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Otsuki S, Sezaki S, Okamoto Y, Ishitani T, Wakama H, Neo M. Safety and Efficacy of a Novel Polyglycolic Acid Meniscal Scaffold for Irreparable Meniscal Tear. Cartilage 2024; 15:110-119. [PMID: 37632127 DOI: 10.1177/19476035231193087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVE Meniscal tears treated with a partial meniscectomy could induce knee osteoarthritis, thereby altering or damaging knee kinetics and biomechanics. We have developed a meniscal scaffold made of polyglycolic acid (PGA) coated with polylactic acid/caprolactone (PGA scaffold), which could induce new tissue growth of meniscus-like tissue. This study aimed to evaluate the safety and efficacy of a novel meniscal scaffold for the treatment of irreparable meniscal injuries. DESIGN This study describes the findings of a cyclic torque test and first clinical trial of a PGA scaffold for inducing meniscus-like tissue in humans. As the first step, biomechanical testing of the PGA scaffold was performed using a cyclic torque test. Six patients underwent arthroscopic implantation of the PGA scaffold. Furthermore, the patients underwent preoperative clinical, serological, radiographic, and magnetic resonance imaging examinations at 3, 6, and 12 months postoperatively. The patients also underwent a second-look arthroscopy 12 months after implantation. RESULTS Torque increased with increasing cyclic loading. However, no structural damage to the sample was noted after 70,000 loading cycles. All patients showed improvement in pain, Lysholm scores, Tegner activity scores, International Knee Documentation Committee, and knee injury and osteoarthritis outcome. The second-look arthroscopy revealed that meniscal tissue had regenerated in 5 patients (83%). Radiography and magnetic resonance imaging confirmed no progression of degenerative joint disease. CONCLUSIONS The PGA scaffold could tolerate shear forces, did not produce safety concerns, and may have therapeutic potentials for irreparable meniscal tears in humans.
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Affiliation(s)
- Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Shunsuke Sezaki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
- QOL Research Division, GUNZE MEDICAL Limited, Kyoto, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Takashi Ishitani
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
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Sezaki S, Otsuki S, Ishitani T, Iwata T, Hananouchi T, Okamoto Y, Wakama H, Neo M. Usefulness of Probing Sensor Device for Evaluating Meniscal Suture and Scaffold Implantation. Biomimetics (Basel) 2024; 9:246. [PMID: 38667258 PMCID: PMC11048524 DOI: 10.3390/biomimetics9040246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/17/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Appropriate suture tension is a key factor in successful meniscal repair. This study aimed to clarify the appropriate value of meniscal stabilization with suture repair based on a probing procedure for healthy porcine menisci and a novel meniscal scaffold. After evaluating the reliability of the probing sensor, meniscal vertical tear and partial meniscectomy models were developed, in which suture repair and meniscal scaffold implantation were performed at suture intervals ranging between 20 and 2.5 mm. The residence forces at each interval were evaluated using a probing sensor. Moreover, a tensile test was conducted to evaluate the displacement and presence or absence of gaps. We found that normal and meniscal scaffolds should be fixed within 5 mm of suture interval. The probing residence forces required were at least 1.0 N for vertical tears and 3.0 N for meniscal scaffolds. These findings may be taken into consideration to reduce suture failure following meniscal tear repair and stabilizing meniscal scaffold fixation.
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Affiliation(s)
- Shunsuke Sezaki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki 569-8686, Japan; (S.S.); (T.I.); (T.I.); (Y.O.); (H.W.); (M.N.)
- QOL Research Division, GUNZE MEDICAL Ltd., Kita-ku, Osaka 530-0003, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki 569-8686, Japan; (S.S.); (T.I.); (T.I.); (Y.O.); (H.W.); (M.N.)
| | - Takashi Ishitani
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki 569-8686, Japan; (S.S.); (T.I.); (T.I.); (Y.O.); (H.W.); (M.N.)
| | - Takeru Iwata
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki 569-8686, Japan; (S.S.); (T.I.); (T.I.); (Y.O.); (H.W.); (M.N.)
| | - Takehito Hananouchi
- Biodesign Division, Department of Academia-Government-Industry Collaboration, Hiroshima University, Minami-ku, Hiroshima 734-8551, Japan;
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki 569-8686, Japan; (S.S.); (T.I.); (T.I.); (Y.O.); (H.W.); (M.N.)
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki 569-8686, Japan; (S.S.); (T.I.); (T.I.); (Y.O.); (H.W.); (M.N.)
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki 569-8686, Japan; (S.S.); (T.I.); (T.I.); (Y.O.); (H.W.); (M.N.)
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Okamoto Y, Wakama H, Nakamura K, Ishitani T, Otsuki S, Neo M. Worse Patient-Reported Outcomes and Spino-Pelvic Parameters After Total Hip Arthroplasty for Rapidly Progressive Osteoarthritis of the Hip Compared to Osteoarthritis: A Propensity-Matched Cohort Study. J Arthroplasty 2024:S0883-5403(24)00328-0. [PMID: 38608844 DOI: 10.1016/j.arth.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND This study aimed to assess the association between the disease process of hip osteoarthritis and total hip arthroplasty (THA) outcomes; this is a critical issue, as rapid progression has been postulated to be responsible for patient dissatisfaction after THA. METHODS This retrospective case-control study included 255 patients who underwent THA and completed a mean follow-up duration of 42.1 months (range, 24.0 to 77.0). We classified patients into those who had (n = 26) and did not have (n = 229) rapidly progressive osteoarthritis of the hip (RPOA), defined as a narrowing rate of joint space ≥ 2 mm yearly or a ≥ 50% loss within 12 months, excluding any other cause of a destructive arthropathy. Propensity score-matched cohorts for age, sex, body mass index, and spino-pelvic measures were created, and the outcomes were compared between the 2 groups. RESULTS After successfully matching RPOA (n = 25) and non-RPOA patients (n = 50), there were significant differences in minimum clinically important difference (P = .009 for European Quality of Life 5-Dimension, and P < .001 for low back pain), patient acceptable symptom state (P = .015 for European Quality of Life 5-Dimension, and P < .001 for Hip Disability and Osteoarthritis Outcome Score Joint Replacement score), patient satisfaction (P = .028), and T1 pelvic angle as an indicator of global sagittal spinal deformity (P = .017). There was a correlation between T1 pelvic angle and low back pain in the RPOA group (R = 0.628, P < .001). CONCLUSIONS Patients who exhibited RPOA before undergoing THA showed worse patient-reported outcomes compared with those who did not have rapid progression. Our study highlights the critical role of the disease process in influencing THA outcomes, advocating for a paradigm shift toward more meticulous preoperative evaluations, including global spinal deformity, standardized diagnostic criteria, and tailored interventions.
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Affiliation(s)
- Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan; Department of Orthopedic Surgery, Saiseikai Ibaraki Hospital, Ibaraki, Japan
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Kaito Nakamura
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Takashi Ishitani
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
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Matsuyama J, Okamoto Y, Wakama H, Nakamura K, Saika T, Otsuki S, Neo M. Factors associated with the progression of sagittal spinal deformity after total hip arthroplasty: a propensity score-matched cohort study. Int Orthop 2024:10.1007/s00264-024-06174-9. [PMID: 38589707 DOI: 10.1007/s00264-024-06174-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 04/02/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE The functional interaction between the hip and spine in patients undergoing total hip arthroplasty (THA) is clinically significant, as it impacts post-operative outcomes. Therefore, this study aimed to identify factors associated with the progression of sagittal spinal deformity and assess the association with patient-reported outcomes. METHODS This retrospective case-control study included 200 patients who underwent primary THA and completed a mean follow-up duration of 42.2 months (range, 24.0-78.0). We employed a multivariate logistic regression to identify variables predictive of a post-THA sagittal vertical axis (SVA) ≥ 50 mm, which was indicative of a spinal sagittal imbalance. Propensity score-matched cohorts for age, sex, body mass index, follow-up duration, hip flexion contracture, developmental dysplasia, pelvic incidence (PI), and SVA were created, and the outcomes were compared between the two groups. RESULTS PI (odds ratio 1.39; 95% confidence interval 1.04-1.86, p = 0.033) was associated with an SVA ≥ 50 mm. After successfully matching patients with (n = 50) and without (n = 50) an SVA ≥ 50 mm, the minimum clinically important difference showed significant differences between the 50 matched pairs (p = 0.016 for EuroQol-5D, p = 0.003 for Hip Disability and Osteoarthritis Outcome Score Joint Replacement, and p < 0.001 for low back pain). CONCLUSION PI is associated with the development of a positive sagittal spinal malalignment post-THA. This finding can assist surgeons in managing patient expectations and in optimising outcomes. Feasible strategies are warranted to minimise the risk of spinal deformity progression post-THA.
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Affiliation(s)
- Junya Matsuyama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan.
- Department of Orthopedic Surgery, Saiseikai Ibaraki Hospital, 2-1-45, Mitsukeyama, Ibaraki, 567-0035, Japan.
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan
| | - Kaito Nakamura
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan
| | - Takafumi Saika
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan
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Okamoto Y, Wakama H, Matsuyama J, Nakamura K, Saika T, Otsuki S, Neo M. The psoas muscle index as a useful predictor of total hip arthroplasty outcomes. Arch Orthop Trauma Surg 2024; 144:1763-1772. [PMID: 38063880 DOI: 10.1007/s00402-023-05146-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/11/2023] [Indexed: 03/27/2024]
Abstract
INTRODUCTION The aim of this study is to assess the association between the psoas muscle index (PMI) and total hip arthroplasty (THA) outcomes. This is a critical issue as sarcopenia has been associated with poor patient satisfaction post-THA. MATERIALS AND METHODS This was a retrospective case-control study of 205 THAs, with a mean follow-up of 3.6 (range, 2.0-5.5) years. Age, sex, serum immune markers, spinopelvic parameters, PMI (quantified as the cross-sectional area of the psoas, bilaterally, at L3 divided by the individual's height squared), and patient-reported outcomes were compared between patients 'with' (n = 118) and 'without' (n = 87) achievement of a minimum clinically important difference (MCID) improvement in the EuroQol 5-Dimension (EQ-5D), post-THA. Logistic regression and receiver operating characteristic curve analyses were used to identify predictive factors. RESULTS A ≥ MCID improvement in the EQ-5D was associated with the PMI (odds ratio, 0.75; 95% confidence interval, 0.63-0.91; P = 0.028), prognostic nutritional index (odds ratio, 0.85; 95% confidence interval, 0.45-0.94; P = 0.043), and age (odds ratio, 1.09; 95% confidence interval, 1.01-1.18; P = 0.044). After adjusting the PMI threshold to 4.0 cm2/m2 for females and 6.4 cm2/m2 for males, there were significant differences in serum factors (P = 0.041 for albumin and P = 0.016 for a prognostic nutritional index < 40), MCID (P < 0.001 for EQ-5D, P < 0.001 for low back pain, and P = 0.008 for the Hip Disability and Osteoarthritis Outcome Score Joint Replacement score), patient satisfaction (P = 0.003), and T1 pelvic angle (P = 0.030). CONCLUSION The PMI, which is associated with nutritional status and global sagittal spinal deformity, does predict THA outcomes. Therefore, it can be useful when discussing THA expectations with patients.
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Affiliation(s)
- Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan.
- Department of Orthopedic Surgery, Saiseikai Ibaraki Hospital, 2-1-45, Mitsukeyama, Ibaraki, 567-0035, Japan.
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan
| | - Junya Matsuyama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan
| | - Kaito Nakamura
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan
| | - Takafumi Saika
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan
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Wakama H, Okamoto Y, Okayoshi T, Ikeda K, Matsuyama J, Otsuki S, Neo M. Unfavorable cortical hypertrophy potentially predisposes to periprosthetic "axe splitter" fracture in a collarless polished curved triple-tapered cemented stem: The time-dependent radiographic change in five SC-stem cases. J Orthop Sci 2024; 29:439-444. [PMID: 36182639 DOI: 10.1016/j.jos.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/20/2022] [Accepted: 09/02/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND The periprosthetic fracture of cemented polished tapered stems is occasionally called a "unique" or "axe splitter" fracture. However, there has been insufficient evidence regarding the association between the radiographic findings prior to incidence and this cumbersome fracture. To determine if there are any radiographic interpretations associated with this fracture pattern, we report the five SC-stem cases with total hip arthroplasty. METHODS We investigate the patient characteristics and serial radiographs of five fracture cases and evaluate the time-dependent specific radiographical changes around the stem between pre-arthroplasty and fracture. RESULTS Fractures developed at 3.5-6.4 years after surgery with low-grade injury or with no particular incentive. Femoral cortical hypertrophy at the distal medial side around the stem was observed in all cases before the development of fractures, at 2-6 years after primary surgery. The duration between cortical hypertrophy appearance to the development of fracture was 0.4-3.1 years. CONCLUSIONS The appearance of this zone-specific cortical hypertrophy might play a key role in the occurrence of periprosthetic fractures. Further studies with larger sample sizes should be conducted to elucidate this eccentric periprosthetic fracture.
