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ABSTRACT: PURPOSE. To measure preoperative hip flexion under general anaesthesia in patients with developmental dysplasia of the hip and analyse its correlation with leg-length change. METHODS. 79 women and 6 men aged 27 to 82 (mean, 59) years underwent 92 total hip arthroplasties for severe developmental dysplasia of the hip of Crowe types II (n=60), III (n=17), and IV (n=15). All such patients had severe pain and/or considerable difficulty in walking and performing daily activities. 16 of the hips were treated with transverse subtrochanteric shortening osteotomy, whereas the remaining 76 had no femoral osteotomy. Preoperative passive hip flexion was measured under general anaesthesia with a goniometer by a single investigator. Its mean value in patients with Crowe type-III deformity was 60.3º. Therefore, >60º of flexion was defined as high. Postoperative leg-length change was measured radiographically. The distraction of the greater trochanter was equal to the leg-length change in patients treated without femoral osteotomy, whereas leg-length change was calculated by subtracting the amount of resection of the femur from the distraction of the greater trochanter in patients treated with femoral osteotomy. RESULTS. Of the 16 hips treated with a transverse subtrochanteric shortening femoral osteotomy, 2, 2, and 12 were Crowe types II, III, and IV, respectively. In these 16 hips, hip flexion was high in 10 (mean, 86º) and low in 6 (mean, 36º). Leg-length change was significantly greater in the high than low flexion groups (31 vs. 13 mm, p<0.01). In the 76 hips without osteotomy, hip flexion was high in 54 (mean, 85º) and low in 22 (mean, 40º). Leg-length change was significantly greater in the high than low flexion groups (25 vs. 19 mm, p=0.016). Preoperative hip flexion under general anaesthesia correlated with leg-length change in hips with osteotomy (r=0.850, p=0.0002) and without osteotomy (r=0.267, p=0.019). CONCLUSION. Preoperative hip flexion measured under general anaesthesia may predict leg-length change after THA.
Journal of orthopaedic surgery (Hong Kong) 12/2012; 20(3):327-30.
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K Kawakita,
T Nishiyama,
T Fujishiro,
S Hayashi,
N Kanzaki,
S Hashimoto,
K Takebe,
K Iwasa,
S Sakata,
K Nishida,
R Kuroda, M Kurosaka
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ABSTRACT: The p53 tumor-suppressor protein p53R2 is activated in response to various stressors that act on cell signaling. When DNA is damaged, phosphorylation of p53 at its Ser 15 residue induces p53R2 production. The role of p53R2 in chondrocytes remains poorly understood. In this study, we evaluated in chondrocytes, p53R2 expression and its regulation in response to mechanical stress. Furthermore, we investigated the function of p53R2 in relation to mechanotransduction.
Osteoarthritis (OA) cartilage obtained from total knee replacements and normal cartilage obtained from femoral neck fractures was used to measure p53R2 expression by using immunohistochemistry, western blotting, and real-time polymerase chain reaction (PCR). The OA chondrocytes were subjected to a high magnitude of cyclical tensile strain by using an FX-2000 Flexercell system. Next, sulfated glycosaminoglycan (sGAG) production was quantified in these cells. Protein expression of p53R2, and phosphorylation of Akt, p38MAPK, ERK1/2, and JNK was also detected using western blotting. Moreover, Akt phosphorylation was detected after transfecting the cells with p53R2-specific small interfering RNA (siRNA).
Expression of p53R2 was significantly increased in OA chondrocytes and in chondrocytes after applying 5% tensile strain to the cells. However, Akt phosphorylation was down-regulated in OA chondrocytes after the strain, and was up-regulated after transfection of p53R2. sGAG protein as well as collagen type II and aggrecan mRNA was increased following transfection of p53R2-specific siRNA after 5% tensile strain.
p53R2 could regulate matrix synthesis via Akt phosphorylation during chondrocyte mechanotransduction. Down-regulation of p53R2 may be a new therapeutic approach in OA therapy.
Osteoarthritis and Cartilage 09/2012; 20(12):1603-9. · 3.90 Impact Factor
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ABSTRACT: To investigate the rate of venous thromboembolism (VTE) in Japanese patients with fractures of the pelvis and/or lower extremities using physical prophylaxis alone.
