Kenji Ohzono

Kansai Rosai Hospital, Itan, Hyōgo, Japan

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Publications (116)241.72 Total impact

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    ABSTRACT: To evaluate the clinical outcome of anatomical double-bundle anterior cruciate ligament (ACL) reconstruction using multistranded hamstring tendons via an outside-in approach. One hundred and twenty-one patients (mean age 28 ± 10 years) who underwent ACL reconstruction were examined. Using an outside-in femoral drill guide, an upper femoral tunnel for the anteromedial (AM) graft was created just below the superior articular cartilage margin of the medial wall of the lateral condyle through a small incision. A lower femoral tunnel for the posterolateral (PL) graft was drilled in the centre of the inferior-posterior half of the attachment area behind the resident's ridge in the same manner. Two tibial tunnels were created at the centre of the AM and PL bundle footprints of a normal ACL. Patients were evaluated at 24 months postoperatively. According to the IKDC form, 52 knees (43 %) were graded as normal, 64 (53 %) as nearly normal, 1 (1 %) as abnormal and 4 (3 %) as graft rupture due to re-injury. Loss of knee extension of <5° was observed in one patient (1 %). Among 111 patients who were directly evaluated, none showed loss of flexion of <5°. Lachman sign was negative in 103 patients (93 %), while the pivot shift test result was negative or equivalent to that of the contralateral healthy knee in 103 patients (93 %). The mean side-to-side difference in anterior laxity at manual maximum force with the KT-2000 arthrometer(®) was 0.9 ± 1.1 mm, and 94 % of patients showed a range between -1 and +2 mm. The anatomical double-bundle outside-in ACL reconstruction provided a satisfactory short-term outcome. Case series, Level IV.
    Knee Surgery Sports Traumatology Arthroscopy 03/2014; · 2.68 Impact Factor
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    ABSTRACT: The incidence of symptomatic adjacent segment pathology (ASP) after fusion surgery for adult low-grade isthmic spondylolisthesis (IS) has been reported to be relatively low compared with other lumbar disease entities. However, there has been no study of symptomatic ASP incidence using posterior lumbar interbody fusion (PLIF) with pedicle screw instrumentation. We investigated the incidence of symptomatic ASP after PLIF with pedicle screw instrumentation for adult low-grade IS and identified significant risk factors for symptomatic ASP. We retrospectively studied records of 40 consecutive patients who underwent PLIF with pedicle screw instrumentation at the Department of Orthopaedic Surgery, Kansai Rosai Hospital, Amagasaki, Japan. The patients were followed for ≥ 4 years. Patients' medical records were retrospectively examined for evidence of symptomatic ASP. Age at time of surgery, sex, fusion level, whole lumbar lordosis, segmental lordosis, preexisting laminar inclination angle, and facet tropism at the cranial fusion segment were analyzed to identify risk factors for symptomatic ASP. Four patients (ASP group) developed symptomatic ASP at the cranial segment adjacent to the fusion. There were no significant differences in age, sex, fusion level, lumbar lordosis, segmental lordosis, or facet tropism at the cranial segment adjacent to the fusion between the ASP and the non-ASP groups. In contrast, laminar inclination angle at the cranial vertebra adjacent to the fusion was significantly higher in the ASP group than in the non-ASP group. Four patients (10%) developed symptomatic ASP after PLIF with transpedicular fixation for adult low-grade IS. Preexisting laminar horizontalization at the cranial vertebra adjacent to the fusion was a significant risk factor for symptomatic ASP.
    Global spine journal. 12/2013; 3(4):219-24.
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    ABSTRACT: The authors report a case of cervical myelopathy caused by invagination of the bilaterally separated lamina of the axis. They also present a literature review. The patient was a previously healthy 68-year-old man with a 1-year history of slowly progressive gait disturbance, right-hand clumsiness, and right dominant sensory disturbance in his trunk and extremities. Both MRI and CT showed that the spinal cord was markedly compressed at the C2-3 level, on the right side, by a deeply invaginated anomalous lamina of the axis. A bilaterally separated lamina was also visible. The patient underwent removal of the anomalous invaginated fragment of the separated lamina and the spinous process of the axis. One year after surgery, his myelopathic symptoms had almost completely resolved. Here, the authors present the case of a patient with an extremely rare anomaly of the lamina of the axis. The underlying pathogenesis of this anomaly could be the failure of the 2 chondrification centers on either side to fuse into a single ossification center. Surgical removal of the anomalous invaginated lamina produced a satisfactory outcome.
