Faculty Profiles - TAKEGAMI Yasuhiko

Papers - TAKEGAMI Yasuhiko

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Fatty infiltration of periarticular muscles in patients with osteonecrosis of the femoral head. Reviewed International journal Open Access

Keiji Otaka, Yusuke Osawa, Yasuhiko Takegami, Hiroki Iida, Hiroto Funahashi, Shiro Imagama

International orthopaedics Vol. 49 ( 5 ) page： 1073 - 1080 2025.5

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

PURPOSE: Muscle mass and fatty infiltration can be assessed on computed tomography (CT) images using the cross-sectional area (CSA) and computed tomography attenuation value (CTV). Femoral head collapse in osteonecrosis of the femoral head (ONFH) may affect both values. We investigated factors influencing the CSA and CTV of the periarticular muscles in patients with ONFH. METHODS: Overall, 101 patients with ONFH with unilateral hip pain (stage 2, 24 patients; stage 3 A, 49 patients; and stage 3B, 28 patients) were included. The CSA and mean CTV of the bilateral gluteus maximus (Gmax), gluteus medius (Gmed), gluteus minimus (Gmin), and iliopsoas (IP) muscles were measured using CT cross-sections. Bilateral comparisons and associations with Japanese Investigation Committee (JIC) stage were analysed. Multiple regression analysis was used to evaluate factors associated with the CSA and CTV. RESULTS: On the symptomatic side, the CSA was significantly lower for the Gmax, Gmed, and IP, whereas the CTV was significantly lower for all tested muscles (all p < 0.01). The CTV, but not the CSA, of the Gmax, Gmed, and Gmin was significantly associated with the JIC stage severity bilaterally (all p < 0.01). Multiple regression analysis showed significant associations of the CTV with age, sex, and JIC stage (all p < 0.01). CONCLUSION: Symptomatic ONFH leads to decreased muscle mass and increased fatty infiltration. Femoral head collapse progression is associated with a decrease in the CTV. Periarticular muscle assessment, including on the contralateral side, is important in patients with ONFH, particularly in older women.

DOI： 10.1007/s00264-025-06457-9

Comparative outcomes of in-situ fixation and fixation after reduction in geriatric patients with severe valgus-impacted femoral neck fractures: a retrospective multicenter (TRON group) study. Reviewed Open Access

Tatsuya Nobori, Yasuhiko Takegami, Katsuhiro Tokutake, Hiroaki Nakashima, Kenichi Mishima, Masanori Okamoto, Nobuyuki Okui, Shiro Imagama

Nagoya journal of medical science Vol. 87 ( 2 ) page： 295 - 304 2025.5

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

The objective of this study was to evaluate and compare the clinical and radiographic outcomes between in situ fixation and fixation after reduction of severe valgus-impacted femoral neck fractures in patients aged 65 years or older. This was a multicenter retrospective study of 561 patients who underwent open reduction and internal fixation for femoral neck fracture. From this population, we selected patients aged 65 years and older with severe valgus-impacted femoral neck fractures characterized by a Garden alignment index greater than 15 degrees compared to that on the non-injury side. After exclusion criteria were applied, the study included 92 patients who were categorized into two groups: in situ fixation group (n = 56) and fixation after reduction group (n = 36). Our analysis covered patient demographics, surgical details, postoperative complications, radiographic evaluations, Numeric Rating Scale for pain, and Parker's Mobility Score for clinical outcomes. Bone union was achieved in all patients. The incidence of avascular necrosis was consistent between the groups. Patients in the reduction group reported lower Numeric Rating Scale scores (mean: 0 vs 2, p = 0.003) and higher Parker's Mobility Score scores (mean: 7 vs 6, p = 0.009) compared with the in situ group. Radiographically, the reduction group showed significantly lower femoral neck shortening (mean: 4.75 mm vs 5.75 mm, p = 0.049) and a reduced length of cannulated cancellous screw backout (mean: 3.4 mm vs 5.4 mm, p = 0.007) at the final follow-up. Fixation after reduction for severe valgus-impacted femoral neck fractures in patients aged 65 and above appears to be a safe and effective approach.

DOI： 10.18999/nagjms.87.2.295

One-Year Survival and Postoperative Complications in Older Patients with Intertrochanteric Fractures: Association with Polypharmacy—A Multicenter Retrospective Cohort Study Reviewed International journal

Yasuhiko Takegami, Yusuke Osawa, Hiroto Funahashi, Takamune Asamoto, Hiroaki Ido, Keiji Otaka, Shinya Tanaka, Hiroshi Asai, Hiroyuki Yokoi, Shiro Imagama

