Prevalence of iliopsoas bursitis in patients with end-stage hip osteoarthritis.

OBJECTIVES: Iliopsoas bursitis (IB) is a relatively rare condition that is associated with hip diseases. It can cause neurological symptoms and swelling of the lower extremities by compressing the femoral nerve and vessels. The aim of this study is to examine the prevalence of IB in patients with end-stage hip osteoarthritis. METHODS: A total of 544 patients underwent total hip arthroplasty between May 2010 and May 2019. All patients were examined using computed tomography (CT) to perform preoperative planning. We reviewed the CT images and examined the prevalence and size of IB. These lesions were divided into three types based on their shape (round type, oval type, and heart-shaped type). RESULTS: Of the 544 patients, IB was found in 37 patients. We observed the round type in 4 patients, the oval type in 31 patients, and the heart-shaped type in 2 patients. Two patients showed severe swelling in the legs and had a blood circulatory disorder of the legs. Both cases were heart-shaped bursitis. CONCLUSION: Symptomatic IB was observed in two cases, both of which had a heart shape surrounding the iliopsoas tendon and femoral neurovascular bundle. Although symptomatic IB is a rare condition, special attention is required for heart-shaped IB.

Clinical characteristics of osteoporotic second hip fracture: From the data of Clinical Pathway with Regional Alliance in rural region in Japan.

BACKGROUND: Second osteoporotic fracture of the hip is a serious comorbidity that can directly cause mortality. Preventing its occurrence is particularly important in Japan, given its rapidly aging society. Here, the clinical characteristics of such recurrence were evaluated using the data of the Clinical Pathway with Regional Alliance (CPRA). METHODS: CPRA for hip fracture started in 2007 and has allowed intranet-based data sharing since July 2011. Data from this alliance, such as number of second cases, duration from initial fracture, Functional Impairment Measure (FIM), revised Hasegawa Dementia Scale (HDS-R) score, muscle force and range of motion of hip joint, and gait status (GS) were collected and statistically evaluated. RESULTS: Overall, 45 of 1118 cases (2.68/100 person-years) developed a second fracture. The mean interval from initial to second fracture was 13.3 months. Thirty of these cases (66.7%, 1.79/100 person-years) occurred within 1 year from initial fracture (G < 1Y). The second fracture tended to be associated with worse parameter values than initial fracture, especially for GS. FIM score for cognitive function, HDS-R score, and GS at acute fracture in the G < 1Y group were significantly lower than in the initial fracture patient group (Initial). The withdrawal rate was also significantly higher than for Initial, whereas deaths and serious comorbidities were also much more numerous. CONCLUSIONS: Osteoporotic second hip fracture is a severe issue, and its prognosis is remarkably poor. The majority of these cases may occur within 1 year from the initial fracture. Dementia severity correlates with such recurrence within 1 year.

Relationship between dementia degree and gait ability after surgery of proximal femoral fracture: Review from Clinical Pathway with Regional Alliance data of rural region in Japan.

BACKGROUND: Proximal femoral fracture (PFF) is one of the most serious injury-related problems in developed countries. Functional prognosis after operation for PFF is unsatisfactory, as a considerable number of patients cannot perform similar gait function before fracture. Postoperative gait function is a key in performing activities of daily living (ADL). It is well known that PFF patients with dementia result in worse prognosis compared to without dementia. It is believed that dementia affects gait function after operation. However, it is still unclear whether lost function recovers after dementia level improves. METHODS: Relationship between ADL and dementia of PFF patients after surgery was investigated using data of Clinical Pathway with Regional Alliance system. Functional Independence Measurement (FIM), revised version of Hasegawa's Dementia Scale (HDS-R), motivation for rehabilitation (MR), and gait status (GS) measured in acute and recovery institute (A-I and R-I) of 266 patients were analyzed with linear regression analysis. Degrees of patients' dementia were classified into three groups with HDS-R for ten points increment partition, and their average FIM and GS in R-I for groups were compared statistically with ANOVA. FIM gain and GS gain from A-I to R-I were compared statistically with chi-square test. RESULTS: FIM and HDS-R demonstrated significant regression with each of all other parameters (p < 0.01) for both A-I and R-I. The group with lowest HDS-R score demonstrated significant lower FIM gain and lower GS gain than groups with higher scores (p < 0.01). However, patients who demonstrated improvement in HDS-R at R-I demonstrated significant better GS gain (p < 0.05) even in the group with lowest HDS-R at A-I. CONCLUSIONS: These results show that there is a very close correlation between patients' gait function and dementia and that it is necessary to control a patient's status not only for physical condition but also for mental status after PFF operation.

