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ABSTRACT: To evaluate whether walking ability recovers early after bipolar hemiarthroplasty (BHA) using a direct anterior approach.
Between 2008 and 2010, 81 patients with femoral neck fracture underwent BHA using the direct anterior approach (DAA) or the posterior approach (PA). The mean observation period was 36 mo. The age, sex, body mass index (BMI), time from admission to surgery, length of hospitalization, outcome after discharge, walking ability, duration of surgery, blood loss and complications were compared.
There was no significant difference in the age, sex, BMI, time from admission to surgery, length of hospitalization, outcome after discharge, duration of surgery and blood loss between the two groups. Two weeks after the operation, assistance was not necessary for walking in the hospital in 65.0% of the patients in the DAA group and in 33.3% in the PA group (P < 0.05). As for complications, fracture of the femoral greater trochanter developed in 1 patient in the DAA group and calcar crack and dislocation in 1 patient each in the PA group.
DAA is an approach more useful for BHA for femoral neck fracture in elderly patients than total hip arthroplasty in terms of the early acquisition of walking ability.
World journal of orthopedics. 04/2013; 4(2):85-9.
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ABSTRACT: BACKGROUND: Reconstruction of the posterior cruciate ligament (PCL) is still in the middle of development. The postoperative results of PCL reconstruction using bone tendon bone (BTB) and semitendinosus and gracilis tendons (STG) were compared and studied retrospectively. The purpose of the present study was to clarify the features of the two surgical methods and explore the problems associated with these procedures and measures to improve them. Materials: Our retrospective study included 14 patients treated with the transtibial anterolateral technique using BTB and 16 patients who underwent the transtibial anterolateral single-bundle technique using STG, with a total of 30 cases. RESULTS: In the BTB group, the grade was unchanged in 2 cases: a Grade-3 case and a Grade-2 case, suggesting the presence of re-rupture due to wearing or elongation of the graft. However, the other outcomes of the BTB group were relatively favorable. Excellent stability and fair results were present in the BTB group. The STG group showed slight residual knee laxity, but there were no complete failures. CONCLUSION: Excellent stability was obtained in the BTB group except in 2 cases. Improvement of the clinical results may be possible by protecting the BTB graft. We have attempted several techniques that have been advocated to minimize the problems of PCL reconstruction using BTB. Since the study was not prospective, and the number of patients was small, precise comparison of the outcome is impossible at present, and so further evaluation is necessary.
Sports Medicine Arthroscopy Rehabilitation Therapy & Technology 08/2012; 4(1):30.
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ABSTRACT: INTRODUCTION: Locking plate is considered biomechanically advantageous for porotic bone, compared with conventional plate. However, clinical evaluations of locking and conventional plates for periprosthetic femoral fracture are still controversial. Thus, we investigated the usefulness of a locking plate compared with the conventional plate for treatment for this fracture. MATERIALS AND METHODS: We reviewed 40 patients (40 fractures) who had undergone internal fixation for Vancouver type B1 or C periprosthetic fracture. Locking and conventional plates were applied for 21 and 19 patients, respectively. RESULTS: No significant difference was found between locking and conventional plate groups in Merle d' Aubigné hip score, walking ability, operation time, and blood loss. Regarding postoperative complications, delayed union was noted in one patient in the locking plate group and subsidence of the stem in one in the conventional plate group. On the final follow-up, bone union was achieved in all patients. CONCLUSION: We cannot suggest the usefulness of locking plate for periprosthetic femoral fracture. However, functional training was performed in the same rehabilitation schedule in our comparative study. Considering the angle stability of the locking plate, weight may be loaded on the locking plate, earlier than that on the conventional plate, which may be an advantage of the locking plate.
