Papers - TAKEGAMI Yasuhiko

Impact of a national reimbursement policy on anti-osteoporosis medication prescription at discharge after hip-fracture surgery in Japan: an interrupted time-series analysis Reviewed International journal

Yasuhiko Takegami, Takahiro Imaizumi, Kikue Sato, Yusuke Osawa, Hiroto Funahashi, Shiro Imagama

Osteoporosis International   Vol. 36 ( 12 ) page： 2509 - 2518   2025.12

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

UNLABELLED: A 2022 pay-for-performance fee in Japan increased the rate of post-hip-fracture osteoporosis treatment (primarily oral agents) by 20.8 percentage points and tripled the annual uptake trend in an interrupted time-series analysis of 78,224 patients. Financial incentives embedded within national fee schedules may help close gaps in secondary fracture prevention. PURPOSE: Although osteoporosis treatment is essential for preventing secondary fractures, many patients remain untreated after hip-fracture surgery. Accordingly, Japan introduced a three-stage reimbursement add-on, the Secondary Fracture Prevention Continuous Management Fee (SFP-CMF) in April 2022. We assessed its real-world impact on anti-osteoporosis medication prescription at discharge. METHODS: Using data from Japan's Diagnosis Procedure Combination Per-Diem Payment System (DPC/PDPS) covering 172 acute-care hospitals in Aichi Prefecture, we identified a retrospective cohort of adults aged ≥ 65 years who underwent hip-fracture surgery between the first quarter of 2015 and fourth quarter of 2023. Quarterly initiation rates for any osteoporosis medication were analyzed using segmented interrupted time-series regression to estimate changes in level and slope associated with the 2022 reimbursement policy, with brief route-specific description (oral vs. injectable). RESULTS: We included 78,224 patients (59,547 pre-intervention; 18,677 post-intervention). Before the policy, discharge prescription increased slowly (+ 1.4 percentage points [pp]/year; 95% CI 1.0-1.8; p < 0.001). SFP-CMF introduction was followed by an immediate + 20.8 pp change (95% CI 14.9-26.7; p < 0.001) and a + 17.8 pp/year post-intervention slope (95% CI 13.6-22.1; p < 0.001) over the subsequent 7-quarter (1.75-year) period. Most gains were attributable to oral agents (vitamin D analogs, bisphosphonates); injectables rose briefly but subsequently declined. CONCLUSION: Embedding a modest, stage-specific financial incentive within the national fee schedule produced a sustained large increase in anti-osteoporosis medication prescription at discharge after hip fracture, predominantly for oral agents. The concomitant decline in injectables suggests that route-specific implementation merits monitoring, and further evaluation across post-discharge phases and fracture outcomes is warranted.

DOI： 10.1007/s00198-025-07721-9

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Periprosthetic femoral fractures following bipolar hemiarthroplasty: A descriptive multicenter study exploring associations with mortality and functional status Reviewed International journal

Koki Miyagawa, Yasuhiko Takegami, Hiroaki Nakashima, Kenichi Mishima, Kazuyoshi Kobayashi, Shiro Imagama

Injury   Vol. 56 ( 12 ) page： 112776 - 112776   2025.12

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Periprosthetic femoral fractures (PFFs) following bipolar hemiarthroplasty (BHA) represent a major complication in elderly patients with frailty and poor bone quality. However, limited data exist on the relationship between fracture type and clinical outcomes such as mortality and functional status in this population. METHODS: This multicenter retrospective study included 157 patients who sustained a PFF following BHA for femoral neck fractures between 2010 and 2023. Fractures were classified using the Vancouver classification. Clinical variables included age, sex, comorbidities (Charlson Comorbidity Index, CCI), dementia, coexisting fragility fractures, pre-injury mobility, and treatment modality. One-year mortality and postoperative functional outcomes were assessed using Kaplan-Meier survival analysis, the Parker Mobility Score (PMS), and Merle d'Aubigné score. RESULTS: The one-year mortality rate was 31.4 %. Higher mortality was significantly associated with CCI ≥2, dementia, and coexisting vertebral or pelvic fragility fractures (p < 0.05). In contrast, no significant differences in one-year mortality or postoperative functional scores were observed across Vancouver classification types or treatment methods. Functional recovery was similarly limited regardless of fracture type. CONCLUSION: In this multicenter retrospective cohort of patients with periprosthetic femoral fractures following bipolar hemiarthroplasty, the 1-year mortality was high at approximately 30 %. Outcomes appeared to be driven primarily by systemic factors-greater comorbidity burden, cognitive impairment, and concomitant fragility fractures. These findings underscore the importance of comprehensive geriatric assessment and proactive osteoporosis management in this vulnerable population.