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Affiliation(s)
- Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki Osaka, Japan.
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki Osaka, Japan
| | - Tomohiro Okayoshi
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki Osaka, Japan
| | - Kuniaki Ikeda
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki Osaka, Japan
| | - Junya Matsuyama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki Osaka, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki Osaka, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki Osaka, Japan
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Otsuki S, Ikeda K, Ishitani T, Okamoto Y, Wakama H, Neo M. Effect of lateral hinge fractures for bone union and clinical outcomes following opening-wedge distal tibial tubercle osteotomy in comparison with opening-wedge high tibial osteotomy. J Exp Orthop 2023; 10:140. [PMID: 38095818 PMCID: PMC10721766 DOI: 10.1186/s40634-023-00701-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/16/2023] [Indexed: 12/17/2023] Open
Abstract
PURPOSE Although the effects of lateral hinge fractures (LHF) on bone union and clinical outcomes after opening-wedge high tibial osteotomy (OWHTO) have been established, the effects of LHF after opening-wedge distal tibial tubercle osteotomy (OWDTO) are unclear. We hypothesised that LHF after OWDTO would be associated with delayed bone union and result in poorer clinical outcomes than expected for LHF after OWHTO. METHODS This study enrolled 100 patients, with 50 OWDTO patients (18 men; mean age, 63.2 years) and 50 OWHTO patients compared based on the propensity score matched analysis. The effect of LHF on bone union was compared between the groups. Clinical outcomes were assessed using the Lysholm score and the Knee Injury and Osteoarthritis Outcome Score (KOOS) at the mean follow-up of 28 months. RESULTS There was no between-group difference in the incidence rate of LHF. However, the rate of bone union at the anterior flange in the presence of an LHF was significantly lower in the OWDTO (26%) than in the OWHTO (80%) 3 months postoperatively (p < 0.05), but no difference was observed 12 months postoperatively. The Lysholm score was significantly lower for patients with LHF following OWDTO than for OWDTO patients without LHF or OWHTO patients with/without LHF 3 and 12 months postoperatively (p < 0.001); Lysholm score and KOOS were not different at the final follow-up. CONCLUSIONS LHF after OWDTO was associated with delayed bone union and poor clinical outcomes until 12 months. This information can guide decisions regarding the indications and the management of patients after OWDTO. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan.
| | - Kuniaki Ikeda
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Takashi Ishitani
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
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Okamoto Y, Wakama H, Matsuyama J, Nakamura K, Saika T, Otsuki S, Neo M. Clinical significance of relative pelvic version measurement as a predictor of low back pain after total hip arthroplasty. Eur Spine J 2023; 32:4452-4463. [PMID: 37779107 DOI: 10.1007/s00586-023-07956-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/12/2023] [Accepted: 09/16/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE To evaluate the association between the preoperative global alignment and proportion (GAP) score and low back pain (LBP) after total hip arthroplasty (THA). METHODS This was a retrospective case-control study of 200 patients who underwent primary unilateral THA for hip osteoarthritis. The following variables were compared between individuals with (n = 76) and without (n = 124) LBP after THA over a mean follow-up of 2 years: age, sex, GAP score, and patient-reported outcome measures. Logistic regression and receiver operating characteristic curve analyses were used to detect predictive factors. RESULTS The following parameters were predictive of post-THA LBP: relative pelvic version (RPV) <-7° (odds ratio, 1.43; 95% confidence interval, 1.10-1.72; P = 0.032) and relative lumbar lordosis <-15° (odds ratio, 1.13; 95% confidence interval, 1.04-2.13; P = 0.041) preoperatively. Using an RPV cutoff value of - 7° (specificity 61/64 = 0.953; sensitivity 121/136 = 0.890), there were significant between-group differences in LBP visual analog scale (P = 0.020), Oswestry Disability Index (ODI, P = 0.014), EuroQol 5-Dimension (P = 0.027), Hip Disability and Osteoarthritis Outcome Score Joint Replacement (HOOS JR, P = 0.012), patient satisfaction (P = 0.024). There was clinically meaningful improvement for LBP visual analog scale (P = 0.001), ODI (P = 0.004), and HOOS JR (P < 0.001). The RPV before THA was correlated with HOOS JR (r = 0.773, P = 0.012) and ODI (r = - 0.602, P = 0.032) postoperatively. CONCLUSION Among the GAP score, a moderate-to-severe pelvic retroversion was significantly associated with LBP post-THA. The RPV measurement may be a useful predictor of THA outcome, which may influence patient satisfaction.
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Affiliation(s)
- Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan.
- Department of Orthopedic Surgery, Saiseikai Ibaraki Hospital, 2-1-45, Mitsukeyama, Ibaraki, 567-0035, Japan.
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan
| | - Junya Matsuyama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan
| | - Kaito Nakamura
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan
| | - Takafumi Saika
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan
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Nakamura K, Okamoto Y, Wakama H, Matsuyama J, Ishitani T, Otsuki S, Neo M. Answer to the Letter to the Editor of Y. Yamada, et al. concerning "T1 pelvic angle is associated with rapid progression of hip arthrosis" by Nakamura K et al. (Eur Spine J [2023]: https://doi.org/10.1007/s00586-023-07580-0). Eur Spine J 2023; 32:2623-2624. [PMID: 37115282 DOI: 10.1007/s00586-023-07723-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/16/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Kaito Nakamura
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan.
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan
| | - Junya Matsuyama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan
| | - Takashi Ishitani
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan
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Sezaki S, Otsuki S, Ikeda K, Ishitani T, Okamoto Y, Wakama H, Matsuyama J, Nakamura K, Neo M. Biomechanical assessment of a novel meniscal scaffold compared to partial meniscectomy: A study on porcine meniscal injury. J Biomed Mater Res B Appl Biomater 2023; 111:895-902. [PMID: 36374005 DOI: 10.1002/jbm.b.35199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/26/2022] [Accepted: 11/06/2022] [Indexed: 11/16/2022]
Abstract
This study aimed to investigate the appropriate size of scaffold implantation on stress distribution and evaluate its mechanical and biomechanical properties considering hydrolysis. The meniscus acts as a load distribution in the knee, and its biomechanical properties are essential for the development of the PGA scaffold. We established a novel meniscal scaffold, which consists of polyglycolic acid (PGA) covered with L-lactide-ε-caprolactone copolymer (P[LA/CL]). After 4 weeks of hydrolysis, the scaffold had a 7% volume reduction compared to the initial volume. In biomechanical tests, the implantation of scaffolds 20% larger than the circumferential and vertical defect size results in greater contact stress than the intact meniscus. In the mechanical evaluation associated with the decomposition behavior, the strength decreased after 4 weeks of hydrolysis. Meanwhile, in the biomechanical test considering hydrolysis, contact stress and area equivalent to intact were obtained after 4 weeks of hydrolysis. In conclusion, the implantation of the PGA scaffold might be a useful alternative to partial meniscectomy in terms of mechanical properties, and the PGA scaffold should be implanted up to 20% of the defect size.
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Affiliation(s)
- Shunsuke Sezaki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan.,QOL Research Laboratory, Gunze Limited, Kyoto, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Kuniaki Ikeda
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Takashi Ishitani
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Junya Matsuyama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Kaito Nakamura
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
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Nakamura K, Okamoto Y, Wakama H, Matsuyama J, Ishitani T, Otsuki S, Neo M. T1 pelvic angle is associated with rapid progression of hip arthrosis. Eur Spine J 2023; 32:1463-1470. [PMID: 36800021 DOI: 10.1007/s00586-023-07580-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/19/2023] [Accepted: 02/03/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE To evaluate the association between global spinal malalignment and rapid progression of hip arthrosis. METHODS This was a retrospective, case-control study including 90 patients, contributing 90 hips, who underwent hemi- or total hip arthroplasty at our institution. For analysis, hips were classified into a rapid progression group, defined as ≥ 2 mm destruction of the femoral head or loss of the hip joint space within a 12-month period (n = 30), and a non-rapid progression group, defined by no observable hip disease progression over a period more than 12 months (n = 60). Logistic regression analysis identified factors that predicted rapid progression, with a receiver operating characteristic curve analysis used to confirm factors. RESULTS Significant between-group differences were identified for the following parameters: pelvic tilt (P = 0.002, PT), sagittal vertical axis (P = 0.002, SVA), and T1 pelvic angle (P < 0.001, TPA). On multiple logistic regression, PT (P = 0.002), SVA (P = 0.002), and TPA (P < 0.001) were predictive of a rapid progression on hip arthrosis, with the area under the curve being greater for TPA than PT (P = 0.035). CONCLUSION Global spinal alignment is associated with rapid progression of hip arthrosis. TPA could assist in identifying patients at risk for rapid progression of hip arthrosis, allowing for time management.
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Affiliation(s)
- Kaito Nakamura
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan.
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan
| | - Junya Matsuyama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan
| | - Takashi Ishitani
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan
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12
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Okayoshi T, Okamoto Y, Wakama H, Otsuki S, Neo M. The flexion-extension gap is predictive of patient-reported outcome measures after cruciate-retaining total knee arthroplasty. Knee 2023; 41:150-160. [PMID: 36702049 DOI: 10.1016/j.knee.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/13/2022] [Accepted: 12/21/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND We aimed to evaluate the association between the flexion-extension gap difference and patient-reported outcome measures after total knee arthroplasty (TKA). METHODS This was a retrospective case-control study of 60 cruciate-retaining single-radius TKAs. Soft tissue balancing was measured using an offset seesaw tensioner and centre-type digital knee balancer under joint distraction forces of 20-50 lbf and 1.5 times body mass index (1.5 BMI). At the last follow up of 2.0-6.5 (mean, 4.5) years postoperatively, patients were asked if they perceived their knee joint as 'natural' (26 knees) or 'artificial' (34 knees). Age, sex, and the flexion-extension gap were compared between the two groups. A receiver operating characteristic curve was used to determine cut-off values of variables predictive of a natural joint perception. RESULTS Natural joint perception was associated with a greater flexion-extension gap difference under a distraction force of 1.5 BMI (P = 0.016), higher knee function (Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, P = 0.019), and quality of life (EuroQol 5-Dimension, P = 0.029). A gap difference of 0.95 mm under 1.5 BMI distraction predicted a natural joint perception post-TKA (sensitivity, 97.1%; specificity, 88.5%). Using a gap threshold of 1.0 mm under a 1.5 BMI distraction force yielded significant between-group differences in postoperative flexion (P = 0.040), satisfaction (P = 0.043), knee joint function (P < 0.001), quality of life (P = 0.032), and posterior femoral condylar offset (P = 0.037) CONCLUSION: A flexion-extension gap difference ≥1.0 mm under a distraction force of 1.5 BMI predicted superior outcomes, including patient satisfaction, after cruciate-retaining TKA. It was suggested that posterior femoral condylar offset could influence this finding.
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Affiliation(s)
- Tomohiro Okayoshi
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan
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13
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Otsuki S, Ikeda K, Ishitani T, Okamoto Y, Wakama H, Matsuyama J, Nakamura K, Neo M. Impact of the Weightbearing Line on Cartilage Regeneration of the Medial Knee Compartment after Open-Wedge High Tibial Osteotomy, Based on Second-Look Arthroscopy. Cartilage 2022; 13:87-93. [PMID: 36420992 PMCID: PMC9924979 DOI: 10.1177/19476035221137724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Cartilage regeneration is multifactorial. This study aimed to optimize the biomechanical factor of weightbearing loading allowing for cartilage regeneration and elucidate the association between cartilage regeneration and clinical outcomes after medial open-wedge high tibial osteotomy (OWHTO). DESIGN This was a retrospective, observational study of 142 patients who underwent OWHTO and subsequently underwent second-look arthroscopic assessment at a single orthopedic surgery center in Japan. Clinical and radiographic outcomes were compared between patients with (group R) and without (group D) cartilage regeneration, measured using the International Cartilage Repair Society grading system and the macroscopic staging system at the time second-look arthroscopy was performed. A receiver operating characteristic curve analysis was used to determine the optimal weightbearing line ratio (WBLR) for cartilage regeneration. RESULTS Group R included 82 knees, and group D 60 knees. The WBLR was higher in group R (60.9% ± 6.7%) than in group D (55.6% ± 7.6%) (P < 0.001) and was associated with a greater improvement in clinical outcomes, namely the Lysholm scale score and all subscales of the Knee Injury and Osteoarthritis Outcome Score (P < 0.01). The WBLR predicted cartilage regeneration with an odds ratio of 1.11 (P = 0.001) and an area under the curve of 0.718, for a WBLR value of 62%. CONCLUSIONS A WBLR of 62% was associated with cartilage regeneration after OWHTO and high patient-reported clinical outcomes.
