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Patients with central osteophytes in the lateral compartment may be poor candidates for unicompartmental knee arthroplasty (UKA) for medial knee arthritis given the thin overlying articular cartilage above the central osteophytes that is inadequate for supporting weight-bearing after UKA. Therefore, attempts should be made to detect central osteophytes to confirm suitability for UKA.
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49,XXXYY is an extremely rare sex chromosomal aneuploidy (SCA), with only seven cases reported worldwide to date. Among these cases, only three have been documented into adulthood. Moreover, no cases of 49,XXXYY have been reported in Japan. This SCA has been identified in two scenarios: in vitro fertilization and abortion. Similar to 47,XXY, this aneuploidy is a type of Klinefelter syndrome. Aneuploidy of the X chromosome can lead to various progressive complications due to excess X chromosomes. Herein, we present the case of a Japanese man with 49,XXXYY. He exhibited developmental delays and external genitalia abnormalities since early infancy but was not closely monitored for these symptoms until the age of 3 years old. At that time, a chromosome test revealed his karyotype to be 49,XXXYY. Subsequent examinations were conducted due to various symptoms, including delayed motor development, intellectual disability, facial dysmorphisms, forearm deformities, hip dysplasia, cryptorchidism, micropenis, primary hypogonadism, and essential tremor. Since reaching puberty, he has undergone testosterone replacement therapy for primary hypogonadism, experiencing no complications related to androgen deficiency to date. He has maintained normal lipid and glucose metabolism, as well as bone density, for a prolonged period. There are no other reports on the long-term effects of testosterone treatment for the SCA. Appropriate testosterone replacement therapy is recommended for individuals with 49,XXXYY to prevent complications. This report will contribute to an enhanced understanding of the 49,XXXYY phenotype, aiding in the diagnosis, treatment, and genetic counseling of future cases.
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Síndrome de Klinefelter , Humanos , Masculino , Síndrome de Klinefelter/genética , Síndrome de Klinefelter/complicações , Síndrome de Klinefelter/diagnóstico , Cromossomos Humanos X/genética , Aneuploidia , Adulto , Hipogonadismo/genética , Pré-Escolar , Testosterona/uso terapêutico , Testosterona/sangue , Terapia de Reposição Hormonal , Aberrações dos Cromossomos Sexuais , SeguimentosRESUMO
BACKGROUND: An inertial measurement unit is small and lightweight, allowing patient measurements without physical constraints. This study aimed to determine the differences in kinematic parameters during gait using an insole with a single inertial measurement unit in healthy controls and on both sides in patients with knee osteoarthritis. METHODS: Twenty patients with knee osteoarthritis and 13 age-matched controls were included in this study. The participants walked at a self-selected speed and foot kinematics were measured during gait using an insole with a single inertial measurement unit. The right side of the healthy controls and both the affected and contralateral sides of patients with KOA were analyzed separately. FINDINGS: The foot extension angular velocity at toe-off was significantly reduced on the affected side than on the contralateral side (P < 0.001) and in healthy controls (P < 0.001). During the swing phase, foot posterior-anterior acceleration was significantly lower on the affected side than on the healthy controls (P = 0.005). Furthermore, despite a decrease in walking speed, foot superior-inferior acceleration at initial contact in patients was significantly lower on the contralateral side than in healthy controls (P = 0.0167), but not on the affected side (P = 0.344). INTERPRETATION: An insole with a single inertial measurement unit can detect differences in foot kinematics during gait between healthy controls and patients with knee osteoarthritis. Our findings indicate that patients with knee osteoarthritis exhibit dysfunction of push-off at toe-off and shock absorption at initial contact on the affected side.