DOI： 10.1016/j.injury.2025.112776

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Changes in spinopelvic alignment and patient-reported outcomes after total hip arthroplasty in osteonecrosis of the femoral head. Reviewed International journal

Hiroaki Ido, Yusuke Osawa, Yasuhiko Takegami, Hiroto Funahashi, Hiroki Iida, Shiro Imagama

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society     2025.11

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BACKGROUND: Osteonecrosis of the femoral head (ONFH) involves femoral head collapse, leading to hip joint pain, low back pain (LBP), and reduced quality of life. While compensatory spinopelvic alignment (SPA) changes are well-documented in hip osteoarthritis, their relationship with ONFH progression remains poorly understood. This study aimed to investigate SPA changes across different ONFH stages and evaluate the effects of total hip arthroplasty (THA) on SPA and patient-reported outcome measures (PROMs), including LBP, in patients undergoing THA at early and late stages of ONFH. METHODS: This retrospective study included 82 patients with ONFH who underwent THA. Patients were classified into three groups based on ONFH stage using the Japanese Investigation Committee classification: stage 2 and 3A, stage 3B, and stage 4. Preoperative and postoperative SPA parameters (pelvic incidence, lumbar lordosis [LL], sacral slope [SS], pelvic tilt [PT], thoracic kyphosis, and sagittal vertical axis [SVA]) and PROMs (Japan Hip Disease Evaluation Questionnaire [JHEQ] and LBP Visual Analog Scale [VAS] scores) were compared across stages. SPA and PROMs were investigated preoperatively and 2 years postoperatively. RESULTS: Preoperative SPA analysis revealed increased SS and SVA as ONFH progressed. Postoperatively, THA significantly reduced LL, SS, and SVA while increasing PT, with similar trends across all stages. Notably, stage 4 patients exhibited significantly greater increases in posterior PT. PROMs, including JHEQ and LBP VAS scores, improved significantly across all stages postoperatively, with no significant differences in the degree of improvement. CONCLUSION: THA improves compensatory SPA changes and PROMs in ONFH cases, regardless of the disease stage. However, patients with advanced-stage ONFH may experience further progression of the posterior PT postoperatively, highlighting the importance of preoperative SPA evaluation in late-stage cases.

DOI： 10.1007/s00586-025-09532-2

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Comparative clinical outcomes of K-wire fixation versus screw fixation in Lisfranc joint injuries: A multicenter (TRON group) retrospective study Reviewed International journal

Atsuya Adachi, Yasuhiko Takegami, Hiroaki Nakashima, Kenichi Mishima, Kazuyoshi Kobayashi, Shiro Imagama

The Journal of Foot and Ankle Surgery   Vol. 64 ( 6 ) page： 683 - 687   2025.11

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

Treatment of Lisfranc joint injuries commonly involves surgical fixation, with screw fixation and Kirschner wire (K-wire) fixation being two primary methods. However, the optimal fixation strategy remains debated, particularly regarding functional outcomes and complications. This multicenter retrospective study analyzed 50 patients (25 per group) who underwent either screw or K-wire fixation for Lisfranc injuries between 2014 and 2024. Patients were matched by age and sex. Outcomes were assessed using AOFAS midfoot scores, complication rates, and radiographic evaluation. Operative time was significantly shorter in the K-wire group (41.0 vs. 118.5 min, p < 0.001). AOFAS scores showed no significant difference between groups (median of 88.0 vs. 90.0, p = 0.84). The K-wire group showed higher rates of malunion (28.0 % vs. 4.0 %, p = 0.049), whereas the screw group had increased rates of implant breakage (12.0 %, p = 0.012), wound irritation (36.0 %, p = 0.095), and unplanned implant removal (28.0 %, p < 0.001). Both fixation methods achieved comparable functional outcomes, which were assessed in patients who were followed for at least 90 days. K-wire fixation offered advantages in shorter operative time and fewer hardware-related complications but showed higher rates of malunion. Treatment choice should be individualized based on patient factors and injury characteristics, with K-wire fixation representing a viable alternative in appropriate cases.

DOI： 10.1053/j.jfas.2025.05.005

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Risk factors for screw breakage in Lisfranc joint injuries: A multicenter retrospective study. Reviewed International journal

Satoshi Muto, Yasuhiko Takegami, Toshihisa Kojima, Shiro Imagama

The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons   Vol. 64 ( 6 ) page： 677 - 682   2025.11

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BACKGROUND: Lisfranc joint injuries are rare but significantly impact foot biomechanics. Open reduction and internal fixation (ORIF) using screws is common, but screw breakage is a frequent issue. While previous studies have reported breakage rates, few have investigated the association between screw type and breakage risk. PURPOSE: This study aims to identify risk factors for screw breakage, analyze the timing and patterns of failures, and evaluate their impact on clinical outcomes. STUDY DESIGN: Multicenter retrospective cohort study. METHODS: This multicenter retrospective study analyzed 233 patients who underwent surgical treatment for Lisfranc injuries at 11 institutions between January 2014 and June 2024. After applying the exclusion criteria, 72 patients were eligible for inclusion in the study. These patients were divided on the basis of screw type (cannulated [n = 31] and solid [n = 41]). Following age- and sex-matching, 48 patients were selected (Group C: cannulated, n = 24; Group S: solid, n = 24). RESULTS: Screw breakage occurred more frequently in Group C (28.6 %) than in Group S (3.6 %) (p = 0.004). The median time to breakage was 39 weeks (range: 8-54). Logistic regression analysis revealed that usage of cannulated screws was a significant risk factor for breakage (OR 0.132, 95 % CI 0.0252-0.694; p = 0.0167). Despite higher breakage rates, Group C had better final AOFAS scores (median 95.00 vs. 90.00, p = 0.031). Among the 11 broken screws, 7 (63.6 %) were retained without adverse effects on functional outcomes. CONCLUSION: Cannulated screws were associated with increased breakage risk in Lisfranc injuries, although this did not negatively impact functional outcomes.

