記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：International Orthopaedics  

Purpose: Patients with dysplastic hip osteo arthritis (DHOA) often have a spinopelvic imbalance, and they are more likely to experience falls. This study aimed to evaluate the risk factors for falls in patients with DHOA, including spinopelvic parameters. Methods: In this cross-sectional study, a total of 103 patients with DHOA were included from 2019 to 2021. Fall risk was evaluated using the Fall Risk Index 5 items version (FRI-5). Demographics, functional outcomes, and spinopelvic parameters were compared between the high-risk group (FRI-5 ≥ 6) and the low-risk group (FRI-5 < 6). Multivariate analysis was performed using factors with significant differences in univariate analysis. Results: High-risk and low-risk groups comprised 54 and 49 patients, respectively. Females were significantly more common in the high-risk group than in the low-risk group. The Harris Hip Score was significantly lower in the high-risk group than in the low-risk group (p = 0.02). Pelvic incidence, tilt, and obliquity were significantly higher in the high-risk group than in the low-risk group (p < 0.01). In multivariate analysis, female sex (odds ratio [OR]: 3.76, 95% confidence interval [CI]: 1.11-12.64, p = 0.03), pelvic obliquity (OR: 1.36, 95% CI: 1.09-1.71, p < 0.01), and Harris hip score (OR: 0.96, 95% CI: 0.93-0.99, p = 0.02) were identified as risk factors. Conclusion: Female sex, pelvic obliquity, and low Harris hip score were associated with an increased risk of falls among patients with DHOA.

DOI： 10.1007/s00264-023-05938-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：European Journal of Orthopaedic Surgery and Traumatology  

Objective: This study aimed to compare radiological and functional outcomes and complication rates between intramedullary nailing (IMN) and plate fixation for diaphyseal forearm fractures in adolescents via an age-matched analysis. Methods: Data were collected from medical records at 11 hospitals from 2009 to 2019, and the age-matched study was conducted between IMN and plate fixation. Functional outcomes, radiographic outcomes, and postoperative complication rates were compared. Results: The IMN group (Group N) and plate fixation group (Group P) each comprised 26 patients after age matching. The mean age after matching was 13.42 years old. Bone maturities at the wrist of the radius and ulna were not significantly different between the two groups (p = 0.764 and p = 1). At the last follow-up period, functional outcomes using the Price criteria were over 90% in both groups, and the rotational range of motion was comparable to that of the healthy side. Over 70% of cases in Group N were performed by closed reduction, and operation time was half that of Group P. Postoperative neurological symptoms and refractures were more common in Group P than in Group N, although not statistically significantly so. Conclusions: Treatment outcomes for age-matched adolescent diaphyseal forearm fractures were excellent with IMN, as well as with plate fixation in many cases despite fewer complications, better cosmesis, and shorter operative times with IMN. IMN for diaphyseal forearm fractures is a useful treatment option even in adolescents although the indications for the best procedure to perform should be considered depending on individual patient needs. Level of evidence IV: Multicenter retrospective study.

DOI： 10.1007/s00590-023-03679-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：European Journal of Orthopaedic Surgery and Traumatology  

Background: Double plate fixation for transcondylar fracture (TCF) tends to be more invasive to the soft tissue, and often carries a higher risk of postoperative complications, including ulnar nerve neuropathy. This study presents the outcomes of TCF of the distal humerus between patients treated with a single plate and cannulated cancellous screw fixation and patients treated with double plate fixation. Methods: Between 2011 and 2021, 371 cases involving treatment of distal humeral fracture were recorded in our multicenter (named TRON group) database. Patients of ≥ 65 years of age with TCF treated with opeb n reduction and internal fixation were included. Clinical outcomes were assessed by the Mayo elbow performance score, range of motion, and total elbow arc joint. Complications included fracture-related infection (FRI) and ulnar neuropathy. Results: There were significant differences in the average operative time (CCS group vs. Plate group: 119.0 min vs. 186.5 min; p < 0.001) and average tourniquet time (CCS group vs. Plate group: 91.5 min vs. 121.0 min; p < 0.001). FRI occurred as a complication in the Plate group (n = 6). The rates of FRI did not differ to a statistically significant extent (CCS group vs. Plate group: 0% vs. 9.2%; p = 0.477). No patients underwent reoperation. The rate of sensory symptoms in the Plate group was higher than that in the CCS group (CCS group: none [n = 25], numbness [n = 1] vs. Plate group: none [n = 57], numbness [n = 15], sensory depression [n = 2]; p = 0.039). Discussion: Among patients of ≥ 65 years of age with TCF, the clinical outcomes of patients treated with medial CCS and lateral/posterolateral plate did not differ from those of patients who received double plate fixation, and the former treatment was associated with significantly fewer complications, including ulnar nerve palsy. In addition to double plate fixation, this less invasive method of medial CCS and single plate fixation should be considered as a treatment option for TCF in elderly patients.

DOI： 10.1007/s00590-022-03464-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：European Journal of Orthopaedic Surgery and Traumatology  

Introduction: Double-plating methods are popular, with perpendicular and parallel plate methods being widely used surgical method for the rigid fixation of distal humeral fracture (DHF). However, which plate method is better for DHF remains controversial. The aim of this study was to compare patient outcomes including the incidences of complications and reoperation between the two plate methods. Methods: We extracted 383 patients with DHF undergoing surgery between 2011 and 2020 from our multicenter database, which is named TRON. We divided the subjects into two groups: perpendicular plating group (Group A) and parallel plating group (Group B). To adjust for baseline differences between the groups, patients were matched for age, sex, olecranon osteotomy, AO type, and type of injury. We assessed the Mayo Elbow Performance Score (MEPS) at 3 and 6 months and the last follow-up month as the clinical outcome. We investigated the incidences of complications and reoperations in both groups. Results: After matching, each group comprised 50 patients. There was no significant difference between Group A versus Group B in MEPS score at each time point. The incidence of implant removal in Group B was higher than that in Group A (26.5% vs 50%, p = 0.023). Discussion: Although there were no significant differences in clinical outcomes or complications between the two groups, the incidence of implant removal was higher in Group B than in Group A. In the parallel plate technique, where the plates have to be placed in areas with thin subcutaneous soft tissue, the incidence of implant removal might be high due to the discomfort caused by the implant.

DOI： 10.1007/s00590-022-03462-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Injury  

Aims: This study aimed to show the mortality rate following humeral shaft fragility fractures (HSFF) in the elderly. The secondary aim was to examine the predictors associated with mortality in elderly patients who have sustained HSFF. Methods: From 2011 to 2020, all elderly patients aged 65 years and older with HSFF managed at our nine hospitals were retrospectively identified from our TRON database. Patient demographics and surgical characteristics were extracted from medical records and radiographs, and multivariable Cox regression analysis was used to identify factors affecting mortality. Results: In total, 153 patients who sustained HSFF were included. The mortality rate for HSFF in the elderly was 15.7% at 1 year and 24.6% at 2 years. Multivariable Cox regression analysis showed significant differences in survival for the following variables: older age (p < 0.001), underweight (p = 0.022), severely ill (p = 0.025), mobility limited to indoors (p = 0.003), dominant-side injury (p = 0.027), and nonoperative treatment (p = 0.013). Conclusion: The outcome following HSFF in the elderly population appears to be relatively grim. The prognosis of elderly patients with HSFF is closely related to their medical history. In the elderly patients with HSFF, operative treatment should be positively considered while taking into account their medical status.

DOI： 10.1016/j.injury.2023.110855

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Injury  

Objective: The relationship between postoperative complications and operative techniques of tension band wiring (TBW) is not well studied. We aimed to evaluate the incidence of implant breakage, implant migration, and loss of reduction in patellar fractures treated with TBW and identify radiographic factors associated with these postoperative complications. Methods: This multicenter (named, TRON group) retrospective study included 224 patients who underwent open reduction and internal fixation of patella fractures using TBW from January 2016 to December 2020. Radiographic findings were evaluated by experienced orthopedic surgeons, and radiographic outcomes were assessed for K-wire migration, implant breakage, and loss of reduction. Logistic regression analysis was performed to identify radiographic factors associated with postoperative complications. Results: Implant migration occurred in 44 cases (19.6%), with bending of a single K-wire end identified as a significant risk factor (OR: 12.90; 95% CI: 4.99–33.30; P < 0.001). Implant breakage occurred in 43 cases (19.2%), with a large patella-tension band ratio (OR: 291.0; 95% CI: 19.60–4330; P < 0.001) and a wide distance between K-wires (OR: 1.15; 95% CI: 1.060–1.250; P = 0.001) identified as significant risk factors. Loss of reduction occurred in 5 cases (2.0%), but no significant risk factors were identified. Conclusion: This study highlights the importance of bending both ends of the K-wires and proper placement of the tension band and K-wires in reducing postoperative complications in patellar fractures treated with TBW. Further research is needed to better understand the risk factors associated with loss of reduction.

DOI： 10.1016/j.injury.2023.110896

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Orthopaedic Science  

Objective: Ankylosing spondylitis (AS) is a progressive inflammatory disease that affects the axial skeleton, and often associated with hip involvement. However, the causative factors for radiological hip involvement in patients with AS are not well characterized. This study aimed to investigate the factors associated with hip involvement in patients with AS. Methods: Sixty-seven patients (134 hips) diagnosed with AS who qualified the modified New York criteria at our institution between January 2005 and June 2022 were enrolled. Patients were divided into two groups: the hip involvement group (BASRI-hip score ≥2 points) and the normal group (BASRI-hip score <2 points). Demographic, clinical and radiographic characteristics were compared between the two groups. Results: Twenty-six patients (38.8%) had radiological hip involvement, of which 23 (88.5%) patients were male. There were significant between-group differences with respect to sacroiliac joint fusion, crossover sign, high centre edge angle and low sharp angle (P < 0.05). On logistic regression analysis, older age, sacroiliac joint fusion and pincer type were identified as independent risk factors for hip involvement. Conclusion: AS with hip involvement was significantly more likely to involve sacroiliac joint fusion, which suggested that mechanical stress in adjacent joints and reduced spinopelvic range of motion may influence hip involvement.

DOI： 10.1016/j.jos.2023.06.012

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Orthopaedic Science  

Purpose: This study aimed to clarify the factors that cause the lateralization and superiorization of the femoral head after eccentric rotational acetabular osteotomy (ERAO) by examining the three-dimensional morphology of the osteotomy site using computed tomography (CT). Methods: This study included 52 patients who underwent ERAO for hip dysplasia. Postoperatively, the center of the femoral head was measured for lateralization and superiorization. We defined the iliac and sciatic osteotomy angles in the coronal and axial CT planes, respectively. The surgical factors for lateralization and superiorization were analysed using multiple logistic regression analysis. We also analysed the relationship between the femoral head relocation and clinical outcomes (as assessed using Japanese Orthopaedic Association (JOA) scores). Results: Thirty-five patients had hips with lateralized femoral heads, and 25 patients’ femoral heads were superiorized. Logistic regression analysis revealed that a higher osteotomy angle of the ilium in the coronal plane served as a significant predictor of superiorization of the femoral head. Similarly, a larger osteotomy angle of the ischium in the axial plane and the amount of change in the lateral centre edge angle were identified as predictors of lateralization. A weak negative correlation was observed between the amount of lateralization and the JOA score. Conclusion: Large osteotomy angles in the superior and posterior aspects of the acetabulum carry a risk of superiorization and lateralization of the center of the femoral head. Surgeons should be aware of the need to chisel through the internal plate to achieve the results described in the ERAO theory. Study design: A single-center, retrospective study.

DOI： 10.1016/j.jos.2023.06.010

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Indian Journal of Orthopaedics  

Purpose: Tibial plateau fracture (TPF) is a complex intra-articular injury involving comminution and depression of the joint, which can be accompanied by meniscal tears. The aims of this study were (1) to demonstrate the rate at which surgical treatment for lateral meniscal injury and (2) to clarify the explanatory radiographic factors associated with meniscal injury in patients with TPF. Methods: We extracted the patients who received surgical treatment for TPF from our multicenter database (named TRON) included from 2011 to 2020. We analyzed 79 patients who were received surgical treatment for TPF with Schatzker type II and III and evaluation for meniscal injury on arthroscopy. We investigated the rate at which surgical treatment of the lateral meniscus was required in patients with TPF and the explanatory radiographic factors associated with meniscal injury. Radiographs and CT scans were evaluated to measure the following parameters: tibial plateau slope, distance from lateral edge of the articular surface to fracture line (DLE), articular step, and width of articular bone fragment (WDT). Meniscus tears were classified according to whether surgery was necessary. The results were analyzed by multivariate Logistic analyses. Results: We showed that 27.7% (22/79) of cases of TPF with Schatzker type II and III had lateral meniscal injury that required repair. WDT ≥ 10 mm (odds ratio 10.9; p = 0.005) and DLE ≥ 5 mm (odds ratio 5.7; p = 0.05) were independent explanatory factors for meniscal injury with TPF. Conclusion: Bone fragment size and the location of fracture line on radiographs in patients with TPF are associated with meniscus injuries requiring surgery.

DOI： 10.1007/s43465-023-00888-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Surgical Infections  

Background: Fracture-related infection (FRI) sometimes occurs with peri-prosthetic femoral fracture (PPF) treatment. Fracture-related infection often leads to multiple re-operations, possible non-union, a decreased clinical function, and long-term antibiotic treatment. In this multicenter study, we aimed to clarify the incidence of FRI, the causative organisms of wound infection, and the risk factors associated with post-operative infection for PPF. Patients and Methods: Among 197 patients diagnosed with peri-prosthetic femoral fracture who received surgical treatment in 11 institutions (named the TRON group) from 2010 to 2019, 163 patients were included as subjects. Thirty-four patients were excluded because of insufficient follow-up (less than six months) or data loss. We extracted the following risk factors for FRI: gender, body mass index, smoking history, diabetes mellitus, chronic hepatitis, rheumatoid arthritis, dialysis, history of osteoporosis treatment, injury mechanism (high- or low-energy), Vancouver type, and operative information (waiting period for surgery, operation time, amount of blood loss, and surgical procedure). We conducted a logistic regression analysis to investigate the risk factors for FRI using these extracted items as explanatory variables and the presence or absence of FRI as the response variable. Results: Fracture-related infection occurred after surgery for PPF in 12 of 163 patients (7.3%). The most common causative organism was Staphylococcus aureus (n = 7). The univariable analysis showed differences for dialysis (p = 0.001), Vancouver type (p = 0.036), blood loss during surgery (p = 0.001), and operative time (p = 0.001). The multivariable logistic-regression analysis revealed that the patient background factor of dialysis (odds ratio [OR], 22.9; p = 0.0005), and the operative factor of Vancouver type A fracture (OR, 0.039-1.18; p = 0.018-0.19) were risk factors for FRI. Conclusions: The rate of post-operative wound infection in patients with a PPF was 7.3%. Staphylococcus was the most frequent causative organism. The surgeon should pay attention to infection after surgery for patients with Vancouver type A fractures and those undergoing dialysis.

DOI： 10.1089/sur.2022.347

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Orthopaedics and Traumatology: Surgery and Research  

Background: Although eccentric acetabular rotation osteotomy (ERAO) is an effective treatment for developmental dysplasia of the hip (DDH), there is little information about return to sports after ERAO. This study aimed to investigate 1) the patient factors that influence the return to sports after ERAO, 2) whether postoperative sports participation will affect future osteoarthritis progression. Hypothesis: Some factors affect the return to sports after ERAO. Patients and methods: Of 503 patients who underwent ERAO from 1990 to 2010, 124 who had been continuously participating in sports preoperatively (average 13.2 years after surgery) were included. Patient demographics of sex, age, body mass index, unilateral to bilateral case ratio, history of treatment for childhood DDH, preoperative Kellgren-Lawrence (KL) grade, center edge angle, joint congruency, Harris hip score, complications and the survival rate were compared between the S group (patients who participated in the same sports preoperatively) and N group (patients who could not participate in sports postoperatively). Results: Seventy-two (58%) and 52 patients (42%) in the S and N groups, respectively, had an overall return to sports rate of 64% (79 patients). The most common sports that patients participated in were swimming (30 patients [24%]), jogging (12 [10%]), and golf (10 [8%]) preoperatively, and swimming (14 patients [11%]), golf (8 [6%]), and jogging (8 [6%]) postoperatively. There were no significant differences between both groups in terms of sex, age, body mass index, unilateral to bilateral case ratio, history of treatment for childhood DDH, preoperative KL grade, and joint congruency. There was a significant difference in patient factors between the S (11 joints [14%]) and N (20 joints [38%]) groups only when the preoperative center edge angle was < 0°. There was no significant difference in the preoperative Harris hip score and the final survey between the S (73.2 ± 4.6 and 93.4 ± 7.2) and N (72.5 ± 4.8 and 92.1 ± 7.4) groups. Complications showed no significant differences between the five patients (7%) in the S group and six patients (13%) in the N group. The KL grade progressed in 10 cases (grade II to III in 2 cases and grade III to IV in 8) in the S group and 8 cases (grade II to III in 1 case and grade III to IV in 7 cases) in the N group. The 10-year and 20-year joint survival rates with THA conversion as the endpoint were 98.1% (95% CI: 87.4%–99.7%) and 83.7% (95% CI: 62.6%–93.4%) in the S group and 100% (95% CI: 70.7%–99.3%) and 95.2% (95% CI: 12.6%–92.6%) in the N group, respectively. In the evaluation of factors affecting sports return by logistic regression analysis, only one significant factor (odds ratio 3.42, 95% confidence interval: 1.58–7.42, p < 0.01) was the preoperative center edge angle < 0°. Discussion: The chief factor affecting the return to sports after surgery was a preoperative center edge angle < 0°; moreover, the continuation of sports did not affect the subsequent progression of osteoarthritis or THA conversion. Level of evidence: level III, cohort study.

DOI： 10.1016/j.otsr.2022.103442

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Revue de Chirurgie Orthopedique et Traumatologique  

Background: Although eccentric acetabular rotation osteotomy (ERAO) is an effective treatment for developmental dysplasia of the hip (DDH), there is little information about return to sports after ERAO. This study aimed to investigate 1) the patient factors that influence the return to sports after ERAO, 2) whether postoperative sports participation will affect future osteoarthritis progression. Hypothesis: Some factors affect the return to sports after ERAO. Patients and methods: Of 503 patients who underwent ERAO from 1990 to 2010, 124 who had been continuously participating in sports preoperatively (average 13.2 years after surgery) were included. Patient demographics of sex, age, body mass index, unilateral to bilateral case ratio, history of treatment for childhood DDH, preoperative Kellgren-Lawrence (KL) grade, center edge angle, joint congruency, Harris hip score, complications and the survival rate were compared between the S group (patients who participated in the same sports preoperatively) and N group (patients who could not participate in sports postoperatively). Results: Seventy-two (58%) and 52 patients (42%) in the S and N groups, respectively, had an overall return to sports rate of 64% (79 patients). The most common sports that patients participated in were swimming (30 patients [24%]), jogging (12 [10%]), and golf (10 [8%]) preoperatively, and swimming (14 patients [11%]), golf (8 [6%]), and jogging (8 [6%]) postoperatively. There were no significant differences between both groups in terms of sex, age, body mass index, unilateral to bilateral case ratio, history of treatment for childhood DDH, preoperative KL grade, and joint congruency. There was a significant difference in patient factors between the S (11 joints [14%]) and N (20 joints [38%]) groups only when the preoperative center edge angle was < 0°. There was no significant difference in the preoperative Harris hip score and the final survey between the S (73.2 ± 4.6 and 93.4 ± 7.2) and N (72.5 ± 4.8 and 92.1 ± 7.4) groups. Complications showed no significant differences between the five patients (7%) in the S group and six patients (13%) in the N group. The KL grade progressed in 10 cases (grade II to III in 2 cases and grade III to IV in 8) in the S group and 8 cases (grade II to III in 1 case and grade III to IV in 7 cases) in the N group. The 10-year and 20-year joint survival rates with THA conversion as the endpoint were 98.1% (95% CI: 87.4%–99.7%) and 83.7% (95% CI: 62.6%–93.4%) in the S group and 100% (95% CI: 70.7%–99.3%) and 95.2% (95% CI: 12.6%–92.6%) in the N group, respectively. In the evaluation of factors affecting sports return by logistic regression analysis, only one significant factor (odds ratio 3.42, 95% confidence interval: 1.58–7.42, p < 0.01) was the preoperative center edge angle < 0°. Discussion: The chief factor affecting the return to sports after surgery was a preoperative center edge angle < 0°; moreover, the continuation of sports did not affect the subsequent progression of osteoarthritis or THA conversion. Level of evidence: Level III, cohort study.

DOI： 10.1016/j.rcot.2022.10.006

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Foot and Ankle Specialist  

Background: The present study aimed to evaluate the hypothesis that a 1-week extension of the waiting period to perform surgery for ankle fracture might affect postoperative results and complications. Methods: We used our multicenter database named TRON (Trauma Research Group of Nagoya). In all, 779 patients who underwent surgery for ankle fracture, who had no comorbidities were eligible. After exclusion, we analyzed 596 patients. We divided the patients into 2 groups according to whether they were operated on within 7 days after the injury with propensity score matching. Results: The operative time of the delayed operation group (DO group) was significantly longer than that of the early operation group (EO group) (115.87 ± 56.59 vs 85.93 ± 34.58 minutes; P <.001). The rate of infection in the DO group was significantly higher than that of the EO group (16 patients [6.5%] vs 4 patients [1.6%]; P =.016). Conclusion: Waiting for more than a week to perform ankle surgery may lead to longer operative times and increased infection rates. Levels of Evidence: III

DOI： 10.1177/19386400231164211

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Hand Surgery Asian-Pacific Volume  

Background: Tension band wiring (TBW) has traditionally been used for simple olecranon fractures, but due to its many complications, locking plate (LP) is increasingly being employed. To reduce the complications, we developed a modified technique for olecranon fracture repair, locked TBW (LTBW). The study aimed to compare (1) the frequency of complications and re-operations between LP and LTBW techniques, (2) clinical outcomes and the cost efficacy. Methods: We retrospectively evaluated data of 336 patients who underwent surgical treatment for simple and displaced olecranon fractures (Mayo Type II A) in the hospitals of a trauma research group. We excluded open fractures and polytrauma. We investigated complication and re-operation rates as primary outcomes. As secondary outcomes, Mayo Elbow Performance Index (MEPI) and the total cost, including surgery, outpatients and re-operation, were examined between the two groups. Results: We identified 34 patients in the LP group and 29 patients in the LTBW group. The mean follow-up period was 14.2 ± 3.9 months. The complication rate in the LTBW group was comparable to that in the LP group (10.3% vs. 17.6%; p = 0.49). Re-operation and removal rates were not significantly different between the groups (6.9% vs. 8.8%; p = 1.000 and 41.4% vs. 58.8%; p = 1.00, respectively). Mean MEPI at 3 months was significantly lower in the LTBW group (69.7 vs. 82.6; p < 0.01), but mean MEPI at 6 and 12 months were not significantly different (90.6 vs. 85.2; p = 0.06, 93.9 vs. 95.2; p = 0.51, respectively). The mean cost/patient of the total cost in the LTBW group were significantly lower than those in the LP group ($5,249 vs. $6,138; p < 0.001). Conclusions: This study showed that LTBW achieved clinical outcomes equivalent to those of LP and was significantly more cost effective than LP in the retrospective cohort.