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Osteoartrite do Joelho , Humanos , Articulação do Joelho , Fenômenos Biomecânicos , Estudos de Casos e Controles , Marcha , CaminhadaRESUMO
A new beta TiNbSn alloy with a low Young's modulus of approximately 40 GPa has been developed to resolve the stress shielding by Young's modulus divergence. In this study, the efficacy of TiNbSn alloy locking plates on bone repair is compared to that of commercially pure titanium (CP-Ti). The TiNbSn alloy and CP-Ti, which have Young's moduli of 49.1 GPa and 107 GPa, respectively, were compared. Male Japanese white rabbits were anesthetized, and osteotomy and osteosynthesis with locking plates were performed on the right tibia. The bone repair was assessed using micro-computed tomography (CT), histomorphometry, immunohistochemistry, and mechanical testing. Micro-CT, histomorphometry, immunohistochemistry, and mechanical testing were performed four weeks after osteotomy. Six weeks after surgery, micro-CT and mechanical testing were performed. Micro-CT analysis at four weeks after surgery showed that the intramedullary fracture callus in the TiNbSn alloy group had more bone volume and numerous bridging structures compared to the CP-Ti group (CP-Ti vs. TiNbSn alloy, 34.3 ± 13.1 mm3 vs. 61.3 ± 19.6 mm3, p = 0.02; mean ± standard deviation). At four weeks post-osteotomy, the healed tibia showed significantly higher strength in the TiNbSn alloy group compared with CP-Ti (CP-Ti vs. TiNbSn alloy, 81.3 ± 31.2 N vs. 133.7 ± 46.6 N, p = 0.04). TiNbSn alloy locking plates had a more positive impact on bone formation and bone strength restoration than the CP-Ti locking plates during the early phase of bone healing.
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Fixação Interna de Fraturas , Tíbia , Masculino , Animais , Coelhos , Módulo de Elasticidade , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Microtomografia por Raio-X , LigasAssuntos
Cifose , Escoliose , Humanos , Adolescente , Escoliose/cirurgia , Extremidade Inferior , Articulação do Joelho , AcetábuloRESUMO
BACKGROUND: The difference between Young's moduli of the femur and the stem causes stress shielding (SS). TiNbSn (TNS) stem has a low Young's modulus and strength with gradient functional properties during the change in elastic modulus with heat treatment. The aim of this study was to investigate the inhibitory effect of TNS stems on SS and their clinical outcomes compared to conventional stems. METHODS: This study was a clinical trial. Primary THA was performed using a TNS stem from April 2016 to September 2017 for patients in the TNS group. Unilateral THA was performed using a Ti6Al4V alloy stem from January 2007 to February 2011 for patients in the control group. The TNS and Ti6Al4V stems were matched in shape. Radiographs were obtained at the 1- and 3-year follow-ups. Two surgeons independently checked the SS grade and appearance of cortical hypertrophy (CH). The Japanese Orthopaedic Association (JOA) scores before and 1 year after surgery were assessed as clinical scores. RESULTS: None of the patients in the TNS group had grade 3 or 4 SS. In contrast, in the control group, 24% and 40% of patients had grade 3 and 4 SS at the 1- and 3-year follow-ups, respectively. The SS grade was lower in the TNS group than in the control group at the 1- and 3-year follow-ups (p < 0.001). The frequencies of CH in both groups were no significant difference at the 1- and 3-year follow-ups. The JOA scores of the TNS group significantly improved at 1 year after surgery and were comparable to control group. CONCLUSION: The TNS stem reduced SS at 1 and 3 years after THA compared to the proximal-engaging cementless stem, although the shapes of the stems matched. The TNS stem could reduce SS, stem loosening, and periprosthetic fractures. TRIAL REGISTRATION: Current Controlled Trials. ISRCTN21241251. https://www.isrctn.com/search?q=21241251 . The date of registration was October 26, 2021. Retrospectively registered.
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Artroplastia de Quadril , Prótese de Quadril , Humanos , Ligas , Módulo de Elasticidade , Fêmur/cirurgiaRESUMO
We report a successful case of two-stage revision total knee arthroplasty performed for treating painless metallosis after total knee arthroplasty with a metal-backed patella. A 63-year-old woman diagnosed with rheumatoid arthritis underwent left total knee arthroplasty with a metal-backed patella at 32 years of age. The patient did not have knee pain; however, knee joint swelling, a strange noise, and pigmentation were reported 4 years ago. Radiographs showed cloud and metal-line signs anteriorly and posteriorly at the femoral condyle. Therefore, a two-stage surgery was performed for infection prevention and ease of performing posterior synovectomy. The patient underwent initial synovectomy via a posterior approach, followed by anterior synovectomy and revision total knee arthroplasty. Synovectomy was performed well without perioperative infection or failure of wound healing. In cases with metallosis after total knee arthroplasty, the two-stage revision total knee arthroplasty should be considered, depending on the degree of synovial proliferation and the risk of complications.