European Journal of Orthopaedic Surgery & Traumatology 05/2012; · 0.10 Impact Factor
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ABSTRACT: We report a case of Stickler syndrome associated with slipped capital femoral epiphysis. A 10-year-old male subsequently developed
left thigh pain without any provoking cause. Three days after, when he swung a bat, marked left hip pain developed. Radiograph
showed a slipped capital femoral epiphysis. At the age of 1year, he underwent surgery due to cleft palate. The visual acuity
was bilaterally decreased, and a diagnosis of bilateral retinal/vitreous degeneration had been made. Radiograph on the normal
side showed coxa valga. According to clinical symptoms and past history, diagnosis of Stickler syndrome associated with slipped
capital femoral epiphysis was made. On the day of the first visit, surgery was performed for slipped capital femoral epiphysis.
No intentional reduction was performed. After gentle protective traction, in situ fixation was performed with 6.5mm cannulated
cancellous screw. After 5-month nonweight-bearing, weight-bearing was initiated, and full-weight bearing was achieved after
1month. MRI 6months after the operation showed no bone necrosis, and lateral radiography confirmed bone union.
European Journal of Orthopaedic Surgery & Traumatology 04/2012; 20(2):165-168. · 0.10 Impact Factor
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ABSTRACT: The Lord type cementless hip prosthesis was developed by Lord in 1975 and began to be clinically applied. In Japan, Shitoto
introduced Lord THA from 1979 and clinically applied it. We investigated 133 patients who could be followed-up for more than
ten years. The 10- and 20-year survival rates for the acetabular component alone were 83.9 and 46.7%, respectively. The survival
rate for the stem alone was evaluated after classifying the Madréporique and Mark-II types as madreporic stems and Polarisée
and L.F.R types as fluted stems. The 10- and 20-year survival rates for madreporic stems were 98.0 and 92.6%, respectively,
and those for fluted stems were 84.0 and 16.8%, respectively. The survival rates for madreporic stems were significantly higher.
However, patients who develop loosening of the acetabular component or the fluted stem of the latter period Lord system are
expected to increase in the future, and careful follow-up is necessary.
European Journal of Orthopaedic Surgery & Traumatology 04/2012; 19(3):163-166. · 0.10 Impact Factor
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ABSTRACT: Displacement fracture of the acetabulum is treated with open reduction and rigid fixation in many cases. We have recently
applied internal fixation using the Dall–Miles cable system (Stryker). We investigated ten patients undergoing cable fixation
between 2003 and 2008. Reduction and fixation were simultaneously performed by simply hanging and tightening a cable on the
quadrilateral surface, showing the usefulness of this cable fixation. Based on our experience of cable detachment in a case
fixed with a cable alone, an anchor screw was inserted in the distal bone fragment of the posterior column, and the cable
was hung on the screw to prevent detachment, which not only prevented cable detachment but also ensured the pulling and fixing
of the posterior column element. To our knowledge, the reduction and fixation of an acetabular fracture by hanging a cable
on an anchor screw has not previously been reported.
European Journal of Orthopaedic Surgery & Traumatology 04/2012; 20(1):75-79. · 0.10 Impact Factor
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ABSTRACT: The purpose of this study was to examine the postoperative results following THA for ankylosing spondylitis, which is very
rare in Japanese. We performed uncemented THA in 31 hips between 1982 and 2007. Patients were followed up for a mean of 12years.
The 10-year survival rate was 100%, and the 15-year survival rate was 63.5%. Revision surgery was performed in 4 hips. Complications
developed in 5 cases. Two patients sustained an intraoperative non-displaced fracture at the level of the calcar femorale.
Three patients experienced postoperative dislocation. Although the study scale was small because of the very low prevalence
(0.0065%) of the disease in Japan, the survival rate was similar to those reported overseas. All revision cases were due to
mechanical loosening of the acetabular component of Lord THA, suggesting that the low survival rate was due to the performance
of the prosthesis and not the pathology of ankylosing spondylitis.