DOI： 10.1142/S2424835523500224

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Hand Surgery  

Purpose: To identify the incidence and the factors associated with a postoperative ulnar nerve neuropathy in patients who had undergone open reduction and internal fixation for intraarticular distal humerus fractures. Methods: We retrospectively reviewed 116 patients who had undergone surgery between January 2011 and December 2020. Age, sex, BMI, mechanism of injury, open or closed fracture, operation time, tourniquet time, and nerve injury at the final examination were collected from medical charts. We essentially used the paratricipital approach. In cases in which the reduction of intraarticular bone fragments was difficult, olecranon osteotomy was used. Ulnar nerve function was graded according to a modified system of McGowan. We conducted logistic regression analysis to investigate factors of neuropathy using items identified as statistically significant in univariate analysis as explanatory variables. Results: Thirty-four patients (29.3%) had persistent neuropathy at the final follow-up. In the modified McGowan classification, 28 patients had grade 1 and 6 patients had grade 2 neuropathy. Olecranon osteotomy emerged as a distinct explanatory variable for the prophylaxis of ulnar nerve neuropathy in the multivariate analysis (odds ratio, 0.30; 95% confidence interval, 0.12–0.73). Anterior transposition, however, was not a statistically significant factor (odds ratio, 1.91; 95% confidence interval, 0.81–4.56). Conclusions: Olecranon osteotomy was the only independent factor associated with preventing the occurrence of ulnar nerve neuropathy. Ulnar nerve transposition might not be associated with prevention of ulnar nerve neuropathy. Type of study/level of evidence: Prognostic IV.

DOI： 10.1016/j.jhsa.2023.02.001

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Injury  

Background: Intramedullary nailing using Kirschner wires in pediatric diaphyseal forearm fractures is often performed as a less invasive treatment than plate fixation, but it remains controversial whether the tips of Kirschner wires are buried or exposed. The purpose of this study was to investigate the relationship between whether the tips are buried or exposed and complications, especially of refracture. Methods: Data of 405 patients under 16 years who underwent surgical treatment for diaphyseal forearm fractures in our 11 hospitals between 2010 and 2020 were collected. Finally, 143 patients who underwent intramedullary nailing with at least 6-month follow-up were analyzed. We investigated difference in complication rates depending on whether the Kirschner wire tips were buried (Group B: n = 79) or exposed (Group E: n = 64). Regarding refractures, we also examined time of onset and status of bone union before the refracture occurred. Results: The duration before implant removal in Group B was more than 4 times longer than that in Group E (mean 187.9 vs. 41.4 days, p<0.001), although there was no significant difference in the progression of bone union between the two groups. Regarding postoperative complications, Group B had a significantly lower rate of refractures than Group E (7.9% vs. 32.8%, p<0.001), although the rate of irritation pain was significantly higher (15.2% vs. 1.6%, p = 0.006). The infection rate was also lower in Group B than Group E, but not significantly so (3.8% vs. 10.9%, p = 0.112). Refractures between 3 and 9 months after surgery accounted for 66.7% of all refractures, and those within 3 months accounted for 14.5% of all fractures. There was no significant difference in the status of bone union before the refracture occurred between patients with and without refracture. Conclusions: The present study showed that longer time of implantation using the buried pin technique for intramedullary nailing reduces refracture of pediatric diaphyseal forearm fractures. Because of the risk of refracture during remodeling, we recommend the implantation of intramedullary nailing for 6–9 months and the instruction for the patients and the parents to pay more attention to refracture at least within 9 months postoperatively. Level of Evidence: Level Ⅲ, Multicenter retrospective study.

DOI： 10.1016/j.injury.2023.01.025

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PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Clinical Medicine  

This study aimed to clarify the relationship between visual acuity and motor function in younger and elderly participants and to compare differences between non-elderly and elderly participants. In total, 295 participants who underwent visual and motor functional examinations were included; participants with visual acuity ≥0.7 were assigned to the normal group (N group) and those with visual acuity ≤0.7 were assigned to the low-visual-acuity group (L group). Motor function was compared between the N and L groups; the analysis was performed by grouping participants into those aged >65 years (elderly) and those aged <65 years (non-elderly). The non-elderly group (average age, 55.6 ± 6.7 years) had 105 and 35 participants in the N and L groups, respectively. Back muscle strength was significantly lower in the L group than in the N group. The elderly group (average age, 71.1 ± 5.1 years) had 102 and 53 participants in the N and L groups, respectively. Gait speed was significantly lower in the L group than in the N group. These results reveal differences in the relationship between vision and motor function in non-elderly and elderly adults and indicate that poor vision is associated with lower back-muscle strength and walking speed in younger and elderly participants, respectively.

DOI： 10.3390/jcm12052008

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PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Orthopaedic Science  

Background: In some cases, patients feel a perceived leg length discrepancy (P-LLD) despite no radiographic leg length discrepancy (R-LLD) after total hip arthroplasty (THA). We aimed to investigate the rate of postoperative P-LLD and the factors that cause postoperative P-LLD. Methods: A retrospective study was conducted on 100 patients with R-LLD ≤5 mm after THA. Patients were classified into two groups based on P-LLD post-THA: group P (with P-LLD) and group E (without P-LLD). Relevant data on the general characteristics and radiological findings between the two groups were compared. Results: We observed that 25 & 75% of patients belonged to group P and group E, respectively, with no significant difference in patient background. Postoperative Japanese Orthopedic Association (JOA) classification of pain and activities of daily living scores were significantly lower in group P than in group E (37.2 ± 3.9 vs. 39.1 ± 2.2, respectively; P = 0.013, and 16.2 ± 4.2 vs. 18.2 ± 2.2, respectively; P = 0.011). The preoperative pelvic oblique angle (POA) was significantly larger in group P than in group E (3.3 ± 2.3° vs. −0.2 ± 2.1°; respectively; P < 0.01). The pelvis tilted toward the surgical side was significantly higher in group P than in group E(88% vs 57%; respectively; P = 0.013). The preoperative C7 coronal vertical axis (C7 CVA) was significantly larger in group P than in group E (6.7 ± 14.7 mm vs. −0.2 ± 10.3 mm; respectively; P = 0.028). Multivariate logistic analysis revealed that preoperative POA (OR, 3.71; 95% CI: 1.86–8.12; P < 0.01) and the pelvis tilted toward the surgical side (OR, 4.14; 95% CI: 2.07–9.71; P = 0.022) were independent risk factors for P-LLD after THA. Conclusion: Even though there was no postoperative R-LLD, 25% of patients had P-LLD. A large preoperative POA and the pelvis tilted toward the surgical side were independent risk factors for P-LLD after THA.

DOI： 10.1016/j.jos.2023.01.013

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PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Orthopaedic Science  

Introduction: This study aimed to investigate the survival rate, postoperative complications, and walking ability in cemented hemiarthroplasty (HA) for displaced femoral neck fractures according to the anaesthesia method. Methods: We conducted a retrospective study of a multicentre group (the TRON group). Three hundred fifty-eight patients who underwent cemented HA between 2015 and 2019 were selected; 289 patients of ≥75 years of age with no missing data were included. Patient background factors were matched and patients were assigned to spinal anaesthesia (SA) and general anaesthesia (GA) groups. The primary outcome was death at any time during the follow-up period. Secondary outcomes included postoperative complications and walking ability assessed using the Parker mobility score (PMS). Overall survival was evaluated using the Kaplan–Meier method, and differences were compared using the log-rank test. The incidence of each complication and PMS were compared between the two groups using Fisher's exact test. Results: Overall survival during follow-up was significantly higher in the SA group in comparison to the GA group (p = 0.037). In the SA and GA groups, the survival rate at 3 months postoperatively was 98.4% and 95.5%, respectively. The incidence of postoperative pneumonia was significantly higher in the GA (p = 0.012), and PMS at 3 months postoperatively was significantly higher in the SA group (p = 0.016). Conclusion: The survival rate of elderly patients who underwent cemented HA was better in the SA group. General anaesthesia in cemented HA may be associated with lower life expectancy, increased incidence of pneumonia, and decreased walking ability.

DOI： 10.1016/j.jos.2023.02.005

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PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：International Orthopaedics  

Purpose: The purpose of this study was to investigate the rate of return to sports after total hip arthroplasty (THA) in patients who regularly participate in sports and evaluate the factors that can affect the return to sports. Methods: In total, 165 patients who had been continuously participating in sports prior to surgery were included from a total of 401 patients who underwent THA from 2015 to 2018. The mean follow-up was 3.3 (range, 2–6) years. Demographics, medical history, surgical parameters, functional outcomes, and anxiety about complications at the final follow-up were compared between the patients who participated in the same sports as before surgery (S group) and those who could not (N group). Results: The overall return to sports rate was 79% for 68 (41%) and 97 (59%) patients in the S and N groups, respectively. The most common sports that patients participated in post-operatively were walking (76 patients, 46%) and swimming (37 patients, 22%), followed by muscle training (25 patients, 15%). There were significant differences between the groups in the following patient factors: sex, primary disease, post-operative Japanese Orthopedic Association Hip-Disease Evaluation Questionnaire outcome, and anxiety about falls and dislocation. In the evaluation of factors affecting return to sports using logistic regression analysis, male sex (odds ratio 3.66, 95% confidence interval 1.13–11.19, p = 0.029) and anxiety of dislocation (odds ratio 3.42, 95% confidence interval 1.58–7.42, p < 0.01) were extracted as independent risk factors. Conclusion: Careful patient guidance and rehabilitation, in addition to accurate surgical procedures, will improve patient participation in sports.

DOI： 10.1007/s00264-023-05724-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Hand Surgery Asian-Pacific Volume  

Background: This multicenter retrospective study aimed to compare clinical outcomes and cost-effectiveness with bone substitutes on volar locking plate (VLP) fixation of unstable distal radial fractures (DRF) in the elderly. Methods: The data of 1,980 patients of ≥65 years of age who underwent surgery for the DRF with a VLP in 2015-2019 were extracted from a database (named TRON). Patients lost to follow-up or who received autologous bone grafting were excluded. The patients (n = 1,735) were divided into the VLP fixation alone (Group VLA) and VLP fixation with bone substitutes (Group VLS). Propensity score matching of background characteristics (ratio, 4:1) was performed. The modified Mayo wrist scores (MMWS) were evaluated as clinical outcomes. The implant failure rate, bone union rate, volar tilt (VT), radial inclination (RI), ulnar variance (UV) and distal dorsal cortical distance (DDD) were evaluated as radiologic parameters. We also compared the initial surgery cost and total cost for each group. Results: After matching, the backgrounds of Groups VLA (n = 388) and VLS (n = 97) were not significantly different. The MMWS values of the groups were not significantly different. Radiographic evaluation revealed no implant failure in either group. Bone union was confirmed in all patients in both groups. The VT, RI, UV and DDD values of the groups were not significantly different. The initial surgery cost and total cost in the VLS group were significantly higher than those in the VLA group ($3,515 vs. $3,068, p < 0.001). Conclusions: In patients of ≥65 years of age with DRF, the clinical and radiological outcomes of VLP fixation with bone substitutes did not differ from those of VLP fixation alone, yet the additional use of bone augmentation was associated with higher medical costs. The indications for bone substitutes should be more strictly considered in the elderly with DRF. Level of Evidence: Level IV (Therapeutic)

DOI： 10.1142/S2424835523500091

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Orthopaedic Science  

Background: Periprosthetic femoral fracture (PFF) after total hip arthroplasty (THA) or bipolar hip arthroplasty (BHA) represents a challenging situation and the treatment is associated with high rates of complications and mortality. The aims of this multicenter retrospective study were to determine 1-year mortality and to identify predictors associated with mortality, including patient characteristics and surgical factors, in patients undergoing surgery for PFF after THA or BHA. Methods: We collected 249 cases of PPF after THA or BHA that were treated in our 11 hospitals (named the TRON group) between January 2010 and December 2019. We excluded patients who were conservatively treated, cases in which the 1-year postoperative outcome was unknown, and Vancouver type A cases. Finally, we analyzed 161 patients. Univariate and multivariate Cox regression analyses were performed to identify factors affecting 1-year mortality. Patient-side factors such as age, BMI, fracture type, and preoperative mobility, and surgical factors such as surgical procedure, time to surgery, and operation time were analyzed respectively. Results: Eighteen of 161 patients (11.2%) died one year after surgery. The multivariate Cox regression analysis identified older age, wheelchair status before injury, and operation time as independent predictors of 1-year mortality (older age: hazard ratio [HR] 1.07, 95% CI 1.01–1.15, P = 0.048; wheelchair status: HR 5.82, 95% CI 1.01–33.47, P = 0.049; operation time: [HR] 1.01, 95% CI 1.00–1.01, P = 0.00929). Meanwhile, fracture type according to the Vancouver classification, body mass index, presence of previous fragility fractures, type of fixation, blood loss during operation, and time to surgery were not independent predictors of 1-year mortality in this analysis. ConclusionThe 1-year mortality rate after surgery for PPFs patients was 11.2%. Factors associated with older and poor activity of daily living (ADL) performance (e.g., wheelchair status before injury), and longer operative time were associated with 1-year mortality after surgery for PPF. Surgeons should carefully plan treatment according to each patient's condition.

DOI： 10.1016/j.jos.2022.12.015

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PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Orthopaedics  

Background: Total hip arthroplasty (THA) for hip disorders helps to alleviate pain and improve active daily life. When determining the effects of medical therapy and the subsequent clinical results, patient quality of life (QOL) also needs to be assessed. Recently, patient-reported outcomes (PRO) have become important as evaluation criteria. This study aimed to evaluate patient QOL and various PRO between different types of cementless stems and to clarify the relationship between PRO and stem-cortical bone contact. Methods: The study comprised 138 consecutive patients undergoing cementless THA for hip osteoarthritis. We assessed three different types of PRO: the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ), patient's joint perception, and peri-hip articular joint pain (PHAP). We measured the state of contact between femur and implant by density mapping. Results: No significant difference was noted in PRO between stem types based on the JHEQ and patient's joint perception. PHAP occurred more frequently in the patients with a taper wedge stem versus a fit-and-fill stem. In both groups, distal contact was associated with PHAP but not with JHEQ results and patient's joint perception. Conclusion: The difference in PHAP between the two stem types groups was significant, with postoperative PHAP being higher with the taper wedge stem because of the more distal contact between the taper wedge stem and femur cortical bone.

DOI： 10.1016/j.jor.2022.10.014

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Bone and Joint Open  

Aims The objectives of this study were to investigate the patient characteristics and mortality of Vancouver type B periprosthetic femoral fractures (PFF) subgroups divided into two groups according to femoral component stability and to compare postoperative clinical outcomes according to treatment in Vancouver type B2 and B3 fractures. Methods A total of 126 Vancouver type B fractures were analyzed from 2010 to 2019 in 11 associated centres' database (named TRON). We divided the patients into two Vancouver type B subtypes according to implant stability. Patient demographics and functional scores were assessed in the Vancouver type B subtypes. We estimated the mortality according to various patient characteristics and clinical outcomes between the open reduction internal fixation (ORIF) and revision arthroplasty (revision) groups in patients with unstable subtype. Results The one-year mortality rate of the stable and unstable subtype of Vancouver type B was 9.4% and 16.4%. Patient demographic factors, including residential status and pre-injury mobility were associated with mortality. There was no significant difference in mortality between patients treated with ORIF and Revision in either Vancouver B subtype. Patients treated with revision had significantly higher Parker Mobility Score (PMS) values (5.48 vs 3.43; p = 0.00461) and a significantly lower visual analogue scale (VAS) values (1.06 vs 1.94; p = 0.0399) for pain than ORIF in the unstable subtype. Conclusion Among patients with Vancouver type B fractures, frail patients, such as those with worse scores for residential status and pre-injury mobility, had a high mortality rate. There was no significant difference in mortality between patients treated with ORIF and those treated with revision. However, in the unstable subtype, the PMS and VAS values at the final follow-up examination were significantly better in patients who received revision. Based on postoperative activities of daily life, we therefore recommend evision in instances when either treatment option is feasible.

DOI： 10.1302/2633-1462.41.BJO-2022-0145.R1

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：International Orthopaedics  

Purpose: Once collapsed, osteonecrosis of the femoral head (ONFH) generally obtains collapse cessation naturally and surgical intervention can be avoided in the long term. This study aimed to investigate the process of hip function and secondary osteoarthritis changes in ONFH patients undergoing conservative treatment. Methods: We included 54 patients with symptomatic ONFH at the first visit with a minimum follow-up of three years with conservative treatment. Patients were divided into two groups based on collapse cessation < 3 mm (stable group) or progression to > 3 mm (progression group). Additionally, we investigated age, sex, body mass index (BMI), etiology, contralateral side hip joint, the Japanese Investigation Committee (JIC) type classification, Harris hip score (HHS), Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ), and survival rate with secondary osteoarthritis as the endpoint. Results: The stable and progression groups had 31 and 23 patients, respectively. No significant differences in age, sex, BMI, and aetiology were observed between the two groups, except for the contralateral side hip joint and JIC type classification. The HHS and JHEQ were significantly improved at the final follow-up than at the first visit in the stable group. However, there were no significant differences in HHS and JHEQ at the final follow-up than at the first visit in the progression group. The five year survival rates with secondary osteoarthritis as the endpoint were significantly higher in the stable group (100%) than in the progression group (32.5%). Conclusion: Hip joint function improved by continuing conservative treatment in ONFH patients with collapse cessation < 3 mm.

DOI： 10.1007/s00264-022-05569-w

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：日本関節病学会  

<p><b>目的</b>：側方骨盤傾斜は変形性膝関節症や変形性腰椎症などの隣接椎間障害や自覚的な脚長差を生じることからQOLを障害する因子の一つとして知られている。変形性股関節症では脚長差や可動域制限により側方骨盤傾斜を呈することが少なくなく，ときとして人工股関節置換術（以下THA）後でも側方骨盤傾斜の改善が得られない症例が存在する。本研究の目的はTHA後の側方骨盤傾斜を認めない症例と残存する症例を比較し，術後側方骨盤傾斜に影響を与える因子について調査することである。</p><p><b>症例および方法</b>：単一施設後ろ向きコホート研究にて，2018年6月から2020年7月までに片側THAを行った91股を対象とした。これらの症例をTHA後の側方骨盤傾斜が2°以内であった48例（以下F群）と2°以上であった43例（以下O群）に分けた。調査項目は年齢，性別，身長，体重，Body Mass Index，術前後のHarris hip score（以下HHS），術前後の股関節可動域，術前後の自覚的脚長差の有無，術前後の側方骨盤傾斜，脚長差，オフセット，術前腰椎側屈可動性について両群間で比較検討を行い，多変量解析を用いて術後の側方骨盤傾斜に影響する因子を評価した。</p><p><b>結果</b>：年齢，性別，身長，体重，BMIは両群で有意差を認めなかった。術前のHHSは両群で有意差を認めなかったが，術後1年でのHHSはF群90.8±7.6に対してO群86.4±11.0で有意にO群が不良であった。術前自覚的脚長差には両群で有意差を認めなかったが術後の自覚的脚長差認識率はF群で20.8%，O群で51.1%と有意にO群で自覚的脚長差を有する症例が多かった。術前後の画像的な脚長差は両群で有意差を認めなかった。術前の腰椎側屈可動性はF群で8.7±4.3°，O群で6.9±4.9°で有意にO群が不良であった。多変量解析の結果では術前側方骨盤傾斜と術前の腰椎側屈可動性が術後の側方骨盤傾斜≧2°の有意なリスク因子であった。</p><p><b>結論</b>：術前の側方骨盤傾斜が大きい症例や腰椎可動性が不良な症例ではTHA後の側方骨盤傾斜が残存するリスクが高く，慎重な術前計画が必要である。</p>

DOI： 10.11551/jsjd.42.12

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Orthopaedic Science  

Background: Tibial plateau fractures (TPFs) are one of the most challenging intra-articular fractures to treat. Along with reconstruction of the articular surfaces, appropriate alignment of the knee joints must be obtained and maintained after open reduction and internal fixation (ORIF) for TPFs because loss of alignment (LA) is associated with worse clinical outcomes. We aimed to investigate and clarify the risk factors related to LA after ORIF for TPFs. Methods: This multicenter, retrospective cohort study used data of hospitals of the Trauma Research Group (TRON group) from January 1, 2011, to December 31, 2020. Among 293 TPFs extracted from the database, we evaluated the alignment of the articular surface to the anatomical axis of the tibia in the immediate postoperative and last follow-up radiographs. We defined a change of alignment from the immediate postoperative radiograph as LA. We evaluated the risk factors of LA using univariate and multiple logistic regression analyses. Results: LA was observed in 27 fractures (9.2%). In multiple logistic regression analyses, preoperative articular step-off and postoperative condylar widening were statistically associated with LA (OR = 1.1, 95% CI: 1.02–1.19 and P = 0.012; OR = 1.04, 95% CI: 1.00–1.08, P = 0.045, respectively). We calculated the threshold by drawing a receiver operating characteristic curve using the final regression model. The threshold of postoperative widening was 8.2 mm. We divided the 293 TPFs into two groups according to this threshold and determined differences between the two groups using Fisher's exact test. The two groups were statistically significantly different (P = 0.00502). Conclusions: Preoperative articular step-off and postoperative condylar widening could be associated with LA after ORIF for TPFs. We suggest that intraoperative restoration of condylar widening is important for the prevention of malalignment following ORIF for TPF.

