Validity of a preoperative scoring system for surgical management of periprosthetic hip infection: one-stage vs. two-stage revision.

INTRODUCTION: There are no widely accepted algorithms for determining optimal treatment for periprosthetic joint infection (PJI). Our study aimed to confirm the validity of a previously published scoring system in a larger number of patients to support a rational surgical treatment strategy for periprosthetic hip infection. MATERIALS AND METHODS: Between February 2001 and December 2020, we performed 155 consecutive revision total hip arthroplasties (THAs) for PJI, with mean follow-up of 6 years. One-stage revision THA was performed in 56 hips and two-stage revision THA in 99 hips. Prosthesis survival from recurrent infection was determined by Kaplan-Meier analysis, using implant removal as the endpoint. The pre-operative scoring system (full score of 12 points), including 6 essential elements, was retrospectively evaluated. RESULTS: The 10-year survival rates were 98% for one-stage (95% confidence interval [CI], 94-100) and 87% (95% CI, 79-96) for two-stage revision THA. Multivariate Cox regression analysis provided a total preoperative score as an independent risk factor for implant removal (hazard ratio, 0.17; 95% CI, 0.06-0.49; p < 0.001). The sensitivity and specificity at the cut-off of 4 points on the scoring system were 80% and 91%, respectively. The average score for one-stage revision THA in successful and failed cases were 8.9 and 6.0, and for two-stage revision THA were 6.5 and 3.9, respectively. We found significant differences between successful cases in one- and two-stage revision THA (p < 0.05). CONCLUSIONS: The preoperative scoring system was useful for managing PJI. One-stage revision THA is recommended in patients scoring ≥ 9 points, and meticulously performed two-stage revision THA is encouraged for patients scoring ≥ 4 points.

Experimental periprosthetic fractures with collarless polished tapered cemented stems.

PURPOSE: After cemented total hip arthroplasty, the risk of periprosthetic fracture (PPF) of taper-slip stems is higher than that of composite-beam stems. We aimed to assess the conditions resulting in PPFs of taper-slip stems using a falling weight. METHODS: Taper-slip stems were fixed to five types of simulated bone models using bone cement, and the fractures were evaluated by dropping stainless-steel weights from a predetermined height onto the heads. The periprosthetic fracture height in 50% of the bone models (PPFH50) was calculated using the staircase method. RESULTS: For the fixation with 0° of flexion, the values for PPFH50 were 61 ± 11, 60 ± 13, above 110, 108 ± 49, and 78 ± 12 cm for the cobalt-chromium-molybdenum alloy, stainless steel alloy (SUS), titanium alloy (Ti), smooth surface, and thick cement mantle models, respectively; for the fixation with 10° of flexion (considering flexure), the PPFH50 values were 77 ± 5, 85 ± 9, 90 ± 2, 89 ± 5, and 81 ± 11 cm, respectively. The fracture rates of the polished-surface stems were 78.6 and 35.7% at the proximal and distal sites, respectively (p < 0.05); the fracture rates of the smooth-surface stems were 14.2 and 100%, respectively (p < 0.05). CONCLUSION: The impact tests demonstrated that the conditions that were less likely to cause PPFs were use of Ti, a smooth surface, a thick cement mantle, and probably, use of SUS.

The modified Spitzy shelf acetabuloplasty for the dysplastic hip.