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BACKGROUND: It has not been clarified yet how much force is acting on the shoulder joint to create Hill-Sachs/reverse Hill-Sachs lesions which are commonly observed in patients with anterior or posterior shoulder instability. The purpose of this study was to determine the magnitude of force to create these bony lesions using cadaveric shoulders. METHODS: Fourteen fresh-frozen cadaveric shoulders were used. Compression tests were performed using the universal testing machine. The specimens were randomly divided into two groups. In group A, the posterior humeral head (the bare area and articular cartilage) was first compressed against the anterior glenoid rim to simulate a Hill-Sachs lesion, followed by the anterior humeral head being compressed against the posterior glenoid rim. In group B, the same procedure was repeated in the reverse order. X-ray microcomputed tomography (microCT) was also performed. RESULTS: The maximum compression force to create a Hill-Sachs lesion was 771 ± 214 N (mean ± SD) on the articular cartilage of the posterior humeral head, which was significantly greater than the force of 447 ± 215 N to create it on the bare area (P = 0.0086). Regarding the reverse Hill-Sachs lesions, the maximum compression force was 840 ± 198 N when it was created on the articular cartilage of the anterior humeral head, which was significantly greater than the force of 471 ± 100 N when it was created at the footprint of the subscapularis tendon (P = 0.0238). MicroCT showed multiple breakage of the trabecular bone. CONCLUSION: A force to create a Hill-Sachs lesion or a reverse Hill-Sachs lesion was significantly greater when it was created on the humeral articular cartilage than at the non-cartilage area. Also, the force to create a reverse Hill-Sachs lesion was significantly greater than the one to create a Hill-Sachs lesion.
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Lesões de Bankart , Doenças Ósseas , Doenças das Cartilagens , Instabilidade Articular , Luxação do Ombro , Articulação do Ombro , Humanos , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/patologia , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/patologia , Microtomografia por Raio-X , Cabeça do Úmero/diagnóstico por imagem , Doenças das Cartilagens/patologia , CadáverRESUMO
In this report, we present a successfully treated case of intractable thoracic pyogenic spondylitis using one-step curettage/bone grafting of spinal anterior segment and less-contaminated percutaneous spinal posterior fixation via separated posterior approaches, which was not compatible with conventional spinal instruments.
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BACKGROUND: Ti6Al4V alloy, which is commonly used for biomedical applications, has a Young modulus (110 GPa) that is higher than that of human cortical bone (11 to 20 GPa). Using an implant with a material with a low Young modulus that enhances load sharing by the bone even more than those made of Ti6Al4V could be beneficial for bone healing and further reduce the potential for stress shielding. A new ß-type TiNbSn alloy has a low Young modulus of approximately 40 to 49 GPa. However, whether the new titanium alloy with a lower Young modulus is advantageous in terms of fracture healing has not been assessed, and a small-animal model seems a reasonable first step in its assessment. QUESTIONS/PURPOSES: To assess the impact of a TiNbSn alloy plate with a lower Young modulus compared with a Ti6Al4V alloy plate on fracture healing, we evaluated: (1) bony bridging and callus volume, (2) new bone formation and remaining cartilage tissue, (3) osteoblast activity in the callus, and (4) mechanical strength and stiffness of the callus in bending. METHODS: Fracture plates manufactured from TiNbSn and Ti6Al4V alloys, which have Young moduli of 49 GPa and 110 GPa, respectively, were compared. The main reason for using rabbits was the high reliability of the three-point bending mechanical test of the rabbit tibia. Forty-two male Japanese white rabbits weighing 2.8 to 3.4 kg were anesthetized. A 5-cm skin incision was made on the medial side in the mid-diaphysis of the right tibia. Eight-hole plates were used, which were 42 mm long, 5 mm wide, and 1.2 mm thick. Plate fixation was performed using three proximal and three distal screws. After the plate was installed, an osteotomy was performed using a 1-mm-wide wire saw to create a standardized tibial transverse osteotomy model with a 1-mm gap. Bone healing was quantitatively assessed by two nonblinded observers using micro-CT (bony bridging and callus volume), histomorphometry (new bone formation and remaining cartilage tissue), immunohistochemistry (osteoblast activity), and mechanical testing (mechanical strength and stiffness in