DOI： 10.1016/j.jos.2022.12.008

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PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Orthopaedic Science  

Background: Patients with locomotive syndrome (LS) are poor ambulatory status and a high risk of requiring nursing care. The purpose of this study is to investigate the relationship between LS and fall risk among community-dwelling elderly individuals. Methods: The subjects were Japanese elderly individuals aged 65 and over who participated in Yakumo study 2019 (N = 189). We defined the fall risk index 5 items version (FRI-5) ≥6 points as the fall risk group. LS was evaluated by stand-up test, two-step test, and 25-Geriatric Locomotive Function Scale (GLFS-25). We divided the subjects into two groups according to the presence or absence of fall risk, and investigated factors associated with fall risk. Results: The fall risk group (30 patients, 15.9%) had higher GLSF-25 (P = 0.001). The results of logistic regression analysis adjusted for age, sex, BMI, and knee osteoarthritis revealed that GLFS-25 (OR: 1.052; 95%CI: 1.009–1.097) was independent factor associated with fall risk. In the ROC analysis, the optimal cut-off value of the GLFS-25 to predict fall risk was 12, which is equivalent to LS stage 1 (AUC 0.688; 95% CI: 0.588–0.787; sensitivity: 0.467, specificity: 0.836). Conclusions: GLFS-25 was associated with fall risk among community-dwelling elderly individuals aged 65 and over.

DOI： 10.1016/j.jos.2022.11.023

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Prosthetics and Orthotics International  

Background:Postoperative protocols after surgical treatment of calcaneal fracture have not been standardized to date. There are only a few reports on the efficacy of heel-unloading orthoses (HUOs; Mars shoe, Graffin orthosis), and thier efficacy is uncertain.Objectives:The purpose of this study was to compare postoperative radiologic and clinical outcomes in patients with calcaneal fractures who used Graffin orthosis.Study design:Multicenter retrospective study.Methods:We finally extracted 182 patients from a database of the Trauma Research Group of Nagoya and divided them into two groups: group C (underwent casting or splinting only) and group O (Graffin orthosis was used). A propensity score algorithm was used to match group C to group O in a 1:1 ratio. We evaluated American Orthopaedic Foot and Ankle Society (AOFAS) score at three and six months after surgery and at final follow-up. Differences in reduction of the Böhler angle between the two groups were evaluated radiographically. All data were analyzed with a t-Test or Fisher's exact test. P <.05 was considered statistically significant.Results:The AOFAS score 3 months after surgery in group O was significantly higher than that in group C (69.57 vs. 77.22; P =.004). However, there were no statistically significant differences between group C vs. group O in AOFAS scores at 6 months after surgery and at final follow-up (81.92 vs. 85.67 and 89.18 vs. 88.13; P =.087 and 0.597, respectively). There was no significant statistical difference in the reduction of the Böhler angle (5.07 vs. 5.89; P =.529).Conclusions:At 3 months postoperatively, the orthosis group showed predominantly better functional results. We believe that heel-unloading orthoses are useful for patients who require an early return to work and to daily life.

DOI： 10.1097/PXR.0000000000000168

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Calcified Tissue International  

Bone collapse, bone deformity, and a long treatment period are major clinical problems associated with juvenile ischemic osteonecrosis (JIO). Accelerating the process of bone repair in JIO is expected to shorten the treatment duration and better maintain morphology. We previously indicated that both bone formation and resorption were accelerated following distraction osteogenesis-mediated limb lengthening in genetically engineered mutant mice with a gain-of-function mutation in fibroblast growth factor receptor 3 (FGFR3) gene (i.e., Fgfr3 mice). The purpose of this study was to investigate the role of FGFR3 in the bone repair process following surgically induced ischemic osteonecrosis in the mutant mice. Epiphyseal deformity was less in the Fgfr3 mice compared to the wild-type mice at 6 weeks following ischemic osteonecrosis in skeletally immature age. Assessment of the morphology by micro-computed tomography (CT) revealed that the trabecular bone volume was increased in the Fgfr3 mice. Dynamic bone histomorphometry revealed increased rates of bone formation and mineral apposition in the Fgfr3 mice at 4 weeks post-surgery. The number of tartrate-resistant acid phosphatase (TRAP)-positive cells rapidly increased, and the numbers of TdT-mediated dUTP nick-end labeling (TUNEL)-positive cells rapidly decreased in the Fgfr3 mice. Vascular endothelial growth factor (VEGF) expression was increased at the earlier phase post-surgery in the Fgfr3 mice. The activation of FGFR3 signaling shortens the time needed for bone repair after ischemic osteonecrosis by accelerating revascularization, bone resorption, and new bone formation. Our findings are clinically relevant as a new potential strategy for the treatment of JIO.

DOI： 10.1007/s00223-022-01019-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Orthopaedic Science  

Background: This study aimed to assess differences in implant failure and bone union rates, amount of change in alignment of lower extremities, and walking ability between early weight-bearing (EWB) and late weight-bearing (LWB) groups following retrograde intramedullary nailing (RIMN) for distal femoral fracture (AO/OTA 33) (DFF) at multiple centers using propensity score matching. Methods: The data of 213 patients who underwent RIMN from 2012 to 2019 in multiple tertiary hospitals were extracted from our database. Cases with the following factors were excluded: age <60, open fracture, AO/OTA-type 33-C3 fracture, preoperative New Mobility Score (NMS) < 3, postoperative follow-up <3 months, and unknown weight-bearing start time. Eighty-four patients were divided into the EWB and LWB groups. EWB group patients were encouraged to perform partial weight-bearing walking at ≤4 weeks after surgery. LWB group patients were not allowed weight bearing for >4 weeks after surgery. After propensity score matching was applied, 26 cases remained in each group. Results: There were no cases of nail failure in either the EWB group or LWB group (P = 1). Screw failure occurred in 0 cases in the EWB group and in 1 case (4.5%) in the LWB group (P = 1.0). Non-union occurred in 5 patients (19.2%) in the EWB group and 4 patients (15.3%) in the LWB group (P = 1). The mean amount of change in lower extremities alignment did not differ between the two groups. The median Knee Society Score was 95.5 (59–100) vs. 93 (72–100) points (P = 0.39). The median NMS was 7 (0–9) vs. 7 (4–9) points (P = 0.82). Conclusions: There were no significant intergroup differences in the rates of implant failure, bone union at one year after surgery, amount of change in lower extremities alignment, or walking ability. We suggest that early weight bearing after RIMN for DFF may not be harmful in elderly people.

DOI： 10.1016/j.jos.2022.10.023

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PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC Musculoskeletal Disorders  

Background: Curved intertrochanteric varus osteotomy (CVO) is a useful treatment option for osteonecrosis of the femoral head (ONFH). However, the effect of proximal femoral deformity in cases of CVO converted to total hip arthroplasty (THA) remains unclear. The aim of this study was to evaluate the effect of trochanter displacement on impingement and the contact state of the implant and femur in THA. Methods: Thirty-eight hips that had undergone CVO for ONFH were reviewed and compared with a control group of 30 contralateral hips that had not undergone surgery. The range of motion (ROM) and impingement patterns and the percentage of cortical bone in the stem placement within the femur were measured by simulation using CT-based three-dimensional template software. We also measured the ROM and the number of joints that achieved the ROM required for activities of daily living when the upward displaced apex of the greater trochanter with osteotomy was resected and compared the findings with those obtained when the apex was not resected. Results: The CVO group showed a significantly greater bony impingement in external rotation (68.4% vs. 43.3%, p = 0.033) and abduction (78.9% vs. 33.3%, p < 0.001) than in the control group. The CVO group showed a significantly smaller range of external rotation (19.0° [interquartile range; 4.0–28.8] vs. 38.0° [interquartile range; 36.0–41.8], p < 0.001) and abduction (23.0° [interquartile range; 8.5–38.8] vs. 56.0° [interquartile range; 50.3–60.0], p < 0.001) than in the control group. Significantly more joints achieved the ROM necessary for activities of daily living when the apex was resected than when it was not (10.5% vs. 63.2%, p < 0.001). The percentage of cortical bone in the stem placement position was significantly higher in the CVO group than in the control group in the proximal portion of the stem (25.5% vs. 0.0%, p < 0.001). Conclusion: In cases requiring conversion to THA, we recommend resecting the upward displaced apex to achieve a sufficient ROM and carefully resecting the bone to avoid malignment of the stem.

DOI： 10.1186/s12891-022-05803-x

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Scopus

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Shoulder and Elbow  

Background: Distal humerus fracture in the elderly is a challenging fracture for orthopedic surgeons. Non-union is one of the serious complications of distal humerus fracture after surgery. This retrospective multicenter study aimed to estimate the incidence of distal humeral non-union after open reduction and internal fixation, determine factors related to non-union, and compare the postoperative results of cases with non-union to cases with the union. Methods: Among 423 patients diagnosed with distal humeral fracture and who were treated by surgical therapy in 2010–2020 from our database called TRON. Only 190 subjects met the inclusion criteria. We performed a logistic regression analysis with the presence of non-union as the response variable to examine risk factors. We compare the Mayo Elbow Performance Scores of cases with non-union to cases with the union. Results: Non-union occurred after surgery in 15 patients (7.9%). The logistic regression analysis showed that body mass index<20 kg/m2 and ≥25 kg/m2, and ≤3 screws in the articular segment were significant explanatory factors for non-union (odds ratio 10.4 and 47.8, respectively). The Mayo Elbow Performance Scores were significantly worse in patients with non-union. Discussion: Low and high body mass index and three or fewer screws in the articular segment might be risk factors for non-union of distal humerus fracture in the elderly. Non-union is associated with poor clinical outcomes.

DOI： 10.1177/17585732221131923

Scopus

記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：日本関節病学会  

<p><b>目的：</b>圧潰をきたした大腿骨頭壊死が自然経過において圧潰停止し，長期的に手術治療を回避できることは少なくない。我々は骨頭後方の壊死領域の範囲が大腿骨頭壊死の圧潰停止に関与すると仮説し，後方壊死領域と圧潰停止の関係性について調査した。</p><p><b>対象および方法：</b>2010年から2016年までに当院に初回受診した片側症状かつ圧潰が3mm以内（Stage 3A）の大腿骨頭壊死77例を対象とした。性別は男性37例，女性40例で平均年齢は45.1歳，平均観察期間は48.7か月，Type分類（B/C1/C2）は3/35/39であった。調査項目は圧潰停止の有無，骨頭後方壊死領域とした。圧潰停止は初診から2年時点で3mm以内の圧潰にとどまった場合に圧潰停止と定義した。骨頭後方壊死領域はMRI横断面で骨頭後方1/3レベルの冠状断T1 MRIにおける荷重面おける壊死領域の割合を評価した。ROC曲線を用いて圧潰停止が得られる後方壊死領域のcut off値を割り出し，cut off値より圧潰進行（>3mm）および人工股関節全置換術をendpointとした生存率を評価した。</p><p><b>結果：</b>圧潰停止は31例（40%）に認めた。後方壊死域は圧潰停止例43.1±31.8%に対して圧潰進行例95.6±19.1%で有意差を認めた（<i>P</i><0.01）。ROC曲線のAUCは0.946でcut off値は後方壊死領域68%（感度96%，特異度92%）であった。圧潰進行および人工股関節全置換術をendpointとした4年生存率は後方壊死領域>68%では6.9%および33%に対し，後方壊死領域<68%では96%および93%でいずれも有意差を認めた（<i>P</i><0.01および<i>P</i><0.01）。</p><p><b>結論：</b>一旦圧潰をきたした大腿骨頭壊死においても後方壊死領域が2/3以下の症例は高い確率で自然経過による圧潰停止が期待でき，保存的治療を行うか判断する際の有効な指標となる。</p>

DOI： 10.11551/jsjd.41.275

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Foot and Ankle Surgery  

A relationship between Böhler angle (BA) before or after surgery and clinical outcomes remains unclear. This retrospective multicenter cohort study aimed to compare pain and functional outcomes between a group in which the reduction angle was preserved and a group in which the reduction angle was lost during follow-up, and to clarify the risk factors leading to loss of last follow-up BA. From 2014 to 2018, 271 cases of calcaneal fractures were surgically treated at ten facilities. We divided patients into Group L (lost reduction of fracture) and Group P (preserved reduction of fracture). We matched subjects between the 2 groups according to age, sex and BA before surgery and compared American Orthopedic Foot and Ankle Society (AOFAS) score between the groups. We investigated the correlation between the amount of BA loss and postoperative pain. The factors leading to loss of last follow-up BA were examined by logistic regression analysis. Ultimately, 112 patients were eligible. After matching, each group included 38 patients. There was no difference between the 2 groups in total AOFAS score. However, the pain component of AOFAS score at 6 months and 12 months were worse in group L than in group P (p = .011, p = .031, respectively). We also showed a weak correlation between the amount of BA loss and postoperative pain. Logistic regression analysis revealed that female and BA before surgery independently predicted loss of reduction (odds ratios: 4.66, 95% CI: 1.15-18.9 and odds ratios: 0.90, 95% CI: 0.82-0.99, respectively). We clarified that reduction and preservation of BA within its normal range should lead to decrease postoperative pain. Female and lower pre-BA were risk factors leading to loss of reduction of BA in operative treatment of calcaneal fractures.

DOI： 10.1053/j.jfas.2021.11.011

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PubMed

記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：一般社団法人 日本ペインクリニック学会  

<p>【症例】46歳女性，身長157 cm，体重58 kg．20歳ごろより両股関節痛を生じ，変形性関節症と診断され保存的に加療していた．当院整形外科紹介受診し，左人工股関節置換術施行予定となった．腰神経叢ブロックと傍仙骨部の坐骨神経ブロックを施行後，全身麻酔導入し，手術を行った．術後のレントゲンで脚延長は20 mmであった．覚醒後，両下肢に運動障害と感覚障害があった．症状は数時間以内に改善し，腰神経叢ブロックが硬膜外ブロックになったと考えられ，画像検査で血種による神経圧迫などを除外した上で経過観察となった．その後，感覚障害と運動障害は改善傾向であったが左足関節の背屈運動のみ回復が遅れ，術28日後の筋電図検査にて腓骨頭レベルでの軽度腓骨神経障害と診断された．術32日後，杖歩行安定し退院した．【まとめ】本症例の神経症状は，腓骨頭レベルでの神経障害であることから，腓骨神経の過伸展等の物理的因子に起因することが推察されるが，腰神経叢ブロックが硬膜外ブロックになったことにより麻痺症状が初期段階ではマスクされた．また今回の神経ブロックが麻痺に影響した可能性も否定できない．</p>

DOI： 10.11321/jjspc.21-0029

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：南江堂  

DOI： 10.15106/j_seikei72_301

CiNii Research

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Web of Science

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：The bone &amp; joint journal  

DOI： 10.1302/0301-620X.103B4.BJJ-2020-1107.R1

Scopus

PubMed

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1302/0301-620X.103B4

Web of Science

記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：中部日本整形外科災害外科学会  

<p>【はじめに】小児上腕骨顆上骨折の術後合併症として神経障害が挙げられる．今までに単施設からの報告はあるが多施設からのまとまった報告は少ない．【対象および方法】2014年から2019年に15歳未満の上腕骨顆上骨折に対して骨接合術を行った症例を関連4施設で集積した．評価項目は骨折型，ピンニングの方法とした．術後合併症における神経障害の有無とし，その要因となるものを単変量解析とロジスティック回帰分析を用いて検討した．【結果】248例に対して骨接合術が施行された．男性155例，女性93例，平均年齢6.4歳，平均身長117.6cm，平均体重22.2kg，骨折型はI型とII型：III型とIV型，171例：77例であった．神経障害を認めた症例は15例（うち正中神経11例，橈骨神経3例，尺骨神経1例）であった．ロジスティック回帰分析の結果，骨折型の違いが有意な因子であった（オッズ比：6.32，P＝0.0036）．【結論】小児上腕骨顆上骨折において骨折型が有意な神経障害の危険因子であった．</p>

DOI： 10.11359/chubu.2021.11

CiNii Research

記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：日本関節病学会  

<p><b>目的 : </b>偏心性寛骨臼回転骨切り術 (以下ERAO) 後のスポーツ復帰率と復帰に影響を与える因子を調査した。</p><p><b>対象及び方法 : </b>1990年から2010年にERAO施行した503例の中, 術前から継続的にスポーツ参加していた124例 (術後平均13.2年) を対象とした。ERAO後に術前と同等のスポーツに参加したと答えたS群と術後参加できていないと答えたN群で評価した。調査項目は性別 (男性or女性), 年齢 (<30歳or 30歳≧), body mass index (BMI) (<25kg/m² or≧25kg/m²), 片側or両側手術例, 術前のKellgren and Lawrence (以下KL) 分類, 関節適合性 (excellent & good or fair & poor), 小児期発育性股関節形成不全の治療歴の有無, 術前のcenter edge (以下CE) 角 (≧0度or 0度>), 術後のCE角 (≧25度or 25度>), スポーツ種目, スポーツ強度, 日本整形外科学会股関節機能判定基準 (以下JOAスコア) (術前, 術後2年, 最終調査時), 術後合併症, KL分類のgrade進行をエンドポイントとした生存率を2群で比較した。<i>P</i><0.05の変数をlogistic regression analysisにより復帰阻害因子を同定した。</p><p><b>結果 : </b>S群72例 (58%), N群は52例 (42%) で全体のスポーツ復帰率は64%であった。術後に多く参加していたスポーツは水泳14例 (11%), ゴルフ8例 (6%), ジョギング8例 (6%) であった。患者因子は術前CE角0度未満のみ両群で有意差を認めた。術前, 術後2年, 最終調査時のJOAスコア及び合併症は両群で有意差を認めなかった。KL分類のGrade進行をendpointとした10年及び20年の関節生存率はS群が98.3%, 75.6%に対してN群は96.8%, 67.1%で有意差は認めなかった。Logistic regression analysisによるスポーツ復帰に影響する因子の評価では術前CE角0度未満のみ有意な因子 (オッズ比3.42, 95%IC 1.58〜7.42, <i>P</i><0.01) として抽出された。</p><p><b>結論 : </b>ERAO後のスポーツ復帰率は69%でスポーツ継続はその後の股関節症の進行には影響しなかった。術後のスポーツ復帰に影響を与える因子は術前CE角が0度未満であった。</p>

DOI： 10.11551/jsjd.40.110

CiNii Research

記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：日本関節病学会  

<p><b>目的 : </b>我々は骨頭変形や関節症進行により関節適合性が不良な寛骨臼形成不全例に対して転子間外反骨切り (ITVO) を併用した偏心性寛骨臼回転骨切り術 (ERAO) を施行してきた。今回, 50歳未満の寛骨臼形成不全症に対してITVOを併用したERAOの長期成績をERAO術単独例と比較検討を行った。</p><p><b>対象および方法 : </b>1989年から2009年に寛骨臼形成不全症に対してITVO併用ERAOを施行した35例36関節 (前股関節症2例, 初期股関節症2例, 進行期股関節症28関節, 末期股関節症4関節) を対象とした。Control群は性別, 年齢, 術前病期をマッチングしたERAO単独施行した65例66関節 (ERAO群) とした。性別は全例女性で, 手術時平均年齢はERAO/ITVO群で41.1/41.9歳, 平均経過観察期間は16.5/16.2年であった。検討項目は術前および最終調査時の日本整形外科学会股関節機能判定基準 (JOA hip score), 合併症, 人工股関節全置換術 (THA) への移行およびJOA hip score<80をend pointとした生存率とした。</p><p><b>結果 : </b>術前JOA hip scoreは両群で有意差を認めなかったが最終経過観察時はITVO/ERAO群で78.9±12.3/87.4±9.7で有意にITVO群が不良であった (<i>P</i><0.01)。合併症はITVO群4例, ERAO群3例で有意差を認めなかった。THAをend pointとしたITVO/ERAO群の生存率は10年91.9/91.4%, 20年60.3/69.2%で有意差を認めなかった。JOA hip score<80をend pointとした生存率は10年56.9/82.8%, 20年42.9/72.7%で有意にITVO群が不良であった (<i>P</i><0.01)。</p><p><b>結論 : </b>股関節機能においてITVOを併用したERAOの長期成績は不良であり, 本術式の適応は若年の前, 初期股関節症に限定するべきである。</p>

DOI： 10.11551/jsjd.39.379

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：南江堂  

DOI： 10.15106/j_seikei70_1333

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Revue de Chirurgie Orthopedique et Traumatologique  

Background: There is a lack of evidence about the risk factors associated with the malseating of the acetabular liner after ceramic-on-ceramic (CoC) total hip arthroplasty (THA). Therefore, we performed a complementary retrospective case-control study to determine the factors predicting the malseating of the acetabular liner after CoC THA and to evaluate the relationship between malseating and (1) osteoarthritis, (2) particularly in terms of the new radiographic parameter “bone sclerotic length” of the acetabular bone. Hypothesis: Osteoarthritis, particularly bone sclerotic length, was an independent risk factor for malseating of ceramic liners. Patients and methods: In total, 219 CoC THAs (174 women and 45 men) were evaluated to determine the risk factors influencing the malseating of the acetabular ceramic liner. An average patient age at the time of surgery was 55.9 ± 9.5 years (range, 23 to 75 years). Data on patient background and preoperative radiographs, such as Tönnis grades; Crowe classification; and indices of acetabular osteoarthritis change; including bone cyst, osteophyte and bone sclerosis, were assessed. The sclerotic length in patients with osteoarthritis was measured as the length between the bilateral edges of sclerosis lesions. The bone sclerotic length was measured as the slant distance between the bilateral edges of the sclerosis lesion of the acetabulum on the anteroposterior view. Results: Preoperative less flexion (hazard ratio [HR]: 0.98; 95% CI: 0.97–0.99), osteoarthritis (HR: 3.15; 95% CI: 1.02–9.70) and the bone sclerotic length (HR: 1.83; 95% CI: 1.35–2.48) were independent risk factors determining the malseating of ceramic liners. Receiver operating characteristic curve analysis showed that a bone sclerotic length of 24.6 mm was defined as the cut-off point for the malseating of the ceramic liner. Discussion: Age, preoperative less flextion, osteoarthritis, and the bone sclerotic were independent risk factors determining malseating of ceramic liners. The acetabular shell can also deform upon insertion of the cup with sclerotic bone of the acetabulum and prevent correct seating of liners. Therefore, these factors must be taken into consideration when seating the ceramic liner. Level of evidence: Case control study III, case control retrospective design.