DOI： 10.1053/j.jfas.2025.06.001

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Radiographic Predictors of Leg Shortening After Curved Intertrochanteric Varus Osteotomy in Osteonecrosis of the Femoral Head Reviewed International journal Open Access

Hiroaki Ido, Yusuke Osawa, Yasuhiko Takegami, Hiroto Funahashi, Yuto Ozawa, Takamune Asamoto, Shiro Imagama

Orthopaedic Surgery   Vol. 17 ( 11 ) page： 3230 - 3240   2025.11

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PURPOSE: Curved intertrochanteric varus osteotomy (CVO) is a joint-preserving option for young patients with osteonecrosis of the femoral head (ONFH), but postoperative leg length discrepancy (LLD) remains a concern. This study investigated factors associated with leg shortening in both the early postoperative phase (P1) and the healing phase until bone union (P2). METHODS: This retrospective study included 48 patients (51 hips) with non-traumatic ONFH who underwent CVO. Radiographic evaluations were performed preoperatively, immediately postoperatively, and at bone union. Pearson's correlation coefficient was used to correlations between radiographic parameters and leg shortening in P1 and P2. Patients were divided into groups based on whether leg shortening ≥ 5 mm was observed in each phase, and statistical comparisons were conducted. Multivariate logistic regression analyses were performed to identify independent risk factors for leg shortening ≥ 5 mm. RESULTS: Leg shortening ≥ 5 mm occurred in 17.6% of hips in P1 and 47.1% in P2. Lateral shift of the osteotomy arc center correlated with leg shortening in P1 (r = 0.689, p < 0.0001). Varus angle and changes in femoral anteversion were also correlated in both P1 and P2 (P1: r = 0.362/0.322; P2: r = 0.404/0.754, all p < 0.05). Greater varus angle and lateral/distal shift of the osteotomy center were significantly associated with P1 shortening. In P2, greater changes in femoral anteversion, increased osteotomy distance from the midpoint of the lesser trochanter, and larger varus angle were significant factors. Multivariate analysis identified lateral shift of the osteotomy center as an independent predictor in P1 (OR, 1.30; 95% CI, 1.06-1.81; p = 0.004). In P2, change in femoral anteversion was an independent predictor of leg shortening ≥ 5 mm (OR: 1.24, 95% CI: 1.07-1.51; p = 0.003). CONCLUSION: Leg shortening post-CVO progresses during surgery and bone healing. Careful surgical planning and postoperative management, particularly in cases requiring extensive varus correction or anteversion changes, is essential for minimizing LLD and optimizing outcomes.

DOI： 10.1111/os.70172

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Association between the central sensitization inventory score and health-related quality of life in community-dwelling middle-aged and older adults. International journal Open Access

Naoki Segi, Hiroaki Nakashima, Ryotaro Oishi, Sadayuki Ito, Jun Ouchida, Ippei Yamauchi, Yasuhiro Nagatani, Taisuke Seki, Yasuhiko Takegami, Shinya Ishizuka, Yukiharu Hasegawa, Shiro Imagama

PloS one   Vol. 20 ( 10 ) page： e0335923   2025.10

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BACKGROUND: Central sensitization is an important factor associated with impaired health-related quality of life in patients with musculoskeletal disorders and community-dwelling older adults. However, health-related quality-of-life domains strongly associated with central sensitization in the general population remain unclear. This study aimed to examine the association between the Central Sensitization Inventory Part A scores and health-related quality of life using community health checkup data. METHODS: A total of 419 middle-aged and older adults (mean age, 64.4 ± 11.2 years; 59.4% female) were included. Participants completed a questionnaire survey on pain, including visual analogue scales (VASs) for lower-back and knee pain, and the Central Sensitization Inventory Part A. Additionally, participants completed the Short-Form 36-Item Health Survey, and three component-summary scores and eight subscales were calculated. Additionally, participants completed the 5-level EuroQol 5 dimensions, and health-state utility values were calculated. The correlation between the Central Sensitization Inventory Part A scores and these health-related quality-of-life measures was investigated. RESULTS: Central Sensitization Inventory Part A score ≥40 was observed in 2.6% participants. Significant moderate negative correlations were observed between the Central Sensitization Inventory Part A scores and EuroQol 5 dimensions health-state utility values (r = -0.631, P < 0.001), Short-Form 36 mental-component summary (r = -0.550, P < 0.001), body pain (r = -0.556, P < 0.001), general health (r = -0.556, P < 0.001), vitality (r = -0.610, P < 0.001), and mental health (r = -0.556, P < 0.001). Similar results were obtained for participants with Central Sensitization Inventory Part A scores <30. CONCLUSIONS: In community-dwelling middle-aged and older adults, Central Sensitization Inventory Part A scores were negatively correlated with health-related quality-of-life scores, even in participants with Central Sensitization Inventory Part A scores <30.