bending). Measurements on nondemineralized specimens were descriptive statistics due to their small number. Four weeks after osteotomy and fixation, 30 rabbits were euthanized to undergo micro-CT and subsequent mechanical testing (n = 12), histomorphometry and immunohistochemistry with demineralized specimens (n = 12), and histomorphometry with a nondemineralized specimen (n = 6). Eight weeks postoperatively, 12 rabbits were euthanized for micro-CT and subsequent mechanical testing. RESULTS: Intramedullary fracture calluses treated with TiNbSn alloy plates had larger bone volumes and more numerous bridging structures than those treated with Ti6Al4V alloy plates at 4 weeks after osteotomy (Ti6Al4V alloy versus TiNbSn alloy: 30 ± 7 mm 3 versus 52 ± 14 mm 3 , mean difference 22 [95% CI 9 to 37]; p = 0.005; ICC 0.98 [95% CI 0.95 to 0.99]). Histologic assessments demonstrated there was greater new bone formation (total callus: Ti6Al4V versus TiNbSn: 16 ± 4 mm 2 versus 24 ± 7 mm 2 , mean difference 8 [95% CI 1 to 16]; p = 0.04; ICC 0.98 [95% CI 0.93 to 0.99]; intramedullary callus: Ti6Al4V versus TiNbSn: 6 ± 4 mm 2 versus 13 ± 5 mm 2 , mean difference 7 [95% CI 1 to 13]; p = 0.02; ICC 0.98 [95% CI 0.95 to 0.99]) and a higher number of osteocalcin-positive cells (Ti6Al4V alloy versus TiNbSn alloy: 1397 ± 197 cells/mm 2 versus 2044 ± 183 cells/mm 2 , mean difference 647 [95% CI 402 to 892]; p < 0.001; ICC 0.98 [95% CI 0.95 to 0.99]) in the TiNbSn alloy group than in the Ti6Al4V alloy group. At 4 weeks after osteotomy, both bone strength and stiffness of the healed bone in the TiNbSn alloy group were higher than those in the Ti6Al4V alloy group (maximum load: Ti6Al4V alloy versus TiNbSn alloy: 83 ± 30 N versus 127 ± 26 N; mean difference 44 [95% CI 8 to 80]; p = 0.02; stiffness: Ti6Al4V alloy versus TiNbSn alloy: 92 ± 43 N/mm versus 165 ± 63 N/mm; mean difference 73 [95% CI 4 to 143]; p = 0.047). Eight weeks after osteotomy, no between-group differences were observed in the strength and stiffness of the healed bone. CONCLUSION: The results of this study indicate that TiNbSn alloy plate with a lower Young modulus resulted in improved bone formation and stiffer callus during the early phase (4 weeks after surgery) but not the later phase (8 weeks after surgery) of bone healing. CLINICAL RELEVANCE: An overly stiff plate may impair callus formation and bone healing. The TiNbSn alloy plate with a low Young modulus improves the early formation of new bone and stiff callus at the osteotomy site compared with the Ti6Al4V alloy plate in the healing process, which may promote bone repair. TiNbSn alloy may be a promising biomaterial for fracture treatment devices. Further research to address concerns about the strength of TiNbSn alloy plates, such as fatigue life and plate fracture, will be necessary for clinical applications, including mechanical tests to verify fatigue life and validation in larger animals with greater body weight.
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Placas Ósseas , Tíbia , Ligas/química , Animais , Fenômenos Biomecânicos , Módulo de Elasticidade , Consolidação da Fratura , Humanos , Masculino , Coelhos , Reprodutibilidade dos Testes , Tíbia/cirurgiaRESUMO
The optimal Young's modulus of material of orthopedic devices for fracture treatment is still unknown. The purpose of present study was to evaluate the impacts of intramedullary nails composed of a titanium alloy with low Young's modulus, on accelerating fracture healing compared with stainless steel with high Young's modulus. A ß-type TiNbSn alloy with a low Young's modulus close to that of human cortical bone was developed for clinical application. TiNbSn alloy with a Young's modulus of 45 GPa and stainless steel with a Young's modulus of 205 GPa were compared, with respect to the impacts on fracture healing. Fracture and fixation using intramedullary nail were performed on the right tibiae of C57BL/6 mice. The assessment of bone healing was performed via micro-computed tomography, histomorphometry, and quantitative reverse transcription polymerase chain reaction. In micro-computed tomography, larger bone volumes were observed in the fracture callus treated with TiNbSn alloy in comparison with those treated with stainless steel. Histological assessments confirmed accelerated cartilage absorption and new bone formation in the TiNbSn alloy group compared with the stainless steel group. The expression of Col1a1, Runx2, Dkk1, and Acp5 was higher in the TiNbSn alloy group, while that of Col2a1 and Col10a1 was lower in the late phase. The present study demonstrated that the fixation by intramedullary nails with TiNbSn alloy offered an accelerated fracture healing with promotion of bone formation via increased Runx2 expression. TiNbSn alloy might be a promising material for fracture treatment devices.