DOI： 10.1016/j.rcot.2019.02.018

Scopus

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Web of Science

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Revue de Chirurgie Orthopedique et Traumatologique  

Background: To avoid wear-induced osteolysis, ceramic-on-ceramic (CoC) and metal-on-metal (MoM) bearings have been developed. At present, there are no direct material related clinical comparisons between cementless total hip arthroplasty with CoC and MoM at more than 5-year follow-up. The bearing that is more likely to prevent osteolysis is still controversial. Therefore, we performed a retrospective case control study evaluating CoC and MoM cementless THAs in order to: compare the longevity and complications for CoC and MoM THAs at 5–10 years postoperatively; compare the incidence of osteolysis between both type THAs, and; evaluate pseudotumors in MoM THAs. Hypothesis: CoC THAs will have a lower rate of osteolysis, better longevity, and better clinical outcomes than MoM THAs. Patients and methods: Ninety-six hips underwent CoC THAs, and 56 hips underwent MoM THA (Ultamet, Pinnacle, Depuy). Average patient age at the time of surgery was 57.1 years (range, 28 to 77 years). Results: There were no differences with regard to the Harris hip score (89.5 and 90.3 for the CoC and MoM groups, respectively). Osteolysis (9 hips, 14.3%) among MoM THAs were significantly more frequently observed compared to CoC THAs (2 hips, 2.1%). Kaplan-Meier survival at 8 years with implant loosening or revision THA as the endpoint was 98.2% (95% CI: 87.8–99.8) for CoC, and 98.6% (95% CI: 90.2–99.8) for MoM (p = 0.684). There was one audible squeaking (1.0%) and no ceramic fracture among CoC THAs. Five (8.9%) hips showed pseudotumors among MoM THAs. Discussion: CoC THAs had a low incidence of osteolysis. No significant difference was seen in the 8 year survival rate between implants, when using implant loosening and revision THA as endpoints. These data indicate that CoC THAs have excellent clinical and radiological outcomes, compared with MoM THAs. Ultamet MoM had a higher rate of osteolysis compared to other MoM bearings; the cup modularity (without polyethylene) and the use of 36 mm heads as well as the process of production (after 2006) may play a significant role in the higher rate of osteolysis. Level of evidence: III, case control study, case control retrospective design.

DOI： 10.1016/j.rcot.2018.09.121

Scopus

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Orthopaedics and Traumatology: Surgery and Research  

Background: Currently, there is a lack of evidence on the medium-term follow-up of cementless total hip arthroplasty (THA) using metal-on-highly cross-linked polyethylene bearing (MoXPE), ceramic on ceramic bearing (CoC) at more than 5 years follow-up. Therefore, we performed a case control study to: compare the incidence rate of osteolysis; compare the longevity for both types of THAs, and to evaluate the wear rate of MoXPE THAs. Hypothesis: CoC THAs will have a lower rate of osteolysis and better longevity than MoXPE THAs. Patients and methods: We performed a retrospective analysis of 77 MoXPE (68 women, 9 men) and 105 CoC (85 women, 20 men) THAs, with an average patient age at the time of surgery of 64.7 years (range, 27 to 76 years). The cohorts were matched according to sex, body mass index, or diagnosis of hip joint disease. Clinical and radiologic measurements were analyzed at a mean follow-up of 6.7 years (range, 5–9 years). Results: There were no between-group differences with regard to the Harris hip score (87.0 [64.0–98.0] and 89.9 [70.0–100.0] for the MoXPE and CoC group, respectively) and the incidence rate of osteolysis (2.6% and 1.9%, respectively). Revision was required for 1 case for each THA type. The Kaplan-Meier survival at 8 years, using implant loosening or revision as the end-point of analysis, was 96.1% (95% confidence interval [CI], 90.0–99.3) for the MoXPE group and 98.9% (95% CI, 92.2–99.8) for the CoC group (p = 0.189). The mean annual liner wear rate was 0.0160 mm/year (range, 0.0050 to 0.0390 mm/year) for the MoXPE THAs. Discussion: There was no difference between CoC and MoXPE THAs in the incidence of osteolysis or in survival rate at 8 years post-surgery. Excellent clinical and radiological outcomes were obtained for both types of bearings. Level of evidence: III, Case control study, case control retrospective design.

DOI： 10.1016/j.otsr.2018.04.016

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Orthopaedic Research  

Bony impingement, especially in the anterior inferior iliac spine (AIIS) after total hip arthroplasty (THA), may cause dislocation. However, the influence of AIIS characteristics on bony impingement after THA is not fully understood. Thus, we aimed to determine the morphological characteristics of AIIS with developmental dysplasia of the hip (DDH) and primary osteoarthritis (pOA) and to evaluate its effect on range of motion (ROM) after THA. Hips from 130 patients who underwent THA, including pOA were analyzed. In total, we had 27 male and 27 female participants with pOA, and 38 male and 38 female participants with DDH. The horizontal distances of AIIS from teardrop (TD) were compared. In the computed tomography simulation, flexion ROM was measured, and its relationship to the distance between TD and AIIS was investigated. DDH had a more medial (male: DDH, 36.9 ± 5.8; pOA, 45.5 ± 6.1; p < 0.001) (female: DDH, 31.5 ± 10.0; pOA, 36.2 ± 4.7; p < 0.001) position of AIIS than pOA. In the male with pOA group, flexion ROM was significantly smaller than that in the other groups, and there was a correlation between flexion ROM and horizontal distances (r = −0.543; 95% confidence interval = −0.765 to −0.206; p = 0.003). AIIS position is a factor that limits ROM during flexion after THA, particularly in males. Further studies are required to develop surgical strategies for cases of impingement at the AIIS site after THA. Level of evidence: Ш, retrospective comparative study.

DOI： 10.1002/jor.25544

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：European Journal of Orthopaedic Surgery and Traumatology  

Purpose: This multicenter, retrospective study aimed to compare clinical outcomes and complications between locking plate fixation and new coracoclavicular (CC) fixation for patients with unstable distal clavicle fracture. Methods: We included 142 patients in this TRON study. The mean follow-up was 15.5 (6–31) months. The patients were divided into two groups: the locking plate group (Group L) and CC fixation group (Group C). To adjust for baseline differences between the groups, a propensity score algorithm was used to match two groups in a 1:1 ratio. After matching, we compared operation time and the University of California Los Angeles (UCLA) shoulder score at 3 and 6 months postoperatively and at last follow-up as clinical outcomes and the rate of complications. Results: After matching, 20 cases from each group remained. Operation time was shorter in Group C (75 [22, 111] vs. 100 [38, 120] min; P = 0.023). At 3 months postoperatively, UCLA score in Group C was better, but no significant differences between the groups were found at 6 months and last follow-up after surgery. The rate of complications was not significantly different between the groups. Conclusion: CC fixation might be equivalent to locking plate fixation in clinical outcome, and the operation time is shorter than that required for locking plate fixation.

DOI： 10.1007/s00590-022-03358-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Global Spine Journal  

Study Design: Cross-sectional study. Objectives: To investigate the effects of pelvic compensation on standing balance in healthy volunteers. Methods: The 180 healthy volunteers were recruited at a basic health checkup. The inclusion criteria were: 1) age ≥ 65 years, 2) underwent a whole spine radiograph and stabilometry, 3) well-balanced standing posture with a sagittal vertical axis <50 mm, and 4) a visual analog scale of lower back pain of <20 mm. Based on the pelvic incidence (PI) and lumbar lordosis (LL) mismatch, subjects were divided into harmonious (PI–LL ≤ 10°) or unharmonious (PI–LL > 10°) groups. Results: Participants in the unharmonious group were significantly older compared with the harmonious group (70.2 ± 4.4 vs. 72.0 ± 4.6 years, P <.01). The PI minus LL values were −2.2° ± 7.5° and 16.6° ± 7.0° in the harmonious and unharmonious groups, respectively (P <.001). Anteroposterior LNG/TIME (average center of pressure sway speed) was significantly greater in the unharmonious group with both open and closed eyes (1.04 ± 0.38 cm/s vs. 1.25 ± 0.47 cm/s, P <.001 and 1.22 ± 0.54 cm/s vs. 1.58 ± 0.77 cm/s, P <.001, respectively). Lateral LNG/TIME was significantly greater in the unharmonious group only with closed eyes (1.24 ± 0.54 cm/s vs. 1.47 ± 0.79 cm/s, P =.03). Conclusions: Healthy elderly subjects with poor spinopelvic harmony had relatively unstable standing balance. The “cone of economy” was demonstrated, showing that unharmonious spinopelvic balance had a non-economic effect on standing.

DOI： 10.1177/21925682211038897

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Hand Surgery: European Volume  

We conducted a retrospective multicentre study to compare the clinical and radiographic outcomes, and complications of three surgical treatments of distal ulna fracture (DUF) when combined with anterior locking plate fixation for distal radial fracture (DRF) in patients over 70 years of age. We identified 1521 patients over 70 years of age who were diagnosed as having DRF and who underwent anterior locking plate fixation between 2015 and 2020, among which 122 cases of DUF were analysed. Three surgical treatment options for DUF were identified in this cohort: K-wire fixation (Group K), locking plate fixation (Group L) and Darrach procedure (Group D). The results of the analysis showed the total immobilization period in Group D to be the shortest among the three treatments. Functional outcomes were superior, and the rate of complications were smaller in Group D than in Group L. In addition, rotational range of motion was larger in Group D and Group L compared with Group K. In patients who are 70 years of age or older with combined unstable DRF and highly comminuted or displaced DUF, the Darrach procedure for DUF seems to be the most useful and reasonable treatment option once the fracture of the distal radius has been rigidly fixed. Level of evidence: IV.

DOI： 10.1177/17531934221150495

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Orthopaedic Science  

Background: Open reduction and internal fixation (ORIF) for unstable ankle fractures (AF) are relatively predictable with excellent outcomes. Rehabilitation strategies are still being debated after surgical intervention for AF: non-weight bearing and cast immobilization for six weeks after the surgical repair of unstable AF or early functional treatment with partial weight bearing. This study aimed to compare early weight bearing and functional outcomes and complications. Methods: Between April 2014 and March 2019, 1421 patients with AF underwent ORIF at 11 institutions (TRON group). The patients were divided into two groups: Group E started weight bearing within six weeks after surgery, and group L started weightbearing for more than six weeks after. To adjust for baseline difference between groups, a propensity score-matched algorithm was used to match Group E with Group L in a 1:1 ratio of 294 cases each. We compared the American Orthopedic Foot and Ankle Society (AOFAS) score as the functional outcome, the rate of wound dehiscence, superficial and deep infections, blistering, nonunion, neurapraxia, and reoperation at 3, 6, and 12 months after surgery. Results: The mean period of non-weight bearing was significantly shorter in group E (3.68 ± 1.02 vs. 6.67 ± 1.43; P < 0.001). The mean period of cast immobilization term were shorter in group E (1.84 ± 1.35 vs. 2.65 ± 1.51; P < 0.001). There were no differences in the AOFAS score at any period. The rates of deep infection and reoperation in Group E were significantly lower than those in Group L (1.7% vs. 6.1%; P = 0.009, 2.0% vs. 7.8%; P = 0.002, respectively). There were no significant differences in superficial infection (9 vs. 15; P = 0.297), nonunion (9 vs. 15 P = 0.30), blistering (4 vs. 3; P = 1.00), neurapraxia (2 vs. 1; P = 1.00), and wound dehiscence (15 vs. 18; P = 0.72). Conclusions: Although functional outcome was similar depending on whether early weight bearing was allowed, the rates of deep infection and reoperation decreased in patients with early weight bearing. We recommend early postoperative weight bearing in patients with a surgically treated AF.

DOI： 10.1016/j.jos.2022.03.002

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Orthopaedic Science  

Background: Distal femur fractures have been reported to have a mortality rate comparable to hip fractures, but the risk is still unknown. Recent studies have reported that low body mass index (BMI) is a risk factor for mortality in the elderly. We investigated the efficacy of low BMI for predicting the risk of mortality in distal femur fractures in patients aged over 65 within 18 months after injury and its impact on postoperative clinical outcomes and mortality. Methods: Data from patients followed for more than six months were obtained from our trauma research group's database. We investigated risk factors for increased mortality using Cox proportional hazards models. We divided the analysed cases into low (<18.5 kg/m2) and high (>18.5 kg/m2) BMI groups. We adjusted the background characteristics of the groups by patient matching, and evaluated the postoperative mortality, complication rate, and knee society score (KSS). Results: We identified 216 patients, including 58 (26.9%) with low BMI values. Low BMI was an independent risk factor for mortality in all models (Hazard Ratio: 2.9, p = 0.011). The overall survival rate of the low BMI group at 18 months was significantly lower than that of the high BMI group (70.7% vs. 89.1%; p = 0.003). The complication rates of the low BMI and high BMI groups were not significantly different (33.3% vs. 22.2%; p = 0.283). The mean KSS values at 3, 6, and 12 months in the low BMI group was significantly worse than that in the high BMI group (78.7 ± 16.2 vs. 84.8 ± 13.1; p = 0.035, 82.2 ± 16.9 vs. 89.7 ± 8.9; p = 0.005, 86.4 ± 13.0 vs. 91.4 ± 8.4; p = 0.020, respectively). Conclusions: Our study indicated that low BMI was independent associated with increased mortality and impaired postoperative functional recovery in distal femur fractures of the elderly patients.

DOI： 10.1016/j.jos.2022.01.014

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Nagoya Journal of Medical Science  

Hook plate fixation and locking plate fixation are two standard internal fixation implants for treating distal clavicle fractures. We aimed to clarify the following: 1) Does the locking plate offer better clinical outcomes than the hook plate? 2) Is bone union better with a locking plate than hook plate? and 3) Are complications different between the locking plate and hook plate? We conducted a retrospective multicenter study of 338 patients who underwent surgery from 2014 to 2018 in our 10 hospitals, which comprise the TRON group. Of them, 208 patients treated using any plates were eligible. After 30 patients were excluded for various reasons, 178 patients were included. We classified them into two groups, locking plate group (Group L) and hook plate group (Group H), using propensity score matching. We confirmed bone union with an X-ray, evaluated the UCLA shoulder score, and compared the frequency of complications. After matching, Group L and Group H included 49 patients each. The UCLA score was higher in Group L than in Group H at each follow-up point. We confirmed bone union in all patients in Group L, but it was not confirmed in three patients (6.1%) in Group H. No statistically significant differences were observed except for plate migration, which was observed in nine patients (18.4%) in Group H but in no patients in Group L. The postoperative UCLA score was significantly better in Group L. We recommend the locking plate as a surgical treatment for distal clavicle fractures

DOI： 10.18999/nagjms.85.2.223

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Indian Journal of Orthopaedics  

Introduction: With the aging of the population, the proportion of distal radius fracture patients who are > 80 years of age is increasing. In this study, we compared the postoperative clinical and radiographic outcomes between super-elderly patients (age: ≥ 80 years) and middle-elderly (age: 65–79 years) who were treated with volar locking plate (VLP) fixation for distal radius fractures. Patients and Methods: Patients of > 65 years of age with distal radius fractures treated by VLP fixation between 2015 and 2019, and who were followed for at least 6 months after surgery were included in our database (named TRON). Patients with open fractures, multiple-trauma, or who received fixation with implants other than a VLP were excluded. We evaluated postoperative complications, Mayo wrist score (MWS), and radiographic outcomes. Results: We identified 589 patients in this study; 452 were 65–79 years of age (Group A) and 137 were ≥ 80 years of age (Group B). After propensity score matching, we evaluated 309 patients in Group A and 103 patients in Group B. The mean follow-up period was 10.7 ± 4.6 months. Twenty-eight patients (9.1%) in Group A and 5 patients in Group B (4.9%) experienced post-operative complications (non-significant: p = 0.212). The postoperative MWS at 1, 3, and 6 months, respectively, was 65.4 ± 11.7, 75.2 ± 11.0, and 79.6 ± 10.5 in Group A and 67.1 ± 9.61, 75.7 ± 10.7, and 80.6 ± 9.7 in Group B (non-significant: p = 0.418, 0.893, 0.452, respectively). The differences in volar tilt, radial inclination, ulnar variance between the postoperative and last follow-up radiographs did not differ between the two groups to a statistically significant extent (p = 0.053, 0.437, 0.529, respectively). Conclusion: Our study showed that the clinical and radiographic outcomes of distal radius fractures treated with VLP in super-elderly patients were comparable to those in middle-elderly patients.

DOI： 10.1007/s43465-022-00788-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Orthopaedic Science  

Background: Although home exercises are used for postoperative rehabilitation of distal radius fractures (DRF), the superiority of home exercise over supervised physiotherapy rehabilitation is controversial. This study aimed to compare the function of home exercise and supervised physiotherapy rehabilitation during postoperative rehabilitation for DRF. Methods: We conducted a multicenter, retrospective study in which we included 1949 patients over 65 years old who underwent volar locking plate fixation for DRF. After propensity score matching, 308 patients were assigned to each of an independent home exercise group (IHG) and supervised physiotherapy group (SPG). Wrist function was assessed after 3, 6, and 12 months postoperatively. Results: The results showed that the Mayo Wrist Score did not differ significantly within the observation period. Range of motion of the wrist was better in the SPG up to 3 months postoperatively but was almost the same as that in the IHG at 6 months. However, the Numerical Rating Scale score was lower in the IHG during all observation periods. Conclusions: Home exercise may be as effective as supervised physiotherapy in the medium term, but supervised physiotherapy rehabilitation should be considered if early recovery and good wrist function are desired.

DOI： 10.1016/j.jos.2022.11.017

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：European Journal of Trauma and Emergency Surgery  

Purpose: This retrospective multicenter study aimed to compare rates of early mobilization and survival and functional outcome of surgical treatment (S) with that of conservative treatment (C) according to each unstable fragility fracture of the pelvis (FFP) classification type with displacement of the posterior component ≥ 5 mm. Methods: We analyzed 64 patients with unstable type III and IV FFP who could move and transfer themselves before injury and had ≥ 5 mm displacement of the posterior component. We compared survival rate, early mobilization, walking ability at final follow-up, and complications at admission for each type of surgical and conservative treatment. Results: Most of the unstable FFP were type IIIa and IVb in the study population. Type III comprised 40 cases (group S:13/group C:27) and type IV comprised 24 cases (group S:7/group C:17). There were no significant differences in 3 month and 1 year survival rates, although group C (III) had the tendency of higher mortality rate (p = 0.08). Mobilization (transferring to a wheelchair) was enabled significantly earlier in group S (III) than in group C (III) (p = 0.02), but in type IV, most patients enabled early mobilization even without surgical intervention. There were no significant differences in hospital complications and walking ability at final follow-up. Conclusion: In this study, the superiority of surgical treatment for unstable FFP was not proven. However, the results suggest that type IVb may be a relatively stable type compared to type III and that type IVb should be considered separately from bilaterally complete unstable sacral fractures due to high-energy trauma.

DOI： 10.1007/s00068-021-01729-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：European Journal of Orthopaedic Surgery and Traumatology  

Purpose: For calcaneal fracture, plate fixation through lateral extensive approach (LEP) is the most common procedure performed to achieve anatomic reduction. However, wound complications sometimes occur after LEP. To reduce complications, minimally invasive operative methods with cannulated screw fixation through sinus tarsi approach (STS) were developed. The aim of this multicenter propensity-matched study was to compare the clinical and radiographic outcomes of LEP to those of STS for calcaneal fracture and to evaluate the incidence of postoperative complications including surgical site infection (SSI). Methods: We extracted 271 patients with calcaneal fracture undergoing surgery between January 2014 and March 2019 from our multicenter TRON database. We assessed the American Orthopedic Foot and Ankle Society (AOFAS) score at the final follow-up as the clinical outcome. We obtained the Bohler and Preis angles as radiographic parameters and also recorded the complications. We divided the subjects into two groups: LEP group and STS group. To adjust for baseline differences between the groups, a propensity score matching algorithm was used in a 1:1 ratio. Results: After matching, there were 32 fractures in each group. There was no significant difference between the LEP versus STS group in AOFAS score at final follow-up (90 vs 90 points, p = 0.98) and in the Bohler and Pries angles (19.2 vs. 18.0 degrees, p = 0.74 and 16.0 vs. 17.5 degrees, p = 0.47). The rate of SSI in the LEP group was higher than that in the STS group (21.9% vs. 0.0%, p = 0.01). Conclusion: For calcaneal fracture, STS provides similar fixation effectiveness and functional outcomes as LEP while reducing the likelihood of infection.

DOI： 10.1007/s00590-021-03115-9

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：European Journal of Trauma and Emergency Surgery  

Purpose: Fragility fractures of the pelvis (FFP) are becoming a commonly encountered disease in aging societies. We aimed to (1) clarify the overall survival rate of FFP, (2) compare survival rates by Rommens and Hofmann classification FFP type, (3) investigate the complications during hospitalization, and (4) investigate walking ability before and after injury depending on the type of fracture in patients with FFP treated conservatively. Methods: This retrospective, multicenter study included 867 patients with FFP treated conservatively between 2014 and 2018 and excluded patients with insufficient follow-up for two years, lost data, and operative cases. This is a retrospective multicenter study. We established the database, which is named as TRON. We evaluated survival rate by fracture type using the log-rank test. We compared walking ability as defined by a new mobility score and the modified Majeed Pelvic Score among fracture types. Results: We reviewed 552 cases (98 males and 454 females) with conservative treatment. The overall survival rates of patients with FFP treated conservatively were 0.90 at 1 year and 0.83 at 2 years. Although the survival rate was the lowest in FFP Type III, there was no significant difference in survival rates between fracture types (P = 0.143). The rates of complications during hospitalization were high for both Type III and Type IV fractures. Walking ability post-injury was worse in the patients with Type III fracture. Conclusions: The survival rate of patients treated by conservative treatment was relatively good. Type III in the Rommens and Hofmann classification was related to lower life expectancy and loss of walking ability.