Records of 66 men and 60 women aged 15 to 95 (mean, 57) years with fractures of the pelvis and/ or lower extremities were retrospectively reviewed. They were screened for VTE based on D-dimer values. Contrast-enhanced computed tomography and/or ultrasonography were performed when the D-dimer value did not decline predictably or exceeded 20 μg/ml even 5 days after injury or surgery. Physical prophylaxis for VTE in terms of graduated compression stockings and intermittent pneumatic compression were applied for all patients.
Of the 126 patients, 24 were detected to have VTE (10 of 29 with multiple fractures and 14 of 97 with single fractures). Six patients were detected to have asymptomatic pulmonary thromboembolism (PTE), whereas 20 patients were detected to have deep vein thrombosis (bilaterally in 7). The rates of VTE were high in patients with multiple fractures (35%), pelvic fractures (18%), and femoral shaft fractures (50%). The rate of PTE was high in patients with pelvic fractures (12%).
The rate of VTE in the Japanese patients was similar to that in western populations. Our screening method was useful for preventing fatal PTEs. Surgeons should be vigilant for VTE during the first 2 weeks after injury, especially in patients with multiple and pelvic fractures.
Journal of orthopaedic surgery (Hong Kong) 08/2012; 20(2):196-200.
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ABSTRACT: We present a rare case of avulsion-fracture of the anterior superior iliac spine with meralgia paresthetica in a 16-year-old male basketball player. He had sensory disturbance affecting his left lateral thigh 10 days after the injury. Tinel's sign was elicited on percussing the avulsed bony fragment of the anterior superior iliac spine. He underwent open reduction and internal fixation. The lateral femoral cutaneous nerve was noted to be entrapped by one third of the avulsed bony fragment. That fragment was removed, and the remaining portion was reduced and fixed with 2 screws. At week 6, the patient had returned to basketball playing without pain. At week 8, sensory distribution in the left lateral thigh had returned to normal.
Journal of orthopaedic surgery (Hong Kong) 12/2011; 19(3):384-5.
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ABSTRACT: To treat large bone defects is a clinically challenging problem and utilizing tissue engineering technology is an attractive approach for overcoming such a problem. Previously, a biodegradable sponge incorporating bone morphogenic protein-2 (BMP-2), which can control the release of BMP-2 for a prolonged time in an in vivo environment, was reported. In addition, a biodegradable sponge composed of gelatin and β-tricalcium phosphate (βTCP), gelatin-βTCP sponge to develop a more ideal scaffold for enhancing bone regeneration was also created and previously reported. The purpose of this study was to investigate the effectiveness of the gelatin-βTCP sponge for the promotion of bone regeneration in a critical-sized bone defect site in vivo. Apparent bone regeneration was induced by the gelatin sponge incorporating BMP-2 and the gelatin-βTCP sponge with BMP-2 incorporation. In contrast, no apparent bone formation was induced by either the gelatin sponge only or the gelatin-βTCP sponge without BMP-2. To investigate the quality of the regenerated bone, we conducted a biomechanical evaluation with a three-point bending test. We found no significant difference between the gelatin sponge incorporating BMP-2 and the gelatin-βTCP sponge incorporating BMP-2 groups. Incorporation of βTCP into the gelatin sponge was expected to enhance biomechanical strength during the initial bone regeneration. However, our observations showed that the gelatin-βTCP sponge did not significantly improve the quality of regenerated bone from the viewpoint of biomechanical assessment, even though it did not impair the effectiveness of the promotion of bone regeneration by BMP-2 in the bone defect.
