Factors associated with cam deformity in Japanese local residents.

Femoroacetabular impingement has increasingly been recognized as a cause of primary hip osteoarthritis; however, its epidemiological indications remain unclear. We aimed to clarify the epidemiological indications and factors associated with cam deformity in a large-scale population-based cohort in Japan. Overall, 1480 participants (2960 hips) (491 men, 989 women; mean age, 65.3 years) analyzed in the third survey of the Research on Osteoarthritis/Osteoporosis Against Disability study were included. The α angle and spinopelvic parameters (lumbar lordosis, sacral slope, pelvic tilt, and pelvic incidence) were radiographically measured. Cam deformity was defined as α angle ≥ 60°. Overall, the cam deformity prevalence was 147/2960 (5.0%). Cam deformity prevalence tended to increase with age; in the univariate analysis, a higher percentage of men was observed in the group with cam deformity than in the group without it. No relationship was observed between cam deformity and hip pain. Factors associated with α angle were examined via multiple regression analysis for each gender; α angle was significantly associated with age and BMI in each gender. The α angle and PT were correlated in women. Thus, α angle and cam deformity prevalence increase with age in Japanese individuals. Accordingly, cam deformity can be considered a developmental disease.

Association between modic changes, disc degeneration, and pelvic incidence-lumbar lordosis mismatch in a large population based cohort: the Wakayama spine study.

PURPOSE: Sagittal plane alignment is crucial for treating spinal malalignment and low back pain. Pelvic incidence-lumbar lordosis (PI-LL) mismatch is commonly used to evaluate clinical outcomes in patients with sagittal malalignment. The association between PI-LL mismatch and changes surrounding the intervertebral disc is very important to understand the compensatory mechanisms involved. This study aimed to examine the association between PI-LL mismatch and magnetic resonance imaging (MRI) changes surrounding the intervertebral disc in a large population-based cohort. METHODS: We evaluated participants from the second Wakayama Spine Study, recruiting the general population aged 20 years or older, irrespective of sex, who were registered residents in one region in 2014. In total, 857 individuals underwent an MRI of the whole spine; however, 43 MRI results were not included due to incomplete or inadequate quality images. PI-LL mismatch was defined as > 11°. We compared the MRI changes, such as Modic change (MC), disc degeneration (DD), and high-intensity zones (HIZ), between PI-LL mismatch and non-PI-LL mismatch groups. Multivariate logistic regression analysis was conducted to determine the association between the MRI changes and PI-LL mismatch with adjustment for age, sex, and body mass index in the lumbar region and at each level. RESULTS: A total of 795 participants (243 men, 552 women, mean age 63.5 ± 13.1 years old) were evaluated; 181 were included in the PI-LL mismatch group. MC and DD in the lumbar region were significantly higher in the PI-LL mismatch group. MC in the lumbar region was significantly associated with PI-LL mismatch (odds ratio (OR); 1.81, 95% confidence interval (CI) 1.2-2.7). MC at each level was significantly associated with PI-LL mismatch (OR; 1.7-1.9, 95%CI 1.1-3.2), and DD at L1/2, L3/4, and L4/5 was associated with PI-LL mismatch (OR; 2.0- 2.4. 95%CI 1.2-3.9). CONCLUSION: MC and DD were significantly associated with PI-LL mismatch. Therefore, profiling MC may be helpful in improving the targeted treatment of LBP associated with the adult spinal deformity.

Association between acetabular dysplasia and sagittal spino-pelvic alignment in a population-based cohort in Japan.

The relationship between acetabular dysplasia and spino-pelvic alignment remains unclear. The aim of this study was to clarify the association between acetabular dysplasia and spino-pelvic alignment, based on a large-scale population-based cohort in Japan. From the third survey of the Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study, 1,481 participants (491 men and 990 women; mean age, 65.3 years) were analyzed. Center-edge (CE) angle and spino-pelvic parameters (lumbar lordosis, LL; sacral slope, SS; pelvic tilt, PT; pelvic incidence, PI) were measured radiographically. Acetabular dysplasia was defined as a CE angle < 20°, and associations between acetabular dysplasia and spino-pelvic parameters were assessed. The group with acetabular dysplasia had significantly higher age, higher percentage of female, higher SS and higher PI than the group without acetabular dysplasia in a univariate analysis. On the other hand, acetabular dysplasia was not significantly associated with spino-pelvic parameters in a multiple logistic regression analysis that include age, sex, SS and PI as explanatory variables; however, PI demonstrated a positive odds ratio (odds ratio, 1.02; 95% CI 1.00-1.04). In conclusion, acetabular dysplasia was not significantly associated with spino-pelvic parameters, but higher PI may be an associated factor for acetabular dysplasia.