DOI： 10.1007/s00068-021-01839-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Injury  

Introduction: One of the complications of the surgical therapy for proximal humerus fractures is fracture-related infection (FRI). This multicenter study aimed to investigate the incidence of FRI and clarify the risk factors associated with FRI in patients receiving open reduction and internal fixation for proximal humerus fracture. Material and methods: Among 684 patients diagnosed as having proximal humerus fracture and who were treated by surgical therapy in 13 institutions (named TRON group) from 2015 through 2020, 496 patients (men, n = 134, women, n = 362; mean [SD] age, 68.5 [14.5] years; mean [SD] body mass index [BMI], 23.0 [4.4] kg/m2) were included as subjects. Excluded were 188 patients due to less than 12 month's follow-up, patients who underwent osteosynthesis using neither plate nor nail and those with open fracture. We extracted the following as risk factors of FRI: sex, BMI, smoking status, diabetes, glenohumeral fracture dislocation, fracture classification, approach, implant, waiting period, type of anesthesia, operative time and blood loss during surgery. We conducted logistic regression analysis to investigate the risk factors of FRI using these extracted items as explanatory variables and the presence or absence of FRI as the response variable. Result: FRI occurred after surgery for proximal humerus fracture in 9 of the 496 patients (1.8%). The causative organism was methicillin-susceptible Staphylococcus aureus in 4 patients, Pseudomonas aeruginosa in one patient and Enterococcus faecalis in one patient. In the other 3 patients, causative organisms were not detected. The univariate analysis showed significant differences for present of glenohumeral fracture dislocation (p = 0.004). Logistic regression analysis showed glenohumeral fracture dislocation to be the significant explanatory factor for FRI (odds ratio 12.3, p = 0.0375). Conclusion: This study revealed an infection rate following open reduction and internal fixation of proximal humerus fracture of 1.8% (9 patients) and that Staphylococcus was the most frequent causative organism. Glenohumeral fracture dislocation is a significant risk for postoperative FRI.

DOI： 10.1016/j.injury.2022.05.022

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Orthopaedic Science  

Background: The risk of locomotive syndrome (LS) has been proposed as a criterion for evaluating physical ability. The expression levels of circulating miRNAs (c-miRNAs) are predictors of various diseases. This preliminary study aimed to evaluate the relationship between serum levels of several miRNAs and LS. Methods: We enrolled 423 participants in whom we conducted a survey with the 25-question Geriatric Locomotive Function Scale (GLFS-25) and measured the serum levels of 21 c-miRNAs. The relationship between the GLFS-25 and each c-miRNA was evaluated with a linear regression analysis, and independent associations between the GLFS-25 and each c-miRNA were assessed with a multiple regression analysis using various independent variables. Results: Only the serum level of miR-199 was significantly associated with LS after adjustment for age, BMI, sex, and all comorbidities. The receiver operating characteristics curve for the predictive value of the miR-199 level to indicate the presence or absence of LS risk had an area under the curve (AUC) of 0.576 (95% confidence interval: 0.501–0.651). Conclusion: The expression level of miRNA-199 was associated with the risk of LS in community-dwelling Japanese people.

DOI： 10.1016/j.jos.2021.02.003

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Bone and Joint Research  

Aims Periprosthetic hip fractures (PPFs) after total hip arthroplasty are difficult to treat. Therefore, it is important to identify modifiable risk factors such as stem selection to reduce the occurrence of PPFs. This study aimed to clarify differences in fracture torque, surface strain, and fracture type analysis between three different types of cemented stems. Methods We conducted biomechanical testing of bone analogues using six cemented stems of three different types: collarless polished tapered (CPT) stem, Versys Advocate (Versys) stem, and Charnley-Marcel- Kerboull (CMK) stem. Experienced surgeons implanted each of these types of stems into six bone analogues, and the analogues were compressed and internally rotated until failure. Torque to fracture and fracture type were recorded. We also measured surface strain distribution using triaxial rosettes. Results There was a significant difference in fracture torque between the three stem types (p = 0.036). Particularly, the median fracture torque for the CPT stem was significantly lower than that for the CMK stem (CPT vs CMK: 164.5 Nm vs 200.5 Nm; p = 0.046). The strain values for the CPT stem were higher than those for the other two stems at the most proximal site. The fracture pattern of the CPT and Versys stems was Vancouver type B, whereas that of the CMK stem was type C. Conclusion Our study suggested that the cobalt-chromium alloy material, polished surface finish, acute-square proximal form, and the absence of a collar may be associated with lower fracture torque, which may be related to PPF.

DOI： 10.1302/2046-3758.115.BJR-2021-0375.R2

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：(株)南江堂  

＜文献概要＞はじめに 人工知能(AI)は今や社会生活の一部となり欠かせないものとなっている.整形外科分野もその例外ではない.本稿では,骨折診断AIに関する文献のレビューを行い,現状の研究開発状況の整理,そして社会実装を含めた今後の展望を述べる.

その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2022&ichushi_jid=J00764&link_issn=&doc_id=20220527300040&doc_link_id=10.15106%2Fj_seikei73_707&url=https%3A%2F%2Fdoi.org%2F10.15106%2Fj_seikei73_707&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JSES International  

Background: In recent years, complex and unstable proximal humeral fractures (PHFs) are treated with intramedullary nails (IMNs) in the elderly; however, the postoperative radiographic findings related to the clinical outcome are not clear. This study evaluated the association of clinical outcomes with the radiographic findings of PHFs treated with IMNs. Methods: We collected data of patients aged >60 years with PHFs treated with IMNs from 2015 to 2019 in 13 associated centers' database (named TRON). We excluded patients lost to follow-up of <6 months postoperatively (PO6M). We evaluated clinical outcomes with the University of California at Los Angeles (UCLA) score at PO6M and defined a score of <27 as poor. We assessed the radiographic findings on the anteroposterior view of the humeral head postoperatively, and each radiographic finding such as humeral head height (HHH), head shaft angle, and cranialization of the greater tuberosity was divided into two groups: poor and good. Factors associated with poor UCLA at PO6M were extracted by logistic regression analysis, and the factors were divided into two groups (poor and good) and matched for age, sex, and fracture type. The UCLA score at PO6M between the groups was examined by the Mann-Whitney U test, and the significance level was set at 0.05. The minimal clinical important difference in the UCLA score was set 2 points. Results: The study included 243 patients (mean age, 76 years; range, 60-95 years). The mean follow-up period was 12 months (range, 6-56 months). The correlation coefficients indicated that there was either no or only a weak correlation between HHH, head shaft angle, and cranialization of the greater tuberosity. A poor HHH (HHH <0 or >10 mm) was extracted as a factor associated with a poor UCLA score at PO6M by logistic regression analysis (odds ratio: 5.78, 95% confidence interval = 1.2-27.7, P = .0287). In matched pair analysis, the UCLA score at PO6M was significantly lower in the poor HHH group (26 [range: 9-33] vs. 24 [range: 10-35], P = .0458). Conclusion: We revealed that the HHH was an independent risk factor for poor short-term outcomes. There was a significant difference in the UCLA score between groups divided by the HHH in cases treated with IMNs. The HHH can be used intraoperatively or postoperatively as a reliable parameter to predict clinical outcomes in PHFs treated with IMNs.

DOI： 10.1016/j.jseint.2021.12.009

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC Musculoskeletal Disorders  

Background: We aimed to examine the inconsistency between radiographic leg length discrepancy (R-LLD) and perceived LLD (P-LLD) in patients with dysplastic hip osteoarthritis and to evaluate the factors that can cause such inconsistency. Methods: We conducted a retrospective study on 120 patients. An inconsistent LLD was defined as a condition in which the P-LLD was shorter than the R-LLD by > 5 mm. We compared relevant data on the general characteristics of the patients and the radiological findings between consistent (group E, 92 cases [76.7%]) and inconsistent LLDs (group S, 28 cases [23.3%]). Results: The number of patients with a history of hip surgery on the affected side and the Japanese Orthopedic Association classification pain scores were significantly higher in group S than in group E (32.1% vs. 10.8%, respectively; P = 0.015, and 21.7 ± 7.0 vs. 17.5 ± 8.2, respectively; P = 0.036). The pelvic oblique angle and length of the R-LLD were significantly higher in group S than in group E (2.9 ± 2.5° vs. 0.3 ± 2.3°, respectively; P < 0.01, and 17.2 ± 8.9 mm vs. 6.3 ± 8.4 mm, respectively; P < 0.01). Multivariate logistic analysis revealed that the pelvic oblique angle (odds ratio [OR]: 1.80, 95% confidence interval [CI]: 1.28–2.52; P < 0.01) and length of the R-LLD (OR: 2.75, 95% CI: 1.24–6.12; P = 0.013) were independent risk factors of inconsistent LLD. Conclusion: The pelvic oblique angle and a long R-LLD were independent risk factors of inconsistent LLD in patients with dysplastic hip osteoarthritis. Therefore, hip surgeons should consider P-LLD rather than R-LLD to understand the need for conservative intervention.

DOI： 10.1186/s12891-022-05348-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Spine  

Study Design.A cross-sectional study.Objective.The present study aimed to investigate the prevalence of NeP in subjects suffering from NSP to reveal the impact of NeP on the health-related QOL (HRQOL) in middle-Aged and elderly people with NSP in a health checkup.Summary of Background Data.No previous studies have established the relationship between NSP and NeP as potential risk factors contributing to a decreased QOL in the general population.Methods.The present study involved 203 participants (men: 84, women: 119; mean age: 63.3 yr). For each subject, anthro-pometric measurements, physical function examinations, and blood testing were performed. A cut-off score of >0 on the short-form spine painDETECT questionnaire defined the presence of NeP. Subsequently, the NSP (+) subjects were divided into 2 sub-groups: The NeP (+) and NeP (-) groups. For the assessment of QOL, the short form 36 health survey and the EuroQol 5 dimension 5 level version (EQ-5D-5L) tool were used.Results.The study included 100 NSP (+) and 103 NSP (-) subjects. Among the NSP (+) subjects, 46 and 54 subjects were found to be NeP (+) and NeP (-), respectively. For the short form 36 health survey, the multivariate regression analysis revealed that the prevalence of NeP was associated with a lower physical QOL (OR 3.56) and lower mental QOL (OR 4.04). Similarly, the NeP prevalence was found to be the predictor for low QOL scores in EQ-5D-5L (EQ-5D-5L index value <0.875; OR 3.61).Conclusion.The prevalence of NeP was reported to be 46.0% in healthy middle-Aged and elderly population suffering from NSP, where it was associated with poor HRQOL. Therefore, strategies aimed at alleviating NeP may contribute significantly to the improvement of QOL in middle-Aged and elderly people with NSP.Level of Evidence: 2.

DOI： 10.1097/BRS.0000000000004207

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：European Journal of Orthopaedic Surgery and Traumatology  

Purpose: Prevention of second hip fracture is mandatory for orthopedic surgeons. We aimed to clarify the incidence and duration of second hip fracture, to compare survival rate and walking ability of patients with a second hip fracture to that of patients with a unilateral fracture, and to identify risk factors for second hip fracture using matched case–control methods. Methods: This retrospective study conducted in a single tertiary emergency center comprised 119 patients with second hip fractures who underwent bilateral operations at our institution from 2007 to 2017 (second hip fracture group [Group A]). The control group (Group B) comprised 357 patients matched to Group A for age, sex, and fracture type. Results: The incidence of second hip fracture was 7.6%, and the average interval from initial fracture to second hip fracture was 22.8 months. Significantly more patients in Group A had decreased postoperative walking ability. Five-year survival rates from initial fracture were 65.0% in Group A and 50.6% in Group B (P = 0.346). Dementia and heart disease were identified as independent risk factors (dementia: HR 2.08, 95% CI 1.27–3.41, P = 0.004; heart disease: HR 1.27, 95% CI1.11–3.22, P = 0.019). Valvular disease was also revealed to be a risk factor for heart disease (P = 0.0272). Conclusions: The incidence of second hip fracture was not low. Although survival rates did not differ between the patients with or without second hip fracture, walking ability of patients with second hip fracture worsened. Dementia and cardiac disease could be risk factors for second hip fracture in elderly patients, and valvular disease might be associated with second hip fracture in patients with heart disease.

DOI： 10.1007/s00590-021-02996-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Injury  

Purpose: This retrospective multicenter study aimed to assess the 1-year mortality rate in elderly patients with distal femoral fractures (DFFs) and identify potential risk factors for mortality. Methods: We analyzed 321 patients aged 65 years and older with DFFs treated surgically between 2012 and 2019 in 13 hospitals. Patient demographics and surgical characteristics were extracted from medical records and radiographs. We used univariable and multivariable Cox regression analyses to identify the factors affecting mortality. Results: The mortality rate for DFFs in elderly patients at 1 year was 9.0%. Multivariable Cox regression analysis revealed older age, male sex, underweight (body mass index [BMI] <18.5 kg/m2), bedridden status, and nursing home residency to be independent predictors for mortality (older age: hazard ratio [HR] 1.07, 95% confidence interval [CI] 1.03–1.11, P<0.001; male sex: HR 3.08, 95% CI 1.23–7.71, P=0.015; underweight: HR 1.93, 95% CI 1.01–3.68, P=0.045; bedridden status: HR 4.59, 95% CI 1.61–13.07, P=0.0042; and nursing home residency: HR 2.63, 95% CI 1.18–5.83, P=0.017). None of the factors associated with surgery including types of fixation, time from initial visit to surgery, blood loss during operation, and operation time was an independent predictor for mortality. Conclusion: The 1-year mortality rate in elderly patients with DFFs was relatively low at 9.0%. Older age, lower BMI, and nursing home residency were associated with mortality after surgery for DFFs. Factors associated with the surgical procedure were not significant predictors.

DOI： 10.1016/j.injury.2022.01.002

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Nagoya Journal of Medical Science  

Frailty is a state of reduced muscle strength and activity in older people. DNA methylation is associated with osteoporosis and muscle loss in murine and other animal studies, but there are no epidemiological studies in humans. This study aimed to assess the association of osteoporosis and muscle loss with DNA methylation in community-dwelling older people. This cross-sectional study was performed in a rural part of Japan. We analyzed 204 subjects (98 men and 106 women). In univariate analysis, the two groups were compared according to the presence or absence of osteoporosis and of muscle loss. Logistic regression analysis was performed to determine predictors of frailty in the muscle loss group. We used age, sex, body mass index, smoking history, drinking history, serum albumin and C-reactive protein levels, diabetes, hypertension, hyperlipidemia, heart disease history, and LINE-1 DNA methylation as the factors. Probability values < 0.05 were considered to be statistically significant. The levels of LINE-1 DNA methylation in leukocytes were associated with muscle loss in men over the age of 60. LINE-1 DNA methylation levels were not associated with bone mineral density in either the men or women over the age of 60. LINE-1 DNA methylation levels in leukocytes correlated significantly with the risk of frailty in men over the age of 60. Promoting an understanding of DNA methylation may lead to a better understanding of the pathophysiology of muscle loss

DOI： 10.18999/nagjms.84.1.60

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Clinical Medicine  

Healthy dietary habits are important to prevent locomotive syndrome (LS). We investi-gated the relationship between LS and nutritional intake using community health checkup data. We included 368 participants who underwent LS staging, blood sampling, and nutritional intake assessments. Participants (163 adults < 65: 205 older adults ≥ 65) were divided into normal (N; LS stage 0) and LS (L; LS stage 1–2) groups, and blood sample data and nutritional intake were compared between groups. Among adults (N group, 71; L group, 92), low-density lipoprotein cholesterol (LDL-C) was significantly lower, and Vitamin B1 intake was significantly higher in the L than in the N group; LDL-C, p = 0.033; Vitamin B1, 0.029. Among older adults (N group, 85; L group, 120), hemoglobin (Hb), albumin, and calcium levels were significantly lower, and sodium, monounsatu-rated fatty acids (MUFA), and n-6 polyunsaturated fatty acids (n-6 PUFA) were significantly higher in the L than the N group; Hb, p = 0.036; albumin, 0.030; calcium, 0.025; sodium; 0.029; MUFA; 0.047, n-6 PUFA; 0.0233). Logistic regression analysis indicated that sodium was the risk factor for the L group (exp (B) 1.001, 95% CI: 1–1.001, p = 0.032). In conclusion, salt intake was associated with LS.

DOI： 10.3390/jcm11030610

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Bone and Joint Open  

Postoperative malalignment of the femur is one of the main complications in distal femur fractures. Few papers have investigated the impact of intraoperative malalignment on postoperative function and bone healing outcomes. The aim of this study was to investigate how intraoperative fracture malalignment affects postoperative bone healing and functional outcomes. Methods In total, 140 patients were retrospectively identified from data obtained from a database of hospitals participating in a trauma research group. We divided them into two groups ac-cording to coronal plane malalignment of more than 5°: 108 had satisfactory fracture alignment (< 5°, group S), and 32 had unsatisfactory alignment (> 5°, group U). Patient character-istics and injury-related factors were recorded. We compared the rates of nonunion, implant failure, and reoperation as healing outcomes and Knee Society Score (KSS) at three, six, and 12 months as functional outcomes. We also performed a sub-analysis to assess the effect of fracture malalignment by plates and nails on postoperative outcomes. Results The rates of nonunion and reoperation in group U were worse than those in group S (25.0% vs 14.3%; 15.6% vs 5.6%), but the differences were not significant (p = 0.180 and p = 0.126, respectively). Mean KSS in group U at all follow-up periods was significantly worse that in group S (75.7 (SD 18.8) vs 86.0 (SD 8.7); p < 0.001; 78.9 (SD 17.2) vs 89.1 (SD 9.8); p < 0.001; 85.0 (SD 11.9) vs 91.1 (SD 7.2); p = 0.002, respectively). In the sub-analysis of plates, mean KSS was significantly worse in group U at three and six months. In the sub-analysis of nails, the rate of reoperation was significantly higher in group U (28.6% vs 5.8%; p = 0.025), and mean KSS at six and 12 months was significantly worse in Group U. Conclusion To obtain good postoperative functional results, intraoperative alignment of the coronal plane should be accurately restored to less than 5°.

DOI： 10.1302/2633-1462.32.BJO-2021-0191.R1

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Modern Rheumatology  

Objectives: Carotenoids are plant pigments found in many vegetables, functioning as antioxidants scavenging singlet molecular oxygen and peroxyl radicals. No longitudinal study exists on the relationship between carotenoids and knee osteoarthritis (KOA) development. We aimed to determine the incidence of KOA development for 10 years in community-dwelling people in Japan and assess its association with serum carotenoids. Methods: Data of 440 participants (174 men, 266 women) with health-screening records for at least 10 years were analysed. We defined KOA development as advancing from K/L grade 0/1 at the initial check-up to grade ≥2 in a unilateral knee during a 10-year follow-up period. Serum carotenoid levels were measured using high-performance liquid chromatography. We used the Cox hazard model for multivariate analysis and investigated each carotenoid's impact on KOA development. Results: KOA developed in 33.4% of patients; the annual KOA development rate was significantly higher among women than among men (p <. 01; 3.4% vs. 1.6%). Among the carotenoids measured, only retinol was associated with KOA development in women using multivariable analysis. KOA development was not associated with any carotenoids in men. Conclusion: The annual rate of KOA development was higher in women, and retinol was associated with KOA development in women.

DOI： 10.1080/14397595.2021.1900030

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：HIP International  

Background: Subtrochanteric shortening osteotomy (SSO) is commonly performed in total hip arthroplasty (THA) for high hip dislocation. However, this procedure is technically difficult and includes complications. Additional neck cut (ANC) of the femur is a procedure that involves femoral shortening by possibly eliminating the need for SSO in THA for high hip dislocation. Herein, we evaluated the effect and the depth limit of ANC of the femur on the range of motion (ROM) in THA for high hip dislocation. Methods: ROM was measured in 26 patients with high hip dislocation using computer software. The stem was deeply positioned at 5-mm intervals from 0 mm to 30 mm (7 groups). The ROM before impingement was measured during flexion, internal rotation (IR) at 90° flexion, external rotation (ER) and abduction. Receiver operator coefficient (ROC) curves for abduction were generated. The cut-off value of ANC where the required ROM was achieved was also determined. Results: Deeper ANCs increased the ROM values during flexion and IR, but they decreased the ROM values during ER and abduction. The ROM values during ER were also limited in 0-mm ANCs. According to the result of the ROC curve for abduction, 15 mm was considered as the permissible range of ANC. Conclusions: In THA for high hip dislocation additional neck cut should be taken into consideration for hips requiring less than 15-mm shortening. For more extended corrections a subtrochanteric shortening osteotomy should be performed.

DOI： 10.1177/1120700020938657

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：European Journal of Orthopaedic Surgery and Traumatology  

Purpose: We aimed to 1) identify predictors of delayed and nonunion of tibial shaft fractures in patients treated with intramedullary nailing (IMN), including patient demographics and surgical factors, and 2) determine whether the nail/shaft ratio is associated with delayed and nonunion. Methods: This retrospective, multicenter study included 315 patients with tibial shaft fracture treated with IMN between 2014 and 2019 and excluded patients with insufficient follow-up for 12 months, lost data and inadequate radiographs. Finally, we analyzed 258 patients (184 males; 74 females). Main outcome measurements were delayed union at 6 and nonunion at 12 months after surgery as determined on anteroposterior and lateral radiographs. We extracted the following as risk factors of delayed and nonunion: age, sex, BMI, fracture site, fracture type, injury energy, smoking history, and nail/shaft ratio. We conducted logistic regression analysis to investigate risk factors of delayed and nonunion using these extracted items as explanatory variables. Results: Type C fracture was independently associated with delayed union (odds ratio 2.9, 95% confidential interval: 1.04–8.09, P = 0.04). Nail/shaft ratio was not an independent factor of delayed union. No independent explanatory factors were related to nonunion. Conclusions: Type C fractures, which were unstable and fragmented, was associated with delayed union in tibia fractures treated with IMN, whereas nail thickness was not associated with delayed or nonunion fractures.