Aims: Although there are various pelvic osteotomies for acetabular dysplasia of the hip, shelf operations offer effective and minimally invasive osteotomy. Our study aimed to assess outcomes following modified Spitzy shelf acetabuloplasty. Methods: Between November 2000 and December 2016, we retrospectively evaluated 144 consecutive hip procedures in 122 patients a minimum of five years after undergoing modified Spitzy shelf acetabuloplasty for acetabular dysplasia including osteoarthritis (OA). Our follow-up rate was 92%. The mean age at time of surgery was 37 years (13 to 58), with a mean follow-up of 11 years (5 to 21). Advanced OA (Tönnis grade ≥ 2) was present preoperatively in 16 hips (11%). The preoperative lateral centre-edge angle ranged from -28° to 25°. Survival was determined by Kaplan-Meier analysis, using conversions to total hip arthroplasty as the endpoint. Risk factors for joint space narrowing less than 2 mm were analyzed using a Cox proportional hazards model. Results: The mean Merle d'Aubigné clinical score improved from 11.6 points (6 to 17) preoperatively to 15.9 points (12 to 18) at the last follow-up. The survival rates were 95% (95% confidence interval (CI) 91 to 99) and 86% (95% CI 50 to 97) at ten and 15 years. Multivariate Cox regression identified three factors associated with radiological OA progression: age (hazard ratio (HR) 2.85, 95% CI 1.05 to 7.76; p = 0.0398), preoperative joint space (HR 2.41, 95% CI 1.35 to 4.29; p = 0.0029), and preoperative OA (HR 8.34, 95% CI 0.94 to 73.77; p = 0.0466). Conclusion: Modified Spitzy shelf acetabuloplasty is an effective joint-preserving surgery with a wide range of potential indications.

Trochanteric Claw Plate Fixation for Greater Trochanteric Fracture or Osteotomy in Total Hip Arthroplasty.

This study retrospectively evaluated 41 consecutive open reductions and internal fixations following primary or revision total hip arthroplasty, which required trochanteric claw plate fixation for greater trochanteric fracture or osteotomy between January 2008 and December 2020. The mean duration of clinical follow-up was 4.2 years (range, 1-13 years). The patients included 13 men and 28 women, with a mean age of 68 years (range, 32-87 years). The indications for intervention included trochanteric osteotomy, intraoperative fracture, and non-union including postoperative fracture in 6, 9, and 26 cases, respectively. The mean Merle d'Aubigné Clinical Score improved from 9.4 points (range, 5-15 points) pre-operatively, to 14.3 points (range, 9-18 points) at the last follow-up. Bone union occurred in 35 cases (85%), while implant breakage occurred in four cases. At the last follow-up, the mean Merle d'Aubigné Clinical Scores of bone union and non-union were 15.3 and 14.1, respectively (p=0.48). The Kaplan-Meier survival rate, with the endpoint being revision surgery for pain, non-union, dislocation, or implant breakage, at 10 years was 80.0% (95% confidence interval: 62.6-97.4%). Greater trochanteric fixation using a trochanteric claw plate yielded successful results.

Treatment strategies for recurrent dislocation following total hip arthroplasty: relationship between cause of dislocation and type of revision surgery.

BACKGROUND: There are many therapeutic options for dislocation following total hip arthroplasty (THA). The aim of this study was to evaluate the results of revision surgery for dislocated hips. METHODS: Between November 2001 and December 2020, 71 consecutive revision hip surgeries were performed at our institution for recurrent dislocation following THA. We conducted a retrospective study of all 65 patients (71 hips), who were followed for a mean of 4.7 ± 3.2 years (range, 1-14). The cohort included 48 women and 17 men, with a mean age of 71 ± 12.3 years (range, 34-92). The mean number of previous surgeries was 1.6 ± 1.1 (range, 1-5). From intraoperative findings, we created six categories of revision hip surgery for recurrent dislocation following THA: open reduction and internal fixation (2 hips); head change or liner change only (6 hips); cup change with increased head size only (14 hips); stem change only (7 hips); cup and stem change (24 hips); and conversion to constrained cup (18 hips). Prosthesis survival was analyzed by the Kaplan-Meier method, with repeat revision surgery for re-dislocation or implant failure as the endpoint. A cox proportional hazards model was used for risk factors of re-revision surgery. RESULTS: Re-dislocation occurred in 5 hips (7.0%) and implant failure in 1 hip (1.4%). The 10-year survival rate was 81.1% (95% confidence interval, 65.5-96.8). A Dorr classification of "positional" was a risk factor for re-revision surgery due to re-dislocation. CONCLUSION: Clear understanding of the cause of dislocation is essential for optimizing revision procedures and improving the rate of successful outcomes.

Endofemoral Shooting Technique for Removing Well-fixed Cementless Stems.