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Ligas , Consolidação da Fratura , Aceleração , Animais , Subunidade alfa 1 de Fator de Ligação ao Core , Módulo de Elasticidade , Camundongos , Camundongos Endogâmicos C57BL , Aço Inoxidável , Microtomografia por Raio-XRESUMO
Medial open wedge high tibial osteotomy (OWHTO) is usually performed with proximal tuberosity osteotomy or setting the osteotomy line proximal to the tuberosity. However, OWHTO can result in patellofemoral complications due to postoperative patella infera. A new OWHTO technique, biplanar osteotomy with a distal tuberosity osteotomy, was reported in 2004 to prevent postoperative patella infera. To ensure that the 2 osteotomy lines maintain perpendicular, we describe the OWHTO procedure with a distal tuberosity osteotomy technique using a TriS Medial HTO Plate System (Olympus Terumo Biomaterials Corp., Tokyo, Japan) and a right angle guide we developed. In this Technical Note, we describe the procedure and advantages, risks, and limitations, as well as the pearls and pitfalls based on our experience.
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INTRODUCTION: This study aimed to determine the effects of denosumab treatment on the joint destruction of Japanese females with rheumatoid arthritis (RA) and anti-cyclic citrullinated peptide (CCP) antibodies. MATERIALS AND METHODS: This retrospective longitudinal study included 56 patients treated with denosumab and 50 patients treated with bisphosphonate. All participants were positive for anti-CCP antibodies. All patients also had a history of osteoporosis treatment with bisphosphonate, which was either continued or switched to 60 mg of subcutaneous denosumab injection every 6 months. To assess the progression of joint destruction, hand and foot radiographs were taken, and changes in modified total Sharp score (mTSS), erosion score (ERO), and joint space narrowing score (JSN) were evaluated at 12 months and 24 months. The changes in BMD of the lumbar spine and hip were also assessed at 12 months. RESULTS: At 12 months, there were significant differences in the change of ERO (p = 0.015) and mTSS (p = 0.01). Similarly, there were significant differences in the change of ERO (p = 0.013) and mTSS (p = 0.003) at 24 months. In contrast, no significant difference was observed in the changes of JSN and clinical parameters. There were significant differences in the changes in BMD in the femoral neck (p = 0.011) and total hip (p = 0.012). CONCLUSION: Denosumab treatment might be effective for the inhibition of bone erosion progression in the patients with RA, and it potentially contributes to the treatment of osteoporosis and prevention of destructive arthritis in patients with switching treatment from bisphosphonate.
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Anticorpos Antiproteína Citrulinada , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/imunologia , Denosumab/administração & dosagem , Difosfonatos/administração & dosagem , Substituição de Medicamentos , Deformidades Articulares Adquiridas/prevenção & controle , Pós-Menopausa , Idoso , Artrite Reumatoide/complicações , Densidade Óssea , Conservadores da Densidade Óssea/administração & dosagem , Progressão da Doença , Feminino , Humanos , Deformidades Articulares Adquiridas/etiologia , Estudos Longitudinais , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/complicações , Osteoporose Pós-Menopausa/tratamento farmacológico , Estudos RetrospectivosRESUMO
BACKGROUND: Obesity is a representative risk factor for osteoarthritis (OA). The relationship between osteoporosis and executed osteonecrosis has been reported. The primary aim of this study was to determine the influence of obesity and osteoporosis on disease progression in patients with medial meniscus posterior root tear (MMPRT). METHODS: We included 41 knees with MMPRT in this study. MMPRT was diagnosed based on the presence of both a meniscus ghost sign and a vertical linear defect on MRI. OA progression and development of osteonecrosis were evaluated using plain radiographs obtained at the initial visit and the final follow-up. The follow-up period for all knees was 30 ± 8 (mean ± standard deviation) months. Patients' physical attributes were assessed at initial visits; these attributes included body mass index (BMI) and the clinical risk for osteoporotic fracture, as determined by the World Health Organization fracture risk assessment tool (FRAX). Patients with a BMI ≥25 kg/m2 were classified in the obesity group and those with a BMI <25 kg/m2 in the control group. Patients with a FRAX score of ≥10% were classified in the high FRAX group and those with a FRAX score of <10% in the low FRAX group. RESULTS: OA progression evaluated by Kellgren-Lawrence grading scale was observed in 75% patients in the obesity group (1 grade in 38%, 2 grades in 31%, and 3 grades in 6%) and 58% in the control group (1 grade in 58%). Patients in the obesity group showed significantly greater OA progression. Spontaneous osteonecrosis was observed in no knees at the initial visit and six knees at the final follow-up. All six lesions were observed in the high FRAX group, which was statistically significant. CONCLUSIONS: OA progression and development of osteonecrosis were the two representative deterioration patterns in patients with MMPRT. High BMI was related with OA progression, and FRAX score of ≥10% with the development of osteonecrosis.