DOI： 10.1371/journal.pone.0335923

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Radiographic parameters of nonunion in Vancouver type C periprosthetic femoral fractures treated with plate fixation. Reviewed International journal

Shimpei Takahashi, Yasuhiko Takegami, Hiroaki Nakashima, Kenichi Mishima, Toshiki Iwase, Shiro Imagama

Archives of orthopaedic and trauma surgery   Vol. 145 ( 1 ) page： 490 - 490   2025.10

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DOI： 10.1007/s00402-025-06088-0

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Serum oxidative stress is associated with the progression of knee osteoarthritis: A 5-year longitudinal cohort in the Yakumo study. Reviewed International journal

Hiroaki Ido, Taisuke Seki, Yasuhiko Takegami, Yusuke Osawa, Hiroki Iida, Hiroaki Nakashima, Shinya Ishizuka, Yukiharu Hasegawa, Shiro Imagama

The Knee   Vol. 56   page： 323 - 331   2025.10

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INTRODUCTION: Knee osteoarthritis (KOA) is a chronic degenerative disease characterized by a reduction in joint cartilage in the in-knee joint. However, few reports have investigated the relationship between serum reactive oxygen species (ROS) and KOA. We aimed to investigate whether oxidative stress, assessed using d-ROM and biological antioxidant potential (BAP), is associated with the severity and progression of KOA in community-dwelling individuals. METHOD: We enrolled 95 participants (190 knees) who participated in the Yakumo Study. We used a computer-aided diagnosis system for KOA to obtain the average joint space width (aJSW), minimal joint space width (mJSW), joint space area (JSA), and femorotibial angle; calculated the difference between JSW and JSA at 5 years and at baseline; and divided the study population into two groups based on median d-ROM and BAP values. Statistical analyses were conducted between the groups, including propensity score matching based on age, sex, body mass index, and medial mJSW at baseline between high d-ROMs (HD) and low d-ROMs (LD) groups. RESULTS: The median values for the lateral and medial mJSW, aJSW, and JSA were significantly narrower in the HD group than in the LD group. The medial mJSW, aJSW and JSA at the 5-year follow-up were significantly narrower in the HD group than those in the LD group. CONCLUSIONS: Oxidative stress level was found to be associated with joint space narrowing and progression of joint space narrowing over the course of five years in clinical settings.

DOI： 10.1016/j.knee.2025.05.023

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Temporal Changes in the Age at Diagnosis of Osteonecrosis of the Femoral Head and Potential Associated Factors: A Multicenter Sentinel Monitoring System in Japan. Invited Reviewed International journal

Shinya Tanaka, Takashi Sakai, Wakaba Fukushima, Yasuhiko Takegami, Wataru Ando, Nobuhiko Sugano, Shiro Imagama

The Journal of arthroplasty   Vol. 40 ( 10S1 ) page： S120 - S128   2025.9

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BACKGROUND: In Japan, a multicenter sentinel monitoring system was implemented as a patient registry for osteonecrosis of the femoral head (ONFH). Although recent monitoring data suggest that the age at diagnosis of ONFH is increasing, it is unclear whether this trend is due to Japan's aging population. We aimed to evaluate the temporal trends in ONFH incidence by age group using other epidemiological data. METHODS: From the monitoring system up to 2023, patients who had diagnoses between 2002 and 2021 were categorized into four 5-year periods (2002 to 2006, 2007 to 2011, 2012 to 2016, and 2017 to 2021). To determine the incidence by sex and 10-years age groups, the sex- and age-specific proportions of newly diagnosed (incident) ONFH cases were calculated from the monitoring system. Assuming this distribution applies to all ONFH patients in Japan, the numerator of the sex- and age-specific annual incidence rates of ONFH was calculated by multiplying each proportion by the number of incident ONFH patients in the country, as estimated from previous nationwide epidemiological surveys. Japan's sex- and age-specific total population was used as the denominator. RESULTS: The incidence rate (per 100,000 population) for men aged under 29 years decreased over the four periods (1.08, 1.06, 1.02, and 0.90, respectively), as did the rate for those aged 30 to 39 years (4.40, 3.70, 3.73, and 3.30, respectively). Conversely, an increase was observed in men aged 60 to 69 years (1.69, 1.97, 2.07, and 2.78, respectively). For women, the incidence rate decreased in those under 29 years (1.12, 0.86, 0.78, 0.82), but increased in those aged 50 to 59 years (1.58, 1.23, 2.20, 2.06) and 60 to 69 years (1.28, 1.50, 1.85, 2.03). CONCLUSIONS: The age at diagnosis of ONFH is increasing among both men and women, even when considering Japan's aging population. The basic characteristics of ONFH may be changing.