Background: The removal of a well-fixed cementless stem poses technical challenges. The aim of this study was to evaluate the outcomes of our endofemoral extraction technique established in 2001. Methods: Between January 2001 and December 2016, 118 consecutive revisions following bipolar or total hip arthroplasty, which required cementless femoral stem removal, were performed at our institution. This retrospective study evaluated 106 patients (108 hips) who were followed up for a mean of 9.2 years (range, 5-20 years). The patients included 15 men and 91 women with a mean age of 65 years (range, 33-87 years). Endofemoral extracted stem removal was performed as follows. Multiple Kirschner wires were sequentially inserted into the interface between the implant and cortical bone, after which the implant was detached using a thin chisel. After the cementless stem was removed, it was replaced with a cemented stem using an autograft, as needed. Radiological loosening of the femoral stem was defined as definite or probable loosening, based on the criteria of Harris et al. Prosthesis survival was analyzed using the Kaplan-Meier method, with the endpoint set as repeat revision surgery for stem loosening or femoral fracture. Results: Re-revision surgery was performed in 7 hips. Stem loosening was observed in 4 hips, and the mean subsidence was 0.3 mm (0-3 mm). The 10-year survival rate was 97.7% (95% confidence interval, 93.2-100). Conclusions: Our technique for removing well-fixed cementless stems yielded successful results.

Linezolid versus daptomycin treatment for periprosthetic joint infections: a retrospective cohort study.

BACKGROUND: Linezolid (LZD) and daptomycin (DAP) are predominantly used to target gram-positive pathogens; however, treatment effectiveness and adverse reactions for periprosthetic joint infections (PJIs) remain unknown. The aim of this study was to compare the effectiveness and adverse reactions of LZD and DAP for PJIs. METHODS: This study retrospectively evaluated 82 patients between June 2009 and December 2017, to compare the effectiveness of LZD (group L, n = 39) and DAP (group D, n = 43) for treatment of PJIs harboring gram-positive microorganisms. Surgical options used with LZD or DAP therapy included implant retention, implant removal, and a shift to another appropriate antibiotic. Infection control was defined as not requiring implant removal after the final treatment. RESULTS: Gram-positive pathogens were isolated from 72% of group L and 70% of group D patients, respectively. Whole infection control rates against gram-positive pathogens in groups L and D were 79% and 77%, respectively. Furthermore, infection control rates were 94% and 58% in group L and 75% and 80% in group D, without and with implant removal, respectively. Significantly higher clinical success rates and lower adverse event rates were observed in group D, including higher red blood cell and platelet counts and lower C-reactive protein (CRP) levels. CONCLUSIONS: Although the effectiveness of LZD and DAP was equivalent in terms of infection control rates for refractory PJIs with gram-positive pathogens, DAP therapy significantly decreased CRP levels and caused fewer adverse events than LZD treatment.

TGF-ß Signaling Accelerates Senescence of Human Bone-Derived CD271 and SSEA-4 Double-Positive Mesenchymal Stromal Cells.

It is generally thought that the proliferative capacity and differentiation potential of somatic stem cells, including mesenchymal stromal/stem cells (MSCs) and hematopoietic stem cells, decline with age. We investigated the effects of aging on human bone-derived MSCs expressing CD271 and SSEA-4 (double-positive MSCs [DPMSCs]). The percentages of DPMSCs in bone tissue decreased significantly with age. The DPMSCs from elderly patients (old DPMSCs) showed cellular senescence, which was evidenced by low growth potential, high senescence-associated ß-galactosidase activity, and elevated p16 and p21 CDK inhibitor levels. Moreover, old DPMSCs showed weak osteogenic differentiation potential and less hematopoiesis-supporting activity in comparison with young DPMSCs. Interestingly, the addition of transforming growth factor ß2 (TGF-ß2) induced cellular senescence in young DPMSCs. With the exception of the adipogenic differentiation potential, all of the aging phenomena observed in old DPMSCs were reversed by the addition of anti-TGF-ß antibodies. These results suggest that, in part, old DPMSCs accelerate cellular senescence through TGF-ß signaling.