Selective COX-2 inhibitor regulates the MAP kinase signaling pathway in human osteoarthritic chondrocytes after induction of nitric oxide.

The purpose of this study was to examine the effect of cyclooxygenase-2 (COX-2) inhibitors on the mitogen-activated protein (MAP) kinase signaling pathway and synthesis of glucosaminoglycan after nitric oxide (NO) induction in articular human chondrocytes. After NO induction, the cells were divided into three groups that were treated with either ethanol (control); a selective COX-2 inhibitor (Celecoxib), or no additive, and evaluated. There were no differences in the effect of the selective COX-2 inhibitor on mitochondrial membrane potential or Annexin V levels. However, Celecoxib significantly decreased prostaglandin E2 (PGE2) production. Celecoxib also decreased the phosphorylation state of p38 and p44/42 of MAP kinase. The ratio of chondroitin-6 sulfate (C6S)/C4S was increased in response to the exposure to Celecoxib. Celecoxib did not affect apoptosis, but decreased the activation of MAP kinase in osteoarthritic chondrocytes after NO induction. NO-induced OA chondrocytes were associated with the p38 and the p44/42 MAPK signaling pathways, in a pathway that is distinct from PGE2-mediated apoptosis.

Lysosomal dysfunction on hydrogen peroxide-induced apoptosis of osteoarthritic chondrocytes.

The purpose of this study was to examine the mechanism of hydrogen peroxide-induced apoptosis in osteoarthritic chondrocytes. We evaluated the reactive oxygen species (ROS) formation, lysosomal staining and dysfunction of the mitochondrial membrane potential in these cells after exposure to hydrogen peroxide. Osteoarthritic chondrocytes were isolated, and divided into 4 dishes in which different concentrations (0.1 mM, 1 mM and 10 mM) of hydrogen peroxide, or no additive (control) was added. The cells were incubated for 1 or 4 h, then assayed for ROS formation, mitochondrial membrane potential and lysosomal staining. ROS formation was detected in chondrocytes after 1 h of exposure to hydrogen peroxide concentrations over 0.1 mM. Lysosomal swelling was detected after 1 h of exposure to hydrogen peroxide concentrations of 0.1 mM and over, possibly revealing lysosomal membrane instability. Moreover, indications of lysosomal rupture, including release of lysosomal enzymes, were apparent 1 h after addition of 10 mM of hydrogen peroxide. The addition of hydrogen peroxide to chondrocytes induces ROS formation and lysosomal dysfunction, revealed by swelling and rupture, prior to dysfunction of the mitochondrial membrane potential. Anti-oxidants may have a therapeutic application in the prevention of lysosomal dysfunction to inhibit chondrocyte apoptosis and degradation of the cartilage matrix.

Position of hip resurfacing component affects strain and resistance to fracture in the femoral neck.