    Journal of neurosurgery. Spine 09/2013; · 1.61 Impact Factor
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    ABSTRACT: Object A systematic review concerning surgical management of lumbar degenerative spondylolisthesis (DS) showed that a satisfactory clinical outcome was significantly more likely with adjunctive spinal fusion than with decompression alone. However, the role of adjunctive fusion and the optimal type of fusion remain controversial. Therefore, operative management for multilevel DS raises more complicated issues. The purpose of this retrospective study was to elucidate clinical and radiological outcomes after 2-level PLIF for 2-level DS with the least bias in determination of operative procedure. Methods Since 2005, all patients surgically treated for lumbar DS at the authors' hospital have been treated using posterior lumbar interbody fusion (PLIF) with pedicle screws, irrespective of severity of slippage, patient age, or bone quality. The authors conducted a retrospective review of 20 consecutive cases involving patients who underwent 2-level PLIF for 2-level DS and had been followed up for 2 years or longer (2-level PLIF group). They also analyzed data from 92 consecutive cases involving patients who underwent single-level PLIF for single-level DS during the same time period and had been followed for at least 2 years (1-level PLIF group). This second group served as a control. Clinical status was assessed using the Japanese Orthopaedic Association (JOA) score. Fusion status and sagittal alignment of the lumbar spine were assessed by comparing serial plain radiographs. Surgery-related complications and the need for additional surgery were evaluated. Results The mean JOA score improved significantly from 12.8 points before surgery to 20.4 points at the latest follow-up in the 2-level PLIF group (mean recovery rate 51.8%), and from 14.2 points preoperatively to 22.5 points at the latest follow-up in the single-level PLIF group (mean recovery rate 55.3%). At the final follow-up, 95.0% of patients in the 2-level PLIF group and 96.7% of those in the 1-level PLIF group had achieved solid spinal fusion, and the mean sagittal alignment of the lumbar spine was more lordotic than before surgery in both groups. Early surgery-related complications, including transient neurological complications, occurred in 6 patients in the 2-level PLIF group (30.0%) and 11 patients in the 1-level PLIF group (12.0%). Symptomatic adjacent-segment disease was found in 4 patients in the 2-level PLIF group (20.0%) and 10 patients in the 1-level PLIF group (10.9%). Conclusions The clinical outcome of 2-level PLIF for 2-level lumbar DS was satisfactory, although surgery-related complications including symptomatic adjacent-segment disease were not negligible.
    Journal of neurosurgery. Spine 05/2013; · 1.61 Impact Factor
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    ABSTRACT: PURPOSE: Modular acetabular reconstructive cups have been introduced in an attempt to offer initial rigid fixation by iliac lag screws and ischial pegs, to support bone grafts with a flanged metal socket, and to restore original hip center in acetabular revision. The purpose of this study was to clarify minimum ten year follow-up results of this cup system with morsellised allografts in revision cases. METHODS: We retrospectively investigated 54 acetabular revisions at a mean of 11 years (range, ten to 14 years). The indications were Paprosky's type 2B (eight hip), 2C (eight hips), 3A (23 hips), 3B (nine hips), and 4 (six hips). RESULTS: Using aseptic loosening as the endpoints, the survival rate was 89.3 % (95 % CI 81-98). Radiographically, one type 3A hip, three type 3B hips and one type 4 hip showed aseptic loosening while no type 2 hips or no cemented cups showed loosening. CONCLUSIONS: The modular reconstructive cups for acetabular revision showed bone stock restoration and stable implantation.
    International Orthopaedics 02/2013; · 2.32 Impact Factor
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    ABSTRACT: Steroid therapy is commonly prescribed, although a variety of complications have been reported. Among such complications, spinal epidural lipomatosis is rare and difficult to diagnose before paraparesis occurs. The purpose of this report is to present a rare but catastrophic complication of steroid therapy. A 64-year-old woman undergoing long-term steroid therapy suffered from an osteoporotic vertebral compression fracture and was unable to walk due to paraparesis. Magnetic resonance imaging (MRI) demonstrated a D7 compression fracture and stored epidural adipose tissue between D5 and D8. After surgery, the patient was able to walk with double canes. This case indicates that long-term steroid use has the potential to induce paraparesis.