In vivo serum concentration of vancomycin in antibiotic-loaded acrylic cement for the treatment and prevention of periprosthetic hip infection.

BACKGROUND: Although antibiotic-loaded acrylic cement (ALAC) is used to prevent and treat periprosthetic hip infection, it is unknown how much antibiotic is deposited in the body in vivo, how high the serum concentration rises, or how long its effects last. The aim of this study was firstly to determine the amount of vancomycin (VCM) deposited as ALAC in the body, and secondly to assess the safety and drug elution profile of VCM in ALAC. METHODS: We administered VCM to prevent infection after total hip arthroplasty (THA) or to treat patients with methicillin-resistant Staphylococcus aureus. Patients were classified into two groups: a low-dose group (21 hips) that received primary THA for high-risk cases, revision THA without infection, or one-staged revision THA for infection; and a high-dose group (6 hips) that received cement beads during a two-staged revision THA. The amount of VCM placed as ALAC into the hip was calculated using the remaining ALAC. The serum concentrations of VCM and creatinine were evaluated at postoperative days 1, 4, 7, 14, and 28, and at 3 and 6 months. RESULTS: The mean amount of VCM placed as ALAC into the hip was 0.9 g and 3.4 g for cemented THA and cement beads, respectively (P < 0.0001). The mean serum concentration of VCM from ALAC in the high-dose group was significantly increased compared with that in the low-dose group on postoperative days 1, 4, 7, 14, and 28 (P < 0.0001), but it remained within a clinically safe range. No significant differences were observed between the preoperative and postoperative serum creatinine levels of either group. CONCLUSION: The average serum concentrations of VCM from ALAC were always less than the effective blood concentration, and were detectable until 6 months after surgery.

Bone Remodeling in Acetabular Reconstruction Using a Kerboull-Type Reinforcement Device and Structural Bone-Grafting in Total Hip Arthroplasty.

BACKGROUND: The purpose of this study was to identify the long-term durability of the Kerboull-type reinforcement device (KT plate) in acetabular reconstruction for massive bone defects, assessing the remodeling of structural bone grafts. METHODS: This study retrospectively evaluated 106 hips that underwent acetabular reconstruction using a KT plate between November 2000 and December 2010. Thirty-eight primary total hip arthoplasties (THAs) and 68 revised THAs were performed, and the mean duration of clinical follow-up was 8 years (5-14 years). Regarding reconstructing the acetabular bone defects, autografts were used in 37 hips, allografts in 68 hips, and A-W glass ceramics in 2 hips. RESULTS: One hip exhibited radiological migration and no revision for aseptic loosening. The mean Merle d'Aubigné Clinical Score improved from 7.5 points (4-12 points) preoperatively to 10.9 points (9-18 points) at the last follow-up. The Kaplan-Meier survival rate for radiological migration of primary and revised THAs at 10 years was 100% and 97% (95% confidence interval: 96%-100%), respectively. Bone remodeling was evaluated using the radiological demarcation at the bone-to-bone interface, and an improvement of 100% in primary THAs and 94% in revised THAs was observed. CONCLUSION: For massive bone defects, acetabular reconstruction using the KT plate with a structural bone grafting can yield successful results.

Long-term results of acetabular reconstruction using three bulk bone graft techniques in cemented total hip arthroplasty for developmental dysplasia.

PURPOSE: The aims of this retrospective study were to firstly introduce three practical bulk bone graft techniques based on acetabular morphology for dysplasia and secondly evaluate the long-term durability of acetabular reconstruction using those techniques combined with cemented total hip arthroplasty (THA). METHODS: The study comprised 101 consecutive THAs with a minimum follow-up of ten years; these procedures were categorised as being L shape (n = 58), Wall (n = 33) and D shape (n = 10) types. RESULTS: At the last follow-up, all bone grafts acquired trabecular reorientation, and no evidence of revision for aseptic or radiological loosening was noted. CONCLUSIONS: These bone graft techniques will be effective for improving the management of dysplasia in cemented THA by providing both acetabular reconstruction and cement containment.

Pre-operative scoring system to determine the surgical strategy for periprosthetic hip infection.