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Osteoartrite do Joelho , Osteoartrite , Osteonecrose , Osteoporose , Lesões do Menisco Tibial , Humanos , Imageamento por Ressonância Magnética , Meniscos Tibiais , Obesidade/complicações , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/epidemiologia , Osteonecrose/diagnóstico por imagem , Osteonecrose/epidemiologia , Osteonecrose/etiologia , Osteoporose/complicações , Osteoporose/diagnóstico por imagem , Osteoporose/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Lesões do Menisco Tibial/complicações , Lesões do Menisco Tibial/diagnóstico por imagemRESUMO
BACKGROUND: The locomotive syndrome risk test was developed to quantify the decrease in mobility among adults, which could eventually lead to disability. The purpose of this study was to establish reference values for the locomotive syndrome risk test for adults and investigate the influence of age and sex. METHODS: We analyzed 8681 independent community dwellers (3607 men, 5074 women). Data pertaining to locomotive syndrome risk test (the two-step test, the stand-up test, and the 25-question geriatric locomotive function scale [GLFS-25]) scores were collected from seven administrative areas of Japan. RESULTS: The reference values of the three test scores were generated and all three test scores gradually decreased among young-to-middle-aged individuals and rapidly decreased in individuals aged over 60 years. The stand-up test score began decreasing significantly from the age of 30 years. The trajectories of decrease in the two-step test score with age was slightly different between men and women especially among the middle-aged individuals. The two physical test scores were more sensitive to aging than the self-reported test score. CONCLUSION: The reference values generated in this study could be employed to determine whether an individual has mobility comparable to independent community dwellers of the same age and sex.
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Locomoção , Limitação da Mobilidade , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Valores de ReferênciaRESUMO
Ti6Al4V alloy orthopedic implants are widely used as Ti6Al4V alloy is a biocompatible material and resistant to corrosion. However, Ti6Al4V alloy has higher Young's modulus compared with human bone. The difference of elastic modulus between bone and titanium alloy may evoke clinical problems because of stress shielding. To resolve this, we previously developed a TiNbSn alloy offering low Young's modulus and improved biocompatibility. In the present study, the effects of sulfuric acid anodic oxidation on the osseointegration of TiNbSn alloy were assessed. The apatite formation was evaluated with Scanning electron microscopy, X-ray diffraction, X-ray photoelectron spectroscopy and transmission electron microscopy analyses. The biocompatibility of TiNbSN alloy was evaluated in experimental animal models using pull-out tests and quantitative histological analyses. The results of the surface analyses indicated that sulfuric anodic oxidation induced abundant superficial apatite formation of the TiNbSn alloy disks and rods, with a 5.1-µm-thick oxide layer and submicron-sized pores. In vivo, treated rods showed increased mature lamellar bone formation and higher failure loads compared with untreated rods. Overall, our findings indicate that anodic oxidation with sulfuric acid may help to improve the biocompatibility of TiNbSn alloys for osseointegration.
