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Effects of hyaluronan on vascular endothelial growth factor and receptor-2 expression in a rabbit osteoarthritis model

Abstract Background Little is known about the expression of vascular endothelial growth factor (VEGF) and its receptor-2 (VEGFR-2) mRNA in the cartilage of a rabbit osteoarthritis model or the influence of intraarticular injection of hyaluronan (HA) on the expression of VEGF and VEGFR-2 in cartilage during the process of osteoarthritis (OA). The therapeutic mechanism of HA is not completely understood, and we hypothesize that the mechanism is through the effects of VEGF and VEGFR2. In this study, we determined the VEGF and VEGFR-2 mRNA expression in a rabbit OA model and assessed the therapeutic mechanism of HA against OA. Methods We carried out this study at the Center Laboratory of Renmin Hospital at Wuhan University and the Key Laboratory of Respiratory Disease of the Ministry of Public Health, Huazhong University of Science and Technology. Between October 2006 and April 2008 a total of 24 mature New Zealand white rabbits were divided into three groups: normal controls, a no-HA group, and an HA group. The no-HA and HA groups underwent unilateral anterior cruciate ligament transection. At 4 weeks after the operation, animals in the HA group received intraarticular injections of 1% sodium hyaluronate (HA) once a week for 5 weeks as per the clinical treatment presently utilized. The no-HA rabbits were not given HA. At death, 11 weeks following surgery, cartilage was harvested and total RNA was extracted. VEGF and VEGFR mRNAs were analyzed using the reverse transcriptionpolymerase chain reaction (RT-PCR) and real-time PCR for each group. Results Cartilage damage (both extent and grade) was less severe in the HA group than in the no-HA group. VEGF and VEGFR-2 mRNA expression was enhanced in the cartilage of the OA model. Intraarticular 1% sodium hyaluronate injection inhibited VEGFR-2 expression but had no effect on reducing the VEGF mRNA expression in cartilage. Conclusions These results suggested that VEGF and VEGFR-2 may be involved in the progression of OA and in the therapeutic mechanism of HA at least partly through the influence of VEGFR-2 expression during the development of OA. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1329-8Authors Jian-Lin Zhou, Renmin Hospital of Wuhan University Department of Orthopedics Wuhan 430060 Hubei Province People’s Republic of ChinaShi-Qing Liu, Renmin Hospital of Wuhan University Department of Orthopedics Wuhan 430060 Hubei Province People’s Republic of ChinaBo Qiu, Renmin Hospital of Wuhan University Department of Orthopedics Wuhan 430060 Hubei Province People’s Republic of ChinaQiong-Jie Hu, Huazhong University of Science and Technology, Key Laboratory of Respiratory Disease of Ministry of Public Health Department of Respiratory Medicine, Tongji Hospital, Tongji Medical College Wuhan 430030 Hubei Province People’s Republic of ChinaJiang-Hua Ming, Renmin Hospital of Wuhan University Department of Orthopedics Wuhan 430060 Hubei Province People’s Republic of ChinaHao Peng, Renmin Hospital of Wuhan University Department of Orthopedics Wuhan 430060 Hubei Province People’s Republic of China Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 3 / May, 2009

Intraspinal canal migration of distal occipitocervical instrumentation rods causing incomplete tetraplegia

Intraspinal canal migration of distal occipitocervical instrumentation rods causing incomplete tetraplegia Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00776-008-1321-8Authors Naohisa Miyakoshi, Akita University School of Medicine Division of Orthopedic Surgery, Department of Neuro and Locomotor Science Akita 010-8543 JapanYuji Kasukawa, Akita University School of Medicine Division of Orthopedic Surgery, Department of Neuro and Locomotor Science Akita 010-8543 JapanShigeru Ando, Akita University School of Medicine Division of Orthopedic Surgery, Department of Neuro and Locomotor Science Akita 010-8543 JapanMichio Hongo, Akita University School of Medicine Division of Orthopedic Surgery, Department of Neuro and Locomotor Science Akita 010-8543 JapanYoichi Shimada, Akita University School of Medicine Division of Orthopedic Surgery, Department of Neuro and Locomotor Science Akita 010-8543 Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 3 / May, 2009

JOA Back Pain Evaluation Questionnaire (JOABPEQ)/JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) The report on the development of revised versions April 16, 2007