DOI： 10.1016/j.arth.2025.05.090

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Increasing Prevalence and Risk Factors for Multifocal Osteonecrosis in Patients Who Have Corticosteroid-Associated Osteonecrosis of the Femoral Head: A 15-Year Multicenter Study. Invited Reviewed International journal

Keiji Otaka, Takashi Sakai, Wakaba Fukushima, Yasuhiko Takegami, Wataru Ando, Shiro Imagama, Nobuhiko Sugano

The Journal of arthroplasty   Vol. 40 ( 10S1 ) page： S146 - S151   2025.9

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BACKGROUND: Multifocal osteonecrosis (MFON) is a rare condition affecting multiple bone sites, with limited epidemiological data available. This study investigated the frequency, trends, and risk factors for MFON in patients aged > 15 years who had corticosteroid-associated osteonecrosis of the femoral head (ONFH) using data from a multicenter sentinel monitoring system in Japan. METHODS: Data from 658 patients between 2009 and 2023 were analyzed. The MFON was defined as osteonecrosis involving three or more separate anatomical sites. The frequency and trends of MFON were assessed across three 5-year periods. The risk factors for MFON were analyzed using data from 2014 onward, when smoking history data became available. The group with no necrosis other than that in the femoral head was defined as the non-MFON group, and the demographics and comorbidities were compared between the MFON and non-MFON groups. The risk factors were analyzed using univariate and logistic regression analyses. RESULTS: The frequency of MFON was 5.3% during the entire period and increased significantly over time (1.6, 7.4, and 8.0%; P < 0.01). The knee joint was the most common site of osteonecrosis, and all patients had knee joint involvement. The MFON group was younger (P < 0.001) and had more women (P < 0.05) than the non-MFON group and had significantly more patients who had systemic lupus erythematosus (SLE) and hematological tumors (both P < 0.01). The independent risk factors for MFON included age < 40 years (P < 0.05), SLE (P < 0.05), and hematological tumors (P < 0.001). CONCLUSIONS: The frequency of MFON in patients who had corticosteroid-associated osteonecrosis of the femoral head was 5.3%. Young patients, those who have SLE, or those who have hematological tumors are at a higher risk of MFON and should be considered for MFON screening.

DOI： 10.1016/j.arth.2025.05.043

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Comparison of the Progression Rate of Femoral Head Collapse in Japanese Investigation Committee Classification Types B1 and B2 of Osteonecrosis of the Femoral Head. Reviewed International journal

Hiroaki Ido, Yusuke Osawa, Yasuhiko Takegami, Hiroto Funahashi, Takamune Asamoto, Shiro Imagama

The Journal of arthroplasty   Vol. 40 ( 10S1 ) page： S66 - S71   2025.9

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BACKGROUND: The Japanese Investigation Committee classification of type B osteonecrosis of the femoral head (ONFH) should be further subdivided into types B1 and B2 based on the center of the weight-bearing area. In this study, we investigated whether there is a difference in survival rates between types B1 and B2. METHODS: This study included patients diagnosed with type B ONFH at our institution between 2010 and 2021 who either progressed to collapse or did not collapse and were followed up for at least 3 years. Magnetic resonance imaging (MRI) and X-ray were used to classify the cases into types B1 and B2, and femoral head survival rates were evaluated using progression to collapse (> 3 mm) as the endpoint. The study analyzed 50 cases (62 hips) classified by MRI (25 men, mean age 38 years) and 45 cases (59 hips) classified by X-ray (22 men, mean age 37 years). RESULTS: Femoral head collapse progression in type B was observed in 10 hips (16.1%) on MRI and seven hips (11.8%) on X-ray. For MRI, type B1 showed one hip (3.4%) and type B2 showed nine hips (27.3%), while using X-ray, type B1 showed zero hips (0%) and type B2 showed seven hips (20.6%), with significant differences (P = 0.015 and P = 0.017, respectively). The 5-year survival rate, with collapse progression as the endpoint, was 100% for type B1 and 72.5% for type B2 on MRI, and 100% for type B1 and 79.4% for type B2 on X-ray, both showing significant differences (P = 0.005 and P = 0.02, respectively). CONCLUSIONS: Comparison of types B1 and B2, classified by MRI and X-ray, showed significantly different survival rates. Subdividing JIC type B ONFH into types B1 and B2 provides an effective indicator for predicting the prognosis of femoral head survival.

DOI： 10.1016/j.arth.2025.05.055

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Dietary intake and its association with sarcopenia in older adults: a cross-sectional analysis. Reviewed Open Access

Hiroaki Nakashima, Sadayuki Ito, Naoki Segi, Jun Ouchida, Ippei Yamauchi, Yasuhiko Takegami, Shinya Ishizuka, Kenji Wakai, Yukiharu Hasegawa, Shiro Imagama

Nagoya journal of medical science   Vol. 87 ( 3 ) page： 451 - 461   2025.8

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Sarcopenia, a condition characterized by the loss of muscle mass and function, poses a major health challenge among older adults. Identifying nutritional factors and dietary patterns associated with sarcopenia is critical for developing targeted interventions. This study analyzed data from 584 community-dwelling older adults (245 male, 339 female) enrolled in the Yakumo Study to investigate the relationship between dietary factors and sarcopenia. Nutritional intake was assessed using a validated Food Frequency Questionnaire (FFQ), while dietary diversity was evaluated using dietary variety score (DVS). Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia (AWGS) criteria, based on skeletal muscle mass, hand grip strength, and walking speed. The prevalence of sarcopenia in the study population was 7.4%. Nutritional intake of individual nutrients, such as protein and vitamin D, did not significantly differ between sarcopenic and non-sarcopenic participants. However, the intake rates for total calories, dietary fiber, vitamin B1, vitamin B2, and vitamin C were significantly higher in the sarcopenia group. No significant differences were found in DVS, and no correlations were found between DVS scores and skeletal muscle mass index, grip strength, or walking speed. These results may indicate that factors beyond nutrient intake-such as nutrient absorption, utilization, and metabolic efficiency-play a pivotal role in sarcopenia development.