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Affiliation(s)
- Shuhei Otsuki
- Shuhei Otsuki, Department of Orthopedic
Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi,
Takatsuki 569-8686, Osaka, Japan.
| | - Kuniaki Ikeda
- Department of Orthopedic Surgery, Osaka
Medical and Pharmaceutical University, Takatsuki, Japan
| | - Takashi Ishitani
- Department of Orthopedic Surgery, Osaka
Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka
Medical and Pharmaceutical University, Takatsuki, Japan
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka
Medical and Pharmaceutical University, Takatsuki, Japan
| | - Junya Matsuyama
- Department of Orthopedic Surgery, Osaka
Medical and Pharmaceutical University, Takatsuki, Japan
| | - Kaito Nakamura
- Department of Orthopedic Surgery, Osaka
Medical and Pharmaceutical University, Takatsuki, Japan
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14
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Okamoto Y, Wakama H, Matsuyama J, Nakamura K, Otsuki S, Neo M. The significance of the pelvic incidence measurement as a possible predictor of TKA outcome. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07224-8. [PMID: 36352242 DOI: 10.1007/s00167-022-07224-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the association between the sagittal alignment of the pelvis and residual knee flexion contracture after total knee arthroplasty (TKA). This is important as a flexion contraction can be associated with the risk of poor outcomes and patient satisfaction after TKA. METHODS This was a retrospective, case-control, study of 200 osteoarthritic knees, contributed by 200 patients, over a mean follow-up of 2.4 years. The following factors were compared between patients 'with' (46 knees) and 'without' (154 knees) a residual flexion contracture ≥ 10° after TKA: age, sex, pelvic incidence (PI), anterior femoral bowing, femoral component flexion angle (FFA), and patient-reported outcomes. Logistic regression and receiver operating characteristic curve analyses were used to identify predictive factors. RESULTS The following factors were predictive of a residual flexion contracture ≥ 10°: a pelvic incidence ≥ 55° (odds ratio, 1.29; 95% confidence interval, 1.05-1.59; P = 0.031) and the FFA (odds ratio, 1.08; 95% confidence interval, 1.03-1.14; P = 0.044). A pelvic incidence cutoff of 55° yielded a significant between-group difference, with a sensitivity of 78.4% and specificity of 89.9% to differentiate a residual knee flexion contracture ≥ 10° (P = 0.001), patient satisfaction (P = 0.029), EuroQol 5-Dimension score (P = 0.028), anterior femoral curvature (P = 0.031), and Knee Injury and Osteoarthritis Outcome Score-Joint Replacement score (P = 0.046). CONCLUSION A pelvic incidence > 55° is associated with a residual knee flexion contracture ≥ 10° after TKA. The significance of the pelvic incidence measurement as a possible predictor of TKA outcome was highlighted, including its impact on patient satisfaction. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan.
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan
| | - Junya Matsuyama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan
| | - Kaito Nakamura
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan
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15
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Otsuki S, Okamoto Y, Ikeda K, Wakama H, Okayoshi T, Neo M. Perioperative duloxetine administration reduces pain after high tibial osteotomy and non-steroidal anti-inflammatory administration: A prospective, controlled study. Knee 2022; 38:42-49. [PMID: 35908360 DOI: 10.1016/j.knee.2022.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 06/03/2022] [Accepted: 07/15/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Postoperative pain management is essential for patient satisfaction; however, no reports have described the effect of perioperative duloxetine administration on the postoperative pain management following knee surgery. This study aimed to determine whether perioperative duloxetine administration reduces pain following high tibial osteotomy. METHODS In this prospective clinical trial, 35 and 33 patients receiving (40 mg/day) and not receiving duloxetine (control), respectively were enrolled. The knee pain and quality of recovery were evaluated using the numeric rating scale (NRS) scores, the frequency of analgesic drugs used, and patient-reported outcome measures, including the NRS score at rest and the Knee Injury and Osteoarthritis Outcome Score (KOOS), were compared between the groups. RESULTS The NRS scores of the duloxetine group (D) were significantly reduced compared with those of the control group (C) on postoperative day 1 (D:3.8 vs C:5.1, p = 0.022), day 7 (D:2.1 vs C:2.9, p = 0.021), and day 14 (D:1.6 vs C:2.9, p = 0.001). Non-steroidal anti-inflammatory drug administration was significantly lower in the duloxetine group than in the control group (p < 0.001). Although the KOOS score was not significantly different in several subcategories at the pre- and postoperative time-points, the Function in Sport subcategory of the KOOS was significantly improved in the duloxetine group compared with that in the control group at 3 months postoperatively (p < 0.05). CONCLUSION Perioperative use of duloxetine from 2 weeks before surgery to 2 weeks after surgery is advantageous in perioperative pain management and KOOS improvement following high tibial osteotomy.
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Affiliation(s)
- Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Japan.
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Japan
| | - Kuniaki Ikeda
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Japan
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Japan
| | - Tomohiro Okayoshi
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Japan
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Otsuki S, Ikeda K, Okuno N, Okamoto Y, Wakama H, Okayoshi T, Matsuyama J, Neo M. Three-dimensional transfer of tibial tuberosity for patellar instability with patella alta preserves patellar position and clinical outcomes: A minimum 3-year follow-up study. J Orthop Sci 2022; 27:1100-1106. [PMID: 34244026 DOI: 10.1016/j.jos.2021.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 05/25/2021] [Accepted: 06/06/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The three-dimensional (3D) transfer of tibial tuberosity has been reported to improve patellofemoral congruity and showed good clinical outcomes during the short follow-up, however, little is known about whether the patellar position and clinical outcomes are preserved at longer follow-ups and the risk factors for poor clinical outcomes. HYPOTHESIS We hypothesized that patellar position and clinical outcomes would be preserved and the predisposing factors were associated with poor clinical outcomes after the 3D transfer of tibial tuberosity. PATIENTS AND METHODS Thirty-nine patients, with a mean age of 27.9 (15-52) years, who underwent the 3D transfer of the tibial tuberosity were enrolled. Patellar position was evaluated using the Caton-Deschamps index and patellar tilt. Clinical outcomes were evaluated with Lysholm and Kujala scores pre- and postoperatively. Age, body mass index (BMI), radiographic measurements, and range of motion (ROM) were compared between the poor group (defined as <80 points on Kujala score) and the good group (≥80 points). The mean follow-up period was 54.1 (36-100) months. RESULTS Patellar position decreased from 1.32 (1.21-1.53) preoperatively to 0.99 (0.84-1.07) at the final follow-up, according to the Caton-Deschamps index (p < 0.01). The mean patellar tilt decreased from 26.0° (21-40°) to 15.1° (5-28°) (p < 0.01). Kujala and Lysholm scales improved from 59.1 to 54.2 to 90.1 and 91.8 at final follow-up, respectively (p < 0.01). Increased BMI, lower femorotibial angle, limited ROM, and poor preoperative clinical outcomes were the predicting factors for poor postoperative clinical outcomes (p < 0.05). CONCLUSION The 3D transfer for patellar instability with patella alta preserved the patellar position and clinical outcomes for at least 3 years. Predisposing factors that may potentially affect postoperative clinical outcomes of the 3D transfer of tibial tuberosity include an increased BMI, valgus knee, limited ROM, and poor preoperative clinical outcomes.
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Affiliation(s)
- Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Japan.
| | - Kuniaki Ikeda
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Japan.
| | - Nobuhiro Okuno
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Japan.
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Japan.
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Japan.
| | - Tomohiro Okayoshi
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Japan.
| | - Junya Matsuyama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Japan.
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Japan.
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17
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Okamoto Y, Wakama H, Matsuyama J, Nakamura K, Otsuki S, Neo M. Association of the Psoas Muscle Index and Sagittal Spinal Alignment With Patient-Reported Outcomes After Total Hip Arthroplasty: A Minimum 5-Year Follow-Up. J Arthroplasty 2022; 37:1111-1117. [PMID: 35151804 DOI: 10.1016/j.arth.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/27/2022] [Accepted: 02/06/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The aim of this study is to assess the association between a spinopelvic malalignment and patient-reported perception of the hip as being "artificial" after total hip arthroplasty (THA). This is a critical issue as an age-related spinopelvic mismatch has been postulated to be associated with the risk of poor outcomes after THA. METHODS This is a retrospective case-control study of 274 THAs (244 of whom were women), with a mean follow-up of 6.2 (range 5.0-8.2) years. Hip perception was assessed by asking subjects whether their joint felt "natural" or "artificial." The association between an artificial perception and the following factors was evaluated: age, gender, psoas muscle index (PMI, cross-sectional area of bilateral psoas at L3 divided by height squared), and spinopelvic measures using logistic regression analysis. RESULTS An artificial hip perception (130 hips, 47.4%) was associated with a lower PMI (P = .016), Hip Disability and Osteoarthritis Outcome Score Joint Replacement score (P = .035), EuroQol 5-Dimension score (P = .041), and a higher incidence of a pelvic incidence-minus-lumbar lordosis (PI-LL) mismatch >10° (P < .001). A flatback deformity (odds ratio 2.24, 95% confidence interval 1.22-6.31, P = .001) and PMI (odds ratio 0.61, 95% confidence interval 0.34-0.82, P = .012) were predictive of an artificial perception. With the threshold of PI-LL set to 10°, PMI (P = .034), Hip Disability and Osteoarthritis Outcome Score Joint Replacement score (P < .001), joint perception (P = .020), EuroQol 5-Dimension score (P = .028), pain (P = .031), and satisfaction (P < .001) differed between the 2 groups. CONCLUSION A flatback deformity is associated with the risk of an artificial perception post-THA, especially in patients with sarcopenia. PMI and PI-LL measurements may help predict THA outcomes.
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Affiliation(s)
- Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Junya Matsuyama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Kaito Nakamura
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
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18
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Otsuki S, Ikeda K, Tanaka K, Okamoto Y, Sezaki S, Neo M. Implantation of Novel Meniscus Scaffold for Irreparable Meniscal Tear. Arthrosc Tech 2022; 11:e775-e779. [PMID: 35646573 PMCID: PMC9134103 DOI: 10.1016/j.eats.2021.12.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 12/18/2021] [Indexed: 02/03/2023] Open
Abstract
Partial meniscectomy, which is generally used for the treatment of meniscal tears, can lead to knee joint osteoarthritis. To prevent this important complication, attempting to restore normal knee joint kinematics and biomechanical forces after partial meniscectomy is essential. Implantation of a meniscal scaffold can be useful in this regard, improving the function of the meniscus on knee joint biomechanics after partial meniscectomy. Use of meniscal scaffolds would have specific clinical merit for young patients who are at highest for developing knee joint osteoarthritis over time. Herein, we describe our novel bioabsorbable meniscal scaffold, fabricated with polyglycolic acid coated with polylactic acid/caprolactone, used after partial meniscectomy for degenerative and irreparable meniscal tears. The method of implantation of the scaffold will have a determinant effect on clinical outcomes. As the implementation technique by arthroscopy will be influenced by the stiffness and strength of the scaffold implant used, we provide a detailed description of our implantation technique, including a description of the pitfalls to consider in order to improve clinical outcomes.
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Affiliation(s)
- Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Japan,Address correspondence to Shuhei Otsuki, M.D, Ph.D., Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki Osaka 569-8686 Japan.
| | - Kuniaki Ikeda
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Japan
| | - Kei Tanaka
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Japan
| | | | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Japan
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19
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Okamoto Y, Wakama H, Okayoshi T, Matsuyama J, Otsuki S, Neo M. Spinopelvic mismatch is associated with patient-reported outcome measures after total knee arthroplasty at a mean follow-up of 15 years. Knee 2022; 34:156-166. [PMID: 34923348 DOI: 10.1016/j.knee.2021.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/02/2021] [Accepted: 11/25/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is widely performed; yet, up to 25% of patients are dissatisfied with outcomes. Our aim was to evaluate the association between a spinopelvic mismatch and patient-reported outcomes after TKA. METHODS This was a retrospective study of 101 TKAs performed for osteoarthritis, at a mean 14.6 (range, 10.0-18.0) years post-surgery. Postoperative knee joint perception was evaluated as 'artificial', with or without restrictions, or 'natural'. Age, sex and the spinopelvic mismatch were compared between the 'artificial' (n = 54) and 'natural' (n = 47) perception groups. Multiple logistic regression analysis was used to identify predictive factors of an artificial perception, with a receiver operating characteristic curve to identify cut-off values for significant factors. RESULTS A spinopelvic mismatch, defined as a pelvic incidence minus lumbar lordosis (PI-LL) ≥ 10°, was associated with an artificial perception (odds ratio, 1.57; 95% confidence interval, 1.29-3.22; P = 0.023). An artificial joint perception was related to lower Knee Injury and Osteoarthritis Outcome Score-Joint Replacement (KOOS-JR, P = 0.021) and EuroQol 5-Dimension (EQ-5D, P = 0.025) scores. The cut-off PI-LL of 11° differentiated the groups with a sensitivity of 87.0% and specificity of 91.9%. Postoperative KOOS-JR (P < 0.001), EQ-5D (P = 0.014), satisfaction (P = 0.015), knee extension angle (P = 0.024), and perception (P = 0.032) differed between the groups when the PI-LL threshold was set at 10°. CONCLUSION A spinopelvic mismatch (PI-LL ≥ 10°) is associated with a risk of artificial perception of function after TKA. Measurement of the PI-LL could assist patients and surgeons to predict TKA outcomes.