JOA Back Pain Evaluation Questionnaire (JOABPEQ)/JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) The report on the development of revised versions April 16, 2007 Content Type Journal ArticleCategory From the Japanese Orthopaedic AssociationDOI 10.1007/s00776-009-1337-8Authors Mitsuru Fukui, Osaka City University Faculty of Medicine Laboratory of Statistics Osaka JapanKazuhiro Chiba, Keio University Department of Orthopaedic Surgery 35 Shinanomachi, Shinjuku Tokyo 160-8582 JapanMamoru Kawakami, Wakayama Medical University Department of Orthopaedic Surgery Wakayama JapanShinichi Kikuchi, Fukushima Medical University Department of Orthopaedic Surgery, School of Medicine Fukushima JapanShinichi Konno, Fukushima Medical University Department of Orthopaedic Surgery, School of Medicine Fukushima JapanMasabumi Miyamoto, Nippon Medical School Department of Orthopedic Surgery Tokyo JapanAtsushi Seichi, The University of Tokyo Department of Orthopaedic Surgery Tokyo JapanTadashi Shimamura, Iwate Medical University School of Medicine Department of Orthopaedic Surgery Morioka JapanOsamu Shirado, Saitama Medical School Department of Orthopaedic Surgery Saitama JapanToshihiko Taguchi, Yamaguchi University School of Medicine Department of Orthopedic Surgery Yamaguchi JapanKazuhisa Takahashi, Chiba University Department of Orthopedic Surgery, Graduate School of Medicine Chiba JapanKatsushi Takeshita, The University of Tokyo Department of Orthopaedic Surgery Tokyo JapanToshikazu Tani, Kochi Medical School Department of Orthopaedics Kochi JapanYoshiaki Toyama, Keio University Department of Orthopaedic Surgery 35 Shinanomachi, Shinjuku Tokyo 160-8582 JapanKazuo Yonenobu, Hoshigaoka Koseinenkin Hospital Department of Orthopaedic Surgery Osaka JapanEiji Wada, Osaka-Minami Medical Center National Hospital Organization Osaka JapanTakashi Tanaka, Houai Hospital Department of Internal Medicine Osaka JapanYoshio Hirota, Osaka City University Faculty of Medicine Department of Public Health Osaka Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 3 / May, 2009

Dumbbell-shaped osteochondroma of the fifth rib causing spinal cord compression

Dumbbell-shaped osteochondroma of the fifth rib causing spinal cord compression Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00776-008-1323-6Authors Masaaki Chazono, The Jikei University School of Medicine, Kashiwa Hospital Department of Orthopaedic Surgery 163-1 Kashiwa-shita, Kashiwa-shi Chiba 277-8567 JapanFumiaki Masui, The Jikei University School of Medicine, Kashiwa Hospital Department of Orthopaedic Surgery 163-1 Kashiwa-shita, Kashiwa-shi Chiba 277-8567 JapanYasuhiko Kawaguchi, The Jikei University School of Medicine, Kashiwa Hospital Department of Orthopaedic Surgery 163-1 Kashiwa-shita, Kashiwa-shi Chiba 277-8567 JapanHiromichi Hazama, The Jikei University School of Medicine, Kashiwa Hospital Department of Orthopaedic Surgery 163-1 Kashiwa-shita, Kashiwa-shi Chiba 277-8567 JapanJunko Ueda, The Jikei University School of Medicine, Kashiwa Hospital Department of Orthopaedic Surgery 163-1 Kashiwa-shita, Kashiwa-shi Chiba 277-8567 JapanShigeru Saito, The Jikei University School of Medicine, Kashiwa Hospital Department of Orthopaedic Surgery 163-1 Kashiwa-shita, Kashiwa-shi Chiba 277-8567 JapanYoshitaka Ito, The Jikei University School of Medicine, Kashiwa Hospital Department of Orthopaedic Surgery 163-1 Kashiwa-shita, Kashiwa-shi Chiba 277-8567 JapanKentaro Kasama, The Jikei University School of Medicine, Kashiwa Hospital Department of Orthopaedic Surgery 163-1 Kashiwa-shita, Kashiwa-shi Chiba 277-8567 JapanKeisho Liu, The Jikei University School of Medicine, Kashiwa Hospital Department of Orthopaedic Surgery 163-1 Kashiwa-shita, Kashiwa-shi Chiba 277-8567 JapanKeishi Marumo, The Jikei University School of Medicine Department of Orthopaedic Surgery Tokyo Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 3 / May, 2009

Long-term impact of atlantoaxial arthrodesis on the pediatric cervical spine

Abstract Background This study was conducted to elucidate radiographically the long-term impact of atlantoaxial arthrodesis on the pediatric cervical spine. Methods The records of eight children who underwent atlantoaxial arthrodesis for the treatment of upper cervical spinal disorders and were followed up to their adulthood were retrospectively reviewed. Changes in the curvature of the whole cervical spine, and anteroposterior diameters of the spinal canal at C1 and C2 levels were investigated on lateral radiographs before surgery, at 6 months after surgery, and at the final follow-up. Results The cervical curvature was lordosis or straight before surgery in all children and became sigmoid in six children at 6 months after surgery. At the final follow-up, three of the six children with postoperative sigmoid curvatures regained some degree of lordosis and became straight. The anteroposterior diameters of the spinal canal at C1 and C2 levels did not increase during the follow-up period. Conclusions Development of postoperative malalignment of the lower cervical spine and impaired growth of the spinal canal at C1 and C2 levels are common after atlantoaxial arthrodesis in children. Postoperative malalignment diminishes during the follow-up period possibly due to remodeling of the pediatric cervical spine, although remodeling of the spinal canal diameter cannot be expected, suggesting the importance of anatomical reduction before or at the time of surgery. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1324-0Authors Masayuki Ishikawa, Keio University Department of Orthopaedic Surgery, School of Medicine 35 Shinanomachi, Shinjuku Tokyo 160-8582 JapanMorio Matsumoto, Keio University Department of Orthopaedic Surgery, School of Medicine 35 Shinanomachi, Shinjuku Tokyo 160-8582 JapanKazuhiro Chiba, Keio University Department of Orthopaedic Surgery, School of Medicine 35 Shinanomachi, Shinjuku Tokyo 160-8582 JapanYoshiaki Toyama, Keio University Department of Orthopaedic Surgery, School of Medicine 35 Shinanomachi, Shinjuku Tokyo 160-8582 JapanKeiji Kobayashi, Higashi Kawaguchi Clinic Department of Orthopaedic Surgery Saitama Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 3 / May, 2009