Drugs & Aging Vol. 42 ( 5 ) page： 435 - 444 2025.5

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

INTRODUCTION: Polypharmacy is common in older patients and associated with adverse outcomes. However, the association with outcomes in patients with intertrochanteric fractures remains unclear. This study aimed to investigate associations between polypharmacy and 1-year survival (primary outcome) and postoperative complications (secondary outcome), in older patients undergoing surgical treatment for intertrochanteric fractures. PATIENTS AND METHODS: This multicenter retrospective study initially identified 1864 patients who underwent surgical treatment for intertrochanteric fractures between 2016 and 2020. We excluded those aged < 65 years, with polytrauma, or with Charlson Comorbidity Index (CCI) > 3 or insufficient data. Patients were classified into polypharmacy (≥ 5 medications) and non-polypharmacy (< 5 medications) groups. We performed two analyses: (1) complete case analysis using 1:1 propensity score matching (498 pairs) with variables including age, sex, body mass index (BMI), CCI, residence before admission, fracture type, American Society of Anesthesiologists (ASA) physical status (PS), and Parker Mobility Score, followed by Kaplan-Meier survival analysis with log-rank test and chi-squared test for complications and (2) multivariate Cox regression analysis using multiple imputation (CART method, five imputed datasets) of the eligible cohort (N = 1608), adjusting for the same variables. RESULTS: In the matched cohort, the 1-year survival rate was significantly lower in the polypharmacy group (91.3%; 95% CI 87.7-93.8) compared with the non-polypharmacy group (94.0%; 95% CI 90.9-96.1; P = 0.027). Postoperative complications showed no significant differences between groups. Cox regression analysis revealed that advanced age, male sex, ASA-PS, and polypharmacy were associated with decreased survival, while higher Parker Mobility Score and normal and higher BMI showed improved survival. CONCLUSIONS: Polypharmacy was associated with lower postoperative survival in older patients with intertrochanteric fractures and few comorbidities. As a potentially modifiable factor, medication review through multidisciplinary collaboration might contribute to improved outcomes.

DOI： 10.1007/s40266-025-01194-5

Longitudinal transitions in frailty and health-related quality of life investigated by a 5-year community study. Reviewed International journal

Ryotaro Oishi, Naoki Segi, Masaki Okazaki, Sadayuki Ito, Jun Ouchida, Ippei Yamauchi, Taisuke Seki, Yasuhiko Takegami, Shinya Ishizuka, Atsushi Hashizume, Yukiharu Hasegawa, Shiro Imagama, Hiroaki Nakashima

Scientific reports Vol. 15 ( 1 ) page： 15162 - 15162 2025.4

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

The purpose of this study was to determine the association between frailty and quality of life (QOL) in a five-year longitudinal cohort of community-dwelling middle-aged and older adults and determine how to identify health-related QOL changes. This study included 124 volunteers (67 women; mean 65 years at baseline) who underwent health checkups in 2014 and 2019. The association between frailty status (robust, prefrail, frail), according to the Japanese Cardiovascular Health Study criteria, and health-related QOL, measured with the SF-36 questionnaire, were investigated. Five-year changes in frailty status were categorized into improved, maintained, and worsened groups. The baseline prevalence of prefrailty and frailty were 44.4% and 7.2%, respectively. Five years later, the frailty of 20 participants improved, 66 maintained frailty status, and frailty worsened in 38 participants. Significant trends toward higher scores on the physical component summary (PCS), role/social component summary (RCS), and subscales of physical functioning, role-physical, vitality, social functioning, and role-emotional were detected across groups with improvements in their frailty status from 2014 to 2019. The fully adjusted multivariable regression model revealed significantly higher PCS scores (β, 12.9; 95% confidence interval (CI), 6.0 to 19.9) and RCS scores (β, 13.6; 95% CI, 6.6 to 20.6) compared with the worsened group. In conclusion, this longitudinal cohort study demonstrates that frailty status is not static and improvements or maintenance of frailty are associated with better physical and social QOL outcomes. Addressing frailty early may reverse or mitigate its impact and improve the overall well-being of older adults.

DOI： 10.1038/s41598-025-99843-7

Is routine implant removal necessary after open reduction internal fixation of Lisfranc injuries? Comparing functional outcomes of routine and on-demand removal: A multicenter study Reviewed International journal

Satoshi Muto, Yasuhiko Takegami, Hiroaki Nakashima, Kenichi Mishima, Hiroaki Kumagai, Shiro Imagama

Injury Vol. 56 ( 4 ) page： 112240 - 112240 2025.4

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

INTRODUCTION: Lisfranc joint injuries are a severe cause of disruption of foot stability and function, often requiring surgical intervention such as open reduction and internal fixation (ORIF). The necessity of routine implant removal after healing remains controversial. This study aimed to compare functional recovery and postoperative complications among patients undergoing routine, on-demand, or no implant removal following ORIF for Lisfranc fracture-dislocations. MATERIALS AND METHODS: This multicenter retrospective study analyzed 188 patients treated with ORIF for Lisfranc fracture-dislocations. Patients were divided into three groups: routine removal (RR), on-demand removal (ODR), and no removal (NR). Functional outcomes were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) midfoot score at the final follow-up. Complications were categorized as implant-related or post-removal. AOFAS midfoot scores and complication rates were compared between the three groups. RESULTS: The median AOFAS midfoot scores at the final follow-up were 92 (IQR 83.00-95.00) in the RR group, 95 (IQR 85.00-95.00) in the ODR group, and 95 (IQR 82.00-95.00) in the NR group, with no significant differences among the three groups (p > 0.05). Implant-related complications were comparable across the groups, although irritation was significantly more frequent in the ODR group (42.9 %) than in the RR (24.4 %) and NR (11.9 %) groups (p = 0.013). Post-removal complications occurred in two cases in the RR group, including one case of loss of correction requiring reoperation. CONCLUSION: Routine implant removal did not show superior outcomes in functional recovery or complication rates compared to selective removal or retention. Implant retention or selective removal based on individual needs minimizes complications and optimizes patient outcomes.