DOI： 10.1007/s00590-021-02939-9

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Arthroplasty  

Background: It is unclear how the condition of one side of the hip joint affects the natural history of contralateral osteonecrosis of the femoral head (ONFH). This study aimed to investigate the natural progression of bilateral ONFH on the asymptomatic side between patients with collapse progression and cessation on the symptomatic side. Methods: The study included 109 patients with bilateral ONFH at the first visit, who were divided into two groups in accordance with the symptomatic side based on the collapse progression of ≥3 mm (progressive group: 74 hips) and collapse cessation of <3 mm (stable group: 35 hips) with a minimum follow-up of 3 years. The assessment parameters included age, gender, body mass index, etiology, type classification, and survival rates of the asymptomatic side with radiographic failure as the endpoints. Results: Age, gender, body mass index, and etiology were not different between the two groups; however, a difference was observed in the type classification of the symptomatic side. The 4-year survival rates were significantly different between the progressive (34.3%) and stable groups (85.7%). Multivariate Cox regression analysis showed that age <40 years (vs ≥40 years; hazard ratio [HR], 2.439), type C2 (vs B + C1; HR, 2.865), and collapse progression on the symptomatic side (vs collapse cessation; HR, 7.751) were independent factors determining collapse on the asymptomatic side. Conclusion: Collapse progression on the symptomatic side is a poor prognostic factor for the natural history of contralateral ONFH.

DOI： 10.1016/j.arth.2021.08.005

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：(一社)日本ペインクリニック学会  

【症例】46歳女性,身長157cm,体重58kg.20歳ごろより両股関節痛を生じ,変形性関節症と診断され保存的に加療していた.当院整形外科紹介受診し,左人工股関節置換術施行予定となった.腰神経叢ブロックと傍仙骨部の坐骨神経ブロックを施行後,全身麻酔導入し,手術を行った.術後のレントゲンで脚延長は20mmであった.覚醒後,両下肢に運動障害と感覚障害があった.症状は数時間以内に改善し,腰神経叢ブロックが硬膜外ブロックになったと考えられ,画像検査で血種による神経圧迫などを除外した上で経過観察となった.その後,感覚障害と運動障害は改善傾向であったが左足関節の背屈運動のみ回復が遅れ,術28日後の筋電図検査にて腓骨頭レベルでの軽度腓骨神経障害と診断された.術32日後,杖歩行安定し退院した.【まとめ】本症例の神経症状は,腓骨頭レベルでの神経障害であることから,腓骨神経の過伸展等の物理的因子に起因することが推察されるが,腰神経叢ブロックが硬膜外ブロックになったことにより麻痺症状が初期段階ではマスクされた.また今回の神経ブロックが麻痺に影響した可能性も否定できない.(著者抄録)

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J03612&link_issn=&doc_id=20210928360003&doc_link_id=10.11321%2Fjjspc.21-0029&url=https%3A%2F%2Fdoi.org%2F10.11321%2Fjjspc.21-0029&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Clinical Rheumatology  

Objective: We aimed to investigate the relationship between high-sensitivity CRP (hs-CRP) levels and the knee osteoarthritis (KOA) status and whether high hs-CRP levels predict the progression of clinical KOA in community-dwelling people. Methods: We enrolled 247 subjects (male, n = 99; female, n = 148) who participated in the “Yakumo study” at least twice from 2003 to 2008. The KOA was evaluated by knee X-ray using the knee osteoarthritis computer-aided diagnosis (KOACAD) measurement system to obtain the mJSW, the size of the osteophyte area (OPA), and femorotibial angle (FTA). The pain intensity of the knee joint was measured using a visual analog scale (VAS, 0–100). First, we performed a multiple regression analysis to assess the relationship between the initial hs-CRP and mJSW, OPA, FTA, and VAS. Second, we examined the correlated coefficients between the amount of change hs-CRP and radiographic progressions and VAS changes. Third, we divided into two groups. Group H elevated hs-CRP levels (> 0.1 mg/dl). We picked up the subject matched to Group H according to BMI, age, sex, and medial mJSW at baseline in a 1:1 ratio; these participants were classified as the control group (Group L). The Mann-Whitney U test was used to compare the demographic data between the two groups. P values of < 0.05 were considered to indicate statistical significance. Results: The initial hs-CRP was a significant explanatory factor for mJSW and VAS change in multiple regression analysis. The change of VAS value negatively correlated with the change of hs-CRP. Besides, the change of hs-CRP did not correlate with the radiographical change. Among these subjects, 55 had elevated hs-CRP levels (> 0.1 mg/dl) (Group H). Among the 192 subjects whose hs-CRP levels were ≤ 0.1 mg/dl, 55 subjects were matched to patients in Group H according to the age, sex, BMI, and average minimum joint space width (mJSW) at baseline and were used as a control group (Group L). The narrowing of the medial mJSW and the amount of change in OPA in group H were significantly greater than group L. The amount of change in FTA and VAS scores did not differ between the two groups. Conclusion: Hs-CRP levels would be significantly associated with the progression of knee osteoarthritis.Key Points• We investigated the relationship between hs-CRP levels and the progression and the pain of osteoarthritis knee.• We used a KOACAD system, which can measure the medial and lateral joint space narrowing, osteophyte, and femoral-tibia angle from plain radiographs automatically.• Hs-CRP levels were significantly associated with the progression of knee osteoarthritis.

DOI： 10.1007/s10067-020-05541-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Injury  

Introduction: One of the complications of the surgical therapy for ankle fractures includes wound infection. This study aimed to evaluate postoperative function and clarify the risk factors associated with postoperative wound infection in patients receiving the open reduction and internal fixation for ankle fracture through a multicenter study. Subjects and method: Among 1421 patients diagnosed as having closed ankle fracture and who were treated by surgical therapy in 11 institutions from 2014 through 2019, 1201 patients (men, n = 512, women, n = 689; the mean (SD) age, 50.9 (15.6) years; the mean body mass index [BMI] (SD), 24.3 (4.2) kg/m2) were included as subjects. Excluded were 220 patients due to self-termination of treatment, inability to follow up after discharge, open fracture, distal tibia shaft fracture, and pilon fracture. We extracted the following as risk factors of wound infection: age, sex, BMI, fracture type, injury energy and histories of smoking, diabetes, arteriosclerosis, heart failure and myocardial infarction. We conducted logistic regression analysis to investigate the risk factors of wound infection using these extracted items as explanatory variables and the presence or absence of wound infection as the response variable. Results: Wound infection occurred after surgery for closed ankle fracture in 69 the 1201 patients (5.7%). The causative organism was methicillin-susceptible Staphylococcus aureus (MSSA) in 15 patients, methicillin-resistant S. aureus (MRSA) in 4 patients, Finegoldia magna in one patient, and S. haemolyticus in one patient. In the other patients, causative organisms were not detected, culture of the causative organisms was not conducted, or they were unknown. The univariate analysis showed significant differences in sex (p = 0.01) and for smoking (p = 0.002), fracture type (p = 0.02) and heart failure (p = 0.042). Logistic regression analysis showed that smoking and type of fracture (trimalleolar fracture) were significant explanatory factors for infection (odds ratio 1.83 and 1.98, p = 0.040 and 0.042, respectively). Conclusions: At 5.7%, the rate of postoperative wound infection in closed ankle fracture was not low. Staphylococcus was the most frequent causative organism. The surgeon should pay attention infection after surgery in the patients who had a trimalleolar fracture or smoking habits.

DOI： 10.1016/j.injury.2021.04.017

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BioMed Research International  

Purpose. Neck and shoulder pain (NSP) is very common in the general population. However, scarce information exists on the relationship between NSP and health-related quality of life (HRQOL) outcomes in this population. The present study described NSP prevalence and its impact on the HRQOL of middle-aged and older persons undergoing a routine medical checkup. Methods. This study recruited 318 subjects (125 males and 193 females; average age, 63.4 years) in good health, collected underwent anthropometric measurements, physical function examinations, and blood testing. This study defined NSP as the presence of muscle tension, stiffness, pressure, or dull pain in areas between the neck and the arch of the scapular. Study subjects were divided into two groups (NSP (+) and NSP (-) groups). The subjects completed questions on the Medical Outcomes Study 36-item short-form health survey (SF-36) and the EuroQol 5-dimension, 5-level version (EQ-5D-5L) tool. Results. Of the patients, 150 and 168 were NSP (+) and NSP (-), respectively. The NSP complaint rate was 47.2%. The NSP (+) group had younger and more female participants than the NSP (-) group. In the multivariate regression analysis, the NSP (+) group had lower physical QOL based on the SF-36 physical component summary (odds ratio (OR), 2.45) and lower mental QOL based on the SF-36 mental component summary (OR, 2.05). Overall, the NSP (+) group had a higher risk of having low QOL scores (EQ-5D-5L index; OR, 1.76). Conclusions. The NSP (+) rate in healthy middle-aged and older persons was 47.2%. Furthermore, NSP (+) status was directly related poor HRQOL. NSP is a predictor of suboptimal physical and mental QOL. Therefore, NSP prevention or intervention for NSP may improve middle-aged and older adults' QOL.

DOI： 10.1155/2021/6674264

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Injury  

Objectives: The purpose of this multicenter study was to assess the differences in the rates of implant failure and bone union by X-ray examination, and walking ability between an early weight-bearing group (EWB) and a non-weight-bearing group (NWB) following treatment with intramedullary nailing (IMN) for tibial shaft fractures with a propensity score-matching method. Material and Methods: We collected data from 336 patients with tibia fractures that were treated surgically. We excluded patients lost to follow-up and polytrauma patients. Finally, 263 patients were included who were divided into two groups, the early weight-bearing (EWB) group, in which partial weight-bearing walking within four weeks was encouraged, and a non-weight-bearing (NWB) group, in which no weight bearing was allowed for more than four weeks. To adjust for baseline differences between groups, a propensity score algorithm was used to match the EWB group with the NWB group in a 1:1 ratio of 75 cases each. After matching, we compared the rate of implant failure, the rate of bone union at six months and one year after surgery, and walking ability at the last follow-up between the two groups. Result: Implant failure occurred in 0 of 75 patients in the EWB group vs. 1 of 75 in the NWB group (P = 1.0). Delayed bone union at six months occurred in 20 of 75 (26%) vs. 13 of 75 (17%) patients, and that at one year occurred in 5 of 75 (6.7%) vs. 3 of 75 (4%) patients. The median New Mobility Score was 9 (4–9) vs. 9 (0–9) points. Conclusions: There were no statistically significant differences in the rate of implant failure, the rates of the bone union at six months and one year after surgery, and walking ability between the EWB group and NWB group. We suggest that instruction in early weight-bearing after IMN nailing for tibial shaft fracture may not be harmful.

DOI： 10.1016/j.injury.2020.12.023

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC Musculoskeletal Disorders  

Background: Less experienced clinicians sometimes make misdiagnosis of hip fractures. We developed computer-aided diagnosis (CAD) system for hip fractures on plain X-rays using a deep learning model trained on a large dataset. In this study, we examined whether the accuracy of the diagnosis of hip fracture of the residents could be improved by using this system. Methods: A deep convolutional neural network approach was used for machine learning. Pytorch 1.3 and Fast.ai 1.0 were applied as frameworks, and an EfficientNet-B4 model (a pre-trained ImageNet model) was used. We handled the 5295 X-rays from the patients with femoral neck fracture or femoral trochanteric fracture from 2009 to 2019. We excluded cases in which the bilateral hips were not included within an image range, and cases of femoral shaft fracture and periprosthetic fracture. Finally, we included 5242 AP pelvic X-rays from 4851 cases. We divided these 5242 images into two images per image, and prepared 5242 images including fracture site and 5242 images without fracture site. Thus, a total of 10,484 images were used for machine learning. The accuracy, sensitivity, specificity, F-value, and area under the curve (AUC) were assessed. Gradient-weighted class activation mapping (Grad-CAM) was used to conceptualize the basis for the diagnosis of the fracture by the deep learning algorithm. Secondly, we conducted a controlled experiment with clinicians. Thirty-one residents;young doctors within 2 years of graduation from medical school who rotate through various specialties, were tested using 300 hip fracture images that were randomly extracted from the dataset. We evaluated the diagnostic accuracy with and without the use of the CAD system for each of the 300 images. Results: The accuracy, sensitivity, specificity, F-value, and AUC were 96.1, 95.2, 96.9%, 0.961, and 0.99, respectively, with the correct diagnostic basis generated by Grad-CAM. In the controlled experiment, the diagnostic accuracy of the residents significantly improved when they used the CAD system. Conclusions: We developed a newly CAD system with a deep learning algorithm from a relatively large dataset from multiple institutions. Our system achieved high diagnostic performance. Our system improved the diagnostic accuracy of residents for hip fractures. Level of evidence: Level III, Foundational evidence, before-after study. Clinical relevance: high

DOI： 10.1186/s12891-021-04260-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Nagoya Journal of Medical Science  

Total hip arthroplasty with cementing techniques leads to good clinical outcomes, but critical vascular complications can sometimes occur due to cement leakage into the pelvis. In this report, we describe a case of massive cement leakage that caused an arterial embolism. When exfoliating cement from an artery, the surgeon should note not only direct injury to the vessels but also the potential for arterial embolism.

DOI： 10.18999/nagjms.83.2.353

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：(一社)日本骨粗鬆症学会  

一般に検診などで撮影頻度が高い胸部単純X線写真が撮影範囲に椎体骨折の好発部位である胸椎〜第2腰椎までを含むことに着目し、骨粗鬆症のスクリーニングに利活用する可能性について検討した。そしてこの診断時に、人工知能(AI)を用いて胸部単純X線写真における既存椎体骨折を検知する画像診断システムの開発を行った。胸部単純X線写真かつ胸椎〜腰椎レベルを含むCTまたはMRIを撮影した65歳以上の患者1889例(男性558例、女性1331例、平均77.4歳)を対象とした。内部データセットにおける機械精度では、蒲郡市民病院から得られたデータセットにより訓練された学習モデルのテスト画像に対する機械精度は診断精度92.1%、閾値0.69としたときの感度が95.8%、特異度が93.0%であった。また、外部データセットにおける機械精度では、蒲郡市民病院から得られたデータセットにより訓練された学習モデルの津島市民病院およびJCHO東京新宿メディカルセンターから得られたテスト画像に対する機械精度は診断精度71.3%であり、ROC曲線から算出されたAUCは0.78となった。既存椎体骨折をAIが検知する画像診断システムは、既存椎体骨折を有する骨粗鬆症患者のスクリーニングに有用な可能性があると考えられた。

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BioMed Research International  

Sarcopenia is a multifaceted geriatric syndrome associated with the loss of muscle mass. We examined the relationship between low muscle mass and inflammatory cytokines in the context of aging. This study involved 299 participants (127 men and 172 women; mean age 63.3±9.8 years) who underwent health checkups for body composition and inflammatory cytokine (TNF-alpha, IL-6, and MCP-1) levels. Muscle mass was determined using the skeletal muscle mass index. We divided the participants into the normal (N) and low muscle mass (L) groups and compared the levels of inflammatory cytokines in nonelderly (<65 years) and elderly (≥65 years) participants. Among the nonelderly subjects, C-reactive protein was significantly lower in the L group than in the N group (p<0.05). However, there was no significant difference in the inflammatory cytokine levels between the groups. Among the elderly subjects, the TNF-alpha level was significantly lower in the L group than in the N group (p<0.05), whereas there were no significant differences in the IL-6 and MCP-1 levels. Moreover, TNF-alpha was identified as a risk factor for the L group in the logistic regression analysis (Exp (B) 0.935, 95% CI: 0.876-0.997, p=0.04). Although a low TNF-alpha level is a risk factor for low muscle mass, inflammatory cytokine levels are not necessarily elevated in elderly individuals with the loss of muscle mass.

DOI： 10.1155/2021/5572742

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BioMed Research International  

Purpose. Preventive medicine is important in an aging society. Presarcopenia is the preliminary stage of sarcopenia. Recent advances in bioelectrical impedance analysis (BIA) devices have enabled automatic estimation of neck circumference (NC). However, the agreement between and interchangeability of NC measured manually and that calculated with BIA have not been evaluated. We performed these analyses in the context of health checkups and investigated their associations with presarcopenia. Methods. We enrolled 318 participants who underwent anthropometric measurements, including NC measured manually and by BIA; assessment of physical function; and blood testing. We used Bland-Altman analysis to calculate the agreement between and interchangeability of NC measurements by BIA and by the manual method. We then statistically compared normal participants and those with presarcopenia. Using multivariable analysis, we subsequently investigated significant risk factors for presarcopenia. We defined presarcopenia according to the appendicular skeletal muscle index (aSMI; the ratio of arm and leg skeletal muscle mass to height2). Results. Bland-Altman analysis showed that bias (BIA-manual) was negative overall (-1.07), for male participants (-1.23), and for female participants (-0.96). This finding suggests that BIA measurement is an underestimate in comparison with manual measurement. NC measurement by BIA was found to be interchangeable with that by manual methods, inasmuch as the percentage error was less than 5% overall (4.38%), for male participants (3.81%), and for female participants (4.58%). Univariable analysis revealed that NC was significantly smaller in the participants with presarcopenia than in those without. Multivariable analysis, adjusted for confounding factors, revealed that a decrease in NC was significantly correlated with presarcopenia. Conclusions. BIA measurements of NC are interchangeable within about 95% with manual measurements. The decrease in NC measured by BIA was significantly associated with presarcopenia in both genders. NC measurement can be used for early detection of presarcopenia.

DOI： 10.1155/2021/6622398

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Arthroplasty Today  

Background: A portable navigation system (PNS) was recently introduced. The PNS enables surgeons to place the acetabular component accurately. While the margin of the error for the cup abduction and anteversion was larger than the values obtained from a computed tomography-based navigation system. We hypothesized that the accuracy of the PNS might be affected by pelvic tilt. Material and Methods: A bone substitute model of the pelvis was used in this in vitro study. We set the acetabular component using PNS. We set the acetabular component angle after changing the sagittal, coronal, and axial pelvic tilt. We calculated the difference between the angle displayed on the PNS display and the actual angle of the acetabular component. The difference in inclination angle was defined as ΔRI, and the difference in the anteversion angle was defined as ΔRA. We evaluated the trends in this ΔRI and ΔRA due to the pelvic tilt. Results: In this in vitro study, the placement of the acetabular component was accurate in the neutral position; ΔRI was 0.5 ± 0.7° and ΔRA was 1.0 ± 0.7°. Sagittal pelvic tilt and axial pelvic tilt increased both the ΔRA and ΔRI (P = .017). Coronal tilt increased ΔRI but did not change ΔRA. Conclusions: While the PNS may enable surgeons to place accurate component placement in the neutral position, its accuracy decreased by pelvic tilt. The surgeons should use a solid pelvic lateral positioner for reducing discrepancies in pelvic tilt when using the PNS in the lateral decubitus position.

DOI： 10.1016/j.artd.2020.12.012

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：European Journal of Orthopaedic Surgery and Traumatology  

Background: Some reports suggested that the status of the opposite-side hip affects clinical outcomes of unilateral total hip arthroplasty (THA) for hip osteoarthritis (HOA). This study aimed to determine whether unilateral THA could improve pain and movement of the non-operative hip. Methods: The analysis included 195 patients divided into three groups according to contralateral hip status based on radiographic change assessed by Kellgren-Lawrence (KL) grade: normal hip (Group N: n = 124), HOA with KL grade > 2 (Group O: n = 39), and THA patients who already underwent THA in their opposite hip joint (Group T: n = 32). All patients were interviewed and examined preoperatively and at 1-year intervals after surgery. Hip function was evaluated with Harris Hip Score (HHS) and range of motion (ROM) preoperatively and at 1-year follow-up. We used the Japanese Orthopedic Association Hip-Disease Evaluation Questionnaire (JHEQ) and the Visual Analogue Scale (VAS) for separately evaluated right and left hip joints. Results: The mJHEQ movement, which indicated the activity, and flexion of ROM in the non-operative hip improved in group N and group T. The VAS and JHEQ pain values did not differ between preoperative and 1-year follow-up in all groups. In the operative side, HHS function, JHEQ movement values in group O were significantly lower than those of groups N and T at 1-year follow-up. Conclusion: Unilateral THA may improve non-operative hip movement and active daily life except when the non-operated hip shows osteoarthritis. It did not improve non-operative hip pain, regardless of the condition on the other side. Clinical outcomes of unilateral THA may be affected by opposite hip status each other.

DOI： 10.1007/s00590-020-02716-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Bone Reports  

Achondroplasia (ACH) is the most common form of short-limbed skeletal dysplasia. Patients with ACH sometimes undergo lower limb lengthening to get functional and psychological achievements. The periosteal resection (PR) is a known mechanism to increase longitudinal bone growth without osteotomy, although the results are not predictable. It could be alternative for limb lengthening in a minimally invasive technique. The purpose of this study is to evaluate the effect of PR on acceleration of bone growth in a mouse model of ACH (Fgfr3ach). We performed a circumferential resection of periosteum on the proximal tibia to both wild-type and Fgfr3ach mice at the age of four weeks. The second PR was done one week later in each mouse, which was subsequently sacrificed at the age of six weeks for micro-computed tomography (micro-CT) scan and histological examinations. We measured tibial bone length, bone volume, and metaphyseal trabecular bone parameters, including bone volume/tissue volume (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N) by reconstructed micro-CT images. We also quantified the entire width of the growth plate of the proximal tibial from the sections stained with hematoxylin and eosin. Tibial bone length and bone volume of the PR side were significantly larger than the sham side in wild-type mice, while they were not statistically significant in Fgfr3ach mice. The BV/TV and Tb.N in the metaphysis were significantly decreased in the PR side of both mice. The histological analysis revealed that the growth plate of the proximal tibia was significantly wider in the PR side of wild-type mice while it showed no difference in width between the PR side and the sham side in Fgfr3ach mice. PR promoted longitudinal bone growth in wild-type mice, but it exhibited only a marginal effect on bone growth in Fgfr3ach mice.

