control group without shoulder symptoms. Patients and methods 30 patients with shoulder impingement (Neer stage 2) and 11 controls were studied during active abduction and 21 patients and 9 controls were studied during passive abduction. Dynamic RSA at a speed of 2 simultaneous exposures per second was used to record the shoulder motions for 5-6 seconds. Results Within the interval statistically evaluated (observations between 20-55 degrees of relative active abduction in the glenohumeral joint), the patient group showed more scapular and trunk motions (p = 0.04), especially at up to 40 degrees . The pattern of motion at passive abduction was somewhat similar to that in the controls. Both controls and patients showed an increasing absolute (i.e. global) proximal displacement of the center of the humeral head with increasing active and passive abduction of the glenohumeral joint and humerus, without any certain difference between the groups. The mean maximum absolute proximal displacement in the patient and control groups amounted to about 30 mm and 20 mm, respectively. The corresponding relative displacement (with fixed scapula) was only 2.0 and 0.5 mm. Active abduction was initiated with angular velocity of about 50 and 80 degrees per second, respectively, in the patients and the controls. In both groups it decreased with progressing abduction down to about 20 degrees per second (controls) after 3 seconds without there being any statistically significant difference. The angular velocities at passive abduction showed a similar pattern, still without any difference. In both groups, the speed of proximal translation during active abduction peaked 0.5-1 second later than the speed of rotation and remained relatively even for about 1 second, followed by a deceleration. Interpretation We found that the glenohumeral-thoracoscapular ratio during abduction of the arm in our study, measured as the distribution of motion between the glenohumeral joint and the trunk in both controls and patients with impingement, was less than or equal to 1:1. This finding differs from earlier results, probably due to the use of a method with high resolution and small influence of motions out of the frontal plane. The reason for reduced glenohumeral motions in the early phase of active abduction in the patient group is uncertain, but pain or avoidance of pain elicited by the motion was probably of importance. PMID: 19857179 [PubMed - as supplied by publisher]

18 years of results with cemented primary hip prostheses in the Norwegian Arthroplasty Register.

Related Articles 18 years of results with cemented primary hip prostheses in the Norwegian Arthroplasty Register. Acta Orthop. 2009;80(4):402-412 Authors: Espehaug B, Furnes O, Engesæter LB, Havelin LI Background and purpose Few studies have compared the long-term survival of cemented primary total hip arthroplasties (THAs), and several prostheses have been used without adequate knowledge of their endurance. We studied long-term outcome based on data in the Norwegian Arthroplasty Register. Patients and methods The 10 most used prosthesis brands in 62,305 primary Palacos or Simplex cemented THAs reported to the Register from 1987 through 2007 were included. Survival analyses with revision as endpoint (for any cause or for aseptic loosening) were performed using Kaplan-Meier and multiple Cox regression with time-dependent covariates. Revision rate ratios (RRs) were estimated for the follow-up intervals: 0-5, 6-10, and > 10 years. Results 5 prosthesis brands (cup/stem combinations) (Charnley, Exeter, Titan, Spectron/ITH, Link IP/Lubinus SP; n = 24,728) were investigated with 0-20 year follow-up (inserted 1987-1997). After 18 years, 11% (95% CI: 10.6-12.1) were revised for any cause and 8.4% (7.7-9.1) for aseptic loosening. Beyond 10 years of follow-up, the Charnley cup had a lower revision rate due to aseptic loosening than Exeter (RR = 1.8) and Spectron (RR = 2.4) cups. For stems, beyond 10 years we did not find statistically significant differences comparing Charnley with Titan, ITH, and SP stems, but the Exeter stem had better results (RR = 0.5). 10 prosthesis brands (9 cups in combination with 6 stems; n = 37,577) were investigated with 0-10 years of follow-up (inserted from 1998 through 2007). The Charnley cup had a lower revision rate due to aseptic loosening than all cups except the IP. Beyond 5 years follow-up, the Reflection All-Poly cup had a 14 times higher revision rate. For stems, beyond 5 years the Spectron-EF (RR = 6.1) and Titan (RR = 5.5) stems had higher revision rates due to aseptic loosening than Charnley. The analyses also showed a marked improvement in Charnley results between the periods 1987-1997 and 1998-2007. Interpretation We observed clinically important differences between cemented prosthesis brands and identified inferior results for previously largely undocumented prostheses, including the commonly used prosthesis combination Reflection All-Poly/Spectron-EF. The results were, however, satisfactory according to international standards. PMID: 19857178 [PubMed - as supplied by publisher]