Serum soluble interleukin-2 receptor levels in patients with malignant lymphoma of bone

Abstract Background The reliability of selected serum markers and radiological features for distinguishing malignant lymphoma of the bone from other osteolytic bone lesions was examined in an effort to improve the differential diagnosis. Methods A total of 23 patients with histologically verified malignant lymphoma of the bone, 57 patients with other osteolytic malignancies (35 males, 22 females; mean age 62.8 years, range 13–89 years), and 13 patients with benign bone lesions that resemble malignant tumor radiographically (6 men, 7 women; mean age 48.1 years, range 20–73 years) were retrospectively reviewed. We evaluated the serum levels of soluble interleukin-2 receptor (sIL-2R), lactate dehydrogenase, and C-reactive protein in addition to radiographic examination and gallium-67 scanning. Results Although every clinical feature examined was found to show significant differences between lymphoma and the other two groups, the feature most highly suggestive of malignant lymphoma is a high serum sIL-2R level (sensitivity 0.95, specificity 0.70, accuracy 0.81). Conclusions The serum sIL-2R level can be a valuable marker for diagnosing malignant lymphoma of the bone. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1335-xAuthors Tsutomu Akahane, Shinshu University School of Medicine Department of Orthopaedic Surgery 3-1-1 Asahi Matsumoto 390-8621 JapanTominaga Shimizu, Shinshu University School of Medicine Department of Orthopaedic Surgery 3-1-1 Asahi Matsumoto 390-8621 JapanKen’ichi Isobe, Shinshu University School of Medicine Department of Orthopaedic Surgery 3-1-1 Asahi Matsumoto 390-8621 JapanYasuo Yoshimura, Shinshu University School of Medicine Department of Orthopaedic Surgery 3-1-1 Asahi Matsumoto 390-8621 JapanHiroyuki Kato, Shinshu University School of Medicine Department of Orthopaedic Surgery 3-1-1 Asahi Matsumoto 390-8621 Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 3 / May, 2009

Scaphocapitate fracture associated with median nerve palsy

Scaphocapitate fracture associated with median nerve palsy Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00776-008-1328-1Authors Takako Nagai, Surugadai Nihon University Hospital Orthopaedic Department 1-8-13 Kanda Surugadai, Chiyoda-ku Tokyo 101-8309 JapanMasahiro Nagaoka, Surugadai Nihon University Hospital Orthopaedic Department 1-8-13 Kanda Surugadai, Chiyoda-ku Tokyo 101-8309 JapanJunnosuke Ryu, Nihon University School of Medicine Orthopaedic Department Tokyo Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 3 / May, 2009

Enlarged peroneal tubercle with peroneus longus tenosynovitis

Enlarged peroneal tubercle with peroneus longus tenosynovitis Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00776-008-1326-3Authors Kazuya Sugimoto, Saiseikai Nara Hospital Department of Orthopaedic Surgery 4-643 Hachijo, Nara-shi Nara 630-8145 JapanYoshinori Takakura, Nara Medical University Department of Orthopaedic Surgery Nara JapanKoujirou Okahashi, Saiseikai Nara Hospital Department of Orthopaedic Surgery 4-643 Hachijo, Nara-shi Nara 630-8145 JapanYasuhito Tanaka, Nara Medical University Department of Orthopaedic Surgery Nara JapanManabu Ohshima, Nara Medical University Department of Orthopaedic Surgery Nara JapanRyouji Kasanami, Nara Medical University Department of Orthopaedic Surgery Nara Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 3 / May, 2009

Preserving the C7 spinous process with its muscles attached: effect on axial symptoms after cervical laminoplasty