    Internal Medicine 01/2013; 52(14):1621-4. · 0.97 Impact Factor
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    ABSTRACT: BACKGROUND: The anterior impingement test is intended to detect anterosuperior acetabular labral lesions. In patients treated for labral lesions its sensitivity is reportedly 95% to 100%, and in a small group of patients undergoing periacetabular osteotomy, its sensitivity was 59% and specificity 100%. However, the sensitivity, specificity, positive predictive value, and negative predict value of this test to detect these labral lesions in unselected patients with hip pain are unknown. QUESTIONS/PURPOSES: We investigated these four parameters (1) in unselected patients with hip pain, and (2) in three subgroups of patients with dysplasia, femoroacetabular impingement (FAI), and with an intact joint space. METHODS: We prospectively studied 69 patients (15 men and 54 women) with a mean age of 57.2 years (range, 27-81 years). One observer performed the anterior impingement test in all patients. We determined the presence or absence of an anterosuperior labral lesion with radial MRI in 107 hips (38 patients in both hips: 14 with pain, and 24 without pain). We also investigated the parameters in the three subgroups which consisted of 60 cases of dysplasia, 27 cases of FAI, and 80 cases with intact joint space; the third subgroup partially overlapped the first and second subgroups. RESULTS: The four parameters in all hips were 50.6% (45/89), 88.9% (16/18), 95.7% (45/47), and 26.7% (16/60), respectively. Parameters in the three subgroups were similar to those of all cases. CONCLUSIONS: Although the sensitivity of the anterior impingement test did not reach a sufficient level for detecting anterosuperior labral lesions, we believe the high positive predictive value makes the test useful. LEVEL OF EVIDENCE: Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 07/2012; · 2.79 Impact Factor
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    ABSTRACT: The Chiari osteotomy reportedly has a 60% to 91% survival rate at a minimum 20 years followup. The dome pelvic osteotomy (DPO) has the advantage of allowing a larger weightbearing surface, and congruity in the sagittal plane presumably would reduce the joint contact stress and perhaps increase longevity. We determined: (1) the survival after DPO at a minimum 25-year followup, (2) patient function, (3) acetabular coverage, and (4) factors influencing conversion to THA. We retrospectively reviewed 50 patients (59 hips) with developmental dysplasia of the hip (DDH) treated with DPO. The preoperative radiographic stages were graded as prearthritis (18 hips), early osteoarthritis (25 hips), and advanced osteoarthritis (16 hips). We performed a Kaplan-Meier survival analysis with THA conversion as the end point. We determined various radiographic parameters reflecting coverage, and compared demographic information for hips without and with THA conversion using multivariate logistic regression analysis. The minimum followup was 25 years (mean, 27.5 years; range, 25-32 years). Survival for all hips was 63.6% (95% CI, 51-76) at 27.5 years and that for hips with prearthritis and early osteoarthritis before the surgery was 79.1% (95% CI, 63-91). Twenty-one hips (36%) had undergone THAs at a mean 18.3 years (range, 2.5-25 years). At the last followup, pain, walking ability, and acetabular coverage improved. We identified four factors predicting THA conversion: greater age, presence of a preoperative Trendelenburg sign, higher preoperative radiographic osteoarthritis grade, and smaller postoperative acetabular head index (AHI) predicted conversion to THA. DPO is a reasonable treatment option for patients with DDH and prearthritis or early osteoarthritis, with high survival at greater than 25 years.
    Clinical Orthopaedics and Related Research 02/2012; 470(9):2573-82. · 2.79 Impact Factor
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    ABSTRACT: Most injuries to the osteochondral region in adolescents have generally been believed to occur as osteochondral fractures. However, we report three cases of pure chondral fragments of the knee in adolescents. The patients were injured during sports activities and as a result had acute limitation of ROM of the knee joint. Only one case out of three could be diagnosed by MRI, and arthroscopic examinations were needed to make a final diagnosis in the remaining two cases. Re-fixation of the fragments was performed using bio-absorbable pins. All the patients were eventually able to return to their previous level of sports activity. Two years after the operation they experienced no symptoms and MRI showed that the re-fixed fragments were continuous to the bed without any abnormal intervening signal area, suggesting successful healing. Moreover, the arthroscopic integration between the re-fixed fragment and the surrounding articular cartilage was acceptable. Chondral fragment of the lateral femoral trochlea in active adolescents should be recognized as a clear entity that can be successfully treated by re-fixation.