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Affiliation(s)
- Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Tomohiro Okayoshi
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Junya Matsuyama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan.
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Nakagawa K, Otsuki S, Murakami T, Okamoto Y, Okuno N, Wakama H, Sezaki S, Ikeda K, Okayoshi T, Neo M. Histological Analysis of the Wrapping Treatment for Meniscal Horizontal Tears in Rabbits. Cartilage 2021; 13:1551S-1561S. [PMID: 31466462 PMCID: PMC8804842 DOI: 10.1177/1947603519870838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To investigate meniscal regeneration and prevent cartilage degeneration using wrapping treatment for meniscal horizontal tears that have been difficult to repair in rabbits. DESIGN Thirty knees from 15 Japanese white rabbits were divided into the horizontal (horizontal tears) or wrapping (horizontal tears with wrapping treatment) groups. Horizontal tears were created and wrapped with a sheet scaffold containing polyglycolic acid, polylactic acid, and polycaprolactone. The meniscus was stained with Safranin-O/Fast Green and evaluated with modified Pauli scores at 8, 12, and 16 weeks after implantation (n = 5). Cell morphology was determined with hematoxylin and eosin staining. Mature collagen was confirmed with Picrosirius Red staining. Furthermore, immunohistochemical analysis of inducible nitric oxide synthase (iNOS) for inflammation, Ki-67 for proliferation, and type II collagen for regeneration was performed. Medial femoral cartilage was stained with Safranin-O/Fast Green and evaluated with the Osteoarthritis Research Society International score at 8 and 16 weeks. RESULTS The wrapping group had significantly better regeneration than the horizontal group, especially at 16 weeks (P < 0.05). Wrapping treatment induced fibrochondrocyte-like cells at 16 weeks. After wrapping treatment, iNOS was overexpressed at 8 weeks, Ki-67 at 8 and 12 weeks, and type II collagen at 16 weeks. Cartilage degeneration in the wrapping group did not progress significantly compared with that in the horizontal group at 16 weeks (P < 0.05). CONCLUSIONS Wrapping treatment for meniscal horizontal tears induced meniscal regeneration as the sheet scaffold might induce intrinsic and extrinsic repair. Regaining the meniscal function by the wrapping treatment prevented cartilage degeneration.
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Affiliation(s)
- Kosuke Nakagawa
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan,Shuhei Otsuki, Department of Orthopedic
Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki-city, Osaka
569-8686, Japan.
| | - Tomohiko Murakami
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
| | - Nobuhiro Okuno
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
| | - Shunsuke Sezaki
- Department of QOL Research Center
Laboratory, Gunze Limited, Osaka, Japan
| | - Kuniaki Ikeda
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
| | - Tomohiro Okayoshi
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
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21
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Otsuki S, Wakama H, Ikeda K, Okuno N, Okamoto Y, Okayoshi T, Matsuyama J, Neo M. Progression of pelvic retroversion is a critical factor for clinical outcome after Opening-wedge high tibial osteotomy among elderly patients. J Exp Orthop 2021; 8:65. [PMID: 34409519 PMCID: PMC8374014 DOI: 10.1186/s40634-021-00376-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/23/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose To evaluate the clinical outcome after opening-wedge high tibial osteotomy (OWHTO) and to determine the critical factors for a poor clinical outcome after OWHTO in patients aged over 65 years. Methods Our retrospective analysis was based on the data from 233 patients who underwent OWHTO for medial compartment knee OA at our institution between January 2013 and December 2018, and 88 patients (36 men and 52 women) over 65 years of age were included in this study. Radiographic parameters of weight-bearing line ratio (WBLR) and pelvic inclination (PI); the knee function, range of motion (ROM) and extension; and clinical outcome with Lysholm score were obtained preoperatively and postoperatively at the final follow-up visit. To evaluate the critical factors for the clinical outcome, univariate regression analysis was used to identify the relationship between postoperative and improved Lysholm score and pre-and post-operative essential factors. To reveal the factor having a greater impact on the clinical outcome, a p < 0.05 in univariate factors was entered into a multivariate regression analysis. Results The preoperative WBLR was significantly changed, and Lysholm score improved from 59.5 to 81.5 (p < 0.0001), whereas the PI, knee extension and ROM were not changed after OWHTO. Regarding the essential factors affecting clinical outcome after OWHTO, age and delta PI were negative, whereas preoperative WBLR, postoperative ROM, especially extension, had a positive effect (p < 0.05). Furthermore, only delta PI had affected the improvement of clinical outcome with OWHTO (p < 0.01), and postoperative knee extension was negatively correlated with the progression of pelvic retroversion (p < 0.01). Conclusion Age at surgery and progression of pelvic retroversion were the critical factors for poor postoperative clinical outcomes after OWHTO. Care should be taken for the progression of pelvic retroversion after OWHTO because it deteriorates the clinical outcome by inducing the knee flexion contracture as the compensatory mechanism for the balance of sagittal alignment.
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Affiliation(s)
- Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan.
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Kuniaki Ikeda
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Nobuhiro Okuno
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Tomohiro Okayoshi
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Junya Matsuyama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
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Okamoto Y, Wakama H, Okayoshi T, Otsuki S, Neo M. Association of global sagittal spinal deformity with functional disability two years after total hip arthroplasty. BMC Musculoskelet Disord 2021; 22:523. [PMID: 34098924 PMCID: PMC8185940 DOI: 10.1186/s12891-021-04415-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The relationship between spinopelvic alignment and functional disability after total hip arthroplasty (THA) has not been fully elucidated despite the growing recognition of its importance on patient-reported outcome measures. Therefore, our aim was to assess the effect of global sagittal spinal deformity on post-operative disability. METHODS This analysis was based on 208 cases of THA, with functional disability measured at a follow-up of 2 years. The Hip Disability and Osteoarthritis Outcome Score-Joint Replacement (HOOS-JR), ranging from a scale of 0 (complete joint disability) to 100 (perfect joint health), was used to divide eligible patients into two groups, namely with and without disability, using a score of 70 as the cut-off. The following factors were compared between the two groups using multivariate analysis: age, sex, body height, body mass index, spinopelvic parameters, and surgeon experience. To identify the cut-off value of the parameters for predicting disability (HOOS-JR < 70/100), we used the receiver-operating characteristic curve. RESULTS The disability (30 hips) and control (178 hips) groups showed a significant difference in pre-operative body height (p = 0.020), T1 pelvic angle divided by pelvic incidence (T1PA/PI; p = 0.018), PI minus lumbar lordosis (p = 0.027), post-operative HOOS-JR (p = 0.010), patient satisfaction (p = 0.033), and the modified Harris Hip Score (p = 0.038). On multivariate analysis, the following factors were associated with persistent disability: T1PA/PI > 0.2 (odds ratio [OR], 2.11; 95% confidence interval [CI], 1.19-4.14; p < 0.001) and height < 148 cm equivalent to legal standards as short stature (OR, 1.26; 95% CI, 1.09-1.48; p = 0.011). The cut-off value of pre-operative T1PA/PI was > 0.19, with a sensitivity of 95% and specificity of 85%. Post-operative satisfaction (p < 0.001), HOOS-JR (p = 0.023), and EuroQol 5-Dimension (p = 0.041) differed between the two groups when the pre-operative cut-off value was chosen as 0.2. CONCLUSIONS A T1PA/PI > 0.2 was associated with greater disability after THA. Clinicians should be aware that patient-related factors, including global spinal deformities, particularly in patients with a short stature, can influence THA outcomes at 2 years postoperatively.
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Affiliation(s)
- Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University (Osaka Medical College), 2-7 Daigaku-machi, Takatsuki, Osaka, 5698686, Japan.
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University (Osaka Medical College), 2-7 Daigaku-machi, Takatsuki, Osaka, 5698686, Japan
| | - Tomohiro Okayoshi
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University (Osaka Medical College), 2-7 Daigaku-machi, Takatsuki, Osaka, 5698686, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University (Osaka Medical College), 2-7 Daigaku-machi, Takatsuki, Osaka, 5698686, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University (Osaka Medical College), 2-7 Daigaku-machi, Takatsuki, Osaka, 5698686, Japan
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Ikeda K, Otsuki S, Okuno N, Sezaki S, Nakagawa K, Miyamoto Y, Okamoto Y, Wakama H, Okayoshi T, Neo M. Development of a novel meniscal sheet scaffold and its effectiveness for meniscal regeneration in a rabbit defect model. J Biomater Appl 2021; 36:517-527. [PMID: 33691527 DOI: 10.1177/08853282211000523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study evaluated the biomechanical strength of a novel two-layer meniscal sheet scaffold (MSS) consisting of polyglycolic acid and poly-Llactic acid/caprolactone and investigated meniscal healing using wrapping treatment for meniscal defect model in a rabbit. The ultimate failure load of the MSS was determined using a tensile testing machine, in vitro. A 2-mm cylindrical defects were created at the medial meniscus of rabbit knees (n = 40). Each knee was assigned to one of two groups. The defect group was not treated and the MSS group underwent wrapping treatment with MSS. Menisci were harvested at 2, 4, 8, and 12 weeks post-implantation. The regenerated meniscus and defect size were evaluated using macrophotographs. Ishida scores for regenerated tissue were determined using Safranin-O/Fast Green staining. Immunohistochemical analysis of Ki-67 for cell proliferation, anti-type I and II collagen antibodies for structure of the regenerated tissue was elucidated. Medial femoral cartilage was stained with Safranin-O/Fast Green and evaluated with Osteoarthritis Research Society International (OARSI) scores. The strength of MSS was maintained over 90% from initial time point to 4 weeks after hydrolysis and over 60% of the strength remained at 8 weeks. The surface area of the meniscus was larger and the defect size smaller in the MSS group than in the defect group at 8 and 12 weeks. Ishida scores revealed that the MSS group improved significantly compared to that of the defect group at all postsurgery time points evaluated. Ki-67 positive cell ratio was significantly higher in the MSS group. OARSI score of the defect group was significantly higher and the defect group showed progressive degeneration in the articular cartilage from 8 to 12 weeks. Overall, wrapping meniscus defects with MSS was useful for accelerating meniscal healing from an early stage and beneficial for tissue regeneration and promoting extracellular matrix maturation.
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Affiliation(s)
- Kuniaki Ikeda
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Nobuhiro Okuno
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | | | - Kosuke Nakagawa
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Yuki Miyamoto
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Tomohiro Okayoshi
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
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Okuno N, Otsuki S, Aoyama J, Nakagawa K, Murakami T, Ikeda K, Hirose Y, Wakama H, Okayoshi T, Okamoto Y, Hirano Y, Neo M. Feasibility of a self-assembling peptide hydrogel scaffold for meniscal defect: An in vivo study in a rabbit model. J Orthop Res 2021; 39:165-176. [PMID: 32852842 DOI: 10.1002/jor.24841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 06/19/2020] [Accepted: 08/18/2020] [Indexed: 02/04/2023]
Abstract
The inner avascular zone of the meniscus has limited healing capacity as the area is poorly vascularized. Although peptide hydrogels have been reported to regenerate bone and cartilage, their effect on meniscus regeneration remains unknown. We tested whether the self-assembling peptide hydrogel scaffold KI24RGDS stays in the meniscal lesion and facilitates meniscal repair and regeneration in an induced rabbit meniscal defect model. Full-thickness (2.0 mm diameter) cylindrical defects were introduced into the inner avascular zones of the anterior portions of the medial menisci of rabbit knees (n = 40). Right knee defects were left empty (control group) while the left knee defects were transplanted with peptide hydrogel (KI24RGDS group). Macroscopic meniscus scores were significantly higher in the KI24RGDS group than in the control group at 2, 4, and 8 weeks after surgery. Histological examinations including quantitative and qualitative scores indicated that compared with the control group, the reparative tissue in the meniscus was significantly enhanced in the KI24RGDS group at 2, 4, 8, and 12 weeks after surgery. Immunohistochemical staining showed that the reparative tissue induced by KI24RGDS at 12 weeks postimplantation was positive for Type I and II collagen. KI24RGDS is highly biocompatible and biodegradable, with strong stiffness, and a three dimensional structure mimicking native extracellular matrix and RGDS sequences that enhance cell adhesion and proliferation. This in vivo study demonstrated that KI24RGDS remained in the meniscal lesion and facilitated the repair and regeneration in a rabbit meniscal defect model.