Relationship Between Age-Related Spinopelvic Sagittal Alignment and Low Back Pain in Adults of Population-Based Cohorts: The ROAD Study.

PURPOSE: The demand for surgical correction in elderly patients with adult spinal deformity (ASD) has recently increased with the growth of the aging population. Age-related changes in spinopelvic sagittal alignment have been recently reported; thus, sagittal realignment should consider age-related changes. This study aimed to investigate the relationship between age-specific sagittal spinopelvic radiographic parameters and low back pain (LBP) to support the establishment of age-specific realignment targets for patients with ASD. MATERIALS AND METHODS: A population-based cohort consisting of 1461 subjects (466 men and 995 women) was used. The participants were divided into five groups based on their age: (1) younger than 50 years, (2) 50-59 years, (3) 60-69 years, (4) 70-79 years, and (5) 80 years and older. Standing lateral whole-spine radiographs were assessed to measure lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), and sagittal vertical axis (SVA). In addition, all participants were asked if they had LBP or not, using the following question: "Have you experienced LBP on most days during the past month and/or now?". RESULTS: The crucial parameter associated with LBP was the mismatch between PI and LL (PI-LL). The mean values of all the radiographic parameters increased with age. PI-LL and PT reached 11.5° and 25.6°, respectively, for women without LBP in the super-aged group (age >80 years), which did not lie in the range of optimal values reported in the previous literature. CONCLUSION: A new optimal age-related target may be needed for the management of patients with ASD.

Differential Biosynthesis and Roles of Two Ferrichrome-Type Siderophores, ASP2397/AS2488053 and Ferricrocin, in Acremonium persicinum.

Ferrichromes are a family of fungal siderophores with cyclic hexapeptide structures. Most fungi produce one or two ferrichrome-type siderophores. Acremonium persicinum MF-347833 produces ferrichrome-like potent Trojan horse antifungal antibiotics ASP2397 and AS2488053, the aluminum- and iron-chelating forms of AS2488059, respectively. Here, we show by gene sequencing followed by gene deletion experiments that A. persicinum MF-347833 possesses two nonribosomal peptide synthetase genes responsible for AS2488059 and ferricrocin assembly. AS2488059 was produced under iron starvation conditions and excreted into the media to serve as a defense metabolite and probably an iron courier. In contrast, ferricrocin was produced under iron-replete conditions and retained inside the cells, likely serving as an iron-sequestering molecule. Notably, the phylogenetic analyses suggest the different evolutionary origin of AS2488059 from that of conventional ferrichrome-type siderophores. Harnessing two ferrichrome-type siderophores with distinct biological properties may give A. persicinum a competitive advantage for surviving the natural environment.

Relationship of sagittal spinal alignment with low back pain and physical performance in the general population.

Studies have suggested a relationship between sagittal spinal malalignment and low back pain (LBP). The current study investigated the relationship of spinal alignment with LBP and physical performance in 1491 individuals who attended the second follow-up visit of the Wakayama Spine Study. The sagittal vertical axis at C7 (C7 SVA) was measured by a spine surgeon. The occurrence of LBP within one month, pain intensity, Oswestry Disability Index (ODI), and physical performance (grip strength, 6-m walking time, chair stand test, one-leg standing test) were also evaluated. LBP in the previous month was determined using ODI, and indicators of physical performance were measured. The mean C7 SVA was 11.0 ± 42.7 mm and was significantly greater in older participants (p < 0.001). LBP was more prevalent in participants with a greater C7 SVA (< 40 mm, 35.7%; 40-95 mm, 47.3%; ≥ 95 mm, 59.4%; p < 0.001) and those with a higher ODI score (10.0%, 17.5%, and 29.4%, respectively; p < 0.001). Physical performance significantly decreased in participants with a greater C7 SVA (p < 0.001). Multiple linear regression analysis revealed that LBP and physical performance were significantly associated with C7 SVA (p < 0.001). Thus, sagittal spinal malalignment may lead to LBP and decreased physical performance.

Prevalence and associated factors of pistol grip deformity in Japanese local residents.