PURPOSE: The aim of this study was to evaluate the results of one- and two-stage revision total hip arthroplasties (THAs) and to determine a rational surgical treatment strategy for periprosthetic hip infections. METHODS: We constructed a 12-point preoperative scoring system to suggest either one- or two-stage revision THAs, based on a retrospective analysis of 55 operative procedures. Prosthesis survival was analysed using the Kaplan-Meier method, and the validity of the scoring system was evaluated using receiver-operating characteristic curves. RESULTS: At the end point of implant removal due to recurrent infection, the ten year survival rates were 94 and 87% for one- and two-stage revision THAs, respectively. One-stage revision THA was recommended for patients scoring >9 points. The risk of recurrent infection in patients scoring 4 points was 83%. The sensitivity and specificity of a cut-off value of 4 points, determined by the scoring system, were 83 and 100%, respectively. CONCLUSIONS: The novel pre-operative scoring system was useful for the management of periprosthetic hip infections.

Induction of autoimmune arthritis after direct injection of bone marrow cells from arthritis-prone SKG/Jcl mice into bone cavity of normal mice.

SKG/Jcl (SKG) mice spontaneously develop T cell-mediated autoimmune arthritis and may be an effective model for studying human rheumatoid arthritis. We sought to confirm that arthritis in SKG mice was caused by stem cell disorders. We induced systemic arthritis in normal C57/BL6 (B6) mice (H-2(b) type) by injecting lineage-negative (lin(-)) immature cells isolated from bone marrow cells (BMCs) of SKG mice (H-2(d) type) directly into bone cavities. Twenty weeks later, we analyzed arthritis scores, hematoxylin-eosin (H-E) staining and tartrate-resistant acid phosphatase (TRAP) staining in ankle joints, H-2 type of hematolymphoid and osteoblast-like cells, serum levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) and percentages of CD4(+) T cells and osteoblast-like cells expressing receptor activator of nuclear factor kappa-B ligand (RANKL) in recipient mice. Donor-derived hematolymphoid cells and osteoblast-like cells had completely replaced donor-derived cells in the recipients (H-2(b) to H-2(d)). All recipients showed severe joint swelling with hyperemia and developed hypertrophic synovitis with lymphocytes accumulated around joints. All recipients also had higher TNF-α and IL-6 levels than untreated B6 controls. Furthermore, the percentages of CD4(+) T cells and osteoblast-like cells expressing RANKL and the number of TRAP(+) cells were greater in treated animals. Donor-derived hematolymphoid cells and osteoblast-like cells persisted in these recipients and promoted autoimmune arthritis and an increase in osteoclasts. Because autoimmune arthritis may be associated with abnormal lin(-) immature cells, patients with intractable autoimmune arthritis may be treated by replacing these cells with direct injection of lin(-) immature cells isolated from normal BMCs.

Endoscopic shelf acetabuloplasty combined with labral repair, cam osteochondroplasty, and capsular plication for treating developmental hip dysplasia.

In addition to the underlying shallow acetabular deformity, a patient with hip dysplasia has a greater risk of development of a labral tear, a cam lesion, and capsular laxity. This combination of abnormalities exacerbates joint instability, ultimately leading to osteoarthritis. Unsurprisingly, only repairing the acetabular labrum remains controversial, and the outcome is unpredictable. In this technical note, with video, we demonstrate an entirely endoscopic approach for simultaneously repairing the most common mechanical abnormalities found in moderate hip dysplasia: labral repair, cam osteochondroplasty, capsular plication, and shelf acetabuloplasty using an autologous iliac bone graft.

Subtrochanteric shortening osteotomy combined with cemented total hip arthroplasty for Crowe group IV hips.