DOI： 10.1016/j.bonr.2020.100708

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BioMed Research International  

Purpose. The aim of this study was to describe the characteristics of each locomotive syndrome (LS) risk stage, including global spine sagittal alignment, spinal degenerative changes evident on plain radiographs, low back pain (LBP), muscle strength, and physical ability in middle-aged and elderly people in a health checkup. Methods. This study included 211 healthy Japanese volunteers (89 men and 122 women; mean age, 64.0 years) who underwent assessment with both radiographs and Spinal Mouse. Spinal sagittal parameters included thoracic kyphosis angle (TKA), lumbar lordosis angle (LLA), sagittal vertical axis, and spinal inclination angle (SIA). Lumbar disc height (LDH) and lumbar osteophyte formation (LOF) at each level were evaluated as the spinal degenerative changes. The LS assessment comprised three tests: Stand-up test, two-step test, and 25-question Geriatric Locomotive Function Scale (GLFS-25). The subjects were divided into three groups (no risk, stage 1 LS, or stage 2 LS) according to LS risk test criteria. The prevalence of LBP was investigated with a visual analogue scale (VAS), and physical performances were also compared among the groups. Results. Of the participants, 122 had no risk of LS, 56 had stage 1 LS risk, and 29 had stage 2 LS risk. With increasing LS risk stage, the prevalence of and VAS score for LBP increased significantly, and back muscle strength and physical abilities decreased significantly. The TKA did not differ among the three groups. The LLA decreased gradually with LS risk stage (P=0.0001). At each level except L1-L2 and L5-S1, LDH decreased gradually with LS risk stage. The prevalence of LOF increased significantly with increasing LS risk stage. The SIA increased significantly with LS risk stage (P=0.0167). Conclusions. Participants with LS had higher prevalence of spinal degeneration, small LLA, and global spinal imbalance by anterior spinal inclination.

DOI： 10.1155/2020/3274864

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BioMed Research International  

Osteoporosis is a disease characterized by deterioration of bone tissue and mass, with an increasing global prevalence. Therefore, the discovery of biomarkers for osteoporosis would help to guide appropriate treatment. Circulating microRNAs (miRNAs) have become increasingly recognized as biomarkers for detecting diseases. However, few studies have investigated the association of circulating miRNA with osteoporosis in the general population. The aim of this study was to identify miRNA associated with osteoporosis in a general resident health check-up for potential use as an osteoporosis biomarker. We conducted a cross-sectional study as part of a health check-up program and recruited 352 volunteers (139 men, 213 women, mean age 64.1±9.6 years). Osteoporosis was diagnosed according to the WHO classification. Twenty-two candidate microRNAs were screened through real-time quantitative PCR, and miRNAs associated with osteoporosis were analyzed using logistic regression analysis including other risk factors. In total, 95 females and 30 males were diagnosed with osteoporosis with bone mineral density tests (BMD: T-score<-2.5). We found that miR195 was significantly lower in females, while miR150 and miR222 were significantly higher in males. The results of the logistic regression analysis indicated that in females, higher age and lower miR195 (odds ratio: 0.45, 95% confidential interval: 0.03-0.98) were significant risk factors for lower BMD, while the presence of a smoking habit and lower miR150 (odds ratio: 1.35, 95% confidential interval: 1.02-1.79) were significant risk factors for osteoporosis. Serum levels of miR195 and miR150 are independently associated with low bone mineral density in females and males, respectively.

DOI： 10.1155/2020/5047243

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Orthopaedic Science  

Introduction: This study aimed to clarify the relationship of individual radiographic parameters and features with the patient-reported outcome measurements (PROMs) of patients with developmental dysplasia of the hip (DDH) in a hospital-referred cross-sectional analysis. Methods: This cross-sectional study included 108 Japanese DDH patients (female, n = 88; male, n = 20; mean age, 43.4 years). We recorded the CE angle, angle of Sharp, ARO, ADR, AHI, crossover sign, pistol grip deformity, and femoral head-neck ratio, which were measured on the AP view, and the α-angle, which was measured on the Lauenstein view. We also recorded cyst formation and osteophytes on either view. We used the Japanese Orthopaedic Association hip disease evaluation questionnaire (JHEQ) to assess the PROMs. The PROMs of patients with and without cysts or osteophytes and those of patients with or without cam or pincer deformity were compared. The relationships between specific PROMs and radiographic features were evaluated with a linear regression analysis and independent associations between PROMs and radiographic features were assessed with a multiple regression analysis using various independent variables. Results: The JHEQ movement and mental values in patients with cyst formation were significantly lower in comparison to those in patients without cyst formation. The JHEQ subscale values did not differ according to the presence or absence of osteophytes, cam deformity or pincer deformity. The CE angle was found to be associated with the JHEQ movement score in the linear regression analysis. To identify radiographic features that were independently associated with each of the JHEQ subscale scores, we performed a multiple regression analysis with age, body mass index, sex and the number of affected hip joints (bilateral or unilateral) included as independent variables. The CE angle was found to be independently associated with JHEQ movement. Conclusion: The CE angle was independently associated with the JHEQ movement value.

DOI： 10.1016/j.jos.2019.09.007

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Arthroplasty  

Background: Given recent advances in total hip arthroplasty (THA), curved intertrochanteric varus osteotomy (CVO) is not indicated as a treatment for osteonecrosis of the femoral head (ONFH), unless indicated to maintain long-term hip function and achieve patient satisfaction. We aimed to compare the clinical outcomes of CVO with those of THA for treatment of ONFH in young adults <50 years old. Methods: This comparative study included 105 ONFH patients: 59 patients (65 hips) who underwent CVO and 46 patients (56 hips) who underwent THA. Assessment tools included the Harris hip score (HHS), patient-reported outcomes of the Short Form-36, Oxford hip score, Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire, and University of California, Los Angeles score, together with complication and survival rates. Results: Preoperative HHS was significantly higher in the CVO group than in the THA group (P < .01). At the last follow-up, no between-group differences were noted in HHS, all domains of Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire scores, Oxford hip score, and Short Form-36. University of California, Los Angeles scores and complication rates were comparable: 3% for the CVO and 7% for the THA group. The 10-year survival rate with surgery for any reason as the end point was comparable, at 91.8% for the CVO and 97.7% for the THA group. Conclusion: Functional outcomes, survival rate, and sporting activities for patients <50 years old undergoing CVO or THA for ONFH were comparable after a mean follow-up period of 10 years. Strict indications for CVO can help maintain hip function and patient satisfaction equivalent to that for THA, in the long term.

DOI： 10.1016/j.arth.2020.01.026

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：International Orthopaedics  

Purpose: The most appropriate procedure and at what type and stage of osteonecrosis of the femoral head (ONFH) these procedures had been argued. We attempted to clarify the trend in surgical operations with respect to the age of patients, type classification, and stage of ONFH over a period of 15 years by using the multi-center sentinel monitoring system in Japan. Methods: We evaluated the hips of 3844 patients using this system in three phases of every five years from 2003 to 2017. We classified the surgical procedures as osteotomy (OT), hemiarthroplasty (Hemi), and total hip arthroplasty (THA). We assessed the trend in age, type classification, and stage of ONFH over three time periods; “early,” and the “late.” We calculated the proportion of surgeries for ONFH in each period. We used the Cochran-Armitage test to evaluate trends in proportion of two levels of characteristics across three time periods. Results: The proportion of younger patients significantly decreased. The proportion of OT and Hemi decreased over time, while the proportion of THA increased. The proportion of patients with types C1 and C2 who underwent OT and Hemi decreased over time. In contrast, that of THA increased. The proportion of patients who underwent OT and Hemi significantly decreased; the proportion of patients who underwent THA significantly increased over time at all stages. Conclusions: In Japan, the younger patients underwent surgery for ONFH decreased. The patients who underwent OT and Hemi for ONFH decreased, while that of THA increased over time.

DOI： 10.1007/s00264-020-04480-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Modern Rheumatology  

Objectives: Digitised patient-reported outcome may be beneficial for physicians and patients. The Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) can only be completed with paper and pencil (pJHEQ). We newly developed a web version of the JHEQ (wJHEQ). This study aimed to determine whether the scores obtained with the wJHEQ are equivalent to those from the pJHEQ, how much the wJHEQ would decrease missing answers, and which JHEQ the participants preferred to use. Methods: To measure equivalence between the pJHEQ and wJHEQ, we evaluated the mean score difference for each subscale (pain, movement, mental) and Visual Analogue Scale (VAS; satisfaction, right hip pain, left hip pain) and then assessed the intraclass correlation coefficients (ICC) between the two scores. ICC values ≥0.75 were defined as excellent agreement. We used Bland–Altman analysis to assess level of agreement between the values of the two questionnaires. We compared the number of incomplete forms and amount of missing data between the two questionnaires. We investigated ease of use by asking the participants which format was easier to use. Results: This study comprised 113 patients (mean age 58.1 years, 81% female) with hip disease. Mean score differences for each subscale between the wJHEQ and pJHEQ were not significantly different. The values of ICC for each subscale and each VAS were all >0.75. All 113 participants completed the wJHEQ questionnaire, whereas nine patients did not complete the pJHEQ form. There was a significant statistical difference between the completion rate of the wJHEQ and that of the pJHEQ (p =.0017). Fifty-seven participants (55%) preferred the wJHEQ, whereas 33 participants (32%) preferred the pJHEQ. Conclusion: The wJHEQ was found to be equivalent to the original pJHEQ. The wJHEQ significantly decreased the numbers of missing answers and incomplete forms. The participants felt ease of use was nearly equivalent. The wJHEQ might help facilitate more complete assessments in clinical trials and research.

DOI： 10.1080/14397595.2019.1592799

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：(公社)日本整形外科学会  

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Scientific Reports  

This Article contains errors in the Reference list. Reference 21 is incorrectly listed as: Masahiro N. et al. A genome-wide association study identifies susceptibility loci for ossification of the posterior longitudinal ligament of the spine. Nature Genetics 46(9), 1012–1016 (2014). The correct reference is listed below as ref. 1. Additionally, Reference 23 is incorrectly listed as: Rita D. Hypertrophic differentiation of chondrocytes in osteoarthritis: the developmental aspect of degenerative joint disorders. Arthritis Research & Therapy 12(5), 216 (2010). The correct reference is listed below as ref. 2. Furthermore, Reference 25 is incorrectly listed as: Marlies, B. et al. The Reason for Discontinuation of the First Tumor Necrosis Factor (TNF) Blocking Agent Does Not Influence the Effect of a Second TNF Blocking Agent in Patients with Rheumatoid Arthritis. The Journal of Rheumatology 36(10), 2171–2177 (2009). The correct reference is listed below as ref. 3. In addition, there is an error in the legend of Figure 4, where: “The number of β-catenin-positive cells is divided by the number of DAPI signals to calculate the ratio of nuclear β-catenin-positive cells. The number of β-catenin-positive cells is divided by the number of DAPI signals to calculate the ratio of nuclear β-catenin-positive cells. *P < 0.05 by one-way ANOVA followed by Tukey’s post-hoc test. Scale = bar 200 μm (A), 100 μm (C), and 25 μm (D). (G) Model of Rspo2-mediated OA development, and the effect of mianserin.” should read:“The number of β-catenin-positive cells is divided by the number of DAPI signals to calculate the ratio of nuclear β-catenin-positive cells. *P < 0.05 by one-way ANOVA followed by Tukey’s post-hoc test. Scale bar = 200 μm (A), 100 μm (C), and 25 μm (D). (G) Model of Rspo2-mediated OA development, and the effect of mianserin.”.

DOI： 10.1038/s41598-020-60112-4

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：(一社)日本骨粗鬆症学会  

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Revista Brasileira de Ortopedia  

Objective Currently, there is a lack of evidence on the medium-term follow-up of cementless total hip arthroplasty (THA) using metal on highly cross-linked polyethylene (MoP), ceramic-on-ceramic (CoC), and metal-on-metal (MoM) bearings. Our aim was to calculate the 5- to 10-year wear rate and the incidence rate of osteolysis for these 3 types of bearings. Methods A total of 77 patients underwent THA with MoP, 105 underwent THA with CoC, and 55 underwent THA with MoM. The average patient age at the time of surgery was 64.7, 55.9, and 59.9 years old in the MoP, CoC, and MoM bearings, respectively. Clinical and radiologic measurements at a mean follow-up of 7.6 years were analyzed. Results The mean postoperative Harris hip scores showed no difference among the groups. The mean annual liner wear rates were 0.0160, 0.0040 and 0.0054 mm/year in MoP, CoC, and MoM bearings, respectively, with that of CoC bearings being significantly lower than those of the others. Osteolysis (14.5%) among MoM bearings was significantly more frequently observed compared with the others. Kaplan-Meier survival at 10 years with implant loosening, or revision THA as the endpoint, was 96.1% (95% confidence interval [CI]: 88.4–98.7) for MoP bearings, 98.6% (95%CI: 90.3–98.6) for CoC bearings, and 98.2% (95%CI: 88.0–99.7) for MoM bearings (p ¼ 0.360). Conclusion Excellent clinical and radiological outcomes were obtained for MoP and CoC bearings.

DOI： 10.1055/s-0039-1691762

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Orthopaedics and Traumatology: Surgery and Research  

Background: There is a lack of evidence about the risk factors associated with the malseating of the acetabular liner after ceramic-on-ceramic (CoC) total hip arthroplasty (THA). Therefore, we performed a complementary retrospective case-control study to determine the factors predicting the malseating of the acetabular liner after CoC THA and to evaluate the relationship between malseating and (1) osteoarthritis, (2) particularly in terms of the new radiographic parameter “bone sclerotic length” of the acetabular bone. Hypothesis: Osteoarthritis, particularly bone sclerotic length, was an independent risk factor for malseating of ceramic liners. Patients and methods: In total, 219 CoC THAs (174 women and 45 men) were evaluated to determine the risk factors influencing the malseating of the acetabular ceramic liner. An average patient age at the time of surgery was 55.9 ± 9.5 years (range, 23 to 75 years). Data on patient background and preoperative radiographs, such as Tönnis grades; Crowe classification; and indices of acetabular osteoarthritis change; including bone cyst, osteophyte and bone sclerosis, were assessed. The bone sclerotic length in patients with osteoarthritis was measured as the slant distance between the bilateral edges of the sclerosis lesion of the acetabulum on the anteroposterior view. Results: Preoperative less hip flexion (hazard ratio [HR]: 0.98; 95% CI: 0.97–0.99), osteoarthritis (HR: 3.15; 95% CI: 1.02–9.70) and the bone sclerotic length (HR: 1.83; 95% CI: 1.35–2.48) were independent risk factors determining the malseating of ceramic liners. Receiver operating characteristic curve analysis showed that a bone sclerotic length of 24.6 mm was defined as the cut-off point for the malseating of the ceramic liner. Discussion: Age, preoperative less flextion, osteoarthritis, and the bone sclerotic were independent risk factors determining malseating of ceramic liners. The acetabular shell can also deform upon insertion of the cup with sclerotic bone of the acetabulum and prevent correct seating of liners. Therefore, these factors must be taken into consideration when seating the ceramic liner. Level of evidence: Case control study III, case control retrospective design.

DOI： 10.1016/j.otsr.2019.01.009

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Archives of Orthopaedic and Trauma Surgery  

Background: Acetabular wall defects after periacetabular osteotomy (PAO) lead to technical difficulties when performing subsequent total hip arthroplasty (THA). There is no unified consensus regarding the solution for THA socket installation after PAO. In the current study, we performed computed tomography (CT)-based simulation of socket installation and evaluated the acetabular defect following THA after PAO and after primary osteoarthritis (OA). Patients and methods: The study group comprised 55 patients (56 hips) who underwent THA after PAO. For the control group, after matching for age, sex, and Crowe classification, we included 55 patients (56 hips) who underwent primary THA for hip dysplasia. We evaluated the anterior, posterior, and superior acetabular sector angle (ASA) and medial wall thickness (MWT) at the anatomical hip center (at the 20-mm vertical hip level from teardrop) in the study group (anatomical PAO group) and control group (primary OA group). In addition, we investigated the changes in the socket covering when the socket was positioned 10 mm above the anatomical hip center (30 mm above the teardrop; elevated osteotomy group). Results: All ASA and MWT values were significantly smaller in the anatomical PAO group than in the primary OA group. In particular, the individuals with a Crowe classification of II/III in the anatomical PAO group presented severe acetabular defects. However, the elevated PAO group had a significantly larger ASA compared to the anatomical PAO group, with improved socket coverings. Conclusion: Acetabular defects in the anatomical hip center following THA after PAO were significantly common compared to those after primary THA. Elevation of hip joint centers as much as 10 mm is one therapeutic option in the case of severe acetabular defects following THA after PAO.

DOI： 10.1007/s00402-019-03174-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Scientific Reports  

Aberrant activation of the Wnt/β-catenin signaling pathway promotes the progression of osteoarthritis (OA). We previously reported that R-spondin 2 (Rspo2), an activator of the Wnt/β-catenin signaling, facilitates differentiation of proliferating chondrocytes into hypertrophic chondrocytes by enhancing Wnt/β-catenin signaling in endochondral ossification. However, the role of Rspo2 in OA remains elusive. Here, we showed that the amounts of Rspo2 protein in synovial fluid were increased in OA patients. We searched for a preapproved drug that suppresses Rspo2-induced Wnt/β-catenin signaling in chondrogenic cells and reduces joint pathology in a rat model of OA. In Rspo2-treated ATDC5 cells, mianserin, a tetracyclic antidepressant, inhibited Wnt/β-catenin signaling, increased proteoglycan production, and upregulated chondrogenic marker genes. Mianserin suppressed Rspo2-induced accumulation of β-catenin and phosphorylation of Lrp6. We identified that mianserin blocked binding of Rspo2 to its receptor Lgr5. We also observed that intraarticular administration of mianserin suppressed β-catenin accumulation and prevented OA progression in a rat model of OA. We conclude that mianserin suppresses abnormally activated Wnt/β-catenin signaling in OA by inhibiting binding of Rspo2 to Lgr5.

DOI： 10.1038/s41598-019-39393-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Nagoya Journal of Medical Science  

Surgical intervention for the treatment of acetabular fracture non-union is often challenging. Here, we present a case of acetabular fracture non-union with pelvic discontinuity in a patient who underwent cemented total hip arthroplasty (THA) after intra- and extra-articular plate fixation. The case was a 70-year-old male with left T-shaped acetabular fracture non-union neglected for 5 months after the injury. The anterior and posterior columns were not healed, and the articular surface was displaced toward the medial side with a protrusion of the collapsed femoral head. As the first surgical intervention, we performed intra- and extra-articular plate fixation after femoral head decapitation. We fixed non-union regions from the inferior acetabular margin to the anterior column using a pelvic reconstruction plate bent three-dimensionally at the acetabular curvature on the intra-articular side. Furthermore, we fixed that of the posterior column on the outside of the acetabulum using a bent pelvic reconstruction plate. Union of the anterior and posterior columns was observed at 4 and 6 months after the first surgical intervention. At 7 months, we performed a cemented THA without additional bone grafting. At 1-year follow-up, the patient did not have left coxalgia and could walk without any gait supports. Based on our experience, we propose this surgical protocol as a useful treatment option for cases of acetabular fracture non-union.

DOI： 10.18999/nagjms.81.1.113

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：HIP International  

Introduction: This study aimed to compare the clinical and radiographic results of 28-mm ceramic-on-ceramic (CoC) total hip arthroplasty (THA) to those of 32-mm CoC during a 5- to 15-year follow-up period. Methods: 107 joints (95 women and 6 men) underwent 28-mm CoC, and 60 (49 women and 7 men) underwent 32-mm CoC. The average patient age at the time of surgery was 56.1 and 55.7 years in the 28-mm and 32-mm CoC groups, respectively. Clinical and radiologic measurements of all patients were analysed. Results: The mean preoperative Harris hip score (HHS) was similar in the 2 groups (28-mm, 58.9; and 32-mm, 58.5). However, at final follow-up, the mean HHS of the 32-mm CoC (91.8) was significantly better than that of the 28-mm CoC (88.2) (p = 0.003), as were the ranges of motion (ROM) for flexion (98.3 ± 13.5° vs. 87.3 ± 19.3°, p < 0.001) and abduction (27.8 ± 14.9° vs. 22.1 ± 19.3°, p = 0.007). The mean wear rate was 0.0044 mm/year for the 28-mm CoC and 0.0044 mm/year for the 32-mm CoC. No ceramic fractures were found in the 2 groups. One joint in the 28-mm CoC (0.9%) required revision owing to progressive osteolysis. Kaplan-Meier survival at 10 years, with implant loosening or revision THA as the endpoint, was 98.3% for 28-mm CoC and 100% for 32-mm CoC (p = 0.465). Conclusion: There was no significant difference in ceramic-related complications between the 2 groups. Our study demonstrated that the 32-mm and 28-mm CoC are safe and are associated with good clinical outcomes.

DOI： 10.1177/1120700018760971

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Orthopaedics and Traumatology: Surgery and Research  

Background: To avoid wear-induced osteolysis, ceramic-on-ceramic (CoC) and metal-on-metal (MoM) bearings have been developed. At present, there are no direct material related clinical comparisons between cementless total hip arthroplasty with CoC and MoM at more than 5-year follow-up. The bearing that is more likely to prevent osteolysis is still controversial. Therefore, we performed a retrospective case control study evaluating CoC and MoM cementless THAs in order to: – compare the longevity and complications for CoC and MoM THAs at 5–10 years postoperatively; – compare the incidence of osteolysis between both type THAs; – evaluate pseudotumors in MoM THAs. Hypothesis: CoC THAs will have a lower rate of osteolysis, better longevity, and better clinical outcomes than MoM THAs. Patients and methods: Ninety-six hips underwent CoC THAs, and 56 hips underwent MoM THA (Ultamet, Pinnacle, Depuy). Average patient age at the time of surgery was 57.1 years (range, 28 to 77 years). Results: There were no differences with regard to the Harris hip score (89.5 and 90.3 for the CoC and MoM groups, respectively). Osteolysis (9 hips, 14.3%) among MoM THAs were significantly more frequently observed compared to CoC THAs (2 hips, 2.1%). Kaplan-Meier survival at 8 years with implant loosening or revision THA as the endpoint was 98.2% (95% CI: 87.8–99.8) for CoC, and 98.6% (95% CI: 90.2–99.8) for MoM (p = 0.684). There was one audible squeaking (1.0%) and no ceramic fracture among CoC THAs. Five (8.9%) hips showed pseudotumors among MoM THAs. Discussion: CoC THAs had a low incidence of osteolysis. No significant difference was seen in the 8-year survival rate between implants, when using implant loosening and revision THA as endpoints. These data indicate that CoC THAs have excellent clinical and radiological outcomes, compared with MoM THAs. Ultamet MoM had a higher rate of osteolysis compared to other MoM bearings; the cup modularity (without polyethylene) and the use of 36 mm heads as well as the process of production (after 2006) may play a significant role in the higher rate of osteolysis. Level of evidence: III, Case control study, case control retrospective design.