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Affiliation(s)
- Nobuhiro Okuno
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Jo Aoyama
- Department of Chemistry and Materials Engineering, Faculty of Chemistry, Materials, and Bioengineering, Kansai University, Osaka, Japan
| | - Kosuke Nakagawa
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Tomohiko Murakami
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Kuniaki Ikeda
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | | | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Tomohiro Okayoshi
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Yoshiaki Hirano
- Department of Chemistry and Materials Engineering, Faculty of Chemistry, Materials, and Bioengineering, Kansai University, Osaka, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
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Wakama H, Okamoto Y, Otsuki S, Nakagawa K, Okuno N, Neo M. Preoperative factors associated with extension gap in cruciate-retaining total knee arthroplasty: A retrospective study on continuous determination of distraction force. J Orthop Sci 2020; 25:1035-1039. [PMID: 31902557 DOI: 10.1016/j.jos.2019.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/07/2019] [Accepted: 12/04/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this retrospective study was to identify the preoperative patient-related factors affecting the soft tissue balancing in cruciate-retaining total knee arthroplasty. This is an important clinical issue, as the acquisition of adequate soft tissue balancing is essential for successful outcomes. METHODS The study group included 59 knees treated for medial compartment osteoarthritis. The extension gap was measured using the newly electric tensor that enables continuous quantification of a distraction force ranging from 0 to 40 lbf. We performed regression analyses to identify the relationship between preoperative factors and the extension gap. RESULTS Patient height, weight, and percent mechanical axis showed univariate correlation with the extension gap of either 30 lbf or 40 lbf. In the multivariate regression analysis without encountering multicollinearity, percent mechanical axis was inversely associated with the extension gap (t-value = -2.31, p = 0.02 for 30 lbf; and t-value = -2.39; p = 0.02 for 40lbf) as a significant independent factor. CONCLUSIONS We revealed the significant influence of several factors on the absolute value of the extension gap. Particularly, the severity of preoperative coronal alignment was a statistically independent explanatory variable, and the extension gap was overvalued in knees with severe varus deformity. This influence should be considered when comparing different individual cases longitudinally. Our feasible strategies could lead to a better understanding about the soft tissue balancing in total knee arthroplasty.
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Affiliation(s)
- Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 5698686, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 5698686, Japan.
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 5698686, Japan
| | - Kosuke Nakagawa
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 5698686, Japan
| | - Nobuhiro Okuno
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 5698686, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 5698686, Japan
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Otsuki S, Ikeda K, Wakama H, Okuno N, Okamoto Y, Okayoshi T, Miyamoto Y, Neo M. Preoperative flexion contracture is a predisposing factor for cartilage degeneration at the patellofemoral joint after open wedge high tibial osteotomy. Knee Surg Relat Res 2020; 32:55. [PMID: 33050942 PMCID: PMC7556938 DOI: 10.1186/s43019-020-00063-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/13/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of the study was to determine the effect of cartilage degeneration at the patellofemoral joint on clinical outcomes after open wedge high tibial osteotomy and to investigate the predisposing factors for progressive patellofemoral cartilage degeneration. Methods Seventy-two knees were evaluated on second-look arthroscopy in patients who opted for plate and screw removal at an average of 20.1 months after osteotomy. Cartilage degeneration at the patellofemoral joint was evaluated using the International Cartilage Repair Society grading system, with cases divided into progression and nonprogression groups. Radiographic parameters of the patellofemoral anatomy, knee range of motion, and clinical outcomes were evaluated from the preoperative baseline to the final follow up, on average 50 months after osteotomy. A contracture > 5° was considered a flexion contracture. Results Cartilage degeneration progressed in 31 knees, and preoperative knee flexion contracture was significantly associated with progressive degeneration (P < 0.01). The Lysholm and Kujala scores were significantly lower in the progression group (87.9 and 85.3, respectively) than in the nonprogression group (91.6 and 93.6, respectively) (P < 0.05). The odds ratio of the flexion contracture resulting in progression of patellofemoral cartilage degeneration was 4.63 (95% confidence interval, 1.77–12.1). No association was detected between progressive degeneration and age, sex, body mass index, Kellgren-Lawrence grade, or radiographic parameters. Conclusions Flexion contracture may be associated with progression of cartilage degeneration at the patellofemoral joint and may negatively affect the clinical outcomes after open wedge, high tibial osteotomy.
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Affiliation(s)
- Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan.
| | - Kuniaki Ikeda
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Nobuhiro Okuno
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Tomohiro Okayoshi
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Yuki Miyamoto
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
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Jimenez-Quevedo P, Bernardo E, Del Trigo M, Otsuki S, Nombela Franco L, Brugaletta S, Ortega Pozi A, Salinas P, Nunez Gil I, Megia Renteria H, Fernandez Ortiz A, Macaya C, Escaned J, Sabate M, Gonzalo N. P5613Proportional relationship between early mobilization of bone marrow progenitor cells and the extent of vascular injury during coronary stenting: insights on the role of systemic mechanisms of vascular. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The role of circulating progenitor cells (CPCs) on vascular repair after everolimus-eluting stent (EES) implantation is largely unknown.
Objectives
The aim of the study was to investigate the quantitative and temporal variations of CPCs levels after EES implantation, and its relationship with the degree of peri-procedural vascular damage, stent healing and neointimal hyperplasia, as measured by optical coherence tomography (OCT).
Methods
In a consecutive series of patients with stable coronary artery disease undergoing stent implantation CPC subpopulations (CD34+/CD45low, CD133+/CD45low, CD34/KDR/CD45low, CD133/KDR/CD45low) were evaluated using a flow cytometry technique at baseline, 1 and 4 weeks. OCT evaluation was performed immediately after stent implantation to quantify stenting-related injury, and at 9-month follow-up to assess mid-term vascular response.
Results
Twenty patients (mean age 66±9 years; 80%male) with 24 stenoses treated with EES were included in the study. Vascular injury score was associated with the increase of CD133+/KDR/CD45 low at 1-week (β0.28 [95% CI0.15; 0.41], p<0.001) and with the maximum neointimal thickness at 9-month follow-up (β0.008 [95% CI-0.0004; 0.002]:p=0.04). Mean neointimal area at 9-month was associated with the increase in the number of CD34+/CD45low at 1 week (β0.029 [95% CI0.025;-0.033]; p<0.0001). Inverse relationships between the number of uncoated and apposed struts at 9-month and the 1-week delta values of CD34/KDR/CD45low and CD133/KDR/CD45low (β-4.49 [95% CI-8.17;-0.82]; p=0.017 and β −12.53 [95% CI: −22.17; −2.90]; p=0.011, respectively) were also found.
Conclusion
Long-term vascular healing after EES implantation is modulated by early changes in levels of CPC subpopulations. This systemic response is proportional to the extent of vessel wall injury. Early mobilization of CPCs influences mid-term strut coverage and the development of neointimal hyperplasia.
Acknowledgement/Funding
Dr Jimenez-Quevedo is a recipient of the ISCIII (Instituto de Salud Carlos III) grant “Fondo de Investigaciόn Sanitaria” (PI11/00299) to perform this
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Affiliation(s)
| | - E Bernardo
- Hospital Clinico San Carlos, Madrid, Spain
| | | | - S Otsuki
- Hospital Clinic San Carlos, Madrid, Spain
| | | | | | | | - P Salinas
- Hospital Clinico San Carlos, Madrid, Spain
| | | | | | | | - C Macaya
- Hospital Clinico San Carlos, Madrid, Spain
| | - J Escaned
- Hospital Clinico San Carlos, Madrid, Spain
| | - M Sabate
- Hospital Clinic San Carlos, Madrid, Spain
| | - N Gonzalo
- Hospital Clinico San Carlos, Madrid, Spain
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Otsuki S, Murakami T, Okamoto Y, Nakagawa K, Okuno N, Wakama H, Neo M. Risk of patella baja after opening-wedge high tibial osteotomy. J Orthop Surg (Hong Kong) 2019; 26:2309499018802484. [PMID: 30295136 DOI: 10.1177/2309499018802484] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Medial opening-wedge high tibial osteotomy (OWHTO) induces a lower patellar position, and the subsequent degree of patellar movement may not be predicted preoperatively. The purpose of this study was to clarify the relationship between preoperative and postoperative patellar height based on the correction angle of OWHTO and to create a formula to predict the appearance of patella baja following OWHTO. MATERIALS AND METHODS Seventy-five knees with varus knee osteoarthritis treated with OWHTO were included in this study. The Caton-Deschamps index was used to evaluate patellar height preoperatively and postoperatively, and the cut-off value for preoperative parameters was determined by a receiver operating characteristic curve to determine the risk ratio for postoperative patella baja. RESULTS The Caton-Deschamps index significantly decreased from 0.93 to 0.77 after OWHTO ( p < 0.01). The OWHTO correction angle negatively correlated with the delta Caton-Deschamps index ( r = -0.44, p < 0.01), and a 1.7% decrease in the Caton-Deschamps index was shown with a 1° correction angle. Receiver operating characteristic curve analysis revealed that a Caton-Deschamps index of 0.8 was the cutoff for OWHTO; knees with a preoperative Caton-Deschamps index of < 0.8 tended to develop patella baja after OWHTO, with a risk ratio of 9.5 (95% confidence interval [4.3-20.7]). CONCLUSIONS OWHTO can induce patella baja, and a 1.7% decrease in the Caton-Deschamps index was shown with a 1°-correction angle. A preoperative Caton-Deschamps index < 0.8 should be considered a risk factor for postoperative patella baja. LEVEL OF EVIDENCE Retrospective study, Level IV.
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Affiliation(s)
- Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Tomohiko Murakami
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Kosuke Nakagawa
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Nobuhiro Okuno
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
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Oda S, Fujita A, Moriuchi H, Okamoto Y, Otsuki S, Neo M. Medial meniscal extrusion and spontaneous osteonecrosis of the knee. J Orthop Sci 2019; 24:867-872. [PMID: 30799164 DOI: 10.1016/j.jos.2019.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 11/30/2018] [Accepted: 02/01/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Causes of spontaneous osteonecrosis of the knee (SONK) have not been clearly elucidated. This study investigated the relationship between medial meniscal extrusion and SONK. METHODS We reviewed 108 SONK knees and determined their Aglietti stage. Meniscal extrusion is defined when it extends beyond the medial margin of tibial plateau and osteophytes are excluded for determining the margin. Both absolute extrusion (AE) and relative percentage of extrusion (RPE) were measured, and meniscal tear patterns were evaluated in the early stages of SONK (I and II). RESULTS All knees had meniscal extrusion. Stage I was detected in 39 knees; II, in 23; III, in 16; IV, in 18; and V, in 12. The mean AE and RPE were 4.2 mm and 42% in stage I, 5.0 mm and 52% in stage II, 6.8 mm and 71% in stage III, 7.0 mm and 69% in stage IV, and 7.8 mm and 80% in stage V, respectively. The knees in the early stages showed less AE and RPE than those in late stages IV (p < 0.05) and V (p < 0.01). Additionally, the level of AE (ρ = 0.63, p < 0.0001) and RPE (ρ = 0.58, p < 0.0001) correlated with the SONK stage. Of knees with early-stage SONK, 12 knees had no tear, 26 had horizontal tears, 1 had longitudinal tear, 6 had degenerative tears, 2 had radial tears, 1 had complex tear, and 14 had root tears. Neither AE nor RPE differed significantly among tear patterns. CONCLUSIONS Meniscal extrusion was recognized even in early stages, with a significant correlation between the SONK stage and extrusion. Although the most frequent tear pattern in early-stage SONK was horizontal tear, 12 knees had meniscal extrusion with no tears. Therefore, meniscal extrusion, which indicates meniscal dysfunction, may be a cause of SONK and be related with the developmental stage of SONK.
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Affiliation(s)
- Shuhei Oda
- Department of Orthopedic Surgery, Katsuragi Hospital, 2-33-1 Habumahi, Higashikishiwada-city, Osaka, 596-0825, Japan; Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki-city, Osaka, 569-8686, Japan.
| | - Akifumi Fujita
- Department of Orthopedic Surgery, First Towakai Hospital, 2-17 Miyanomachi, Takatsuki-city, Osaka, 569-0081, Japan.
| | - Hiromitsu Moriuchi
- Department of Orthopedic Surgery, First Towakai Hospital, 2-17 Miyanomachi, Takatsuki-city, Osaka, 569-0081, Japan.
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki-city, Osaka, 569-8686, Japan.
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki-city, Osaka, 569-8686, Japan.
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki-city, Osaka, 569-8686, Japan.