Journal of Tissue Engineering and Regenerative Medicine 06/2011; 6(4):291-8. · 3.28 Impact Factor
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T Fujimoto,
T Andoh,
T Sudo,
I Fujita,
M Imabori,
H Moritake,
T Sugimoto,
Y Sakuma,
T Takeuchi,
H Sonobe,
Alan L Epstein,
T Akisue,
M Kirihata, M Kurosaka,
Y Fukumori,
H Ichikawa
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ABSTRACT: Clear cell sarcoma (CCS), a rare malignant tumor with a predilection for young adults, is of poor prognosis. Recently however, boron neutron capture therapy (BNCT) with the use of p-borono-L-phenylalanine (BPA) for malignant melanoma has provided good results. CCS also produces melanin; therefore, the uptake of BPA is the key to the application of BNCT to CCS. We describe, for the first time, the high accumulation of boron in CCS and the CCS tumor-bearing animal model generated for BNCT studies.
Applied radiation and isotopes: including data, instrumentation and methods for use in agriculture, industry and medicine 02/2011; 69(12):1713-6. · 1.09 Impact Factor
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T Andoh,
T Fujimoto,
T Sudo,
I Fujita,
M Imabori,
H Moritake,
T Sugimoto,
Y Sakuma,
T Takeuchi,
S Kawabata,
M Kirihata,
T Akisue,
K Yayama, M Kurosaka,
S Miyatake,
Y Fukumori,
H Ichikawa
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ABSTRACT: Clear cell sarcoma (CCS) is a rare melanocytic malignant tumor with a poor prognosis. Our previous study demonstrated that in vitro cultured CCS cells have the ability to highly uptake l-BPA and thus boron neutron capture therapy could be a new option for CCS treatment. This paper proved that a remarkably high accumulation of (10)B (45-74 ppm) in tumor was obtained even in a CCS-bearing animal with a well-controlled biodistribution followed by intravenous administration of L-BPA-fructose complex (500 mg BPA/kg).
Applied radiation and isotopes: including data, instrumentation and methods for use in agriculture, industry and medicine 02/2011; 69(12):1721-4. · 1.09 Impact Factor
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ABSTRACT: ACL (Anterior Cruciate Ligament) reconstruction is performed to recover the injured knee which often happens in sports activity such as skiing, and basketball. The ACL reconstruction makes one or two bone tunnel(s) in the femur and tibia. Then, the harvested graft passes the bone tunnels so that the femur and tibia are connected. The graft is fixed to the femur by using EndoButton. However, loosening of the fixation sometimes happens due to transposition of the EndoButton. It results in instability of the knee motion. Occurrence frequency of the fixation loosening affects clinical outcome. Therefore, it is important to analyse an EndoButton position with high accuracy. This study set the goal to propose an analysis method of the EndoButton position with registration in MDCT images. In the experiments, the proposed method was applied to 5 (single bundle) and 8 (double bundle) sets of MDCT images. Each set consists two different direction posing of the same patient in one day. EndoButton of AM shows a distinctive time-depend movement. the EndoButton flexion movements of single and AM increase with time. As a result, the proposed method could calculate the EndoButton position with registration in MDCT images.
World Automation Congress (WAC), 2010; 10/2010
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ABSTRACT: Anterior cruciate ligament (ACL) reconstruction is making a hole called as bone tunnel to fix a graft to the femur and tibia. A volume change of this bone tunnel enlargement with time affects a knee motion. We have already developed three dimensional analysis method for knee july-row detector computed tomography (MDCT) image. However, the direction of the bone tunnel enlargement was unclear, because the conventional method considered only volume change of bone tunnel. Then, the aim of this study is to propose a method to analyze the direction of bone tunnel enlargement. There are two important things for the calculation. The first is to determine the femur coordinate system. Then, the second is to execute registration for unifying the femur coordinate system between different MDCT images. In addition, the bone tunnel was evaluated by dividing three region (i.e., proximal, intermediate, and distal) for specifying a location of the enlargement. In the experiment, MDCT images of five patients (single bundle), and eight patients (double bundle) were acquired with informed consent. As a result, about volume change, distal and proximal region had tendencies of enlargement and reduction, respectively. Then, about gravity point movement, all regions had tendencies of distal movement. The proposed method could determine the tibial bone coordinate system.
World Automation Congress (WAC), 2010; 10/2010
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ABSTRACT: Adult patients may present with acetabular dysplasia without a history of developmental dysplasia of the hip. The purpose of the present study was to clarify the development of primary acetabular dysplasia in patients under the age of eighteen years by evaluating the contralateral hip in those with unilateral developmental dysplasia of the hip.