BACKGROUND: Retrieval studies have suggested that the cause of femoral implant failure after metal-on-metal hip resurfacing is multifactorial. Both varus positioning of the femoral component and notching of the superior part of the femoral neck have been associated with femoral component failure. The hypotheses of this study were that placement of a femoral resurfacing component alters femoral neck loading and that the cortical strain pattern reflecting this loading is directly related to the spatial orientation of the resurfacing component. An additional hypothesis was that notching of the superior part of the neck during implantation results in a decreased resistance to neck fracture under axial loading. METHODS: Varus, anteverted, retroverted, and anatomic positions of the femoral component were tested in sixty-four cadaveric femora. Simulated stance-phase loading was applied, and the shear strain on the femoral neck cortex was quantified with use of a photoelastic method. Preimplantation and postimplantation strain levels were compared over the entire neck region with use of generalized estimating equations. The influence of anteversion and retroversion of the component and notching of the superior part of the neck on the neck strength were evaluated. RESULTS: Placement of the implant in 10 degrees of varus alignment relative to anatomic positioning increased strain on the superior aspect of the neck by 19% to 23% compared with intact femora. Anteverted and retroverted placement of the implant produced elevated strain in the anterior-inferior and posterior-inferior aspects of the neck, respectively. Placement of the component stem in alignment with the anatomic neck axis decreased neck cortical strain 6% to 19% compared with intact femora. Notching of the superior aspect of the neck decreased neck strength by 21%. CONCLUSIONS: Relatively small deviations from anatomic alignment of a resurfacing hip component result in marked localized increases in loading of the femoral neck under conditions approximating single-limb stance. Neutral positioning of the femoral component results in localized strain reduction. Notching of the superior aspect of the femoral neck significantly reduces the resistance to fracture (p = 0.008).

In situ crosslinking elastin-like polypeptide gels for application to articular cartilage repair in a goat osteochondral defect model.

The objective of this study was to evaluate an injectable, in situ crosslinkable elastin-like polypeptide (ELP) gel for application to cartilage matrix repair in critically sized defects in goat knees. One cylindrical, osteochondral defect in each of seven animals was filled with an aqueous solution of ELP and a biocompatible, chemical crosslinker, while the contralateral defect remained unfilled and served as an internal control. Joints were sacrificed at 3 (n = 3) or 6 (n = 4) months for MRI, histological, and gross evaluation of features of biomaterial performance, including integration, cellular infiltration, surrounding matrix quality, and new matrix in the defect. At 3 months, ELP-filled defects scored significantly higher for integration by histological and gross grading compared to unfilled defects. ELP did not impede cell infiltration but appeared to be partly degraded. At 6 months, new matrix in unfilled defects outpaced that in ELP-filled defects and scored significantly better for MRI evidence of adverse changes, as well as integration and proteoglycan-containing matrix via gross and histological grading. The ELP-crosslinker solution was easily delivered and formed stable, well-integrated gels that supported cell infiltration and matrix synthesis; however, rapid degradation suggests that ELP formulation modifications should be optimized for longer-term benefits in cartilage repair applications.

A subclinical impairment of ventilatory function in cervical spondylotic myelopathy.

OBJECTIVE: To evaluate the ventilatory function in patients with cervical spondylotic myelopathy (CSM). DESIGN: Prospective cohort study. SETTING: Medical school in Japan. PARTICIPANTS: Thirty-seven consecutive patients with CSM. INTERVENTIONS: All the patients had surgical intervention for mild to moderate spastic limb paresis. MAIN OUTCOME MEASURES: Analysis of the maximum voluntary ventilation (MVV) in addition to routine spirometry before and after surgical decompression. Functional assessment was made by using the Japanese Orthopaedic Association (JOA) Scale. RESULTS: The MVV (% predicted) increased significantly (P<.002) from 77%+/-19% preoperatively to 84%+/-20% postoperatively. None of the other routine spirometric data (ie, vital capacity, forced vital capacity, forced expired volume in 1 second, peak expiratory flow rate) increased significantly. According to the JOA score, tetraparesis improved significantly (P<.0001) from 8.3+/-3.2 preoperatively to 11.4+/-3.0 postoperatively. The ratio of postoperative to preoperative MVV showed a significant correlation (r=.538, P<.002) with that of the JOA score. CONCLUSIONS: MVV provides a useful measure for monitoring ventilatory impairment in patients with myelopathy.