KeywordsAnkylosing spondylitis-Japanese patient-Total hip arthroplasty-Lord THA
European Journal of Orthopaedic Surgery & Traumatology 04/2012; 20(8):613-618. · 0.10 Impact Factor
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Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine 06/2011; 21(4):362-4. · 1.50 Impact Factor
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ABSTRACT: A 50-year-old man with a history of alcohol-induced pancreatitis was admitted to a hospital with swelling and pain of the right ankle, and fever, and was suspected to have osteomyelitis. Radiographs of the fingers, ankles, and feet, in which pain and swelling were present, revealed multiple pathological fractures. The histological examination of the tissue sample in the right radius showed sequestrated fat necrosis. Bacterial culture test remained negative. Based on the findings mentioned above, a diagnosis of intraosseous fat necrosis associated with pancreatitis was made. Treatments proven to be effective in the literature for pancreatitis were started. Symptoms of the bones and joints gradually improved. However, pancreatitis relapsed, triggered by drinking, 4 months after discharge. He had complaints of back pain without any history of trauma. Radiographs showed fractures of the entire vertebral body from the 12th thoracic to 5th lumbar vertebrae. What was interesting about the present case was that, after the pathological fractures of the extremities were completely resolved, osteonecrosis relapsed as pancreatitis deteriorated, resulting in pancreatic cyst rupture into the intrathoracic cavity and vertebrae, differing from the previous lesions that were affected. There are very few cases of pathological fracture induced by pancreatitis that affect the vertebrae.
Archives of Orthopaedic and Trauma Surgery 03/2010; 131(1):11-4. · 1.37 Impact Factor
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ABSTRACT: Although many authors have reported the serum concentrations of metal ions in patients who had metal-on-metal coupling prostheses, most of the studies were not longitudinal, and the follow-up periods were short. We evaluated the longitudinal changes of serum chromium levels in 44 patients who had undergone unilateral metal-on-metal total hip arthroplasty for a minimum of 7 years postoperatively. Although there was a consistent increase in the mean serum chromium level until 3 years after implantation, there was little difference in the levels from years 3 to 7 postoperatively. Although the serum chromium concentration was low throughout postoperative follow-up for 7 years in about 25% of patients, the serum chromium level stayed high or showed gradual elevation in 16.3% of our patients.
The Journal of arthroplasty 10/2009; 25(8):1196-200. · 1.79 Impact Factor
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ABSTRACT: The treatment of residual deformity following surgery for developmental dysplasia of the hip remains controversial. The rationale for the use of the rotational acetabular osteotomy (RAO) is that it increases the weight-bearing area by shifting the osteotomized acetabulum to cover the femoral head. This can improve joint function as well as achieve relief of pain. However, it is unclear if this osteotomy can improve a compromised hip when performed for the treatment of residual deformity and acetabular dysplasia after surgery for developmental dysplasia of the hip. We aimed to report the clinical outcome as assessed by need for total hip arthroplasty (THA) and by the Merle d'Aubigné and Postel scores. In addition, we tried to assess the radiographic outcomes as assessed by Tönnis's classification. Only two hips required THA, which was performed in two patients at 11 and 12 years after RAO, respectively. The mean Merle d'Aubigné clinical score improved from 14.1 +/- 2.3 points (range, 10 to 17) preoperatively to 15.8 +/- 2.9 points (8 to 18) at final follow-up (p < 0.02). Radiological assessment at final follow-up showed the obvious progression of osteoarthritis in five hips. One patient in grade 1 preoperatively progressed into grade 3 at final follow-up; four patients in grade 2 preoperatively progressed into grade 3. In our study, this osteotomy prolonged the functional life of the hip, and only two hips needed THA after a mean follow-up of 11 years. We found that advanced arthritis pre-osteotomy is associated with progression of radiologic changes.
HSS Journal 06/2009; 5(2):137-42.