BACKGROUND: Total hip arthroplasty (THA) is a challenging surgical procedure that can be used to treat severely dislocated hips. There are few reports regarding cemented THAs involving subtrochanteric shortening osteotomy (SSO), even though cemented THAs provide great advantages because the femur is generally hypoplastic with a narrow, deformed canal. PURPOSES: We evaluated the utility of cemented THA with SSO for Crowe group IV hips, and assessed the relationship between leg lengthening and nerve injury. Our goal was to describe surgical techniques for optimizing surgical outcomes while minimizing the risk of nerve injury. METHODS: We retrospectively reviewed 34 cases of cemented THAs with transverse SSO for Crowe group IV. Prior to surgery, mean hip flexion was 93.1° (40°-130°). The mean follow-up period was 5.2 years (3-10 years). RESULTS: Bone union took an average of 7.7 months (3-24 months). Mean leg lengthening was 40.5 mm (15-70 mm) and was greater in patients without hip flexion contracture. None of the patients experienced any nerve injuries associated with leg lengthening, and radiographic evidence of loosening was not observed at the final follow-up. CONCLUSIONS: SSO combined with cemented THA is an effective treatment for severely dislocated hips. Leg lengthening is not necessarily associated with nerve injuries, and the likelihood of this surgical complication may be related to the presence of hip flexion contracture.

Development of a salmon-derived crosslinked atelocollagen sponge disc containing osteogenic protein-1 for articular cartilage regeneration: in vivo evaluations with rabbits.

BACKGROUND: We have developed crosslinked salmon-derived atelocollagen sponge, which has a denaturation temperature of 47 degrees Celsius. The purpose of this study is to evaluate the fundamental in vivo efficacy of the osteogenic protein (OP) -1 containing salmon-derived collagen sponge disc (SCS) on cartilage regeneration, using a rabbit model. METHODS: A total of 24 rabbits were used in this study. In each animal, a full-thickness osteochondral defect was created in each femoral trochlea. Then, each 12 rabbits were randomly divided into the two groups. In Group I, an OP1-SCS disc was implanted into the defect in the right knee. In Group II, a SCS disc without OP-1 was implanted into the defect in the right knee. A control group of 12 rabbits was assembled from randomly-selected left knees from among the first two groups. In Group-III, we applied no treatment for a defect in the left knee to obtain the untreated control. All rabbits were sacrificed at 12 weeks after surgery. In each group, 10 animals were used for histological and immunohistological evaluations, and the remaining 2 were used for real-time polymerase chain reaction (PCR) analyses. RESULTS: In Group I, a regenerated cartilage tissue rich in proteoglycan and type-2 collagen was found at 12 weeks, although the width was thicker than that of Group II. In Group II, the defect was filled with thick inhomogeneous tissues, including cartilage, fibrous, and bone tissues at 12 weeks. Concerning the gross observation and histological scores at 12 weeks, the ANOVA showed significant differences (p < 0.0001, and p < 0.0001, respectively). The post-hoc test indicated that the gross observation and histological scores of Group I was significantly greater than those of Groups II (p = 0.035, and p = 0.0104, respectively) and III (p < 0.0001, and p < 0.0001, respectively), while Group II was significantly greater than Group III (p = 0.0069, and p = 0.005, respectively). The real time PCR analysis showed that gene expression of type-2 collagen and aggrecan of Group I was greater than that of Group II. CONCLUSIONS: The present study clearly demonstrated that the implantation of the OP1-SCS disc without any cultured cells may induce spontaneous hyaline-like cartilage regeneration to greater degrees than implantation of only the salmon-derived collagen sponge disc.

A less-invasive cervical laminoplasty for spondylotic myelopathy that preserves the semispinalis cervicis muscles and nuchal ligament.