DOI： 10.1016/j.injury.2025.112240

Direction of pelvic obliquity after total hip arthroplasty for dysplastic hip osteoarthritis: a retrospective observational study. Reviewed International journal Open Access

Hiroyuki Yokoi, Yusuke Osawa, Yasuhiko Takegami, Yuto Ozawa, Hiroto Funahashi, Shiro Imagama

Archives of orthopaedic and trauma surgery Vol. 145 ( 1 ) page： 195 - 195 2025.3

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

INTRODUCTION: Pelvic obliquity (PO) in dysplastic hip osteoarthritis (DHOA) can present as either upward or downward tilting of the affected side. This study investigated the influence of preoperative PO direction on postoperative clinical outcomes and hip-spine morphology in patients undergoing total hip arthroplasty (THA). MATERIALS AND METHODS: Data from 116 (21 men, 95 women) patients with unilateral DHOA, who underwent THA at a single institution between June 2018 and September 2023 and exhibited ≥ 2° of PO, were analyzed. Patients were categorized into two groups: upward PO (U-PO [≥ 2° upward tilt, n = 35]); and downward PO (D-PO [≥ 2° downward tilt, n = 81]). Patient demographic information, surgery-related factors, hip function scores, and radiographic parameters of the hip, lower limbs, and spine were compared between the groups. RESULTS: Except for the duration of hip disorders, no significant differences were observed in patient background and surgical data between the groups. Preoperatively, the U-PO group exhibited a larger acetabular offset, greater hip adduction angle, longer functional leg length on the affected side, and greater ipsilateral convex lumbar scoliosis than the D-PO group (P = 0.034, P < 0.001, P < 0.001, and P < 0.001, respectively). Postoperatively, a greater hip adduction angle and longer functional leg length discrepancy persisted in the U-PO group compared to those in the D-PO group (P < 0.001 and P = 0.002, respectively). The median (interquartile range) residual PO was greater in the U-PO group (3° [0-4°]) than that in the D-PO group (1° [0-3°]) (P = 0.009). Compared with the D-PO group, the mean postoperative hip Japanese Orthopaedic Association scores were significantly lower in the U-PO group (85 [81-92] vs. 92 [85-96], P = 0.016). CONCLUSION: The U-PO group exhibited greater residual hip adduction angles, longer functional leg lengths on the affected side, and less improvement in PO after THA than the D-PO group, resulting in poorer postoperative hip function.

DOI： 10.1007/s00402-025-05829-5

Computed tomography-based navigation versus accelerometer-based portable navigation in total hip arthroplasty for dysplastic hip osteoarthritis. Reviewed International journal Open Access

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

European journal of orthopaedic surgery & traumatology : orthopedie traumatologie Vol. 35 ( 1 ) page： 83 - 83 2025.3

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

PURPOSE: Accurate cup placement is challenging in total hip arthroplasty (THA) for dysplastic hip osteoarthritis (DHOA) because of the complex morphology of the acetabulum. Studies have reported good accuracy for total hip arthroplasty (THA) using computed tomography-based navigation (CTN); however, in recent years, portable navigation (PN) has become more widely applied because of its low cost and ease of use. This study aimed to compare the accuracy of portable navigation with that of CT-based navigation. METHODS: A total of 114 patients underwent THA for DHOA via the standard posterior approach in the lateral decubitus position using the CTN (CTN-THA group) or PN (PN-THA group) system. After propensity score matching, 32 patients were included in each group. The accuracy of cup inclination, anteversion, cup placement position, and operative time were compared between the groups. RESULTS: There was no difference in accuracy error between the CTN-THA (inclination 2.8 ± 2.0° and anteversion 3.4 ± 2.1°) and PN-THA groups (inclination 2.5 ± 1.8° and anteversion 2.6 ± 2.2°). The CTN-THA group (inclination 2.2 ± 2.0° and anteversion 2.1 ± 1.6°) achieved better navigation error compared to the PN-THA group (inclination 2.6 ± 2.2° and anteversion 3.8 ± 3.3°). The error of cup placement position in the anteroposterior direction was significantly larger in the PN-THA group (4.27 ± 3.02 mm) than in the CTN-THA group (2.13 ± 2.17 mm). The operative time was significantly longer in the CTN-THA group (115 ± 41 min) than in the PN-THA group (87 ± 19 min). CONCLUSIONS: CTN-THA exhibited better accuracy than PN-THA for both cup placement angles and positions. CTN-THA tended to increase the operative time compared to PN-THA.