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ABSTRACT: We reviewed 42 hips which had undergone revision THA between 1995 and 2005 (the Kerboull plate in 24 hips, and the KT plate in 18 hips). Patients were followed-up for a mean of 7.5 years (range 3-13). In the Kerboull plate group, the five- and ten-year survival rates were 89.9% and 79.4%, respectively. In the KT plate group, the five-year survival rate was 87.5%. The Kerboull and KT plates are placed as close as possible to the original acetabular position and used in combination with a bone graft for bone defects. In Japan, for patients with large bone defects, femoral heads with good quality which have been resected due to osteoarthritis are difficult to prepare as bone grafts. Therefore, use of the KT plate can reduce the bone graft volume to a certain extent by high placement, which was effective in our cases.
International Orthopaedics 06/2009; 34(3):341-7. · 2.03 Impact Factor
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ABSTRACT: We report a case of insert fracture and metal shell penetration by the inner head after ceramic-on-ceramic THA. A 67-year-old
female underwent ceramic-on-ceramic THA (Osteonics Secur-Fit HA, Ceramic-on ceramic Bearing System, Stryker) in another hospital.
However, she noticed pain and crepitation and first visited our hospital due to aggravation of pain. Radiograph showed insert
fracture and metal shell penetration by the inner head, and she was admitted for revision. During the operation, the intra-articular
area showed marked metallosis. In the anterior area of the metal shell, there was a hole due to penetration by the inner head.
The metal shell was removed and the acetabulum was reconstructed by filling with reinforcement granules, followed by implantation
of a KT plate.
European Journal of Orthopaedic Surgery & Traumatology 01/2009; 19(2):109-112. · 0.10 Impact Factor
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ABSTRACT: The treatment of osteonecrosis of the femoral head in younger patients varies among orthopaedic surgeons. In particular, the optimal treatment of extensive osteonecrosis associated with femoral head collapse remains controversial. Since 1995, we have performed rotational acetabular osteotomy on 70 hips, including those of 3 patients with extensive osteonecrosis of the femoral head after intracapsular fracture of the neck of the femur. In all 3 patients, adequate coverage of the femoral head by the osteotomized acetabulum was obtained, and their symptoms (especially pain) showed marked improvement at latest follow-up.
Journal of orthopaedic trauma 11/2008; 22(9):658-62. · 1.78 Impact Factor
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ABSTRACT: Between August 1986 and July 1997, we performed rotational acetabular osteotomy (RAO) according to the methods of Ninomiya and Tagawa in 161 patients (179 hips). Among them, 63 patients (68 hips) had advanced osteoarthritis. We assessed the outcome at a mean of 12 years after rotational acetabular osteotomy was performed for the treatment of advanced osteoarthritis in a series of patients with acetabular dysplasia. Eleven patients did not return for final follow-up and were excluded from the study, leaving 52 patients (57 hips) for analysis. The mean Merle d'Aubigné clinical score improved from 12.6 points (range 9-16) preoperatively to 14.3 points (range 7-18) postoperatively (p < 0.002), mainly because of increased scores for pain. At final follow-up, 50 of the 57 hips were still functioning. The results of rotational acetabular osteotomy for correction of advanced osteoarthritis in adults with acetabular dysplasia were satisfactory after a mean of 12.2 years.
International Orthopaedics 10/2008; 33(6):1549-53. · 2.03 Impact Factor
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ABSTRACT: We investigated the changes of serum chromium levels before and after revision surgery in 10 patients (1 male and 9 females) who underwent exchange of a metal-on-metal articulation for a metal-on-polyethylene component because of aseptic loosening of a metal-on-metal total hip prosthesis. Of the 10 patients, 2 had bilateral metal-on-metal total hip arthroplasty. In the 8 patients who had no residual metal articulation, the mean serum chromium levels before and after revision surgery were 2.53 microg/L and 0.46 microg/L, respectively. In the 2 patients who still had a metal articulation on the contralateral side, the mean serum chromium levels before and after revision surgery were 2.85 microg/L and 1.90 microg/L, respectively. Moderate serum chromium levels in patients with metal-on-metal total hip arthroplasty show a decrease after removal of the metal-on-metal articulation.