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Okamoto Y, Otsuki S, Nakajima M, Jotoku T, Wakama H, Neo M. Sagittal Alignment of the Femoral Component and Patient Height Are Associated With Persisting Flexion Contracture After Primary Total Knee Arthroplasty. J Arthroplasty 2019; 34:1476-1482. [PMID: 30905642 DOI: 10.1016/j.arth.2019.02.051] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/10/2019] [Accepted: 02/22/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim of our retrospective case-control study is to identify risk factors associated with a persisting flexion contracture after total knee arthroplasty (TKA). This is an important clinical issue as a flexion contraction can lead to poor long-term clinical outcomes and patient satisfaction after TKA. METHODS The study group included 120 knees treated for a varus osteoarthritic deformity of the knee using a posterior cruciate-retaining TKA. We evaluated the association between a flexion contracture >10°, 2 years after surgery, and the following potential risk factors, using logistic regression analysis: age, body height, body mass index, preoperative knee extension and hip-knee-ankle angle, and radiological parameters of component alignment, namely the femoral component medial angle, the femoral component flexion angle (FFA), the tibial component medial angle, and the posterior tibial slope. RESULTS Of the 120 knees, a persisting flexion contracture >10° was identified in 33 (28%). The mean FFA in these cases was 7.3° (standard deviation, 1.4) compared to 4.2° (standard deviation, 1.2) for cases with a contracture of ≤10° (P = .034). On multivariate analysis, the FFA (odds ratio, 3.73; 95% confidence interval, 1.16-17.81; P = .034) and body height (odds ratio, 0.43; 95% confidence interval, 0.29-0.57; P = .041) were independent predictive risk factors for a residual flexion contracture >10°. CONCLUSION Clinicians should be aware that flexed position of the femoral component, particularly in patients of short stature, is associated with increased occurrence of persistent flexion contracture.
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Affiliation(s)
- Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Mikio Nakajima
- Department of Orthopaedic Surgery, Katsuragi Hospital, Kishiwada, Japan
| | - Tsuyoshi Jotoku
- Department of Orthopaedic Surgery, Katsuragi Hospital, Kishiwada, Japan
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
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Otsuki S, Nakagawa K, Murakami T, Sezaki S, Sato H, Suzuki M, Okuno N, Wakama H, Kaihatsu K, Neo M. Evaluation of Meniscal Regeneration in a Mini Pig Model Treated With a Novel Polyglycolic Acid Meniscal Scaffold. Am J Sports Med 2019; 47:1804-1815. [PMID: 31172797 DOI: 10.1177/0363546519850578] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal injury is a severe impediment to movement and results in accelerated deterioration of the knee joint. PURPOSE To evaluate the effect of a novel meniscal scaffold prepared from polyglycolic acid coated with polylactic acid/caprolactone on the treatment of meniscal injury in a mini pig model. STUDY DESIGN Controlled laboratory study. METHODS The model was established with a 10-mm resection at the anterior medial meniscus on both knee joints. A scaffold was implanted in the right knee joint. The meniscal scaffold was inserted and sutured next to the native meniscus. The histological analysis was performed to determine meniscal regeneration with safranin O staining, cell proliferation with PCNA, inflammation with TNF, and collagen structure and production with picrosirius red and immunofluorescence. Cartilage degeneration was evaluated with Safranin O. Meniscal regeneration and joint fluid were evaluated with magnetic resonance imaging. RESULTS Although compressive stress and elastic modulus were significantly lower in the scaffold than in the native porcine menisci, ultimate tensile stress was similar. Implanted scaffolds were covered with tissue beginning at 4 weeks, with increased migration of proliferating cells to the implant area at 4 and 8 weeks. Scaffolds were absorbed with freshly produced collagen at 24 weeks. Cartilage degeneration was significantly lower in the meniscus-implanted group than in the meniscectomy group. Magnetic resonance imaging results did not show severe accumulation of joint fluids, suggesting negligible inflammation. Density of the implanted menisci was comparable with that of the native menisci. CONCLUSION Meniscal scaffold prepared from polyglycolic acid has therapeutic potential for meniscal regeneration. CLINICAL RELEVANCE This meniscal scaffold can improve biological knee reconstruction and prevent the increase of total knee arthroplasty.
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Affiliation(s)
- Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Kosuke Nakagawa
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Tomohiko Murakami
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | | | - Hideki Sato
- Gunze Limited, QOL Research Laboratory, Kyoto, Japan
| | | | - Nobuhiro Okuno
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | | | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
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Otsuki S, Murakami T, Okamoto Y, Nakagawa K, Okuno N, Wakama H, Neo M. Hybrid high tibial osteotomy is superior to medial opening high tibial osteotomy for the treatment of varus knee with patellofemoral osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2019; 27:1332-1338. [PMID: 29947840 DOI: 10.1007/s00167-018-5015-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 06/04/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate patellofemoral congruity after opening wedge high tibial osteotomy (OWHTO) and hybrid HTO. METHODS Twenty-four knees with hybrid HTO and 24 with OWHTO were evaluated in this study. The Caton-Deschamps and modified Miura-Kawamura indices were used to evaluate pre- and post-operative patellar heights for both types of surgery. Tibial tuberosity-trochlear groove (TT-TG) distance, patellar tilt, and medial and lateral joint space at the patellofemoral joint were compared. Anterior knee pain was assessed using the Kujala anterior knee pain scale. RESULTS There was no significant difference between the correction angles of the hybrid HTO and OWHTO. Pre- and post-operative values for the Caton-Deschamps and modified Miura-Kawamura indices in patients who underwent hybrid HTO changed from 0.90 to 0.94 and from 0.95 to 1.03, respectively, with no significant differences noted. Following OWHTO, these values decreased significantly from 0.91 to 0.73 and from 1.06 to 0.84, respectively (p < 0.01). The post-operative patellar height after OWHTO was significantly lower than that after hybrid HTO (p < 0.01). After hybrid HTO, the TT-TG distance decreased significantly from 11.4 to 7.4 (p < 0.01), but it did not change significantly after OWHTO. Although pre- and post-operative patellar tilt were not altered significantly in either group, the medial joint space of the patellofemoral joint was significantly increased post-operatively following hybrid HTO (p = 0.035). The pre-operative Kujala scores were significantly lower in the hybrid HTO group, but post-operative scores improved in both groups. CONCLUSIONS Hybrid HTO provides a better post-operative patellofemoral joint than does OWHTO with regard to patellar position and reduction of the TT-TG distance, as well as improved clinical outcomes. Hybrid HTO, rather than OWHTO, is the preferred technique for the treatment of varus knees combined with patellofemoral osteoarthritis. LEVEL OF EVIDENCE Retrospective comparative study, Level III.
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Affiliation(s)
- Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan.
| | - Tomohiko Murakami
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Kosuke Nakagawa
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Nobuhiro Okuno
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
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Otsuki S, Alvarez-Garcia O, Lotz MK, Neo M. Role of heparan sulfate 6-0 endosulfatases in intervertebral disc homeostasis. Histol Histopathol 2019; 34:1051-1060. [PMID: 30924907 DOI: 10.14670/hh-18-107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The expression of heparan sulfate endosulfatases (Sulfs) was investigated in the intervertebral disc (IVD) to clarify their role in IVD homeostasis. Sulf-1 and -2 expression were elucidated in normal and degenerated human IVD. Age-related effects on Sulf expression, type II collagen levels, and structural changes were analyzed in IVDs of wild-type (WT) and Sulf-1 knockout (Sulf-1⁻/⁻) mice. The effect of recombinant Sulf-1 (100 ng/ml) and Sulf-1 knockdown on heparan sulfate proteoglycan and collagen expression in ATDC5 cells were examined. Finally, the effect of Sulf-1 on transforming growth factor (TGF) β1-induced signaling was evaluated. Results show that Sulf-1 and -2 levels were higher in degenerated human IVDs. In WT mice, Sulf-1 and -2 expression generally declined as the animals aged. In particular, Sulf-1 in the nucleus pulposus was higher compared with Sulf-2 at the age of 1 and 6 months and significantly declined with aging. Sulf-1⁻/⁻ mice showed more severe IVD pathology than WT mice, with lower type II collagen levels in nucleus pulposus, and degeneration with type I collagen in annulus fibrosus. In vitro, Sulf-1 induced type II collagen expression and significantly increased TGF-β1-induced Smad2/3 phosphorylation in ATDC5 cells. In conclusion, Sulf-1 might play a critical role from development to maintenance of IVD homeostasis by regulating collagen expression.
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Affiliation(s)
- Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, Japan.
| | | | - Martin K Lotz
- Department of Molecular Medicine, The Scripps Research Institute, USA
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Japan
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Murakami T, Otsuki S, Okamoto Y, Nakagawa K, Wakama H, Okuno N, Neo M. Hyaluronic acid promotes proliferation and migration of human meniscus cells via a CD44-dependent mechanism. Connect Tissue Res 2019; 60:117-127. [PMID: 29658360 DOI: 10.1080/03008207.2018.1465053] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Treatment of meniscal injury is important for osteoarthritis (OA) prevention. Meniscus cells are divided between inner and outer cells, which have different characteristics and vascularity. We evaluated the effects of hyaluronic acid (HA) on the proliferation and migration of human inner and outer meniscus cells, and investigated the underlying healing mechanisms. MATERIALS AND METHODS Lateral menisci from 18 patients who underwent total knee arthroplasty were used. Meniscus cells were harvested from the outer and inner menisci and evaluated using migration and proliferation assays after treatment with HA or chondroitin sulfate (CS). The effects of HA on prostaglandin E2 (PGE2)-induced apoptosis and gene expression were evaluated. RESULTS Cell migration and proliferation were increased by HA in a concentration-dependent manner, in both inner and outer meniscus cells. PGE2-induced apoptosis and caspase-3/7 activity were suppressed by HA in both inner and outer meniscus cells, and these effects were blocked by an anti-CD44 antibody. COL2A1 and ACAN mRNA levels were upregulated following HA treatment of inner meniscus cells. MMP13 mRNA was downregulated following CS stimulation of both inner and outer meniscus cells. These results suggest that CS treatment suppresses the inflammatory reaction rather than providing meniscal restoration. The phosphatidylinositol 3-kinase (PI3K) and mitogen-activated protein kinase (MAPK) pathways were activated by HA in both types of meniscus cells; these effects were blocked by treatment with an anti-CD44 antibody. CONCLUSIONS HA promoted human meniscus regeneration by inhibiting apoptosis, promoting cell migration, and accelerating cell proliferation, potentially through the PI3K/MAPK pathway via the CD44 receptor.
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Affiliation(s)
| | - Shuhei Otsuki
- a Orthopedic Surgery , Osaka Medical College , Osaka , Japan
| | | | - Kosuke Nakagawa
- a Orthopedic Surgery , Osaka Medical College , Osaka , Japan
| | - Hitoshi Wakama
- a Orthopedic Surgery , Osaka Medical College , Osaka , Japan
| | - Nobuhiro Okuno
- a Orthopedic Surgery , Osaka Medical College , Osaka , Japan
| | - Masashi Neo
- a Orthopedic Surgery , Osaka Medical College , Osaka , Japan
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Murayama K, Nakayama H, Murakami T, Yoshiya S, Otsuki S, Tachibana T. The Effect of Concomitant Arthroscopic Lateral Retinacular Release on Postoperative Patellar Position and Orientation in Open Wedge High Tibial Osteotomy. Knee Surg Relat Res 2018; 30:241-246. [PMID: 30157592 PMCID: PMC6122939 DOI: 10.5792/ksrr.18.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 07/09/2018] [Accepted: 07/23/2018] [Indexed: 11/13/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the effect of concomitant arthroscopic lateral release (LR) in open wedge high tibial osteotomy (OWHTO) by comparing the pre- and postoperative radiological parameters of patellar position and orientation. Materials and Methods The study was comprised of 19 knees undergoing OWHTO and concomitant LR and 18 knees undergoing OWHTO alone. Radiological parameters for patellar position and orientation included the Caton-Deschamps index (CDI), Blackburne-Peel index (BPI), patellar tilting angle (PTA), patellar lateral shift (PLS), and patellofemoral distance (PFD), which were evaluated in the preoperative period and at one year after surgery. Results Patellar height was significantly reduced after surgery as indicated by the decrease in BPI (p=0.03) in the OWHTO/LR group, and decrease in CDI (p=0.03) and BPI (p=0.04) in the OWHTO alone group. PTA and PLS were significantly reduced after the combined OWHTO/LR procedure (p=0.04 and p=0.04, respectively). By contrast, no significant changes were detected when isolated OWHTO was performed. Conclusions OWHTO induced a postoperative decrease in patellar height in both groups. Regarding the change in patellofemoral alignment, concomitant LR in OWHTO significantly decreased lateral patellar tilt and shift, while no significant difference in those parameters were noted in the OWHTO alone knees.
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Affiliation(s)
- Kazuhiro Murayama
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroshi Nakayama
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tomohiko Murakami
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Shinichi Yoshiya
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Toshiya Tachibana
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
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Otsuki S, Murakami T, Morikura R, Nakagawa K, Okamoto Y, Neo M. Back out of Locking Pin with Hinge Fracture after High Tibial Osteotomy. Knee Surg Relat Res 2018; 30:171-175. [PMID: 29715712 PMCID: PMC5990232 DOI: 10.5792/ksrr.17.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 07/06/2017] [Accepted: 07/11/2017] [Indexed: 11/28/2022] Open
Abstract
Low-profile fixation devices for medial opening wedge high tibial osteotomy (OWHTO) were developed in order to avoid skin irritation and additional invasion. However, the low-profile system is associated with additional risks. We report three cases of locking pin back out with the low-profile locking plate system for medial OWHTO.