    The Knee 02/2012; 19(5):719-23. · 2.01 Impact Factor
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    ABSTRACT: The Japanese Orthopaedic Association Hip Score is widely used in Japan, but this tool is designed to reflect the viewpoint of health-care providers rather than that of patients. In gauging the effect of medical therapies in addition to clinical results, it is necessary to assess quality of life (QOL) from the viewpoint of patients. However, there is no tool evaluating QOL for Japanese patients with hip-joint disease. With the aim of more accurately classifying QOL for Japanese patients with hip-joint disease, we prepared a questionnaire with 58 items for the survey derived from 464 opinions obtained from approximately 100 Japanese patients with hip-joint disease and previously devised evaluation criteria. In the survey, we collected information on 501 cases, and 402 were subjected to factor analysis. From this, we formulated three categories-movement, mental, and pain-each comprising 7 items, for a total of 21 items to be used as evaluation criteria for hip-joint function. The Cronbach's α coefficients for the three categories were 0.93, 0.93, and 0.95, respectively, indicating the high reliability of the evaluation criteria. The 21 items included some related to the Asian lifestyle, such as use of a Japanese-style toilet and rising from the floor, which are not included in other evaluation tools. This self-administered questionnaire may become a useful tool in the evaluation of not only Japanese patients, but also of members of other ethnic groups who engage in deep flexion of the hip joint during daily activities.
    Journal of Orthopaedic Science 11/2011; 17(1):25-38. · 0.96 Impact Factor
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    ABSTRACT: To analyze long-term survivorship of cementless total hip arthroplasties (THAs) with the third-generation alumina ceramic-on-ceramic bearing, 100 consecutive THAs between 1996 and 1998 were reviewed. One cup and 2 stems were revised due to aseptic loosening. Another cup showed chipping of the acetabular liner at 8 years and required cup revision. The remaining hips showed stable bone ingrowth fixation with no osteolysis at the final follow-up. The 14-year survivorship as the end point of revision was 97.9% for the cup, 97.8% for the stem, and 95.7% for the overall implants, respectively. We conclude that cementless THA with the third-generation ceramic-on-ceramic hip bearing provided an excellent survivorship and eliminated periprosthetic osteolysis for 11 to 14 years.
    The Journal of arthroplasty 10/2011; 27(5):736-41. · 1.79 Impact Factor
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    ABSTRACT: The acetabular component orientation of total hip arthroplasty is of critical importance to the clinical results. Although navigation systems have recently been introduced, acetabular component alignment guides are still used in most of ordinary hospitals. However, the accuracy of alignment guides themselves has not been evaluated. Fifteen types of alignment guide were examined. In all the alignment guides, the angles actually indicated and those stated by manufacturers were different. Our results showed that usage of modern alignment guides inherently misleads anteversion into decrease by a mean of 6° (maximum, 12°) and inclination into increase by a mean of 2° (maximum: 4°). Such setting of alignment guides could be one of the factors of error in acetabular component orientation.
    The Journal of arthroplasty 09/2011; · 1.79 Impact Factor
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    ABSTRACT: A Tensor/Balancer device has been recently developed in order to assess soft tissue balancing in total knee arthroplasty (TKA) under more physiological conditions. This device allows us to measure the joint gap with a trial femoral component in place with the patella reduced. The purpose of this study was to clarify whether the placement of the component changes the intraoperative gap difference (flexion gap distance minus extension gap distance). We prospectively investigated the extension (0°) and flexion (90°) gaps in 73 posterior-stabilized TKAs under 30 lb of joint distraction force. Then, we compared the gap difference with and without the trial femoral component in place. Our results showed that the intraoperative gap difference with the trial femoral component in place was larger than the intraoperative gap difference without the trial component (p=0.00003; with the trial component: mean 4.7 mm (standard deviation (SD): 3.0mm); without the trial component: mean 2.7 mm (SD: 3.3mm)). We consider that the change in gap difference with or without femoral component was caused by a relative difference in the elasticity and/or tightness of the soft tissue in extension versus flexion. Surgeons should be aware of this effect of the femoral component when considering intraoperative soft tissue balancing which leads to postoperative stability of the knee joint consequently.