Radiographs of the contralateral hip of eighty-eight patients with unilateral developmental dysplasia of the hip were reviewed retrospectively. The center-edge angle was measured at the age of eighteen years. The primary acetabular dysplasia group included hips with a center-edge angle of <20 degrees , and the normal group included hips with an angle of > or =20 degrees . The acetabular index at the age of three years, the center-edge angle between the ages of three and eighteen years, and the acetabular angle of Sharp between the ages of six and eighteen years were measured.
According to our classification system, twelve hips (13.6%) were assigned to the primary acetabular dysplasia group. At the age of three years, there were no significant differences between the two groups radiographically. A significant difference in the center-edge angle between the two groups was seen at each evaluation period after the age of six years. However, twenty-two patients in the normal group had poor acetabular coverage and three patients in the primary acetabular dysplasia group had good acetabular coverage at the age of nine years. After the age of nine years, improvements in the center-edge angle and the acetabular angle of Sharp were noted in the normal group, whereas no acetabular growth was seen in the primary acetabular dysplasia group. There was no patient with a center-edge angle of <15 degrees at the age of twelve years in the normal group.
After the age of six years, a difference in acetabular growth develops between patients with primary acetabular dysplasia and those with normal hips. However a final prognosis for acetabular development appears to be difficult to determine until the age of twelve years.
The Journal of Bone and Joint Surgery 06/2010; 92(6):1390-7. · 3.27 Impact Factor
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ABSTRACT: Anterior Cruciate Ligament (ACL) reconstruction is performed to recover the injured knee which often happens in sports activity such as skiing, and basketball. The ACL reconstruction makes two bone tunnels in the femur and tibia. Then, the harvested graft passes the bone tunnels so that the femur and tibia are connected. The graft is fixed to the femur by using EndoButton. However, loosening of the fixation sometimes happens due to movement the EndoButton. It results in instability of the knee motion. Examination of frequency of occurrence of fixation loosening contributes to improve surgery procedure. This study set the goal to propose an evaluation method of EndoButton Position in MDCT image after ACL reconstruction. The proposal system was examined with this manually results. In the results, the error of anteromedial and posterolateral EndoButton were 1.88±1.03 and 1.78±1.19, respectively. As a result, the proposed method could detect automatically anatomical reference points and evaluate EndoButton positions.
Systems, Man and Cybernetics, 2009. SMC 2009. IEEE International Conference on; 11/2009
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ABSTRACT: The anterior cruciate ligament (ACL) plays important role as a preventing excessive anterior movement of the knee. When the ACL is injured, ACL reconstruction is often performed. In ACL reconstruction, bone tunnels of the femur and tibia are made for passing graft to the bone. It is reported that the bone tunnel is usually enlargement. The bone tunnel enlargement affects much knee function. In serious case, ACL reconstruction should be required again. Therefore evaluation of the bone tunnel is important. However, it has not been analyzed in 3D image, because the bone tunnel is unclear at distal region in MDCT image. To overcome this problem, this study proposed extraction method with fuzzy inference. As a result, our proposed method could detect bone tunnel region. Then, the bone tunnel enlargement was examined. A future work is to specify the enlarge part within the extract volume.
Fuzzy Systems, 2009. FUZZ-IEEE 2009. IEEE International Conference on; 09/2009
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T Fujimoto,
H Ichikawa,
T Akisue,
I Fujita,
K Kishimoto,
H Hara,
M Imabori,
H Kawamitsu,
P Sharma,
S C Brown,
B M Moudgil,
M Fujii,
T Yamamoto, M Kurosaka,
Y Fukumori
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ABSTRACT: Neutron-capture therapy with gadolinium (Gd-NCT) has therapeutic potential, especially that gadolinium is generally used as a contrast medium in magnetic resonance imaging (MRI). The accumulation of gadolinium in a human sarcoma cell line, malignant fibrosis histiocytoma (MFH) Nara-H, was visualized by the MRI system. The commercially available MRI contrast medium Gd-DTPA (Magnevist, dimeglumine gadopentetate aqueous solution) and the biodegradable and highly gadopentetic acid (Gd-DTPA)-loaded chitosan nanoparticles (Gd-nanoCPs) were prepared as MRI contrast agents. The MFH cells were cultured and collected into three falcon tubes that were set into the 3-tesra MRI system to acquire signal intensities from each pellet by the spin echo method, and the longitudinal relaxation time (T1) was calculated. The amount of Gd in the sample was measured by inductively coupled plasma atomic emission spectrography (ICP-AES). The accumulation of gadolinium in cells treated with Gd-nanoCPs was larger than that in cells treated with Gd-DTPA. In contrast, and compared with the control, Gd-DTPA was more effective than Gd-nanoCPs in reducing T1, suggesting that the larger accumulation exerted the adverse effect of lowering the enhancement of MRI. Further studies are warranted to gain insight into the therapeutic potential of Gd-NCT.