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Affiliation(s)
- Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Tomohiko Murakami
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Rei Morikura
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Kosuke Nakagawa
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
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37
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Otsuki S, Okamoto Y, Murakami T, Nakagawa K, Okuno N, Wakama H, Neo M. Patellofemoral reconstruction for patellar instability with patella alta in middle-aged patients: Clinical outcomes. Orthop Traumatol Surg Res 2018; 104:217-221. [PMID: 29410197 DOI: 10.1016/j.otsr.2018.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/23/2017] [Accepted: 01/03/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Although several surgical treatments for patellar instability with patella alta have been reported, the clinical outcomes and optimal surgical procedures for patellar instability with patella alta in middle-aged patients are still controversial. We hypothesized that optimal surgical procedures for patellar instability with patella alta in middle-aged patients may induce good clinical outcomes with better patellofemoral geometry. MATERIALS AND METHODS Twelve middle-aged patients with a mean age of 44 years (range: 40-55 years), who presented with patellar instability and patella alta, were treated with a combination of several surgeries, such as medial patellofemoral ligament (MPFL) reconstruction, trochleoplasty, lateral release, and three-dimensional transfer of the tibial tuberosity, based on a surgical algorithm. Patellar position and clinical outcomes were evaluated postoperatively. The mean follow-up time was 41.5 months (range: 24-72 months). RESULTS Patellar position altered from 1.31 (1.21-1.53) preoperatively to 0.88 (0.69-1.06) postoperatively on the Caton-Deschamps Index (p<0.01). The tibial tuberosity-trochlear groove (TT-TG) distance altered from 21.8mm (20.1-25.8mm) to 10.3mm (5.1-14.7mm), and patellar tilt ranged from 28.1° (21-40°) to 14.6° (5-28°), respectively (p<0.01). Clinical outcomes on the Lysholm and Kujala scales improved from 43.1 and 38.4 to 86.7 and 78.3, respectively, at final follow-up (p<0.01). Surgical treatment that included trochleoplasty resulted in better outcomes than other surgical combinations without trochleoplasty (p<0.05). Sulcus angle and postoperative patellar tilt improved more in those who underwent trochleoplasty than in those who did not (p<0.05). DISCUSSION Surgical treatment for patellar instability with patella alta in middle-aged patients resulted in improved clinical outcomes. In particular, a combination surgery including trochleoplasty resulted in the greatest improvement in case of severe trochlear dysplasia. LEVEL OF EVIDENCE IV. Retrospective case series study.
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Affiliation(s)
- S Otsuki
- Department of orthopedic surgery, Osaka medical college, 2-7 Daigakumachi Takatsuki, 569-8686 Osaka, Japan.
| | - Y Okamoto
- Department of orthopedic surgery, Osaka medical college, 2-7 Daigakumachi Takatsuki, 569-8686 Osaka, Japan
| | - T Murakami
- Department of orthopedic surgery, Osaka medical college, 2-7 Daigakumachi Takatsuki, 569-8686 Osaka, Japan
| | - K Nakagawa
- Department of orthopedic surgery, Osaka medical college, 2-7 Daigakumachi Takatsuki, 569-8686 Osaka, Japan
| | - N Okuno
- Department of orthopedic surgery, Osaka medical college, 2-7 Daigakumachi Takatsuki, 569-8686 Osaka, Japan
| | - H Wakama
- Department of orthopedic surgery, Osaka medical college, 2-7 Daigakumachi Takatsuki, 569-8686 Osaka, Japan
| | - M Neo
- Department of orthopedic surgery, Osaka medical college, 2-7 Daigakumachi Takatsuki, 569-8686 Osaka, Japan
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Nakagawa M, Tomii C, Inokuchi M, Otsuki S, Kojima K. Feasibility of a Clinical Pathway With Early Oral Intake and Discharge for Laparoscopic Gastrectomy. Scand J Surg 2017; 107:218-223. [PMID: 29268666 DOI: 10.1177/1457496917748228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND AIMS Although some studies have reported the safety of early oral intake after gastrectomy, it still remains controversial. This study focused on the feasibility of a clinical pathway with early oral intake and discharge setting for exclusively laparoscopic distal gastrectomy. MATERIALS AND METHODS A clinical pathway was applied to 403 patients until December 2014. In the protocol, patients are allowed to take a sip of water and a soft diet on the first and second days after the operation, respectively, and the discharge day is set as the fifth to seventh day after the operation. Clinicopathological variables were prospectively collected, and risk factors for discharge variances were analyzed. RESULTS The completion rate of the clinical pathway was 76.9%. There were five re-admissions (1.2%). The overall morbidity rate was 18% ( n = 72), and major complications (Clavien-Dindo IIIa or greater) occurred in 13 patients (3%). Complications were the causes for discharge variances in 68 cases (73%), while the attending surgeons' judgment was the cause in 25 cases (27%). On multivariate analysis, age (odds ratio = 2.23, 95% confidence interval = 1.38-3.60, p = 0.001) and operative time (odds ratio = 2.38, 95% confidence interval = 1.45-3.98, p = 0.001) were independent risk factors for discharge variances. CONCLUSION A high completion rate of a clinical pathway with early oral intake and discharge setting for laparoscopic distal gastrectomy was achievable with an acceptably low re-admission rate. Laparoscopic distal gastrectomy is recommended as a first step for a clinical pathway with an early oral intake and discharge protocol.
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Affiliation(s)
- M Nakagawa
- 1 Department of Gastric Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - C Tomii
- 1 Department of Gastric Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - M Inokuchi
- 1 Department of Gastric Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - S Otsuki
- 1 Department of Gastric Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - K Kojima
- 2 Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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Okamoto Y, Otsuki S, Jotoku T, Nakajima M, Neo M. Clinical usefulness of hindfoot assessment for total knee arthroplasty: persistent post-operative hindfoot pain and alignment in pre-existing severe knee deformity. Knee Surg Sports Traumatol Arthrosc 2017; 25:2632-2639. [PMID: 27056693 DOI: 10.1007/s00167-016-4122-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 03/29/2016] [Indexed: 01/09/2023]
Abstract
PURPOSE The purpose of this study was to compare the hindfoot alignment and symptoms in patients with pre-existing moderate and severe knee deformities after total knee arthroplasty (TKA). METHODS Eighty knees of 75 patients who underwent TKA for varus osteoarthritis were enrolled retrospectively and evaluated the following pre-operatively and at 2 years post-operatively: the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale (pain and function scores), calcaneal pitch, and naviculocuboid overlap as an indicator of hindfoot alignment. The knees were divided into two groups according to the pre-operative hip-knee-ankle angle defined as the angle between the mechanical axis of the femur and the tibia: group M with genu varus of ≤6°, and group S with varus >6°. RESULTS The pain (p = 0.03) and function (p = 0.02) scores improved in group M; however, in group S, these measures did not change. The differences between the groups were not significant concerning the pre-operative calcaneal pitch and naviculocuboid overlap. The post-operative pitch (p = 0.03) and the overlap (p = 0.04) in group M was significantly greater and less than those in group S, respectively. Although the pitch (p < 0.01) and the overlap (p = 0.03) increased in group M, these did not change in group S. Post-operative hindfoot pain and valgus remained in patients in group S. CONCLUSIONS For pre-existing moderate knee deformities, a relationship was observed between post-operative knee alignment and compensatory hindfoot alignment, whereas patients with severe deformities experienced persistent post-operative hindfoot pain and valgus alignment. It was concluded that evaluations and managements of residual symptoms after TKA including the hindfoot are important. These findings are clinically relevant that perioperative evaluation of the hindfoot should be required in knee surgery. To help improve the outcomes of TKA, clinicians may consider perioperative intervention in the insole and/or physical therapy of the foot and ankle. LEVEL OF EVIDENCE Therapeutic study, Level III.
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Affiliation(s)
- Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Tsuyoshi Jotoku
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Mikio Nakajima
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
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Nakagawa K, Otsuki S, Okamaoto Y, Murakami T, Neo M. Radiographic discrepancy of lower limb alignment between preoperative planning and postoperative opening wedge high tibial osteotomy. Asia Pac J Sports Med Arthrosc Rehabil Technol 2017. [DOI: 10.1016/j.asmart.2017.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Otsuki S, Murakami T, Okamoto Y, Hoshiyama Y, Oda S, Neo M. Suppression of cartilage degeneration by intra-articular injection of heparan sulfate 6-O endosulfatase in a mouse osteoarthritis model. Histol Histopathol 2016; 32:725-733. [PMID: 27808352 DOI: 10.14670/hh-11-838] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We previously reported that heparan sulfate 6-O endosulfatases (Sulfs) were expressed in articular cartilage, and that the Sulf-1 knockout mouse developed severe knee osteoarthritis. In this study, we hypothesised that intra-articular injection of Sulf-1 would prevent cartilage degeneration. After confirming that 1 mg/ml Sulf-1 did not induce ATDC5 cell death in vitro, gene expression of type II collagen and matrix metalloproteinase (MMP)-13 in the presence of Sulf-1 (1 100 ng/ml) were determined by quantitative real-time polymerase chain reaction. Sulf-1 was also injected intra-articularly into mice following surgical destabilisation of the medial meniscus to produce a model of osteoarthritis, and cartilage degeneration was evaluated by safranin O and MMP-13 staining. We also investigated fibroblast growth factor 2 (FGF2)/extracellular signal-regulated kinase (Erk) cell signalling by western blotting. Exposure to Sulf-1 in vitro increased type II collagen expression and decreased MMP-13 expression in a concentration-dependent manner. Sulf-1 injection into the mouse osteoarthritic knee significantly suppressed glycosaminoglycan loss and MMP-13 expression. Erk1/2 signalling pathway activation was significantly reduced by Sulf-1 and FGF2. These findings indicate that Sulf-1 prevents cartilage degeneration by suppressing MMP-13 via an effect on FGF2/Erk1/2 signalling.
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Affiliation(s)
- Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan.
| | - Tomohiko Murakami
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | | | - Shuhei Oda
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
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Okamoto Y, Nakajima M, Jotoku T, Otsuki S, Neo M. Capsular release around the intercondylar notch increases the extension gap in posterior-stabilized rotating-platform total knee arthroplasty. Knee 2016; 23:730-5. [PMID: 27174384 DOI: 10.1016/j.knee.2015.11.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/26/2015] [Accepted: 11/29/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND In posterior-stabilized (PS) total knee arthroplasty (TKA), various post-cam designs can be used. A larger cam of the femoral component may tighten the extension gap. Few studies have investigated the relationship between capsular release around the intercondylar notch and the extension gap. The aim of this study was to assess the effect of capsular release around the intercondylar notch on the extension gap. METHODS Forty-eight patients (54 knees) who underwent PS rotating-platform TKA (PFC Sigma RP-F) were enrolled retrospectively. We measured the extension gap with and without a femoral trial using a knee balancer, applying a joint distraction force of 44lb. When an intraoperative flexion contracture of >5° persisted, we performed a capsular release approximately 10mm cranial to the intercondylar notch. After full knee extension was achieved, the extension gap was measured again. RESULTS Thirty knees required capsular release. With a trial, the medial and lateral differences between the extension gaps before and after capsular release were 1.7mm (p<0.0001) and 2.3mm (p<0.0001), respectively. Without a trial, the gaps were enlarged by 0.4mm (p=0.0452) and 0.6mm (p=0.0215), respectively. Twenty-four knees did not require release. No significant differences were noted in the range of motion at one-year follow-up between the two cohorts. CONCLUSIONS With PS rotating-platform TKA, capsular release around the intercondylar notch is found to increase the extension gap and may prevent postoperative flexion contracture. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan.
| | - Mikio Nakajima
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Tsuyoshi Jotoku
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
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Otsuki S, Nakajima M, Okamoto Y, Oda S, Hoshiyama Y, Iida G, Neo M. Correlation between varus knee malalignment and patellofemoral osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2016; 24:176-81. [PMID: 25274097 DOI: 10.1007/s00167-014-3360-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 09/25/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the relationship between patellofemoral osteoarthritis (OA) and varus OA of the knee with a focus on the location of joint space narrowing. METHODS Eighty-five patients scheduled to undergo total knee arthroplasty caused by varus OA were enrolled in this study. The relationship between patellofemoral OA and varus knee malalignment was elucidated. To determine the alignment of the patellofemoral joint in varus knees, patellar tilt, and the tibial tuberosity-trochlear groove (TT-TG) distance were measured, and patellofemoral OA was classified using computed tomography. RESULTS The femorotibial angles in patients with stage II-IV patellofemoral OA were significantly larger than those in patients with stage I patellofemoral OA, and the patellar tilt in patients with stage II-IV patellofemoral OA and the TT-TG distance in patients with stage IV patellofemoral OA were significantly larger than those in patients with stage I patellofemoral OA. The TT-TG distance was strongly correlated with patellar tilt (R(2) = 0.41, P < 0.001). Patellofemoral joint space narrowing was mainly noted at the lateral facet, and it was found on both sides as patellofemoral OA worsened. CONCLUSION Varus knee malalignment was induced by patellofemoral OA, especially at the lateral facet. Patellar tilt and the TT-TG distance are considered critical factors for the severity of patellofemoral OA. Understanding the critical factors for patellofemoral OA in varus knees such as the TT-TG distance and patellar will facilitate the prevention of patellofemoral OA using procedures such as high tibial osteotomy and total knee arthroplasty to correct knee malalignment. LEVEL OF EVIDENCE Retrospective cohort study, Level III.