DOI： 10.18999/nagjms.87.3.451

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Conventional versus computer-tomography based navigation assisted eccentric rotational acetabular osteotomy in less experienced surgeons. Reviewed International journal

Yusuke Osawa, Yasuhiko Takegami, Hiroto Funahashi, Hiroaki Ido, Takamune Asamoto, Shiro Imagama

Archives of orthopaedic and trauma surgery   Vol. 145 ( 1 ) page： 383 - 383   2025.7

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INTRODUCTION: The use of navigation systems may improve the preoperative planning and outcomes of less-experienced surgeons for periacetabular osteotomies. This study aimed to evaluate the clinical outcomes of conventional and navigation-guided eccentric rotational acetabular osteotomy (ERAO). METHODS: The inclusion criteria were patients that underwent ERAO performed by less experienced surgeons (performing ERAO less than 25 cases) for hip dysplasia between January 2016 and December 2022. The study group was divided into the conventional (38 patients, 42 hips) and navigation groups (32 patients, 34 hips). Assessment tools included the operative time, blood loss, preoperative and final follow-up Harris Hip Scores (HHS), complications, and acetabular imaging parameters. RESULTS: The study included a total of 70 patients (6 men and 64 women, average age of 35.1 years, 76 hip joints). There were no significant differences in the operative time, intraoperative blood loss, and preoperative and final HHS scores between the two groups. Complications were observed in 10 (24%) and 3 (9%) hip joints in the conventional and navigation groups, respectively. Conversion to total hip arthroplasty was performed in two hip joints (5.4%) in the conventional group and none in the navigation group. The postoperative lateral center edge angle and acetabular head index were significantly greater in the navigation group than in the conventional group. DISCUSSION: This study demonstrated that even less experienced surgeons can reduce complications and achieve favorable acetabular coverage with ERAO using navigation systems.

DOI： 10.1007/s00402-025-05990-x

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Elderly trochanteric fracture outcomes: Unveiling the risks of excessive postoperative sliding - A retrospective multicenter (TRON group) investigation. Reviewed

Makoto Suzuki, Yasuhiko Takegami, Katsuhiro Tokutake, Hiroaki Nakasima, Kenichi Mishima, Hiroaki Kumagai, Shiro Imagama

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association   Vol. 30 ( 4 ) page： 678 - 684   2025.7

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BACKGROUND: Intramedullary nailing (IMN) for femoral trochanteric fractures (FTF) is the primary surgical intervention. Excessive lag screw sliding (ES) of the femoral neck screw sometimes occurs. This multicenter investigation sought to 1) determine the prevalence of ES, 2) evaluate the relationship between ES and postoperative complications, and 3) identify the factors of ES in elderly patients with FTF undergoing IMN. METHODS: From 2016 to 2020, 1448 patients with FTF were treated using a short IMN across 11 institutions (TRON group). Upon applying exclusion criteria, 519 patients (127 men, 392 women; mean age, 84.4 years) were included. The postoperative sliding distance was measured immediately after surgery and at final follow-up. A sliding distance of ≥8 mm categorized patients as having ES. We identify the factors contributing to ES using the logistic regression analysis, with a p < 0.05 as statistical significance. RESULTS: ES was observed in 116 patients (22.4 %). Patients with ES had a higher incidence of postoperative cut-out and peri-implant fracture. Logistic regression analysis showed that achieving optimal reduction in both AP and lateral views (odds ratio (OR) 0.48, p = 0.0012) and the use of a double screw system or twin screws with integrated locking mechanism significantly reduced the risk of ES (OR 0.27, 0.17; p = 0.0027, <0.001). CONCLUSIONS: The incidence rate of ES was 22.4 %. ES was associated with a higher risk of postoperative complications. The surgeons should aim for optimal reduction and use a double screw or twin screws with an integrated interlocking mechanism as the implant of choice.