DOI： 10.1007/s00590-025-04188-6

Comparative Outcomes of Anterior and Posterior Plating for Distal-Third Humerus Shaft Fractures. Reviewed International journal

Yuya Shimamoto, Katsuhiro Tokutake, Yasuhiko Takegami, Yuta Asami, Ken Sato, Hiroki Ueno, Takahiko Nakano, Sei Fujii, Nobuyuki Okui, Shiro Imagama

The Journal of hand surgery Vol. 50 ( 3 ) page： 375.e1 - 375.e8 2025.3

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

PURPOSE: When treating distal-third humerus shaft fractures (HSFs) surgically, the optimal approach for plating is controversial. We conducted a retrospective multicenter study to investigate and compare the clinical outcomes of anterior and posterior plating in distal-third HSFs and the incidence of complications including iatrogenic radial nerve palsy. METHODS: We identified 116 patients from our multicenter trauma database who were diagnosed as having distal-third HSFs and who underwent surgical treatment, including intramedullary nailing between 2011 and 2020. We analyzed 50 cases treated in one of two ways: open reduction internal fixation with anterior plating (group A: 20 cases) and open reduction internal fixation with posterior plating (group P: 30 cases). RESULTS: The findings were similar in terms of operation time, estimated bleeding, and clinical and radiographic outcomes between the groups. Postoperative radial nerve palsy occurred only in group P (4 cases) and never in group A. CONCLUSIONS: The results of this study suggest that the anterior approach is a safe and effective method for treating distal-third HSFs with satisfactory outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

DOI： 10.1016/j.jhsa.2023.07.014

Fracture of the patella involving inferior pole is associated with postoperative patella baja - A retrospective multicenter study. Reviewed

Fuminori Murase, Yasuhiko Takegami, Katsuhiro Tokutake, Hiroki Oyama, Oki Arakawa, Tetsuro Takatsu, Hiroaki Nakashima, Kenichi Mishima, Shiro Imagama

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association Vol. 30 ( 2 ) page： 379 - 384 2025.3

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

BACKGROUND: The patella fracture involving of inferior pole fractures (IPF) may be associated with patella baja, However, the clinical impact of this condition remains unclear. This study aims to clarify 1) the incidence of patella baja following patellar fracture surgery, 2) the associated clinical outcomes with and without the presence of patella baja, and 3) the potential correlation between the detection of IPF on CT and the occurrence of patella baja. METHODS: We conducted a retrospective multicenter study involving 251 patients who underwent surgical treatment for patellar fractures. Patients were divided into the patella baja (PB; n = 49) group and patella norma (PN; n = 202) group. Data collected included demographics, radiographic findings, surgical details, and postoperative complications. We compared these items between PB group and PN group. Logistic regression analyses were used to identify risk factors for patella baja. RESULTS: Immediately following surgery, 36 (14.3%) patients presented with patella baja which increased to 49 cases (19.5%) at six months postoperatively. There is no statistically significant difference in the demographics, surgical details, clinical outcomes and complication between PB group and PN group. While, in the radiographical assessment, the prevalence of IPF on CT scan in the patella baja group was significantly higher than that in the patella norma group. By logistic regression analysis, IPFP on CT was identified as an independent risk factor for patella baja. (odds ratio 2.11, 95% confidence interval: 1.03-4.33, p = 0.042). CONCLUSION: In patients with patellar fractures, the incidence of patella baja increased from 14.3% immediately post-surgery to 19.5% at the six-month check-up. No significant differences were observed in clinical outcomes between the patella baja group and the norma group. The patella fracture involving IPF on CT emerged as a predictive factor for patella baja.

DOI： 10.1016/j.jos.2024.03.008

Diaphyseal forearm fracture management in adolescent patients from 2011 to 2020: A multicenter study of surgery and regional anesthesia trends. Reviewed

Yoshihiko Kimura, Yuta Asami, Katsuhiro Tokutake, Yasuhiko Takegami, Kazuma Oshima, Noriko Ishihara, Shiro Imagama

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association Vol. 30 ( 2 ) page： 385 - 389 2025.3

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

BACKGROUND: Diaphyseal forearm fractures are common traumatic injuries among children. There has been much debate on the use of intramedullary nailing (IMN) or plate fixation in the adolescent population (10-16 years of age). Furthermore, as ultrasound technology has advanced, the safety and efficacy of ultrasound-guided axillary brachial plexus block for children has dramatically improved. Therefore, anesthesia options for adolescent patients have increased in recent years. This study aimed to investigate recent surgical and regional anesthesia trends of diaphyseal forearm fractures in patients 10 to 16 years of age in Japan through a multicenter epidemiological survey from 2011 to 2020. METHODS: This retrospective, multicenter study included 226 pediatric patients with diaphyseal forearm fracture aged 10-16 years treated from January 2011 to December 2020. We divided the patients into four groups according to the period in which they were treated: early (2011-2013), middle (2014-2016), late (2017-2019), and COVID-19 (2020). Information from medical records was used to investigate the number of surgeries, types of anesthesia administered, and internal fixation methods used for diaphyseal forearm fracture in adolescent patients during each period. RESULTS: The number of surgeries was generally constant in each period but decreased during the COVID-19 period. In the early, middle, late, and COVID-19 periods, the percentages of surgeries performed under regional anesthesia were 67.7, 85.5, 87.0, and 100% respectively (p = 0.003). During the same periods, the percentages of patients receiving IMN were 41.5, 49.3, 58.0, and 66.7%, respectively (p = 0.033). CONCLUSION: The use of IMN and regional anesthesia to treat diaphyseal forearm fracture in patients 10 to 16 years of age steadily increased during the study period from 2011 to 2020. These results indicate that regional anesthesia is safe, effective, and well-tolerated by adolescent patients. The treatment strategy for diaphyseal forearm fractures in adolescents using regional anesthesia in combination with IMN worked well and was effective during COVID-19. Our evidence suggests this trend will continue. We anticipate that our findings can be extrapolated for upper extremity fractures in adolescent patients beyond the Tokai region of Japan where the study was based.