Pistol grip deformity (PGD) may be the main factor in femoroacetabular impingement development. This study aimed to clarify the epidemiological indices and factors related to PGD in Japanese people. This population-based cohort study included 1575 local Japanese residents. PGD, center edge angle, and joint space width were measured radiographically. We investigated the relationship between PGD and spino-pelvic parameters. Factors associated with PGD were examined using multiple logistic regression analysis, with the presence/absence of PGD as an objective variable, and sex, age, body mass index (BMI), and the presence/absence of hip pain or spino-pelvic parameters as explanatory variables. In the entire cohort, 4.9% (10.6% men, 2.1% women) had PGD on at least one side. A trend was observed between PGD and increasing age in both men and women (men: p < 0.0001, women: p = 0.0004). No relationship was observed between PGD and hip pain (risk ratio 1.0 [95% confidence interval 0.97-1.03]). Factors significantly associated with PGD were age, sex, and BMI in the multivariate model. Acquired factors may be related to PGD in Japanese people as the PGD prevalence increased with age and PGD was not significantly associated with hip pain. This study provides new insights into the etiology and clinical significance of PGD.

The incidence and risk factors for adjacent vertebral fractures in community-dwelling people with prevalent vertebral fracture: the 3rd and 4th survey of the ROAD study.

In this 3-year follow-up study of 66 community-dwelling adults with severely deformed vertebral fractures, the annual incidence of adjacent vertebral fracture (AVF) was 6.1%/year. Lower bone mineral density at the femoral neck and spinopelvic malalignment were risk factors for AVF. PURPOSE: This study aimed to clarify the incidence and risk factors of adjacent vertebral fractures (AVFs)-fractures adjacent to a prevalent vertebral fracture (VF)-using an established population-based cohort from the ROAD study. METHODS: Among the 1213 participants who underwent whole-spine radiography in ROAD's third (2012-2013, the baseline) and fourth surveys (2015-2016, the follow-up), 66 (12 men, 54 women) had at least one VF at the baseline. VF and AVF were determined radiographically using Genant's semi-quantitative (SQ) method, where VF was SQ ≥ 2 and AVF was a one-level cranial or caudal vertebra with an SQ grade one or more higher at the follow-up. An interviewer-administered questionnaire was applied, and anthropometric measurements and bone mineral density (BMD) measurements at the lumbar spine and femoral neck were performed. Sagittal imbalance of the spine was defined as a mismatch between pelvic incidence and lumbar lordosis (PI-LL) of > 20°. Multivariate logistic regression analyses were performed to identify risk factors for AVF. RESULTS: AVF occurred in 12 participants (1 man, 11 women). The annual incidence of AVF was estimated at 6.1%/year. Logistic regression analyses revealed that lower BMD at the femoral neck and PI-LL > 20° were risk factors for AVF. CONCLUSIONS: The annual incidence of AVF in a general population with prevalent VF was 6.1%/year. In addition, lower BMD at the femoral neck and PI-LL > 20° were risk factors for AVF.

Differences in prevalence and associated factors between mild and severe vertebral fractures in Japanese men and women: the third survey of the ROAD study.

Vertebral fracture (VF) is a common osteoporotic fracture, while its epidemiology varies according to regions and ethnicities, little is known about it in Japan. Using whole-spine radiographs from a population-based cohort study, the Research on Osteoarthritis/Osteoporosis Against Disability study 3rd survey performed in 2012-2013, we estimated the sex- and age-specific prevalence of VF in the Japanese. Genant's semiquantitative method (SQ) was used to define VF; SQ ≥ 1 as VF, SQ = 1 as mild VF, SQ≥ 2 as severe VF. We also revealed accurate site-specific prevalence, and associated factors with mild and severe VF. The participants were 506 men [mean age 66.3 years, standard deviation (SD):13.0] and 1038 women (mean age 65.3 years, SD: 12.6). The prevalence of VF in participants aged under 40, in their 40s, 50s, 60s, 70s, and ≥ 80 years was 17.4, 7.9, 18.5, 25.6, 26.3, and 41.5%, respectively, in men, and 2.9%, 2.4%, 7,3, 10.3, 27.1, and 53.0%, respectively, in women. Men had a significantly higher prevalence of mild VF (21.2%) than women (10.0%, p < 0.001); whereas, severe VF was significantly more prevalent in women (9.1%) than in men (4.7%, p = 0.003). VF was distributed with 2 peaks regarding site; one large peak at the thoracolumbar region, and another at the middle thoracic lesion. Low back pain and decreased walking ability were independently associated with severe VF, but not with mild VF, after adjustment for participant characteristics. Decreased walking ability was associated with multiple VFs in women, but not in men.