The Journal of arthroplasty 05/2008; 24(4):549-53. · 1.79 Impact Factor
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ABSTRACT: Marked activation of thrombosis is common in patients undergoing total hip arthroplasty, especially during reaming of the femur and after insertion of the femoral prosthesis. This suggests that management designed to minimize deep vein thrombosis and fatal pulmonary embolism after total hip arthroplasty should be focused on the period during insertion of the femoral component. In some previous studies, a low dose of heparin administered intraoperatively was shown to suppress the formation of fibrin.
The present study was performed to evaluate the influence of intraoperative heparin administration on the D-dimer level and on the prevention of pulmonary embolism after total hip arthroplasty.
A total of 22 and 26 consecutive patients respectively underwent total hip arthroplasty with and without intraoperative administration of unfractionated heparin. Postoperatively, all patients wore knee-high elastic stockings and were fitted with calf-to-thigh intermittent pneumatic compression devices. Active ankle flexion and extension exercises were commenced as soon as motor function recovered. None of the 48 patients received prophylactic anticoagulants postoperatively.
There was a significant difference of the mean D-dimer level on the 1st day between the patients with and without intraoperative administration of heparin (8.9 +/- 6.6 vs. 15.7 +/- 12.7, P < 0.05). Although there were no patients with symptomatic deep venous thrombosis and pulmonary embolism, asymptomatic pulmonary embolism was detected by pulmonary perfusion scintigraphy in three patients who did not receive intraoperative heparin. The operative blood loss and postoperative drainage were similar in both groups and no bleeding complications were observed. In conclusion, we recommend a safe and inexpensive regimen comprising 1,000 U of intravenous unfractionated heparin intraoperatively, postoperative pneumatic compression, and early active mobilization for prevention of thoromboembolic complications after total hip arthroplasty.
Archives of Orthopaedic and Trauma Surgery 02/2008; 128(1):37-40. · 1.37 Impact Factor
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ABSTRACT: The operative procedures chosen to treat arthrosis in patients with severe acetabular dysplasia vary among orthopaedic surgeons, particularly in younger patients. We operated on 450 hips with acetabular dysplasia by using the rotational acetabular osteotomy (RAO) method of Ninomiya and Tagawa by Ninomiya (Clin Orthop 247:127-137, 1989). In this report, we describe our technique of performing RAO with hydroxyapatite tricalcium phosphate-composite (HAP-TCP) blocks to achieve good acetabular coverage and the results of this procedure in 16 hips with severe dysplasia, including nine with advanced arthrosis. Adequate coverage of the osteotomized acetabulum was maintained and symptoms, especially pain, showed marked improvement at the latest follow up.
Archives of Orthopaedic and Trauma Surgery 09/2006; 126(6):421-4. · 1.37 Impact Factor
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ABSTRACT: In 54 patients (1 man and 53 women), 55 hips underwent primary metal-on-metal total hip arthroplasty (Metasul) with a Wagner standard cup (44-48 mm in outer diameter) and were followed for a minimum of 3 years. All patients received the same type of cementless femoral component (Natural Hip Stem) and femoral head (28 mm in diameter). Twelve (21.8%) of the 55 Wagner standard cups showed aseptic loosening over a mean period of 31 months postoperatively, and there were no bone anchors on the outer surface of the 9 retrieved cups. From our experience, the small Wagner standard cup does not achieve sufficient osteointegration and we do not recommend use of this cup, especially for dysplastic hips.
The Journal of Arthroplasty 07/2006; 21(4):522-6. · 2.38 Impact Factor
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The Journal of Bone and Joint Surgery 07/2005; 87(6):1358-62. · 3.27 Impact Factor