DOI： 10.1016/j.jos.2024.03.009

Comparison of conjoined tendon-preserving posterior approach and conventional posterolateral approach in hemiarthroplasty for femoral neck fracture in the elderly: A multicenter (TRON group) retrospective study. Reviewed

Keisuke Ogura, Yasuhiko Takegami, Yutaro Kuwahara, Katsuhiro Tokutake, Ryo Nakashima, Shigeto Yamamoto, Kenta Naito, Takehiro Kasai, Kazuya Makida, Shiro Imagama

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association Vol. 30 ( 2 ) page： 352 - 357 2025.3

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

BACKGROUND: Femoral neck fractures (FNF) are one of the most common traumatic injuries in the elderly. The conjoined tendon-preserving posterior (CPP) approach was developed as a modification of the conventional posterolateral (PL) approach in hemiarthroplasty (HA) for displaced femoral neck fractures (FNF) to reduce postoperative dislocation. We hypothesized that the CPP approach would result in fewer dislocations and similar functional and radiographic outcomes compared to the PL approach. PATIENTS AND METHODS: This was a retrospective multicenter (TRON group) study. We evaluated the rate of complications, and functional and radiographic outcomes for patients aged >65 years who underwent HA via the PL approach or the CPP approach from 2017 to 2019 and followed up for at least 24 months. To adjust for baseline differences between the groups, a propensity score-matching algorithm was used in a 1:1 ratio. RESULTS: We identified 135 patients who underwent HA via the PL approach and 135 patients via the CPP approach. The mean follow-up period was 32.4 ± 14.0 months. The incidence of dislocation was 6 in 135 patients (4.4%) in the PL group and 0 in 135 patients (0%) in the CPP group, and there was significant difference (p = 0.04). Operation time was equivalent between the two groups (73.1 ± 30.4 vs. 71.8 ± 30.0 min; p = 0.72). The rate of varus insertion of stems in the PL group lower than that in the CPP group (19.3% vs. 33.3%; p = 0.01). Postoperative Parker's mobility score was similar between the two groups at 12 months follow-up (6.17 vs. 6.27; p = 0.81). CONCLUSION: The CPP approach showed a significantly lower dislocation rate, similar functional outcome and more varus stem insertions compared with the PL approach in this retrospective study.

DOI： 10.1016/j.jos.2024.05.003

PDZRN3 regulates adipogenesis of mesenchymal progenitors in muscle Reviewed International journal

Hiroki Iida, Minako Kawai-Takaishi, Yoshihiro Miyagawa, Yasuhiko Takegami, Akiyoshi Uezumi, Takeshi Honda, Shiro Imagama, Tohru Hosoyama

Regenerative Therapy Vol. 28 page： 473 - 480 2025.3

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

INTRODUCTION: Intramuscular adipose tissue (IMAT) is frequently formed in certain pathological conditions, such as biological aging, and ectopic fat accumulation leads to muscle weakness and a subsequent decline in physical function. Although mesenchymal progenitors (MPs) are present in postnatal skeletal muscle and are the cells from which IMAT originates, the molecular mechanism by which MPs contribute to IMAT formation has not been completely elucidated. Recently, we found that PDZ domain-containing ring finger 3 (PDZRN3), an E3-ubiquitin ligase, was highly expressed in MPs. In this study, we aimed to clarify the functions of PDZRN3 in MPs and the roles of PDZRN3 in IMAT formation using in vitro and in vivo experiments. METHODS: Primary mouse MPs isolated from hindlimb muscles were applied to adipogenic differentiation conditions, and expression fluctuation of PDZRN3 was verified with adipogenic differentiation and Wnt signaling markers. The role of PDZRN3 on MP's adipogenesis was evaluated in vitro by gene knock-down experiments. To evaluate the contribution of PDZRN3 to IMAT formation in vivo, tamoxifen-inducible MP-specific Pdzrn3 knockout (Pdzrn3 MPcKO) mice were developed. RESULTS: PDZRN3 was more expressed in MPs than in muscle stem cells, and its expression profile of PDZRN3 fluctuated with the adipogenic differentiation of MPs. Our results revealed that PDZRN3 suppressed the adipogenesis of MPs in vitro through the activation of Wnt signaling and that a decrease in PDZRN3 accelerated adipogenesis. Indeed, IMAT significantly increased in the denervated muscles of Pdzrn3 MPcKO mice. CONCLUSIONS: Our findings suggest that PDZRN3 is a key molecule in regulating IMAT formation. Since ectopic fat accumulation is frequently found in the skeletal muscles of older adults and also muscular dystrophy patients, PDZRN3 and its related pathways may represent a novel therapeutic target for these muscle pathologies.