Prevalence of Facet Effusion and Its Relationship with Lumbar Spondylolisthesis and Low Back Pain: The Wakayama Spine Study.

INTRODUCTION: Facet effusion represents a magnetic resonance imaging finding suggesting accumulation of fluid in the facet joint, potentially predictive of lumbar spondylolisthesis and low back pain. However, its prevalence and epidemiological characteristics in the general population remain unclear, because previous studies only included patients or volunteers. The aim of the present study was to investigate the prevalence of facet effusion in the general population and to describe its potential relationship with spondylolisthesis and low back pain. MATERIAL AND METHODS: Our study enrolled 808 participants from the Wakayama Spine Study who underwent magnetic resonance imaging investigations in supine position. Facet effusion was defined as a measurable, curvilinear, high-intensity signal within the facet joint, closely matching that of cerebrospinal fluid on the axial T2 images. We used standing lateral radiographs to diagnose L4 spondylolisthesis. RESULTS: We found that the prevalence of facet effusion in the lumbar spine was 34.3%, which did not differ significantly between men and women (p=0.13) and did not tend to increase with age, either in men (p=0.81) or in women (p=0.65). Additionally, we found no significant association between facet effusion and low back pain (odds ratio, 1.04-1.49; 95% confidence interval, 0.57-2.64; p=0.17-0.85), or between facet effusion and L4 spondylolisthesis (odds ratio, 1.55; 95% confidence interval, 0.80-2.86; p=0.17). In a subset of participants with L4 spondylolisthesis, we also noted that facet effusion was not significantly associated with low back pain (odds ratio, 1.26; 95% confidence interval, 0.37-4.27; p=0.70). DISCUSSION: This is the first study of facet effusion employing a population-based cohort, and the findings are thus expected to accurately describe the relationship between facet effusion and low back pain in the general population. We are planning a follow-up survey of the Wakayama Spine Study cohort to clarify the natural history of facet effusion and its relationship with clinical symptoms.

Serum levels of matrix metalloproteinase-3 and autoantibodies related to rheumatoid arthritis in the general Japanese population and their association with osteoporosis and osteoarthritis: the ROAD study.

To purpose of this study was to reveal the mean levels and positive proportion of serological markers related to rheumatoid arthritis, and clarify their relationship with osteoporosis and hand osteoarthritis (OA). A total of 1546 participants from the third survey of the research on osteoarthritis/osteoporosis against disability study were enrolled in the current study. Using participant blood samples, the levels of anti-cyclic citrullinated protein (CCP) antibody, rheumatoid factor (RF), matrix metalloproteinase-3 (MMP-3), C-reactive protein (CRP), and high-sensitivity CRP (hsCRP) were measured. Subjects with higher than normal levels were defined as being positive. Osteoporosis was defined according to the recommendations set by World Health Organization criteria in 1994. Radiographic hand OA was evaluated using the modified Kellgren-Lawrence (KL) scale. The positive proportion of anti-CCP antibody, RF, MMP-3, CRP, and hsCRP was 1.8, 7.1, 15.0, 6.7, and 6.4%, respectively. MMP-3 was associated with age, and was significantly higher in men than in women. Positive MMP-3 was not significantly related to osteoporosis or severe hand OA (KL grade ≥3) after adjustment for other factors including age, sex, and body mass index. The results from this study clarified the values and positive proportion of RA-related markers and revealed their relationship with osteoporosis and hand OA.

Sagittal spino-pelvic alignment in adults: The Wakayama Spine Study.