    The Knee 08/2011; 19(5):601-5. · 2.01 Impact Factor
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    ABSTRACT: The purpose of this study was to describe a safer and more anatomical technique of MPFL reconstruction and to report the short-term results. The subjects included 20 patients with patellar dislocation with a mean age of 23. The operation was performed using a double-looped autogenous semitendinosus tendon graft. Two small bone tunnels were made at the medial edge of the patella, mimicking the wide patellar insertion of the MPFL and a bone tunnel was made at the femoral insertion site. The free ends of the graft attached to the patella and the loop end was fixed to the femoral side. Five patients were available for follow-up interviews by telephone and the remaining 15 were directly examined by physical examination and radiographic evaluation at 2 years or longer postoperatively. The average follow-up period was 30 months. Re-dislocation or patellar fracture was not seen in any patients. The average Kujala's score was 96 with a range from 84 to 100. Six patients were classified as excellent and 14 as good, according to the Crosby and Insall grading system. Radiographically, narrowing of the patellofemoral joint space was observed in 2 cases with previous osteochondral fracture out of those who were directly examined. The dual tunnel MPFL reconstruction produces favorable results in subjective and functional assessment of outcome without complications.
    The Knee 08/2011; 18(4):214-9. · 2.01 Impact Factor
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    ABSTRACT: The purpose of the present study was to evaluate the 6- to 11-year follow-up results of hemispherical porous-coated cups implanted into dysplastic hips using press-fit technique without screws focusing on the amount of host bone coverage. There were 87 patients who underwent 98 primary total hip arthroplasties. Bony coverage was measured as the angle between the vertical line and the line drawn from the cup center to the lateral edge of the acetabulum, which was named the cup center-edge angle (cup-CE angle). All 98 cups were judged to be bone ingrown. The minimum cup-CE angle was 8.4° (mean, 26.3°). Bone-cup contact of more than 8.4° of the cup-CE angle was large enough for press-fit cups to resist superior directed loads during this follow-up period.
    The Journal of arthroplasty 06/2011; 26(4):562-8. · 1.79 Impact Factor
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    ABSTRACT: The purpose of this retrospective study was to analyze the functional and radiographic results of cementless, modular total hip arthroplasty combined with subtrochanteric osteotomy for the treatment of patients who had had Crowe Group-IV developmental dysplasia of the hip as a child. Twenty-five consecutive patients (thirty-three hips) who had previously had Crowe Group-IV developmental dysplasia of the hip were treated with a modular cementless prosthesis at a mean age of sixty years. The mean follow-up period was eight years (range, five to eleven years). The acetabular cup was placed in the position of the anatomical hip center in every patient. Subtrochanteric femoral shortening osteotomy was performed with use of a step-cut design. The mean Merle d'Aubigné and Postel hip score improved from 9 to 16 points (out of a maximum of 18 points). The mean limb-length discrepancy in seventeen patients with unilateral involvement was reduced from 5.1 cm (range, 3.7 to 6.5 cm) to 2.8 cm (range, 1.4 to 4.6 cm). Two patients had a positive Trendelenburg sign, and three had a slight limp at the time of the latest follow-up. No cases of nonunion or nerve palsy were encountered. Postoperative dislocations occurred in two hips. One hip showed progressive radiolucent lines around the proximal femoral sleeve within two years after the surgery, and this was followed by progressive stem subsidence. Only one femoral stem was revised. Cementless, modular total hip arthroplasty combined with subtrochanteric osteotomy for the treatment of patients with prior Crowe Group-IV developmental dysplasia of the hip resulted in satisfactory outcomes. Hips with poor bone quality and a developmentally short femoral neck present technical challenges with regard to achieving sufficient rotatory stability, following osteotomy, for osseointegration of the modular implants. Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.
    The Journal of Bone and Joint Surgery 03/2011; 93(6):548-55. · 3.23 Impact Factor
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    ABSTRACT: The long-term results of grafting with hydroxyapatite granules for acetabular deficiency in revision total hip replacement are not well known. We have evaluated the results of revision using a modular cup with hydroxyapatite grafting for Paprosky type 2 and 3 acetabular defects at a minimum of ten years' follow-up. We retrospectively reviewed 49 acetabular revisions at a mean of 135 months (120 to 178). There was one type 2B, ten 2C, 28 3A and ten 3B hips. With loosening as the endpoint, the survival rate was 74.2% (95% confidence interval 58.3 to 90.1). Radiologically, four of the type 3A hips (14%) and six of the type 3B hips (60%) showed aseptic loosening with collapse of the hydroxyapatite layer, whereas no loosening occurred in type 2 hips. There was consolidation of the hydroxyapatite layer in 33 hips (66%). Loosening was detected in nine of 29 hips (31%) without cement and in one of 20 hips (5%) with cement (p = 0.03, Fisher's exact probability test). The linear wear and annual wear rate did not correlate with loosening. These results suggest that the long-term results of hydroxyapatite grafting with cement for type 2 and 3A hips are encouraging.