DOI： 10.1016/j.jos.2024.09.003

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Risk factors for non-union in femoral neck fractures patients with internal fixation: A multicenter (TRON Group) retrospective study Reviewed

倉橋真吾, 竹上靖彦, 伊藤圭吾, 木下晋, 杉野貴之, 伊藤裕哉, 福井絢之郎, 若山貴洋, 金子京平

骨折(Web)   Vol. 30 ( 4 ) page： 672 - 677   2025.7

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: Femoral neck fractures (FNFs) are common in elderly individuals. When minimally displaced, they are typically treated with internal fixation. Nonunion is a complication of internal fixation of FNF, that sometimes necessitates reoperation. Radiographic parameters, including the Pauwels angle and posterior tilt angle, are risk factors for nonunion. However, these parameters are assessed solely in a two-dimensional context. We developed a novel radiographic parameter named the "Kindex." This multicenter investigation aimed to identify risk factors for nonunion following FNF fixation and evaluate the validity of this index. METHODS: This retrospective multicenter study collected data from 939 FNF patients who underwent internal fixation between 2016 and 2020 at 11 facilities (TRON group). The following exclusion criteria were applied: age <65, insufficient data, and Garden Stage III or IV fracture. Patient data, including age, sex, BMI, ASA classification, alcohol and smoking history, and comorbidities, were recorded. Radiographic measurements of the Pauwels angle and posterior tilt angle at the time of injury were used to calculate the Kindex. Correlations between the Pauwels angle, posterior tilt angle, Kindex, and nonunion were evaluated. A multivariate logistic regression analysis was performed to investigate independent risk factors for nonunion. A receiver operating characteristic (ROC) analysis was performed to determine the cutoff value of the Kindex, and the area under the curve (AUC) was calculated. RESULTS: The study included 594 patients (males, n = 151; females, n = 443; average age, 80.9 years). Nonunion was observed in 13 cases (2.2 %). While the Pauwels angle and posterior tilt angle did not show significant correlations, the Kindex exhibited strong correlations with both parameters. In the multivariate analysis, the Kindex and renal impairment were independent risk factors for nonunion (Kindex: OR 1.06, p = 0.015; renal impairment: OR 1.48, p = 0.021). In the ROC analysis, a Kindex of 50 was identified as the optimal cutoff value (AUC 0.72). CONCLUSION: The nonunion rate after internal fixation of FNF was 2.2 %. Renal impairment and the Kindex were identified as independent risk factors. The Kindex at the time of injury may serve as a novel radiographic parameter to consider when evaluating the need for internal fixation in FNF cases.

DOI： 10.1016/j.jos.2024.09.002

Web of Science

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PubMed

J-GLOBAL

An Easy New Method for Reducing Anterior Shoulder Dislocations: The Lateral Position Technique. Reviewed International journal

Koichiro Makihara, Nobuhiko Makihara, Yasuhiko Takegami

Cureus   Vol. 17 ( 7 ) page： e88803   2025.7

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Background Anterior shoulder dislocation is the most common dislocation that occurs in the human body, and reduction can still be a major challenge to the physician. Objectives To develop a new reduction technique called the lateral position maneuver (LPM) method (also known as the Makihara method), which is performed in a lateral position by a single physician without sedation. Methods Eighty-five patients with clinically and radiographically proven acute anterior shoulder dislocations were included. The LPM method was used for all the patients included in the study. The inclusion criterion was a traumatic anterior dislocation of the shoulder that presented within 24 hours of injury, including those with a greater tuberosity fracture or Bankart lesion. Patients with multiple traumas, Neers three- or four-part fractures, insufficient clinical data, neuropathy, and dislocations repaired by other methods were excluded. Ultimately, 13 shoulders (13 patients) were included in the study. Results Numerous reduction techniques for anterior glenohumeral joints exist, and the success rate for first-time anterior shoulder dislocations ranges from 70% to 90%. Most of these techniques required assistance and sedation during the procedure; however, our technique is easy to perform as we were able to achieve a closed reduction of acute anterior dislocation, requiring only a single physician to perform it without the use of sedation. Conclusions This study showed that there were no complications from the use of the LPM method (Makihara method) and that it is useful. The number of patients included in this study was small, but further additional studies are needed to confirm its efficacy.

DOI： 10.7759/cureus.88803

PubMed

Postoperative Rehabilitation Following Total Hip Arthroplasty in Achondroplasia: A Case Report Focused on Dislocation Prevention and Environmental Simulation. Reviewed International journal Open Access

Shota Uchida, Shusuke Nojiri, Azusa Kayamoto, Hiroki Iida, Yusuke Osawa, Yasuhiko Takegami

Cureus   Vol. 17 ( 7 ) page： e88271   2025.7

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Individuals with achondroplasia (ACH), a skeletal dysplasia characterized by disproportionate short stature and joint laxity, often adopt greater hip flexion as a compensatory movement to navigate environments designed for individuals of average stature, such as when climbing relatively high standard steps or using standard-height furniture. This necessary adaptation, however, consequently increases the risk of dislocation following total hip arthroplasty (THA). This case report describes the postoperative rehabilitation course of a 68-year-old Japanese woman (height: 113.7 cm, weight: 31.8 kg, body mass index: 24.6 kg/m²) with ACH and coexisting osteoarthritis who underwent a right THA via the posterior approach. The patient's primary goal was to return to living on the second floor of her two-story house. Achieving this goal required her to learn how to negotiate stairs safely, with careful attention to minimizing dislocation risk, to ensure a safe discharge home. Early postoperative rehabilitation was specifically tailored to her short stature. It included transfer training with a footstool and gait training with a pediatric walker. A key part of the rehabilitation was early stair negotiation training, which used an adapted kneeling technique to prevent deep hip flexion. This technique simulated her home environment and was designed to reduce the risk of posterior dislocation. By postoperative day (POD) 7, the patient could walk independently with a T-cane. By POD 24, she had mastered stair negotiation, which allowed her to be discharged home. This case highlights the critical need for highly individualized rehabilitation plans for patients with ACH undergoing THA. Successful outcomes depend on careful consideration of the patient's specific body measurements (anthropometrics), their home environment, the early start of adapted movement training, and thorough education on how to prevent dislocation.