Abstract Background Many efforts to reduce axial symptoms after cervical laminoplasty have been tried and reported; nevertheless, avoiding the axial symptoms has not yet been solved. There have been some reports that preserving the muscles attached to the C7 spinous process could reduce axial symptoms. The purpose of this study was to investigate whether axial symptoms can be reduced by preserving the C7 spinous process with its muscles attached during cervical laminoplasty. Methods A series of 21 patients (group A) with C4–6 laminoplasty, preserving the C7 spinous process and its attached muscles, were compared with 22 patients (group B) with C4–7 laminoplasty. The axial symptoms (incidence, intensity, severity), cervical mobility, cervical curvature morphology, cross-sectional area of posterior cervical muscles, and Japanese Orthopaedic Association (JOA) score were evaluated. Results There were no significant differences in incidence, intensity, or severity of axial symptoms 1 year after operation. In addition, there were no significant differences in the cervical mobility or curvature morphology, the cross-sectional area of the posterior cervical muscles, or the JOA score. Conclusions These results suggest that both preserving and not preserving the C7 spinous process with its muscles attached during cervical laminoplasty are acceptable in the long term. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1331-1Authors Kenji Kowatari, Hirosaki Memorial Hospital Department of Orthopedics Hirosaki, Aomori JapanKazumasa Ueyama, Hirosaki Memorial Hospital Department of Orthopedics Hirosaki, Aomori JapanAkio Sannohe, Hirosaki Memorial Hospital Department of Orthopedics Hirosaki, Aomori JapanYoshihito Yamasaki, Hirosaki Memorial Hospital Department of Orthopedics Hirosaki, Aomori Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 3 / May, 2009

Three-dimensional motion analysis of compensatory movements in patients with radioulnar synostosis performing activities of daily living

Abstract Background The aim of this study was to quantify the compensatory movements of the shoulder and elbow in patients with congenital radioulnar synostosis during 10 activities of daily living (ADL). Methods Maximum and minimum joint angles and range of motion were measured by use of a motion capture system in seven patients and seven matched controls. The forearm was fixed in 0° of rotation in four patients and in 20° of pronation in three patients. Results The main compensatory movements were shoulder internal/external rotation during five ADL tasks, shoulder abduction/adduction and elbow flexion/extension during three tasks, and shoulder flexion/extension during two tasks. These compensatory movements were observed mainly when turning a key and drawing. Conclusions Patients with congenital radioulnar synostosis in nearly neutral rotation could perform all ADL tasks with the aid of compensatory movements of the shoulder and elbow. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1332-0Authors Philip Kasten, Orthopaedic University Hospital of Heidelberg Department of Shoulder and Elbow Surgery Schlierbacher Landstrasse 200 A 69118 Heidelberg GermanyOliver Rettig, Orthopaedic University Hospital of Heidelberg Department of Shoulder and Elbow Surgery Schlierbacher Landstrasse 200 A 69118 Heidelberg GermanyMarkus Loew, Orthopaedic University Hospital of Heidelberg Department of Shoulder and Elbow Surgery Schlierbacher Landstrasse 200 A 69118 Heidelberg GermanySebastian Wolf, Orthopaedic University Hospital of Heidelberg Department of Shoulder and Elbow Surgery Schlierbacher Landstrasse 200 A 69118 Heidelberg GermanyPatric Raiss, Orthopaedic University Hospital of Heidelberg Department of Shoulder and Elbow Surgery Schlierbacher Landstrasse 200 A 69118 Heidelberg Germany Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 3 / May, 2009

Transposition osteotomy of the acetabulum for advanced-stage osteoarthritis of the hips

Abstract Background Transposition osteotomy of the acetabulum (TOA) was the first periacetabular osteotomy in which the acetabulum was transposed with articular cartilage. TOA improves coverage of the femoral head and joint congruity. The purpose of this study was to investigate whether TOA is an appropriate option for treating osteoarthritis of the hips at the advanced stage by comparing it with matched control hips at the early stage. Methods Between 1998 and 2001, TOA was performed in 104 hips of 98 patients. Altogether, 16 of 17 hips (94%) with osteoarthritis at the advanced stage were examined and compared with 37 matched control hips at the early stage. The mean age at the operation was 48 years (38–56 years), and the mean follow-up period was 88 months (65–107 months). Results TOA corrected the acetabular dysplasia and significantly improved containment of the femoral head. Clinical scores were also significantly improved in both groups. In the advanced osteoarthritis cases, there was a tendency for abduction congruity before transposition osteotomy of the acetabulum to reflect the clinical outcome. Conclusions TOA is a promising treatment option for advanced osteoarthritis of the hips as well as for patients at an early stage when preoperative radiographs show good congruity or containment of the joint. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1327-xAuthors Atsushi Matsuo, Kyushu University Department of Orthopaedic Surgery, Graduate School of Medical Sciences Fukuoka JapanSeiya Jingushi, Kyushu Rosai Hospital Department of Orthopaedic Surgery 1-3-1 Kuzuhara Takamatsu, Kokura Minami-ku Kitakyushu 800-0296 JapanYasuharu Nakashima, Kyushu University Department of Orthopaedic Surgery, Graduate School of Medical Sciences Fukuoka JapanTakuaki Yamamoto, Kyushu University Department of Orthopaedic Surgery, Graduate School of Medical Sciences Fukuoka JapanTaro Mawatari, Kyushu University Department of Orthopaedic Surgery, Graduate School of Medical Sciences Fukuoka JapanYasuo Noguchi, Saga Prefectural Hospital Kouseikan Department of Orthopaedic Surgery Saga JapanToshihide Shuto, Chiyoda Hospital Department of Orthopaedic Surgery Hyuga, Miyazaki JapanYukihide Iwamoto, Kyushu University Department of Orthopaedic Surgery, Graduate School of Medical Sciences Fukuoka Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 3 / May, 2009