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Affiliation(s)
- Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.
| | - Mikio Nakajima
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Shuhei Oda
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Yoshiaki Hoshiyama
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Go Iida
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
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Kamiya A, Inokuchi M, Otsuki S, Sugita H, Kato K, Uetake H, Sugihara K, Takagi Y, Kojima K. Prognostic value of tropomyosin-related kinases A, B, and C in gastric cancer. Clin Transl Oncol 2015; 18:599-607. [PMID: 26459250 DOI: 10.1007/s12094-015-1407-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 09/03/2015] [Indexed: 01/01/2023]
Abstract
PURPOSE Tropomyosin-related kinase (Trk) receptors play critical roles in tumor development and are considered attractive targets for cancer therapy. We investigated correlations of the expression of TrkA, TrkB, and TrkC with clinicopathological features and outcomes in gastric cancer. METHODS Tumor samples were obtained from 221 patients with gastric cancer who underwent gastrectomy between 2003 and 2007. The expression of TrkA, TrkB, and TrkC was analyzed using immunohistochemical staining. The relationship of their expression to clinicopathological factors and outcomes was assessed. RESULTS High expression of TrkA, TrkB, or TrkC was significantly associated with histopathology (p = 0.022, p < 0.001, and p < 0.001). High expression of TrkA was significantly correlated with variables related to tumor progression, including lymph node metastasis (p = 0.024) and distant metastasis or recurrence (p < 0.001). Distant metastasis or recurrence was found in a significantly higher proportion of patients with high expression of TrkC than in those with low expression (p = 0.036). High expression of TrkA was significantly associated with poorer relapse-free survival (RFS) in univariate analysis (p = 0.001). High expression of TrkA or TrkC was significantly associated with poorer disease-specific survival (DSS) in univariate analysis (p < 0.001 and p = 0.008). In multivariate analysis, TrkA was an independent predictor of RFS [hazard ratio (HR), 2.294; 95 % confidence interval (CI), 1.309-4.032; p = 0.004] and DSS (HR, 2.146; 95 % CI, 1.195-3.861; p = 0.011). Expression of TrkB was not associated with RFS or DSS in univariate analysis. CONCLUSIONS Our results demonstrated that TrkA expression was associated with tumor progression and poor survival, and was an independent predictor of poor outcomes in gastric cancer patients.
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Affiliation(s)
- A Kamiya
- Department of Surgical Oncology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - M Inokuchi
- Department of Surgical Oncology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - S Otsuki
- Department of Surgical Oncology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - H Sugita
- Department of Surgical Oncology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - K Kato
- Department of Surgical Oncology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - H Uetake
- Department of Surgical Oncology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - K Sugihara
- Department of Surgical Oncology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Y Takagi
- Department of Translational Oncology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - K Kojima
- Center for Minimally Invasive Surgery, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
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Nishi N, Inokuchi M, Otsuki S, Fujimori Y, Kojima K. P-005 Clinical significance of Eph, FGFR, and PDGF expressions in advanced gastric cancers. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv233.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hoshiyama Y, Otsuki S, Oda S, Kurokawa Y, Nakajima M, Jotoku T, Tamura R, Okamoto Y, Lotz MK, Neo M. Chondrocyte clusters adjacent to sites of cartilage degeneration have characteristics of progenitor cells. J Orthop Res 2015; 33:548-55. [PMID: 25691232 PMCID: PMC4454425 DOI: 10.1002/jor.22782] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 10/31/2014] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to investigate the site-specific characteristics and roles of chondrocyte clusters in human knee osteoarthritis. Cartilage explants were obtained from 45 knees undergoing total knee replacement surgery. The explants were taken from 4 locations in the knee: the medial femoral condyle, the medial posterior femoral condyle (MPC), the lateral femoral condyle, and the lateral posterior femoral condyle (LPC). Cartilage degeneration, cell density, and cell arrangement were compared histologically. A live/dead cell viability assay and immunohistochemical analyses using antibodies against STRO-1, FGF2, and Ki-67 were performed. Cell proliferation and cartilaginous nodule production in MPC and LPC explants in monolayer culture were compared. Finally, MPC cartilage explants were cultured to observe histological changes. The cell density of the MPC explants was higher than that of the LPC because of clustering. MPC explants contained more live cells than the LPC did, and the expression of IHC markers in MPC explants was higher than that in LPC. Chondrocytes from MPC proliferated faster and produced more nodules in monolayer culture than those from the LPC and MPC explants were repaired during organ culture. In conclusion, chondrocyte clusters adjacent to severe cartilage degeneration have specific characteristics, with progenitor and proliferative potential.
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Affiliation(s)
- Yoshiaki Hoshiyama
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki city, Osaka 569-8686, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki city, Osaka 569-8686, Japan
| | - Shuhei Oda
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki city, Osaka 569-8686, Japan
| | - Yoshitaka Kurokawa
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki city, Osaka 569-8686, Japan
| | - Mikio Nakajima
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki city, Osaka 569-8686, Japan
| | - Tsuyoshi Jotoku
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki city, Osaka 569-8686, Japan
| | - Ryuichi Tamura
- Department of Orthopedic Surgery, Rakusai Shimizu Hospital, 13-107 Oekutsukakecho Nishikyo-ku, Kyoto city, Kyoto 610-1106, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki city, Osaka 569-8686, Japan
| | - Martin K. Lotz
- Department of Molecular and Experimental Medicine, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, USA
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki city, Osaka 569-8686, Japan
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Scalone G, Brugaletta S, Gomez O, Otsuki S, Sabate M. Bioresorbable scaffolds: focus on vascular response and long-term safety. Panminerva Med 2015; 57:1-13. [PMID: 25373397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Bioresorbable vascular scaffolds (BVS) are considered the fourth revolution in Interventional Cardiology, thus promising to address some of the pending issues with current-generation drug eluting stents (DES). Notably, most of the potential advantages of BVS over other current devices are due to a peculiar vascular response, called "vascular restoration therapy". The emerging data from real-world expanded use registries suggest that BVS use is feasible in a wide variety of patients (from low- to high- risk), and lesions (from simplex to complex). However, few safety concerns with currently available BVS have arised from initial experiences all over the word. Data from ongoing large-scale randomized controlled trials will be able to demonstrate whether BVS improve patient early and long-term outcomes compared to best-in-class DES.
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Affiliation(s)
- G Scalone
- Thorax Institute. Department of Cardiology IDIBAPS: Institut d'Investigacions Biomediques Agust Pi i Sunyer (IDIBAPS) Hospital Clinic, Barcelona, Spain -
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Oda S, Otsuki S, Kurokawa Y, Hoshiyama Y, Nakajima M, Neo M. A new method for meniscus repair using type I collagen scaffold and infrapatellar fat pad. J Biomater Appl 2015; 29:1439-48. [PMID: 25633959 DOI: 10.1177/0885328215568984] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM The aim of this study was to investigate a new method for meniscal repair by combinative transplantation with type I collagen scaffold and infrapatellar fat pad. METHODS Two-mm cylindrical defects at the anterior part of bilateral medial menisci were prepared in nine Japanese white rabbits. The 18 knees were equally divided into three groups: I, no treatment; II, collagen scaffold transplantation; and III, collagen scaffold and infrapatellar fat pad transplantation. Another three rabbits (six knees) underwent sham surgery and served as controls. Rabbits were sacrificed at eight weeks after transplantation. Surface area of the medial meniscus was evaluated using macrophotographs. Ishida score for meniscal regeneration was used for assessment. To evaluate the composition of regenerated tissue, immunohistochemistry was analyzed with anti-type I and anti-type II collagen antibodies, and anti-Ki67 antibody. To investigate the effects of collagen scaffold on human meniscus, cells were isolated from human meniscus and infrapatellar fat pad, and cultured with collagen scaffold for three weeks. After that, gene expression was evaluated by using quantitative real-time polymerase chain reaction. RESULTS In group I, the meniscus shrank anterior to posterior, and the surface area was significantly less than that of normal meniscus. However, the surface area was maintained in group III. Ishida score and Ki67-positive cell ratio in group III were significantly higher than that in any other group, and staining with type I and type II collagen was similar to that of the control. Expression of matrix metalloproteinase was significantly lower in cocultures of collagen scaffold, meniscus cell, and infrapatellar fat pad cell than in monocultured meniscus cell, and expression of interleukin-1β was not increased. CONCLUSION This new method for meniscal repair by combinative transplantation with type I collagen scaffold and infrapatellar fat pad showed meniscal regeneration and potential for suppressing inflammation.
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Affiliation(s)
- Shuhei Oda
- Department of Orthopedic Surgery, Osaka Medical College, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, Japan
| | | | | | - Mikio Nakajima
- Department of Orthopedic Surgery, Osaka Medical College, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Japan
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Otsuki S, Nakajima M, Oda S, Hoshiyama Y, Fujiwara K, Jotoku T, Neo M. Three-dimensional transfer of the tibial tuberosity for patellar instability with patella alta. J Orthop Sci 2013; 18:437-42. [PMID: 23475223 DOI: 10.1007/s00776-013-0364-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 01/30/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although patellar instability can be treated with several surgical procedures, the appropriate surgical treatment for patellar instability with patella alta has not yet been investigated. The objective of this study is to find out whether three-dimensional transfer of the tibial tuberosity elicits good knee functionality with improved patella alta and prevents further patellar dislocation. METHODS Twelve knees (10 patients) underwent surgery for patellar instability with patella alta from 2007 to 2011. The surgery performed was a three-dimensional transfer for the anteromedial distalization of the tibial tuberosity. Predisposing anatomical factors for patellar instability were evaluated preoperatively; femorotibial angle (FTA), patella alta (IS ratio), trochlear dysplasia (sulcus angle) and tilting angle (lateral tilt). The function of the knee was assessed before and after surgery by Lysholm and Kujala score. RESULTS Before surgery, the IS ratio was 1.34 ± 0.13, lateral tilt was 22.4° ± 6.5°, and the sulcus angle was 151.7° ± 8.3°, indicating patella alta, laterality, and trochlear dysplasia. After surgery, the IS ratio and lateral tilt significantly improved to 0.95 ± 0.13, and 10.6° ± 3.4°, respectively. FTA and sulcus angle were not altered. Lysholm and Kujala score improved from 63.8 to 94.7 and 67.0 to 94.1 points, respectively. Most patients displayed good outcomes except for one patient who suffered re-dislocation by hitting their knee on the floor, 2.5 years after surgery. CONCLUSION Three-dimensional tibial tuberosity transfer was shown to correct the patella position and result in a good clinical outcome. This method is introduced as an alternative surgery for patellar instability with patella alta.
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Affiliation(s)
- Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
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Hasegawa A, Otsuki S, Pauli C, Miyaki S, Patil S, Steklov N, Kinoshita M, Koziol J, D'Lima DD, Lotz MK. Anterior cruciate ligament changes in the human knee joint in aging and osteoarthritis. ACTA ACUST UNITED AC 2012; 64:696-704. [PMID: 22006159 DOI: 10.1002/art.33417] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The development and patterns of spontaneous age-related changes in the anterior cruciate ligament (ACL) and their relationship to articular cartilage degeneration are not well characterized. This study was undertaken to investigate the types and temporal sequence of age-related ACL changes and to determine their correlation with cartilage lesion patterns at all stages of osteoarthritis (OA) development in human knee joints without prior joint trauma. METHODS Human knee joints (n = 120 from 65 donors ages 23-92) were obtained at autopsy, and ACLs and cartilage were graded macroscopically and histologically. Inflammation surrounding the ACL was assessed separately. RESULTS Histologic ACL substance scores and ligament sheath inflammation scores increased with age. Collagen fiber disorganization was the earliest and most prevalent change. The severity of mucoid degeneration and chondroid metaplasia in the ACL increased with the development of cartilage lesions. A correlation between ACL degeneration and cartilage degeneration was observed, especially in the medial compartment of the knee joint. CONCLUSION Our findings indicate that ACL degeneration is highly prevalent in knees with cartilage defects and may even precede cartilage changes. Hence, ACL deficiencies may not only be important in posttraumatic OA, but may also be a feature associated with knee OA pathogenesis in general.
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Affiliation(s)
- Akihiko Hasegawa
- Department of Molecular and Experimental Medicine,The Scripps Research Institute, La Jolla, CA 92037, USA
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