DOI： 10.7759/cureus.88271

Open Access

PubMed

Comparison of Clinical Outcomes of Periprosthetic Fractures Between Cemented vs Cementless Stem Methods After Initial Total Hip Arthroplasty or Bipolar Hemiarthroplasty: A Multicenter Analysis (TRON Study) Reviewed International journal

Hiroaki Tachi, Yasuhiko Takegami, Toshiaki Okura, Katsuhiro Tokutake, Hiroaki Nakashima, Kenichi Mishima, Takehiro Kasai, Shiro Imagama

Arthroplasty Today   Vol. 33   page： 101699 - 101699   2025.6

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Periprosthetic femoral fractures are challenging complications after total hip arthroplasty (THA) or bipolar hemiarthroplasty (BHA). This multicenter study compared clinical outcomes of surgical periprosthetic femoral fracture (PFF) treatment following initial implantation of cemented vs cementless femoral stems. METHODS: This retrospective multicenter study included 201 patients from multiple hospitals who had PFFs treated surgically between 2010 and 2022. They were divided into THA (n = 71) and BHA (n = 130) cohorts based on initial arthroplasty. Clinical outcomes of mortality, radiographic bone union, operative metrics, and complications were compared after the patients were matched for age. RESULTS: In the matched THA cohorts (n = 15 each), there were no significant differences in mortality, bone union, operative time, blood loss, or complications between cemented and cementless stems. In the matched BHA cohorts (n = 27 each), mortality and bone union were similar, but cementless stems showed higher intraoperative blood loss. Furthermore, Type B fractures were more common with cementless stems, whereas Type C fractures were predominated with cemented stems. CONCLUSIONS: Among patients who underwent THA or BHA, mortality and bone union following treatment of PFFs did not differ between cemented and cementless stems. However, patients who underwent BHA with cementless stems required longer operations and lost more blood. Type B fractures requiring revision occurred more frequently with cementless stems, whereas Type C fractures treated with open reduction and internal fixation were more frequent with cemented stems, which thus influenced perioperative factors. Cement use for initial arthroplasty was associated with certain favorable characteristics and positive treatment outcomes of PFFs.

DOI： 10.1016/j.artd.2025.101699

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PubMed

Primary nerve exploration is required in more than 10% of complete motor nerve paralysis cases associated with Gartland type III paediatric supracondylar humerus fractures : a multicentre retrospective study. Reviewed International journal Open Access

Rina Ito, Katsuhiro Tokutake, Yasuhiko Takegami, Nobuyuki Okui, Tadahiro Natsume, Shukuki Koh, Masahiro Tatebe, Michiro Yamamoto

Bone & joint open   Vol. 6 ( 6 ) page： 609 - 617   2025.6

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AIMS: This study aims to determine the prevalence, prognosis, and outcome of complete motor paralysis associated with Gartland type III paediatric supracondylar humerus fractures (SCHFs) and identify when primary nerve exploration is indicated. METHODS: In this multicentre retrospective study, we investigated complete motor paralysis associated with Gartland type III paediatric SCHFs. Iatrogenic paralysis was excluded. Radiographs were used to determine a fascial penetration sign. Findings from nerve explorations were recorded. Notable cases were defined as those with the following nerve conditions: 1) complete or partial laceration; 2) tethering/entrapment; 3) formation of a neuroma; or 4) entrapment at the fracture site or callus. The frequency with which ultrasound was used was documented and its findings were examined. RESULTS: Among 691 patients with Gartland type III SCHFs, 45 (7%) had complete motor paralysis. Of these, 20 (44%) were managed without primary nerve exploration. Overall, 18 (90%) spontaneously recovered and two (10%) required neurorrhaphy and nerve grafting during a secondary exploration. Of the other 25 (56%) who underwent primary nerve exploration, one had a complete radial nerve laceration, and five had tethered/entrapped nerves. The fascial penetration sign was positive in each of the eight notable cases (18%), a rate that was substantially higher than in the others (19 of 37; p = 0.014, sensitivity 100%, specificity 49%). Ultrasound was used preoperatively in 14 cases (31%) to investigate the condition of the nerve, possible contact with the proximal fragment, and its changes after traction. CONCLUSION: For Gartland type III paediatric SCHF patients with complete motor paralysis, we estimate that more than 10% require primary nerve exploration due to tethered/entrapped or lacerated nerves. A positive fascial penetration sign on radiography provided early evidence that primary nerve exploration was warranted. In addition, preoperative ultrasound under general anaesthesia to assess the condition of the nerves can play a crucial role.

DOI： 10.1302/2633-1462.66.BJO-2025-0020.R1

Open Access

Web of Science

Scopus

PubMed