    Journal of Bone and Joint Surgery - British Volume 09/2010; 92(9):1215-21. · 2.69 Impact Factor
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    ABSTRACT: We compared a modular neck system with a non-modular system in a cementless anatomical total hip replacement (THR). Each group consisted of 74 hips with developmental hip dysplasia. Both groups had the same cementless acetabular component and the same articulation, which consisted of a conventional polyethylene liner and a 28 mm alumina head. The mean follow-up was 14.5 years (13 to 15), at which point there were significant differences in the mean total Harris hip score (modular/non-modular: 98.6 (64 to 100)/93.8 (68 to 100)), the mean range of abduction (32 degrees (15 degrees to 40 degrees )/28 (0 degrees to 40 degrees )), use of a 10 degrees elevated liner (31%/100%), the incidence of osteolysis (27%/79.7%) and the incidence of equal leg lengths (> or = 6 mm, 92%/61%). There was no disassociation or fracture of the modular neck. The modular system reduces the need for an elevated liner, thereby reducing the incidence of osteolysis. It gives a better range of movement and allows the surgeon to make an accurate adjustment of leg length.
    Journal of Bone and Joint Surgery - British Volume 06/2010; 92(6):770-6. · 2.69 Impact Factor
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    ABSTRACT: The acetabular component orientation of total hip arthroplasty is of critical importance to the clinical results. Although navigation systems have recently been introduced, acetabular component alignment guides are still used in most of ordinary hospitals. However, the accuracy of alignment guides themselves has not been evaluated. Fifteen types of alignment guide were examined. In all the alignment guides, the angles actually indicated and those stated by manufacturers were different. Our results showed that usage of modern alignment guides inherently misleads anteversion into decrease by a mean of 6 degrees (maximum, 12 degrees ) and inclination into increase by a mean of 2 degrees (maximum: 4 degrees ). Such setting of alignment guides could be one of the factors of error in acetabular component orientation.
    The Journal of arthroplasty 10/2009; 25(6):986-9. · 1.79 Impact Factor
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    ABSTRACT: To evaluate the clinical efficacy of mechanical thromboprophylaxis after elective hip surgery, we reviewed 3016 patients who underwent hip surgery at 5 centers. Primary total hip arthroplasty (THA), revision THA, and pelvic or femoral osteotomies were performed in 2648, 298, and 70 patients, respectively. Epidural anesthesia, intraoperative calf bandage, early mobilization, and intermittent pneumatic compression postoperatively with additional use of elastic stockings were the basic regimen for thromboprophylaxis. Postoperatively, no cases of fatal pulmonary embolism (PE) were encountered. One symptomatic PE and 4 symptomatic deep vein thrombosis cases were identified, all of which were successfully treated using heparin and warfarin. By 6 months, no deaths had occurred. We conclude that mechanical thromboprophylaxis without anticoagulant drugs is safe and effective for elective hip surgeries in our patient population.
    The Journal of arthroplasty 08/2009; 24(8):1254-7. · 1.79 Impact Factor

Publication Stats

1k Citations
241.72 Total Impact Points

Institutions

  • 2001–2013
    • Kansai Rosai Hospital
      Itan, Hyōgo, Japan
  • 1992–2013
    • Osaka City University
      • Department of Orthopaedic Surgery
      Ōsaka-shi, Osaka-fu, Japan
  • 2009
    • Hyogo Prefectural Amagasaki Hospital
      Amagasaki, Hyōgo, Japan
  • 1995–2006
    • Osaka National Hospital
      • Department of Orthopaedic Surgery
      Ōsaka-shi, Osaka-fu, Japan
    • Hoshigaoka Koseinenkin Hospital
      Hirakata, Ōsaka, Japan
  • 2002–2003
    • University Hospital Medical Information Network
      Edo, Tōkyō, Japan
  • 1998–2002
    • Osaka University
      • Division of Orthopaedic Surgery
      Ōsaka-shi, Osaka-fu, Japan