DOI： 10.1016/j.reth.2025.01.018

Impact of Fixation Length for Single-Level Spinal Metastasis Surgery in the Elderly: A Multicenter Study. Reviewed International journal

Hiroki Ito, Yasuhiko Takegami, Hiroaki Nakashima, Kenichi Mishima, Kenichi Yamauchi, Shiro Imagama

Cureus Vol. 17 ( 3 ) page： e80886 2025.3

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

Purpose Spinal metastases are common and affect most patients with metastatic cancer. Surgery is crucial for managing symptoms such as pain and paralysis but carries a high risk of complications, especially in the elderly. This study aimed to investigate the impact of short versus long fixation on outcomes mainly focused on surgery-related complications in elderly patients ≥60 years old undergoing surgery for single-level spinal metastasis. Methods This study is a retrospective multicenter cohort study. We retrospectively analyzed data from 153 patients who underwent spinal metastasis surgery between 2014 and 2023, focusing on 44 patients aged ≥60 years with single-level lesions. Out of 151 patients, those under 60 years old, those who underwent only decompression surgery, and those with missing data were excluded, resulting in a final inclusion of 44 patients. Patients were divided into short fusion (four or fewer vertebrae) and long fusion (five or more vertebrae) groups. This study aims to compare the impact of short (four or fewer vertebrae) versus long (five or more vertebrae) spinal fixation on surgical and patient-centered outcomes in elderly patients undergoing surgery for single-level spinal metastasis. Patients' demographics, surgical details, and complications were compared between the groups. Results The study included 44 patients: long fusion group (n = 24) and short fusion group (n = 20). No significant between-group differences were found in demographics or surgery-related factors. Minimally invasive surgery was performed in 29.2% of long fusion group patients and 10% of short fusion group patients, but this difference was not statistically significant. Survival analysis showed no significant difference in median survival between the groups (short fusion group = 29 months vs. long fusion group = 26 months, P = 0.533). Mortality rates were also similar between groups during the follow-up period. The short fusion group had a higher rate of surgical complications (45% vs. 12.5%, P = 0.021) and more frequent postoperative complications (55% vs. 29.2%, P=0.125), although the difference was not statistically significant. Conclusion This study found no significant difference in survival rates between short and long fixation in elderly patients undergoing surgery for single-level spinal metastasis. In spinal metastasis surgery, extending the fixation range may be considered if necessary.

DOI： 10.7759/cureus.80886

A Case of Successful Perioperative Rehabilitation in Two-Stage Revision Total Hip Arthroplasty for an Intraoperative Acetabular Fracture: Insights Into Interim-Period Rehabilitation Strategies. Reviewed International journal

Shusuke Nojiri, Yusuke Osawa, Shinya Tanaka, Yasuhiko Takegami

Cureus Vol. 17 ( 2 ) page： e78619 2025.2

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

Two-stage revision arthroplasty often results in poor functional outcomes. Rehabilitation strategies to maximize functional recovery after two-stage revision arthroplasty have not yet been established. This report presents a case of successful rehabilitation in two-stage revision total hip arthroplasty (THA). A 75-year-old Japanese woman underwent primary THA and experienced an intraoperative acetabular fracture. Staged revision THA was performed because of a large bone defect. After the first-stage implant removal, progressive muscle strength training, such as quadriceps and isometric exercises for the hip muscles, was performed with consideration of bone fusion, in addition to strengthening the unaffected limbs. During the interim period, an improvement in muscle strength was observed in both the upper and lower limbs. After the second-stage reimplantation, weight-bearing was gradually allowed. Three weeks after full weight-bearing was allowed, the patient was able to walk at 0.67 m/s with a cane. Further recovery of walking speed was achieved after a further four weeks of inpatient rehabilitation, reaching 0.90 m/s. In this case, interim-period muscle strength training was assumed to have contributed to early gait acquisition after reimplantation, without interfering with bony fusion. Well-worked muscle strength training to maintain or even improve muscle strength during the prosthesis-free interval may be important for functional recovery after two-stage revision arthroplasty.