OBJECTIVES: To establish the normal values of spino-pelvic alignment and to clarify the effect of age-related changes using large, community-based cohorts. METHODS: In this study, data from 1461 participants (466 men, 995 women) were analyzed. On lateral standing radiographs, the following parameters were measured: thoracic kyphosis (TK), lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), and C7 sagittal vertical axis (SVA). All values are expressed as the mean±standard deviation. The Spearman rank correlation coefficient was used to examine correlations between variables of spino-pelvic parameters. Finally, we analyzed the relationship between age and spino-pelvic parameters. Therefore, we entered values for the body mass index (BMI), SVA, TK, and PI-LL into a multiple regression model to adjust for potential confounding factors. RESULTS: The SVA, TK, and PT increased with age, and LL decreased with age. Regarding sex differences, the TK was statistically significantly larger in men than in women, and LL, PT, and PI were statistically significantly smaller in men than in women. Correlation coefficients between the SVA and TK, between the SVA and PI-LL, and between TK and PI-LL were none, strong, and weak, respectively. Results of multiple regression analysis between age and spino-pelvic parameters showed that the standardized partial regression coefficients for the SVA, TK, and PI-LL were 0.17, 0.30, and 0.23, respectively, in men and 0.29, 0.32, and 0.23, respectively, in women. CONCLUSIONS: We found that all parameters were significantly associated with age in men and women. The SVA, TK, and PT increased with age, and LL decreased with age. Results of multiple regression analysis also demonstrated that the SVA, TK, and PI-LL are related to age. Indeed, the PI-LL value increased with age. In this study, a more excessive PI-LL mismatch was shown, indicating an increased risk of spinal malalignment. Differences in the absolute values of spino-pelvic parameters in each sex were small yet statistically significant. Thus, further study should be performed to corroborate this finding.

Prevalence of hand osteoarthritis and its relationship to hand pain and grip strength in Japan: The third survey of the ROAD study.

OBJECTIVES: To examine the prevalence and pattern of hand osteoarthritis (HOA), and determine its relationship with grip strength and hand pain. METHODS: Among the participants of the third survey of the Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study, 507 Japanese men and 1028 Japanese women were included. Radiographs of both hands were graded for osteoarthritis (OA) using the modified Kellgren-Lawrence (KL) scale. HOA was defined as the presence of at least one affected joint. The absence or presence of subchondral erosion was also scored. RESULTS: The prevalence of HOA (KL grade ≥2) was 89.9% in men and 92.3% in women (p = 0.11), and it was significantly associated with age. OA in the distal interphalangeal (DIP) joint was the highest overall. After adjusting for age, sex, body mass index, and the residing area, both severity (KL grade ≥3) and erosion were significantly related to low grip strength and hand pain. With regard to the joint groups, severe OA in the DIP and first carpometacarpal joints were related to hand pain. CONCLUSION: This study showed a high prevalence of radiographic HOA and a significant relationship between hand pain and the severity of HOA, in addition to erosion.

Quadriceps muscle strength, radiographic knee osteoarthritis and knee pain: the ROAD study.

BACKGROUND: The objective of this study was to clarify the association of quadriceps muscle strength with knee pain using a large-scale, population-based cohort of the Research on Osteoarthritis/osteoporosis Against Disability (ROAD) study. METHODS: From the 2566 subjects at the third visit of the ROAD study, the present study analyzed 2152 subjects who completed radiographic examinations and measurements of muscle strength and mass (690 men and 1462 women; mean age, 71.6 ± 12.2 years). Knee pain was assessed by an experienced orthopedist. Knee osteoarthritis (OA) was defined according to Kellgren-Lawrence (KL) grade. Quadriceps muscle strength and muscle mass at the lower limbs were measured by the Quadriceps Training Machine (QTM-05F, Alcare Co., Ltd. Tokyo, Japan) and the Body Composition Analyzer MC-190 (Tanita Corp., Tokyo, Japan), respectively. RESULTS: Quadriceps muscle strength and weight bearing index (WBI: quadriceps muscle strength by weight) were significantly associated with knee pain after adjustment for age and body mass index, whereas grip strength and muscle mass at the lower limbs were not. The significant association of quadriceps muscle strength with knee pain was independent of radiographic knee OA. CONCLUSION: The present cross-sectional study showed an independent association of quadriceps muscle strength with knee pain.

Superior lateral genicular artery flap for coverage of a soft tissue defect after total knee arthroplasty.

This is the first report of a superior lateral genicular artery (SLGA) flap transfer for treatment of skin necrosis after total knee arthroplasty. A 5 x 17-cm SLGA flap was used to cover the exposed left knee prosthesis. The SLGA flap survived completely, and a good clinical outcome was obtained. The SLGA flap provides good recontouring of soft tissue defects around the knee. The donor site on the lateral aspect of the thigh is inconspicuous. The SLGA flap is a suitable option for reconstruction of skin necrosis after total knee arthroplasty.