Impact of serum caffeine monitoring on adverse effects and chemotherapeutic responses to caffeine-potentiated chemotherapy for osteosarcoma

Abstract Background Caffeine can safely enhance the cytocidal effects of anticancer drugs through its DNA repair-inhibiting effect. We have demonstrated in several studies that caffeine-potentiated chemotherapy induces a high complete response rate in patients with osteosarcoma. The present study focused on monitoring and adjusting serum caffeine levels during caffeine-potentiated chemotherapy to reduce adverse effects. Methods We utilized a method for rapidly determining caffeine concentration by high-performance liquid chromatography. The maximum caffeine concentration was predicted from the measured concentrations at 24 and 48 h after the beginning of caffeine administration. The caffeine infusion rate was then modified accordingly to prevent the expected final concentration from exceeding 80 μg/ml. The study involved 22 American Joint Committee on Cancer (AJCC) stage IIB high-grade osteosarcoma patients treated with caffeine-potentiated chemotherapy. Nine patients underwent monitoring of their serum caffeine levels (monitoring group), and the remaining 13 patients were not monitored (nonmonitoring group). Toxicities were graded according to the Japan Clinical Oncology Group Toxicity Criteria. Results Hematological toxic events were well tolerated in both groups. Grade 4 leukocyte toxicity events occurred in both groups. In the nonmonitoring group grade 2 or higher toxicities included 5 elevated aspartate aminotransferase/alanine aminotransferase level events and 17 hyponatremia events versus 1 hyponatremia event in the monitoring group. Histological examination of excised tumor samples after preoperative chemotherapy revealed that chemotherapeutic efficacy in the monitoring group was as good as in the nonmonitoring group. The median follow-up period in all patients was 72 months. Event-free survival was 76%, and overall survival was 100%. Conclusions Monitoring and adjusting caffeine levels were achieved without apparent loss of chemotherapeutic efficacy. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1336-9Authors Katsuhiro Hayashi, Kanazawa University Department of Orthopaedic Surgery, Graduate School of Medical Science 13-1 Takaramachi Kanazawa 920-8641 JapanHiroyuki Tsuchiya, Kanazawa University Department of Orthopaedic Surgery, Graduate School of Medical Science 13-1 Takaramachi Kanazawa 920-8641 JapanNorio Yamamoto, Kanazawa University Department of Orthopaedic Surgery, Graduate School of Medical Science 13-1 Takaramachi Kanazawa 920-8641 JapanToshiharu Shirai, Kanazawa University Department of Orthopaedic Surgery, Graduate School of Medical Science 13-1 Takaramachi Kanazawa 920-8641 JapanKensuke Yamauchi, Kanazawa University Department of Orthopaedic Surgery, Graduate School of Medical Science 13-1 Takaramachi Kanazawa 920-8641 JapanAkihiko Takeuchi, Kanazawa University Department of Orthopaedic Surgery, Graduate School of Medical Science 13-1 Takaramachi Kanazawa 920-8641 JapanMasami Kawahara, Kanazawa University Hospital Department of Pharmacy Kanazawa JapanKen-Ichi Miyamoto, Kanazawa University Hospital Department of Pharmacy Kanazawa JapanKatsuro Tomita, Kanazawa University Department of Orthopaedic Surgery, Graduate School of Medical Science 13-1 Takaramachi Kanazawa 920-8641 Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 3 / May, 2009