DOI： 10.7759/cureus.78619

Impact of diffuse idiopathic skeletal hyperostosis on quality of life and locomotive syndrome in community-dwelling older adults: the Yakumo study. Reviewed International journal

Kazuma Ohshima, Hiroaki Nakashima, Naoki Segi, Sadayuki Ito, Jun Ouchida, Yasuhiko Takegami, Shinya Ishizuka, Ippei Yamauchi, Yukiharu Hasegawa, Kenta Murotani, Shiro Imagama

Scientific reports Vol. 15 ( 1 ) page： 3582 - 3582 2025.1

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

Diffuse idiopathic skeletal hyperostosis (DISH) is a common disease in older adults that causes extensive spinal ankylosis. However, its impact on quality of life (QOL) and locomotive syndrome (LS) remains unknown. Thus, we aimed to evaluate the DISH effect on QOL and LS in community-dwelling middle-aged and older adults. Data of community volunteers who attended a health checkup in 2018-2019 were assessed. A total of 455 subjects were included. Whole spine lateral radiographs were obtained to detect DISH according to the Resnik criteria. QOL was evaluated using SF-36 and EQ5D HUSV. LS was evaluated using the stand-up and two-step tests and GLFS-25. Multivariate regression analysis was performed, adjusting for sex, age, body mass index, and knee osteoarthritis. Additionally, a sex-stratified analysis was performed. DISH was detected in 83 (18.2%) participants. Multivariate analysis demonstrated that DISH was significantly associated with low EQ5D HSUV. Multivariate analysis in men demonstrated that DISH was associated with low PCS, low EQ5D HSUV, high LS stage. Multivariate analysis in women demonstrated that DISH was not associated with any QOL or LS. DISH may be associated with a poor QOL. Additionally, DISH is more common and produces a greater clinical impact in men than in women.

DOI： 10.1038/s41598-025-87878-9

Risk factors for intraoperative femoral fractures in cementless bipolar hip arthroplasty for femoral neck fracture in multicenter: The TRON group study. Reviewed

Hiroaki Ido, Yasuhiko Takegami, Yusuke Osawa, Masanori Okamoto, Hiroki Iida, Shiro Imagama

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association Vol. 30 ( 1 ) page： 101 - 106 2025.1

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

BACKGROUND: Intraoperative femoral fractures are more common in cementless bipolar hip arthroplasty (BHA) for displaced femoral neck fractures than they are in cemented BHA and remain one of the major concerns. This study aimed to investigate the risk factors for intraoperative femoral fractures in cementless BHA. METHODS: The study included 1,392 patients who underwent cementless BHA for displaced femoral neck fractures from January 2015 to December 2019 in 14 hospitals of the Trauma Research Group. They were divided into two groups according to the presence or absence of intraoperative femoral fractures, and factors associated with intraoperative fractures were statistically examined. RESULTS: Forty (2.9 %) intraoperative and 28 (2.0 %) postoperative, totally 68 (4.9 %) femoral fractures occurred. The mean age of the patients, presence of opposite-side proximal femoral fracture, approach, and cementless stem design were significantly different between the two groups (P < 0.05). The logistic regression analysis model showed that a fully HA-coated stem (odds ratio, 4.12; 95 % confidence interval, 1.43-11.9) was an independent factor associated with intraoperative femoral fractures. CONCLUSION: This study investigated the risk factors associated with intraoperative fractures and showed that fully HA-coated stems were an independent factor associated with intraoperative femoral fractures. Surgeons should be cautious in the early stages of introducing fully HA-coated stems.

DOI： 10.1016/j.jos.2024.01.005

Total Hip Arthroplasty Using the Conjoined Tendon-Preserving Posterior Approach: The Modified Posterior Approach with a Minimum of 2-Year Follow-Up. Reviewed International journal

Yuto Ozawa, Yusuke Osawa, Taisuke Seki, Yasuhiko Takegami, Hiroki Iida, Hiroto Funahashi, Shiro Imagama

Orthopaedic surgery Vol. 17 ( 1 ) page： 53 - 61 2025.1

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

PURPOSE: The conjoined tendon-preserving posterior (CPP) approach is a modified posterior approach for total hip arthroplasty (THA) that preserves the short external rotator muscles and most ischiofemoral ligaments. The objective of the present study was to compare the short-term clinical outcomes, complications, and imaging evaluations of CPP and posterior approaches in THA. METHODS: This retrospective study included 83 patients from May 2018 to September 2021: 36 patients with 42 hips who underwent THA with the CPP approach (CPP group) and 47 patients with 60 hips who underwent THA with the standard posterior approach (PA group) with a minimum of 2 years of follow-up. Assessment tools included operative times, blood loss, preoperative and last follow-up Harris Hip Scores (HHS), postoperative complications, and implant placement angles between the groups. Statistical analysis was performed using chi-square tests and T-tests. RESULTS: The CPP approach had a significantly longer operative time and greater blood loss compared to the PA group. Preoperative and postoperative HHS were not significantly different between groups. Considering complications, the PA group had one case each of dislocation and infection, and the CPP group had two cases of sciatic nerve palsy, but the difference was not significant. Cup anteversion, inclination and stem anteversion were not significantly different between groups. CONCLUSION: Functional outcomes, complication rates, and implant placement angles were comparable with the posterior approach, and the CPP approach has the potential to reduce postoperative dislocations. However, careful attention should be paid to sciatic nerve palsy during early initiation of the CPP approach, and this study did not demonstrate that the CPP approach was clearly superior to the posterior approach.