DOI： 10.1016/j.otsr.2018.08.005

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Clinical Orthopaedics and Related Research  

Background Patients with comparable severities of developmental dysplasia of the hip (DDH) may variably progress to osteoarthritis (OA) over time. Although joint congruency may be associated with OA progression in patients with DDH, it has only been assessed subjectively. We assessed the gap between the rotational centers of the acetabulum and femoral head (center gap) as a possible predictive measure ofOAprogression in patientswithDDH. Questions/purposes In patients with bilateral DDH, we asked: (1) What is the probability of OA progression (Tönnis grade) or symptom development (pain) in the asymptomatic contralateral hip of patients with DDH undergoing unilateral joint-preserving surgery? (2) Is the center gap measurement associated with OA progression or symptom development in these hips? (3) Is the center gap measurement correlated with previous radiographic parameters? Methods A total of 297 patients (319 hips) underwent unilateral eccentric rotational acetabular osteotomy at our institution between July 1989 and December 1999. We performed no other joint-preserving surgery to treat patients with DDH during this timeframe. The inclusion criteria for the study were patients younger than 55 years of age, the contralateral hip classified as Tönnis Grade 0, no previous surgical interventions, and asymptomatic at the time of eccentric rotational acetabular osteotomy (155 patients, 155 hips). The exclusion criteria were a contralateral hip without dysplasia (four patients, four hips), loss to followup before 10 years (42 patients, 42 hips [27%]), or missing medical records or radiographs (21 patients, 21 hips [14%]). The remaining 88 patients (88 hips; 11 males and 77 females) with a mean age of 39 years (range, 17-53 years) and mean followup of 20 years (range, 10-27 years) were analyzed. From the institutional database, radiographic parameters including the center gap in the AP view were assessed using radiographs at the time of eccentric rotational acetabular osteotomy, and the Tönnis grade was recorded 1 year postoperatively and annually thereafter retrospectively. We defined migration of the rotational center of the femoral head based on the rotational center of the acetabulum in the horizontal plane as center gap X (mm) and in the vertical plane as center gap Y (mm) and defined the absolute value between the centers as center gap distance (mm). Using κ statistics, intra- and interobserver reliabilities were determined to be 0.896 and 0.857 for center gap X, 0.912 and 0.874 for center gap Y, and 0.912 and 0.901 for the center gap distance, respectively. When patients reported any contralateral ipsilateral hip pain during clinic visits, the hip was considered symptomatic. Kaplan-Meier survivorship analyses were performed with OA progression or symptom development in the nonoperative hip as the endpoint. Multivariate analyses were performed to assess risk factors for each outcome using the Cox proportional hazards model. Correlation analyses between the center gap and other parameters including lateral center-edge angle, femoral head extrusion index, acetabular depth-to-width index, femoral head lateralization, minimum width of the joint space, head sphericity, and joint congruency were performed using Pearson's correlation coefficient. Results At 20 years postoperatively, the probability of OA progression in the nonoperative hip was 13% (95% confidence interval [CI], 7.1-22.1) and the probability of symptom development was 34% (95% CI, 24.7-46.1). The center gap X measurements in the groups with OA progression (lateral 2.0 ± 2.1 [SD] mm) or symptom development (lateral 0.9 ± 2.4 mm) took a more lateral direction than those in the group without OA progression (medial 0.4 ± 2.1 mm) or symptom development (medial 0.5 ± 2.0 mm) (OA progression, p < 0.001; symptom development, p = 0.005). The center gap Y measurements in the groups with OA progression (distal 2.767.1 mm) or symptom development (distal 2.1 ± 6.0 mm) took a more distal direction than those in the group without OA progression (proximal 1.6 ± 6.2 mm) or symptom development (proximal 2.5 ± 6.1 mm) (OA progression, p = 0.027; symptom development, p = 0.001). Independent risk factors for OA progression were the femoral head extrusion index (hazard ratio [HR], 1.11; 95% CI, 1.01-1.22; p = 0.028) and the center gap X (HR, 1.52; 95% CI, 1.07-2.16; p = 0.019), whereas no independent risk factors for symptom development were found. The center gap in the horizontal plane had no correlations with any other radiographic parameter studied. Conclusions The center gap in the horizontal plane had a modest association with OA progression in this group of patients with DDH. Future studies are needed to determine the normal value of the center gap for patients without DDH and to assess the center gap in lateral radiographic views. Level of Evidence Level IV, prognostic study.

DOI： 10.1097/CORR.0000000000000458

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.rcot.2018.06.009

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：(公社)日本整形外科学会  

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：HIP International  

Introduction: This study investigates differences in femoral head penetration between highly cross-linked polyethylene (HXLPE) cemented sockets both with and without radiolucent lines (RLLs) in the early postoperative phase and at 5 years follow-up. Methods: There were 35 patients (37 hips), mean age of 66.8 years, who underwent total hip arthroplasty (THA) using highly HXLPE cemented sockets. They were divided into 2 groups based on postoperative the early appearance of RLLs. Femoral head penetrations on both anteroposterior- and Lauenstein-view radiographs were evaluated, and the mean polyethylene (PE) wear rate was calculated based on femoral head penetrations between 2 and 5 years. Results: Femoral head penetrations in the proximal direction were 0.075 mm and 0.150 mm in the RLL and non-RLL groups at 1 year postoperatively (p = 0.019). At 5 years measured penetration was 0.107 mm and 0.125 mm in the RLL and non-RLL groups, respectively (p = 0.320). The mean PE wear rates in anteroposterior-view were 0.008 mm/year and 0.003 mm/year in the RLL and non-RLL groups (p = 0.390) and those in Lauenstein-view were 0.010 mm/year and 0.005 mm/year, respectively (p = 0.239). Conclusions: In the RLL group, the PE bedding-in was less compared with those in the non-RLL group. Additionally, the mean PE wear rate in the RLL group tended to be higher than that in the non-RLL group. The distribution of stress loading through the cement may differ according to whether early RLLs appear.

DOI： 10.1177/1120700018754308

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：International Orthopaedics  

Purposes: The objectives of this study were to investigate patient-reported outcomes and referral pain at the first visit in patients with osteonecrosis of the femoral head (ONFH) and to clarify the influence of collapse of the femoral head and the contralateral condition. Methods: The study included 105 patients (130 hips) with ONFH at the first visit, who were divided into two groups based on the presence of bilateral walking hip pain (bilateral group 25 patients, 50 hips) and unilateral hip pain (unilateral group 80 patients, 80 hips). We compared the Short Form-36 (SF-36), Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), and visual analog scale (VAS) responses for hip, knee, and low back pain between the groups to investigate the influence of the contralateral condition. Regarding the influence of femoral head collapse, we investigated these subjects based on the stage classification in the unilateral group. Results: The physical component summary (PCS) of the SF-36 and all domains of the JHEQ were poorer in the bilateral group than in the unilateral group. In addition, the VAS score for low back pain was significantly poorer in the bilateral group than in the unilateral group. Regarding the collapse of the femoral head, the SF-36 for the PCS and JHEQ for pain had a significant relationship in the ONFH stage. The VAS scores for hip and knee pain had a significant relationship in the ONFH stage. Conclusion: Collapse of the femoral head and the contralateral condition of ONFH strongly affect patients’ activities of daily life.

DOI： 10.1007/s00264-018-3867-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：International Orthopaedics  

Purpose: The aim of this study was to compare the clinical outcomes of cementless total hip arthroplasty (THA) used for the treatment of osteonecrosis of the femoral head (ONFH) and for osteoarthritis (OA) at a mean ten years follow-up. Methods: Case-control study of 78 patients (86 hips) who underwent THA for ONFH treatment (ONFH group). Patients were matched for age and sex to 78 patients (86 hips) who underwent THA for OA (OA group). We compared the clinical and patient-reported outcomes, implant survival rates, and rates of complications between the groups. Results: There were no between-group differences in the Harris Hip Score and in the following patient-reported outcomes at the last follow-up: Japanese Orthopedic Association Hip-Disease Evaluation Questionnaire (JHEQ) pain and movement scores and the Physical Component Summary and Role/Social Component Summary scores of Short Form-36 (SF-36). However, the mental score of the JHEQ, the Mental Component Summary score of SF-36, and The Visual Analog Scale score for satisfaction were lower for the ONFH group than for OA group. The rate of complication was equivalent between the groups: 5% for the ONFH group and 3% for the OA group. The ten year implant survival rate was equivalent between the groups, at 97.5% for the ONFH group and 98.2% for the OA group. Conclusion: The functional outcomes, implant survival, and rate of complications for cementless THAs are comparable at a mean follow-up of ten years for ONFH and OA.

DOI： 10.1007/s00264-018-3987-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Arthroplasty  

Background: Few studies have reported risk factors for stress shielding. We sought to evaluate clinical and radiographic outcomes of a proximally hydroxyapatite-coated straight tapered titanium femoral component stem during a minimum 5-year follow-up and identify factors associated with high-degree stress shielding. Methods: A total of 156 total hip arthroplasties (n = 124; 98 women and 26 men; mean age, 56.5 years) with a minimum follow-up period of 5 years were included in the study. Clinical and radiologic measurements at follow-up (range, 5-16.3 years; mean, 10.2 years) were analyzed. Results: The mean preoperative Harris Hip Score (HHS) was 56.6, and the mean HHS at the latest follow-up was considerably improved at 86.8. Stress shielding at the latest follow-up was low degree in 136 (87%) hips and high degree in 20 (13%) hips. On average, high-degree stress shielding occurred 9.9 years (5-14 years) after surgery. The results of Cox proportional hazard analysis showed that a canal bone ratio ≥ 0.49 was an independent risk factor for high-degree stress shielding (P =.0075; hazard ratio, 3.981). HHS at the latest follow-up was significantly lower in high-degree stress shielding than in low-degree stress shielding (80.7 and 87.7, respectively; P =.0030). Conclusion: Preoperative canal bone ratio ≥ 0.49 is independently associated with high-degree stress shielding. In addition, the number of cases with high-degree stress shielding significantly increased over time during a mean 10-year follow-up.

DOI： 10.1016/j.arth.2017.12.019

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Orthopaedic Science  

Background: There has been constant discussion about whether the clinical outcome of THA after periacetabular osteotomy (PAO) is equivalent to that after primary total hip arthroplasty (THA). However, there have been few reports about patient-reported outcomes (PRO) for those who undergo THA after PAO. We compared the pre- and postoperative PRO of patients who underwent THA after PAO and those who underwent primary THA alone. Methods: We performed a case–control study. Twenty-seven patients (29 hips) underwent THA after PAO (osteotomy group); their mean age at surgery was 57.2 years, and they underwent postoperative follow-up for a mean period of 3.0 years. For the control group, after matching age, sex, and Crowe classification, we included 54 patients (58 joints) who underwent primary THA for hip dysplasia. Assessment performed preoperatively and at the last follow-up included the Harris hip score, the Short Form 36 (SF-36) for the Physical Component Summary (PCS), Mental Component Summary (MCS), and Role/Social Component Summary (RCS) domains, Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ) for pain, movement, and mental health, and the visual analog scale (VAS) score of hip pain and satisfaction. Results: The two groups demonstrated no significant difference in the preoperative Harris hip score, each domain of the SF-36, JHEQ, and the VAS score of hip pain and satisfaction. The osteotomy group demonstrated significantly poor Harris hip scores for gait and activity, and JHEQ for movement at the last follow-up. There was no significant difference in each domain of the SF-36 and the VAS score of hip pain and satisfaction at the last follow-up. Conclusion: Previous PAO affects the quality of physical function in patients who undergo subsequent THA.

DOI： 10.1016/j.jos.2017.11.001

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Arthroplasty  

Background This study aimed at investigating differences in femoral head penetration between highly cross-linked polyethylene (HXLPE) cemented sockets and uncemented liners during 5 years postoperatively. Methods Ninety-six patients (106 hips) with a mean age of 64.4 (range, 35-83) years underwent total hip arthroplasty using a HXLPE cemented socket or liner and were respectively divided into cemented (35 patients [37 hips]) and uncemented (61 patients [69 hips]) groups. Femoral head penetrations were evaluated on both anteroposterior (AP)-view and Lauenstein-view radiographs, and mean polyethylene (PE) wear rates were calculated based on femoral head penetration from 2 to 5 years. Multivariate analyses were performed to assess risk factors for PE wear. Results At 5 years postoperatively, the cemented and uncemented groups exhibited proximal direction femoral head penetrations of 0.103 mm and 0.124 mm (P =.226) and anterior direction penetrations of 0.090 mm and 0.151 mm (P =.002), respectively. The corresponding mean PE wear rates were 0.004 mm/y and 0.009 mm/y in the AP-view (P =.286) and 0.005 mm/y and 0.012 mm/y in the Lauenstein-view (P =.168), respectively. Left-side operation and high activity were independent risk factors for PE wear on AP-view. Conclusion When HXLPE was used, all mean PE wear rates were very low and those of cemented sockets and uncemented liners were very similar. PE particle theory suggests that the occurrence of osteolysis and related aseptic loosening might consequently decrease.

DOI： 10.1016/j.arth.2017.07.017

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Orthopaedic Science  

Introduction This study clarified individual associations of joint space narrowing (JSN) and radiographic features (RF) of hip osteoarthritis (HOA), i.e., cyst and osteophyte formation and subchondral sclerosis, with quality of life (QOL) in Japanese HOA patients. Methods This cross-sectional study comprised 117 Japanese HOA patients (98 women, 17 men; mean age, 61.2 years). We recorded locations and the size of each RF and measured JSN on the acetabular side (Ace) or femoral head (FH). We evaluated pain with the Visual Analog Scale (VAS) and assessed QOL with the physical component summary (PCS) and mental component summary (MCS) of the Medical Outcomes Study Short Form-36. We compared QOL with/without the RF on the Ace, FH or both and analyzed relationships between each RF and VAS, PCS and MCS with linear regression analysis. We assessed independent associations of each RF with PCS and MCS with multiple regression analysis using various independent variables. Results VAS values with the cyst on the Ace only were significantly lower than those with the cyst at both locations. PCS values with the cyst on the Ace only were significantly higher than those for both locations. Independent associations existed for maximum cyst length on the Ace and FH with VAS and for JSN with PCS, but none existed for MCS. Conclusions Our study suggested that the location and the size of the cyst formation were associated with both VAS and QOL in Japanese HOA patients. The JSN was independently associated with the PCS.

DOI： 10.1016/j.jos.2017.08.014

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Arthroplasty  

Background The objective of the present study was to investigate clinical, quality of life, and radiographic outcomes of patients who underwent total hip arthroplasty (THA) after transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head (ONFH). Methods We performed a case-control study. The participants were 29 patients (34 hips) who underwent THA after TRO (TRO group). These patients had a mean age at surgery of 51.6 years (range, 30-72 years) and underwent postoperative follow-up for a mean period of 10.5 years (range, 3-19 years). For the control group (primary group), we included 58 patients (68 hips) who underwent primary THA for ONFH, matching for age and gender. Results The Harris Hip Scores at the last follow-up were significantly poorer in the TRO group than in the primary group. Similarly, preoperative and postoperative hip range of motion was significantly poorer in the TRO group than in the primary group. Quality of life (Short Form-36, Oxford Hip Score, and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire) and complication rates were not significantly different between the groups. The survival rates at 10 years, with revision for any reason as the endpoint, were 81% in the TRO group and 91% in the primary group, showing no significant difference between the groups. The TRO group had a larger average postoperative leg length discrepancy and a higher rate of stem malalignment than the primary group. Conclusion The clinical outcomes of THA after TRO for ONFH were poorer than those of primary THA.

DOI： 10.1016/j.arth.2017.05.020

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PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Nagoya Journal of Medical Science  

Although many patients use the internet to access health-related information, the quality and the reliability of the information is highly inconsistent. Periacetabular osteotomy (PAO) is one of the surgical procedures for hip dysplasia. However, medical information on PAO is limited on the internet. This study aims to evaluate the quality and reliability of information available on PAO on the internet in Japan. A web search was conducted on two search engines for the following terms: "hip osteotomy," "pelvic osteotomy," and "osteotomy for hip preservation" in Japanese. In total, we found 120 websites. To determine the quality and reliability of information on each website, we used the Health on the Net Foundation (HON) score, the Brief DISCERN score, and an osteotomy-specific content (OSC) score. After eliminating duplicate websites, we reviewed 49 unique websites. Only three websites (6.1%) had good reliability, as indicated by their HON scores. Twelve websites (24.4%) had good-quality information, as measured by their Brief DISCERN scores. As evaluated by their OSC scores, physician websites were found to be biased toward etiology and surgical indication and did not provide information on the complications of procedures. Nonphysician websites were generally insufficient. The information about PAO on the internet is, therefore, unreliable and of poor-quality for Japanese patients.

DOI： 10.18999/nagjms.79.3.375

Web of Science

Scopus

PubMed

記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：公益社団法人 日本理学療法士協会  

<p>【はじめに，目的】</p><p></p><p>我々はこれまでに，人工股関節全置換術（THA）前の身体活動量は術後早期の歩行能力や在院日数に関連するという結果を得ており，術前の変形性股関節症（股OA）患者にとって身体活動量低下の予防は重要であると考えられる。3軸加速度計は，患者の実際の日常生活において，歩数などで示される身体活動量に加え，活動強度の測定を行うことが可能である。股OA患者の身体活動量や活動強度は，痛みや身体機能，精神機能など様々な因子の影響を受けることが予測されるが，これらを包括的に検討した報告はない。本研究の目的は，3軸加速度計を用いて股OA患者の身体活動量および活動強度に影響する因子を検討することである。</p><p></p><p>【方法】</p><p></p><p>対象は2015年12月～2016年9月に当院にて片側THAを施行された患者のうち，術前に身体活動量および活動強度，下肢関節可動域，下肢筋力，10m歩行の測定，痛みおよび精神機能に関するアンケート評価を行い，歩行非自立であった2例を除いた40例（男性7例，女性33例，年齢66.9±10.5歳）とした。3軸加速度計（ActiGraph GT3X-BT）を用いて入院前1週間分の1日平均歩数，1日のうちの低強度の身体活動時間（light physical activity；LPA），中～高強度の身体活動時間（moderate-to-vigorous physical activity；MVPA）を測定した。ハンドヘルドダイナモメーター（μTas F-100）を用い，術側，非術側の股関節外転および膝関節伸展トルクを算出した。Visual Analogue Scale（VAS），Pain Catastrophizing Scale（PCS），Hospital Anxiety and Depression Scale（HADS）を用い，痛みおよび精神機能を評価した。Pearsonの相関係数を用い歩数および活動強度と各評価項目にて相関関係を検討した。次に，歩数および活動強度を従属変数とし，これらと有意な相関関係を認めた各評価項目を独立変数に投入したステップワイズ重回帰分析を行った。いずれの検定も有意水準を5%とした。</p><p></p><p>【結果】</p><p></p><p>歩数は，術側および非術側股関節伸展可動域，非術側股関節外転可動域，非術側股関節外転トルク，HADS抑うつと有意に相関し，重回帰分析の結果，非術側股関節伸展可動域（p＜0.01，β=0.41），HADS抑うつ（p＜0.01，β=-0.36），非術側股関節外転可動域（p=0.02，β=0.35）が有意な関連因子として抽出された。LPAと有意に相関する因子は無かった。MVPAは，非術側股関節伸展可動域，非術側股関節外転可動域，年齢と有意に相関し，重回帰分析の結果，非術側股関節伸展可動域（p＜0.05，β=0.34），年齢（p＜0.05，β=-0.30）が有意な関連因子として抽出された。</p><p></p><p>【結論】</p><p></p><p>歩数，MVPAは，ともに非術側股関節伸展可動域と関連しており，非術側股関節伸展可動域の低下は身体活動量，活動強度を低下させる因子であった。また，股OA患者の精神的健康の低下は，身体活動量を低下させる因子であった。さらに，股OA患者では年齢とともに活動強度が低下することが示された。</p>

DOI： 10.14900/cjpt.2016.0281

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Laterality  

There are few reports of the laterality in radiological knee osteoarthritis (ROA). This study aimed to evaluate laterality in terms of the minimum joint space width (mJSW) and osteophyte areas (OFs) in a cross-sectorial general population screen and elucidate the association between laterality and risk of osteoarthritis. We enrolled 330 participants (mean age 64.6 years) and examined the presence of ROA (Kellgren–Lawrence grade ≧ 2) laterality in terms of the mJSW and OF on the medial tibia using auto-measuring software. Moreover, we examined the association between laterality and leg dominance. The right and left medial mJSWs were 4.02 ± 0.98 mm and 4.05 ± 1.01 mm, respectively, showing no laterality; the laterals were also similar. The participants who had osteophytes ≥1 mm2 in the right, left, and bilateral knees were 15, 37, and 57 respectively, with osteophytes being significantly more common in the left knee. The OF was significantly larger in the left knee. Conversely, the medial and lateral mJSWs and OF did not differ according to leg dominance. The prevalence of ROA was higher and the OF was more pronounced in the left knee. However, the mJSW showed no laterality. Additionally, the mJSW and OF showed no differences according to leg dominance.

DOI： 10.1080/1357650X.2016.1199560

Web of Science

Scopus

PubMed

記述言語：日本語   出版者・発行元：日本股関節学会  

記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

記述言語：日本語   出版者・発行元：(公社)日本整形外科学会