Measurement of bone electrical impedance in fracture healing

Abstract Background Although external fixation is widely used for fractures and limb lengthening, evaluation of the time for removing the external fixator is dependent upon radiographic examinations and clinical findings, and a useful method has yet to be established clinically. This study aimed to measure the bone electrical impedance (Z values) non-invasively by using external fixation pins as electrodes, and clarify the relationship with bone union. Methods Thirty rabbits received the external fixation at the right tibia and were assigned to a control group (group C; n = 5) and a fractured group (group F; n = 25). Z values were measured once a week following surgery. The animals of group F were assigned to 5 groups (weeks 2, 3, 4, 5, and 6 after osteotomy, each n = 5). The resistivity (ρ) of the electrical property between electrodes was measured prior to euthanasia, and fracture cross-sectional area (FrA) of the conduction pathway and maximum bending stress (Bmax) were measured following excision of the tibia. Results Although Z values in group F increased through 5 weeks after surgery, Z values in group C remained constant at 3 weeks, and significant differences were observed between groups at 4, 5, and 6 weeks. The ρ values and FrA in group F decreased through 5 weeks; while Bmax increased, reaching a plateau at 5 weeks. Conclusions Narrowing of conduction pathway due to the decrease in the contour of fracture area accompanying bone remodeling resulted in an increase of Z values. Both Z values and Bmax in group F reached a peak at 5 weeks, this was believed to be the optimal time for removal of external fixation. These results suggest that measurement of Z values makes it possible to evaluate bone union. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1333-zAuthors Takashi Yoshida, Kyoto Prefectural University of Medicine Department of Orthopaedics, Graduate School of Medical Science 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku Kyoto 602-0841 JapanWook-Cheol Kim, Kyoto Prefectural University of Medicine Department of Orthopaedics, Graduate School of Medical Science 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku Kyoto 602-0841 JapanKoei Kawamoto, Kyoto Prefectural University of Medicine Department of Orthopaedics, Graduate School of Medical Science 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku Kyoto 602-0841 JapanToshiko Hirashima, Kyoto Prefectural University of Medicine Department of Orthopaedics, Graduate School of Medical Science 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku Kyoto 602-0841 JapanYoshinobu Oka, Kyoto Prefectural University of Medicine Department of Orthopaedics, Graduate School of Medical Science 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku Kyoto 602-0841 JapanToshikazu Kubo, Kyoto Prefectural University of Medicine Department of Orthopaedics, Graduate School of Medical Science 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku Kyoto 602-0841 Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 3 / May, 2009

Femoral and acetabular revision using impacted nondemineralized freeze-dried bone allografts

Abstract Background Favorable results have been obtained by the use of deep-frozen bone allografts in total hip arthroplasty. However, owing to the shortage of deep-frozen allografts and the risk of infectious disease, other materials have been studied, such as sterile nondemineralized freeze-dried allografts. The aim of this study was to describe midterm clinical outcomes and radiographic bone incorporation of human freeze-dried bone grafts in 42 revision total hip arthroplasty procedures using cancellous impacted bone grafting. Methods This report presented clinical and radiographic evidence of allograft incorporation in 42 hip reconstructions performed between 1996 and 2002. The patient group included 13 (31%) men and 29 (69%) women with mean ± SD age of 63 ± 14 years (range 28–80 years). Meanfollow-upwas 82 months (range 63–127) months. Clinical analysis was based on the D’Aubigné-Postel score. Radiographic incorporation was defined according to specific criteria. Results The D’Aubigné and Postel criteria showed adequate outcome in 38 (90%) of the patients. The radiographic evaluation revealed that allograft remodeling and incorporation were found in 39 (93.0%) and 36 (86.5%) of acetabular and femoral cases, respectively. The overall graft survival rate at an average follow-up of 8 years (range 5–10 years) was 90%. Conclusions Bone grafts obtained by the lyophilization process developed and carried out in our tissue bank provide suitable grafts for revision total hip arthroplasty. Clinical and radiographic midterm results were excellent, indicating that nondemineralized freeze-dried bone allografts are suitable for replacing deep-frozen grafts. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1322-2Authors Carlos Roberto Galia, University Hospital Tissue Bank Department of Orthopaedics, Hospital de Clínicas de Porto Alegre (HCPA) Rua Ramiro Barcelos 2350 90035-003 Porto Alegre RS BrazilCarlos Alberto De Souza Macedo, University Hospital Tissue Bank Department of Orthopaedics, Hospital de Clínicas de Porto Alegre (HCPA) Rua Ramiro Barcelos 2350 90035-003 Porto Alegre RS BrazilRicardo Rosito, University Hospital Tissue Bank Department of Orthopaedics, Hospital de Clínicas de Porto Alegre (HCPA) Rua Ramiro Barcelos 2350 90035-003 Porto Alegre RS BrazilLourdes Maria Araújo Quaresma Camargo, HCPA University Hospital Tissue Bank Porto Alegre RS BrazilDiane Ruschel Marinho, Universidade Federal do Rio Grande do Sul (UFRGS) Graduate Program in Surgery Porto Alegre RS BrazilLuis Fernando Moreira, Universidade Federal do Rio Grande do Sul (UFRGS) Graduate Program in Surgery Porto Alegre RS Brazil Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 3 / May, 2009

Effect of increases in tumor volume after neoadjuvant chemotherapy on the outcome of stage II osteosarcoma regardless of histological response