DOI： 10.1111/os.14194

Acetabular osteophyte formation in dysplastic hip osteoarthritis. Reviewed International journal

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

BMC musculoskeletal disorders Vol. 25 ( 1 ) page： 1072 - 1072 2024.12

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

The growth of periacetabular osteophytes with developmental dysplasia of the hip (DDH) remains unclear. This study aimed to perform a three-dimensional assessment of periacetabular osteophytes and the effects of superiorization (SP) and lateralization (LT) of the femoral head on osteophyte formation. Female (n = 105) with unilateral hip osteoarthritis due to DDH who underwent total hip arthroplasty between 2016 and 2022 were included. The SP and LT of the femoral head were assessed using anteroposterior radiographs. We measured the periacetabular osteophyte using computed tomography. The correlation coefficient between SP or LT and the length of each osteophyte were investigated. Furthermore, multiple regression analyses with SP and LT as explanatory variables and each osteophyte as an objective variable were performed to evaluate the effect of SP and LT on osteophyte formation. The longest osteophyte was the anterior osteophyte (20.48 mm ± 11.8 mm). Acetabular osteophytes correlated with LT as follows: anterior (r = 0.55), posterosuperior (r = 0.51), and inferior (r = 0.48). Multiple regression analysis showed that all acetabular osteophytes were influenced by LT (p < 0.05 for all factors). Hip surgeons may need to be aware that cases with marked lateralization of the femoral head require treatment of the periacetabular osteophytes.

DOI： 10.1186/s12891-024-08211-5

Discrepancy between radiography and magnetic resonance imaging in Japanese Investigation Committee classification type C osteonecrosis of the femoral head. Reviewed International journal Open Access

Keiji Otaka, Yusuke Osawa, Yasuhiko Takegami, Hiroto Funahashi, Shiro Imagama

International orthopaedics 2024.12

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

PURPOSE: The Japanese Investigation Committee (JIC) classification for osteonecrosis of the femoral head (ONFH) is based on the necrotic area relative to the weight-bearing surface on anteroposterior (AP) radiographs or central coronal MRI. Discrepancies exist between these methods, potentially related to the AP necrosis area. This study evaluated these discrepancies and the extent of AP necrotic lesions. METHODS: We retrospectively reviewed 139 patients (188 hips) with nontraumatic ONFH, JIC type C1 or C2 on radiography, and collapse < 3 mm. Cases with and without discrepancies between radiography and MRI were designated as discrepancy and consistent groups, respectively. We assessed the proportion of patients in the discrepancy group and survival rates in both groups, with femoral head collapse > 3 mm as the endpoint. The cutoff value for AP necrotic regions on lateral radiographs identifying discrepancies was calculated using ROC curve analysis. RESULTS: The discrepancy group comprised 28 hips (14.9%) vs. 160 hips in the consistent group. Five-year survival rates were 73.3% vs. 31.9% (P < 0.01), and AP necrotic region extent was 61.2 vs. 73.8 mm (P < 0.001) in discrepancy vs. consistent groups. The cutoff value for necrotic region extent revealing discrepancies was 66.9% (AUC 0.833, sensitivity 83.8%, specificity 82.4%). CONCLUSION: Patients with AP necrotic regions < 66.9% were more likely to show discrepancies between radiography and MRI in type classification. This study can help improve accuracy in assessing ONFH severity and prognosis.

DOI： 10.1007/s00264-024-06396-x

Changes of hip fracture in older patients before and after the COVID-19 pandemic: a retrospective multicentre study in Japan. Reviewed International journal

Shinya Tanaka, Yusuke Osawa, Yasuhiko Takegami, Nobuyuki Okui, Ken-Ichi Yamauchi, Yoshiki Aoki, Shiro Imagama

BMC musculoskeletal disorders Vol. 25 ( 1 ) page： 1006 - 1006 2024.12

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

BACKGROUND: The COVID-19 pandemic had a significant impact on healthcare systems and the general population. However, it remains unclear to what extent these major societal changes have had an impact on the management of hip fractures in older people in Japan. Therefore, we investigated the effect of the COVID-19 pandemic on the number of patients with hip fractures, their characteristics, and their perioperative management as a retrospective multicentre study. METHODS: We included 1894 patients aged ≥ 65 years who underwent surgery for hip fracture at three hospitals between January 2019-December 2021. Patients were classified according to the time of injury; patients treated between January-December 2019, January-December 2020, and January-December 2021 were divided into the pre-COVID-19 group, early COVID-19 group, and late COVID-19 group, respectively. We compared age, sex, body mass index, preadmission residence, surgical procedure, length of hospital stay, waiting time for surgery, in-hospital complications, and in-hospital death. RESULTS: Our findings suggested that the early COVID-19 and late COVID-19 groups showed a 6.8% and 7.5% reduction in the number of HF patients, respectively, compared to the pre-COVID-19 group. Waiting days for surgery, length of hospital stay, and in-hospital mortality or complication rates did not significantly change before and after the pandemic. However, infection was increased in the early COVID-19 group regarding the subgroup of complications. CONCLUSIONS: The COVID-19 pandemic altered the characteristics of hip fractures in older individuals.

DOI： 10.1186/s12891-024-08050-4

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