OBJECT: Modified cervical laminoplasty techniques have been developed to reduce postoperative axial neck pain and preserve function in patients with cervical spondylotic myelopathy (CSM). However, the previous studies demonstrating satisfactory surgical outcomes had a retrospective design. Here, the authors aimed to prospectively evaluate the 2-year outcomes of a modified cervical laminoplasty technique for CSM that preserves the paravertebral muscles. METHODS: Outcomes were analyzed for 40 patients (22 men and 18 women; mean age, 66.6 years; age range 44-92 years) with CSM who underwent C4-6 laminoplasty with C-3 and C-7 partial laminectomies or C-3 total and C-7 partial laminectomies and received hydroxyapatite spacers. Neurological, pain severity, and spinal radiographic evaluations were performed preoperatively and at 3, 6, 12, 18, and 24 months postoperatively. Plain radiography and MRI of the cervical spine were performed to evaluate the range of motion (ROM), sagittal alignment, and cross-sectional areas of the deep extensor muscles. The extent of bone-spacer bonding and bony union at the gutter was assessed by CT. RESULTS: The mean preoperative Japanese Orthopaedic Association CSM score was 10.2, but it increased to 14.4 by 24 months after surgery. Eleven patients had axial neck pain preoperatively, but only 3 reported mild pain at 24 months, and in all 3 cases the pain was mild. The mean angle of lordosis was 11.7° preoperatively and 12.0° 2 years postoperatively. Although the ROM at the C2-7 levels was significantly reduced 3 months postoperatively, an increasing trend was observed up to 12 months, and 86% of the preoperative ROM was achieved by 2 years postoperatively. The mean paravertebral muscle cross-sectional areas were 833 ± 215 mm(2) preoperatively and 763 ± 197 mm(2) 24 months postoperatively, but the difference was not statistically significant. The rates of bone-spacer bonding and bony union at the gutter were low during the early stages but increased to 90% and 93%, respectively, by 2 years after surgery. CONCLUSIONS: The modified laminoplasty technique used in this study ensured very good neurological status and ROM after 2 years and was associated with low incidences of axial neck pain and serious complications. This simple and easy operative method could benefit future laminoplasty protocols.

Clinical and radiographic results from a 2-year comparison of once-weekly versus twice-weekly administration of etanercept in biologics-naive patients with rheumatoid arthritis.

OBJECTIVES: The twice-weekly administration of 25 mg of etanercept (TW) has been shown to be effective in patients with rheumatoid arthritis (RA). However, the once-weekly administration of 25 mg of etanercept (OW) was tried in order to address the economic burden of anti-rheumatic biologics. We evaluated the clinical and radiographic results from a 2-year follow-up study of patients receiving OW or TW. METHODS: Sixty-three biologics-naive patients with RA were randomly assigned to receive either OW (n = 42) or TW (n = 21). RESULTS: From baseline to year 2, rates of clinical remission,according to the Disease Activity Score of 28 joints(DAS-28) (based on C-reactive protein; CRP)­with clinical remission being regarded as a DAS-28 (CRP) score of\2.3­were significantly improved in the OW group (from 1.6 to 39.0%) and in the TW group (from 9.5 to 47.6%),but no significant between-group difference was observed at year 2. Radiographic joint damage, quantified with the modified Sharp score, was significantly progressive in the OW group in contrast to findings in the TW group. Thus,among patients receiving TW therapy, the progression of joint damage may have been inhibited or may have shown remission. CONCLUSIONS: These results suggest that, in terms of DAS-28 remission, OW therapy can efficiently substitute for TW therapy in biologics-naive patients with RA. However, TW therapy was indispensable in preventing the worsening of joint damage.

Involvement of cancer biomarker C7orf24 in the growth of human osteosarcoma.

BACKGROUND: Up-regulation of the expression of the gene C7orf24, encoding γ-glutamyl cyclotransferase, is a common event in cancers derived from various tissues, but its involvement in osteosarcomas (OS) has not yet been demonstrated. MATERIALS AND METHODS: The expression of C7orf24 was analyzed in human OS cell lines and primary tumor samples. The biological effects of C7orf24 on growth, motility, and invasion in the OS cell lines were investigated using siRNA for C7orf24. Genes related to the function of C7orf24 were sought by genome-wide gene expression profiling. RESULTS: The level of C7orf24 expression was much higher in the OS cell lines and OS primary tumors than in normal osteoblasts. Down-regulation of C7orf24 expression inhibited the growth of the cell lines in association with enhancement of cell-clustering. Treatment with C7orf24-siRNA inhibited cell motility and invasion. Gene ontology suggested the function of C7orf24 to be related to cell adhesion and protein transport. CONCLUSION: C7orf24 is also involved in the growth of OS, and is a potential biomarker for this type of tumor.