Applied radiation and isotopes: including data, instrumentation and methods for use in agriculture, industry and medicine 04/2009; 67(7-8 Suppl):S355-8. · 1.09 Impact Factor
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ABSTRACT: We have developed a new tensor for total knee replacements which is designed to assist with soft-tissue balancing throughout the full range of movement with a reduced patellofemoral joint. Using this tensor in 40 patients with osteoarthritis we compared the intra-operative joint gap in cruciate-retaining and posterior-stabilised total knee replacements at 0 degrees , 10 degrees , 45 degrees , 90 degrees and 135 degrees of flexion, with the patella both everted and reduced. While the measurement of the joint gap with a reduced patella in posterior-stabilised knees increased from extension to flexion, it remained constant for cruciate-retaining joints throughout a full range of movement. The joint gaps at deep knee flexion were significantly smaller for both types of prosthetic knee when the patellofemoral joint was reduced (p < 0.05).
Journal of Bone and Joint Surgery - British Volume 04/2009; 91(4):475-80. · 2.83 Impact Factor
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ABSTRACT: The haematoma occurring at the site of a fracture is known to play an important role in bone healing. We have recently shown the presence of progenitor cells in human fracture haematoma and demonstrated that they have the capacity for multilineage mesenchymal differentiation. There have been many studies which have shown that low-intensity pulsed ultrasound (LIPUS) stimulates the differentiation of a variety of cells, but none has investigated the effects of LIPUS on cells derived from human fracture tissue including human fracture haematoma-derived progenitor cells (HCs). In this in vitro study, we investigated the effects of LIPUS on the osteogenic activity of HCs. Alkaline phosphatase activity, osteocalcin secretion, the expression of osteoblast-related genes and the mineralisation of HCs were shown to be significantly higher when LIPUS had been applied but without a change in the proliferation of the HCs. These findings provide evidence in favour of the use of LIPUS in the treatment of fractures.
Journal of Bone and Joint Surgery - British Volume 03/2009; 91(2):264-70. · 2.83 Impact Factor
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ABSTRACT: A 75-year-old male presented with progressive myelopathy due to massive retro-odontoid deposits of calcium pyrophosphate dehydrate (CPPD) crystals. Magnetic resonance imaging revealed a non-enhanced isointense extradural mass on a T1-weighted image and a heterogeneous intense mass on a T2-weighted image. Computed tomography (CT) showed linear calcification within the mass. The mass was resected via a posterolateral approach resulting in marked improvement of the symptoms. Histological examination revealed birefringent rhomboid crystals consistent with CPPD. The preoperative differential diagnosis of periodontoid CPPD deposition disease in the elderly population should be considered, particularly if CT studies demonstrate small areas of calcification within the retro-odontoid mass.
Skeletal Radiology 08/2007; 36(7):699-702. · 1.54 Impact Factor
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ABSTRACT: The anterior cruciate ligament (ACL) plays very important role of rotational stability of the knee function. To recover the rotational stability of the ACL injured knee, double bundle technique has been developed which drills two bone tunnels in the femur and tibia, and connects the femur with the tibia by using double bundle graft. However the double bundle technique can cause bone tunnel enlargement which results in instability of the knee. The goal of this study is to examine shape of the bone tunnel enlargement from multi detector row computed tomography (MDCT) data. The proposed method was applied MDCT data of two patients who were performed ACL reconstruction. As a result, our proposed method could extract region of the bone tunnels from MDCT data, and calculate volume of the bone tunnels quantitatively. It reminds as a future work to confirm direction of the bone enlargement.