Abstract Background We assessed volume changes after neoadjuvant chemotherapy and evaluated relations between tumor size changes and clinical characteristics. In addition, we sought to determine whether tumor size change influences patient outcome. Methods The records of 127 patients with stage II osteosarcoma who showed more than a 15% volume change after chemotherapy were retrospectively reviewed. Patients were divided into two groups depending on whether tumors increased or decreased in size. Fisher’s exact test was performed to analyze correlations between tumor size changes and clinicopathological variables. Five-year metastasis-free survival and overall survival were evaluated using univariate and multivariate analyses. Results A total of 71 patients (55.9%) showed a decrease in tumor volume, and 56 patients (44.1%) showed an increase. An increase in tumor volume after neoadjuvant chemotherapy was found to be positively correlated with a poor histological response and subsequent metastasis. Univariate analysis identified the following parameters as poor prognostic factors: age ≤15 years (P = 0.03), American Joint Committee on Cancer (AJCC) stage IIB (P = 0.02), a subtype other than osteoblastic (P < 0.01), a poor histological response (P < 0.001), and increased tumor volume after preoperative chemotherapy (P < 0.0001). Multivariate analysis revealed that AJCC stage IIB (P = 0.006) and an increase in tumor volume after preoperative chemotherapy (P < 0.001) both independently shortened metastasis-free survival. However, a poor histological response lost its prognostic significance (P = 0.34). Conclusions Increased tumor volume after neoadjuvant chemotherapy independently shortened metastasis-free and overall survival in AJCC stage II osteosarcoma patients. Tumor volume changes may serve as a basis for risk-adapted therapy when used in combination with other prognostic factors. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1334-yAuthors Min Suk Kim, Korea Cancer Center Hospital Department of Pathology Seoul KoreaSoo-Yong Lee, Korea Cancer Center Hospital Department of Orthopedic Surgery 215-4 Gongneung-dong, Nowon-gu Seoul 139-706 KoreaWan Hyeong Cho, Korea Cancer Center Hospital Department of Orthopedic Surgery 215-4 Gongneung-dong, Nowon-gu Seoul 139-706 KoreaWon Seok Song, Korea Cancer Center Hospital Department of Orthopedic Surgery 215-4 Gongneung-dong, Nowon-gu Seoul 139-706 KoreaJae-Soo Koh, Korea Cancer Center Hospital Department of Pathology Seoul KoreaJun Ah Lee, Korea Cancer Center Hospital Department of Pediatrics Seoul KoreaJi Young Yoo, Korea Cancer Center Hospital Department of Radiology Seoul KoreaSung Taek Jung, Chonnam National University Medical School Department of Orthopedic Surgery Gwangju KoreaDae-Geun Jeon, Korea Cancer Center Hospital Department of Orthopedic Surgery 215-4 Gongneung-dong, Nowon-gu Seoul 139-706 Korea Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 3 / May, 2009

Results of total hip arthroplasty for dialysis arthropathy in long-term hemodialysis patients

Abstract Background The number of hemodialysis patients has progressively increased in Japan. Among the orthopedic complications in this population, chronic hip arthropathy associated with long-term hemodialysis is one of the most devastating problems. Total hip arthroplasty (THA) is often indicated. However, varying results have been reported for THA in these patients. This study was undertaken to assess the risk-benefit ratio of THA performed in patients with dialysis hip arthropathy. Methods We evaluated 17 patients (19 hips) with dialysis hip arthropathy who underwent THA. The duration of hemodialysis before surgery ranged from 10 to 27 years. Histological examination of the tissue samples revealed accumulation of amyloid deposits in all cases. Three patients died within 2 years after operation; the remaining 14 patients (16 hips) were followed for a minimum of 3 years. Results The cumulative survival rate of the prostheses in these 16 hips up to the latest follow-up was 94%. Regarding surgery-related complications, deep infection occurred in one hip, and revision THA was required in one patient with recurrent dislocation and aseptic loosening. Conclusions THA for dialysis hip arthropathy in long-term hemodialysis patients is associated with substantial local and general risks. Despite the substantial risk, THA for this patient population seems to afford reasonably satisfactory results. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1330-2Authors Shigeo Fukunishi, Hyogo College of Medicine Department of Orthopaedic Surgery 1-1 Mukogawa-cho, Nishinomiya Hyogo 663-8501 JapanTomokazu Fukui, Hyogo College of Medicine Department of Orthopaedic Surgery 1-1 Mukogawa-cho, Nishinomiya Hyogo 663-8501 JapanShoji Nishio, Hyogo College of Medicine Department of Orthopaedic Surgery 1-1 Mukogawa-cho, Nishinomiya Hyogo 663-8501 JapanFumiaki Imamura, Hyogo College of Medicine Department of Orthopaedic Surgery 1-1 Mukogawa-cho, Nishinomiya Hyogo 663-8501 JapanKousei Yoh, Hyogo College of Medicine Department of Orthopaedic Surgery 1-1 Mukogawa-cho, Nishinomiya Hyogo 663-8501 JapanShinichi Yoshiya, Hyogo College of Medicine Department of Orthopaedic Surgery 1-1 Mukogawa-cho, Nishinomiya Hyogo 663-8501 Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 3 / May, 2009