Complex Medical Engineering, 2007. CME 2007. IEEE/ICME International Conference on; 06/2007
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ABSTRACT: The purpose of this study was to clarify the change in the cross-sectional area (CSA) of a patellar tendon graft after anterior cruciate ligament (ACL) reconstruction, and its relationship with postoperative knee laxity. Forty patients (25 men and 15 women) were included in this study. Intraoperative CSA measurements were performed with an instrumented areamicrometer, while a magnetic resonance imaging (MRI) evaluation was utilized for the assessment postoperatively. For intraoperative measurement, the average CSA of a 10-mm wide patellar tendon graft was 32.3 +/- 7.0 mm2, while the average CSA measured at follow-up (mean: 14.8 months) was 48.8 mm2, showing a significant mean increase ratio of 49.4%. This value corresponded to 115% of the native ACL. The average CSA measured in 30 patients at 6 months was 49.7 mm2, almost equal to the value at the final follow-up (49.8 mm2) in the same patient group. Among potentially influential factors, postoperative notch width (available space for the ACL graft) had significant correlation with the CSA of the graft at follow-up. Finally, both intra- and postoperative CSA values did not correlate with postoperative knee laxity, indicating that a bigger graft does not guarantee a better laxity.
Knee Surgery Sports Traumatology Arthroscopy 06/2007; 15(5):515-21. · 2.21 Impact Factor
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ABSTRACT: Human bone-marrow stromal cells are believed to be multipotent even in adults. This study assessed the effectiveness of autologous bone-marrow stromal cells, which were embedded within a collagen scaffold, to repair a full-thickness articular cartilage defect in the medial femoral condyle of an athlete.
A 31-year-old male judo player suffering from pain in the right knee was reviewed. A 20 x 30-mm full-thickness cartilage defect (International Cartilage Repair Society classification (ICRS) grade IV) was revealed in the weight-bearing area of the medial femoral condyle. With the informed consent of the patient, the defect was treated with autologous bone-marrow stromal cells. Bone marrow was aspirated from the iliac crest of the patient 4 weeks before surgery. After removing the erythrocytes, the remaining cells were expanded in culture. Adherent cells were collected and embedded within a collagen gel, which was transferred to the articular cartilage defect in the medial femoral condyle. The implant was covered with an autologous periosteal flap.
Seven months after surgery, arthroscopy revealed the defect to be covered with smooth tissues. Histologically, the defect was filled with a hyaline-like type of cartilage tissue which stained positively with Safranin-O. One year after surgery, the clinical symptoms had improved significantly. The patient had reattained his previous activity level and experienced neither pain nor other complications.
Our findings indicate that the transplantation of autologous bone-marrow stromal cells can promote the repair of large focal articular cartilage defects in young, active patients.
Osteoarthritis and Cartilage 03/2007; 15(2):226-31. · 3.90 Impact Factor
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ABSTRACT: We isolated multilineage mesenchymal progenitor cells from haematomas collected from fracture sites. After the haematoma was manually removed from the fracture site it was cut into strips and cultured. Homogenous fibroblastic adherent cells were obtained. Flow cytometry revealed that the adherent cells were consistently positive for mesenchymal stem-cell-related markers CD29, CD44, CD105 and CD166, and were negative for the haemopoietic markers CD14, CD34, CD45 and CD133 similar to bone-marrow-derived mesenchymal stem cells. In the presence of lineage-specific induction factors the adherent cells could differentiate in vitro into osteogenic, chondrogenic and adipogenic cells. Our results indicate that haematomas found at a fracture site contain multilineage mesenchymal progenitor cells and play an important role in bone healing. Our findings imply that to enhance healing the haematoma should not be removed from the fracture site during osteosynthesis.
Journal of Bone and Joint Surgery - British Volume 02/2007; 89(1):133-8. · 2.83 Impact Factor