In vivo anterior cruciate ligament elongation in response to axial tibial loads

Abstract Background The knowledge of in vivo anterior cruciate ligament (ACL) deformation is fundamental for understanding ACL injury mechanisms and for improving surgical reconstruction of the injured ACL. This study investigated the relative elongation of the ACL when the knee is subject to no load (<10 N) and then to full body weight (axial tibial load) at various flexion angles using a combined dual fluoroscopic and magnetic resonance imaging (MRI) technique. Methods Nine healthy subjects were scanned with MRI and imaged when one knee was subject to no load and then to full body weight using a dual fluoroscopic system (0°–45° flexion angles). The ACL was analyzed using three models: a single central bundle; an anteromedial and posterolateral (double functional) bundle; and multiple (eight) surface fiber bundles. Results The anteromedial bundle had a peak relative elongation of 4.4% ± 3.4% at 30° and that of the posterolateral bundle was 5.9% ± 3.4% at 15°. The ACL surface fiber bundles at the posterior portion of the ACL were shorter in length than those at the anterior portion. However, the peak relative elongation of one posterolateral fiber bundle reached more than 13% whereas one anteromedial fiber bundle reached a peak relative elongation of only about 3% at 30° of flexion by increasing the axial tibial load from no load to full body weight. Conclusions The data quantitatively demonstrated that under external loading the ACL experiences nonhomogeneous elongation, with the posterior fiber bundles stretching more than the anterior fiber bundles. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1325-zAuthors Ali Hosseini, Massachusetts General Hospital/Harvard Medical School Bioengineering Laboratory, Department of Orthopaedic Surgery 55 Fruit Street GRJ 1215 Boston MA 02114 USAThomas J. Gill, Massachusetts General Hospital/Harvard Medical School Bioengineering Laboratory, Department of Orthopaedic Surgery 55 Fruit Street GRJ 1215 Boston MA 02114 USAGuoan Li, Massachusetts General Hospital/Harvard Medical School Bioengineering Laboratory, Department of Orthopaedic Surgery 55 Fruit Street GRJ 1215 Boston MA 02114 USA Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 3 / May, 2009

The future of orthopedics

The future of orthopedics Content Type Journal ArticleCategory EditorialDOI 10.1007/s00776-008-1320-9Authors James H. Beaty, University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery 1211 Union Avenue, Suite 510 Memphis TN 38104 USA Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 3 / May, 2009

The role of the JOA in the globalization of orthopedics

The role of the JOA in the globalization of orthopedics Content Type Journal ArticleCategory EditorialDOI 10.1007/s00776-009-1319-xAuthors Yukihide Iwamoto, Kyushu University Department of Orthopaedic Surgery, Clinical Medicine, Graduate School of Medicine 3-1-1 Maidashi, Higashi-ku Fukuoka 812-8582 Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 2 / March, 2009

Chemotherapy for Langerhans cell sarcoma

Chemotherapy for Langerhans cell sarcoma Content Type Journal ArticleCategory Letter to the EditorDOI 10.1007/s00776-009-1318-yAuthors Gen Ohara, Tsukuba Gakuen General Hospital Department of Internal Medicine Tsukuba, Ibaraki JapanYasunori Funayama, Tsukuba Gakuen General Hospital Department of Internal Medicine Tsukuba, Ibaraki JapanHiroaki Satoh, University of Tsukuba Division of Respiratory Medicine, Institute of Clinical Medicine Tsukuba, Ibaraki 305-8575 JapanKenzo Uchida, Fukui University Faculty of Medical Sciences Department of Orthopaedics and Rehabilitation Medicine Shimoaizuki 23 Matsuoka, Fukui 910-1193 Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658 Journal Volume Volume 14 Journal Issue Volume 14, Number 2 / March, 2009

Incidence of stress fractures of the femoral shaft in women treated with bisphosphonate.

Related Articles Incidence of stress fractures of the femoral shaft in women treated with bisphosphonate. Acta Orthop. 2009 Jan 1;:1-3 Authors: Schilcher J, Aspenberg P Background Recent case reports have identified an association between long-term bisphosphonate treatment and stress fractures of the femoral shaft. The risk of such fractures in bisphosphonate users has not been determined. Methods We identified women over 55 years of age with the specific fracture pattern by searching the operation registry of the hospitals in 2 healthcare districts. Prevalence of bisphosphonate treatment was provided by a Swedish national registry covering all drugs delivered to all individuals since 2005. Results The number of women on bisphosphonate treatment was 3,087. Of these, 5 had femoral stress fractures. They had been taking bisphosphonates for 3.5 to 8.5 years. The incidence density for a patient on bisphosphonate was 1/1,000 per year (95% CI: 0.3-2). In the remaining 88,869 women who were not taking bisphosphonates, there were 3 stress fractures. Thus, their risk (without correction for inhomogeneity in age distribution) was 46 times less (95% CI: 11-200). Interpretation These results are rough estimations based on a comparatively small material. Still, a treatment-associated incidence density of 1/1,000 is acceptable, considering that bisphosphonate treatment is likely to reduce the incidence density of any fracture by 15/1,000 according to a large randomized trial (Black et al. 1996). PMID: 19568963 [PubMed - as supplied by publisher]