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Intramedullary nailing is widely performed for internal fixation of fractures. The applicable elasticity of materials composing intramedullary nails remains unclear. The present study aimed to evaluate the effects of the elastic property of ß-type titanium alloy nails on fracture healing compared with conventional Ti-6Al-4V alloy nails using a rabbit tibial osteotomy model. Two types of intramedullary nails composed of ß-type Ti-Nb-Sn alloy (Young's modulus: 37 GPa) or Ti-6Al-4V alloy (Young's modulus: 110 GPa) were used for osteotomy fixation in the tibiae of rabbits. At 4, 8, and 16 weeks postoperatively, microcomputed tomography (micro-CT) and three-point bending tests were performed. Micro-CT images showed that the callus volume was significantly larger in the Ti-Nb-Sn alloy group at 4 and 8 weeks. The callus bone mineral density did not differ at each time point. In mechanical testing, the maximum load was significantly higher at all time points in the Ti-Nb-Sn alloy group. Taken together, the elastic intramedullary nails composed of Ti-Nb-Sn alloy improved the mechanical properties of the bone healing site from the early phase to the remodeling phase. Adequate Young's modulus of the Ti-Nb-Sn alloy enhanced fracture union and bone strength restoration. The Ti-Nb-Sn alloy is a promising biomaterial for fracture fixation devices. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2018. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 700-707, 2019.
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Ligas/química , Pinos Ortopédicos , Regeneração Óssea , Módulo de Elasticidade , Teste de Materiais , Osteotomia , Tíbia , Animais , Nióbio/química , Coelhos , Tíbia/metabolismo , Tíbia/patologia , Tíbia/cirurgia , Estanho/química , Titânio/químicaRESUMO
PURPOSE: To analyze the influence of meniscal tear pattern on clinical outcomes following arthroscopic partial meniscectomy in middle-aged patients with medial meniscal tears. METHODS: A total of 123 patients (130 knees) aged ≥ 50 years who underwent arthroscopic partial meniscectomy for medial meniscal tears were evaluated. Inclusion criteria were none to moderate medial knee osteoarthritis [Kellgren-Lawrence (KL) grade ≤ 3] and a minimum of 2-year follow-up (median 4.6 years; range 2.1-8.0 years). Meniscal tears observed during arthroscopic examination were classified into six types: radial tear of the middle segment, posterior root tear, horizontal tear of the posterior segment, flap tear, minor tear, and complex tear. Postoperative outcomes were classified into effective (group 1) and non-effective (group 2) according to the pain relief administered 1 month postoperatively and at the final follow-up. Demographic variables, KL grade, type of meniscal tear, and postoperative follow-up period were evaluated. RESULTS: Forty knees (38%) were classified into group 1. Of the six types of tears, radial tear of the middle segment [odds ratio (OR) 4.1, 95% confidence interval (CI) 1.1-20.9] and flap tear (OR 12.9, 95% CI 1.8-140.7) were significant predictors of good outcome on multivariate logistic regression analysis. CONCLUSIONS: In middle-aged patients with medial meniscal tears, radial tear of the middle segment was independently associated with less pain following arthroscopic meniscectomy. Arthroscopic partial meniscectomy may be indicated in patients with radial tear if conservative treatment fails. LEVEL OF EVIDENCE: Case-control study, Level III.
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Artralgia/terapia , Artroscopia , Meniscectomia/métodos , Lesões do Menisco Tibial/patologia , Lesões do Menisco Tibial/cirurgia , Idoso , Artroscopia/efeitos adversos , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Masculino , Meniscectomia/efeitos adversos , Meniscos Tibiais/patologia , Meniscos Tibiais/cirurgia , Pessoa de Meia-Idade , Razão de Chances , Osteoartrite do Joelho/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Lesões do Menisco Tibial/classificaçãoRESUMO
PURPOSE: Although many studies have been performed to evaluate the quality of life (QOL) and patient satisfaction after total knee arthroplasty (TKA), almost all evaluations were performed in patients after unilateral TKA or in patients after mixed unilateral and bilateral TKA. Accordingly, this study aimed to evaluate QOL after staged bilateral TKA. METHODS: A total of 78 patients who underwent staged bilateral TKA for varus knee osteoarthritis were included in this study. All patients had longitudinal follow-up evaluations for at least five years. QOL was assessed by the Japanese Knee Osteoarthritis Measure (JKOM), a disease-specific and patient-derived QOL measure for Japanese patients. Conventional objective outcome scales, including the Knee Society Score and the Timed Up and Go test, were also assessed. In addition, QOL and objective outcomes were compared between the younger (≤ 80 years, average 75.8 years) and older (> 80 years, average 84.7 years) age groups at the final follow-up. RESULTS: Improvements in both JKOM and objective outcomes reached a plateau one year after staged bilateral TKA. Improvements were prolonged for more than five years. There were no statistically significant differences in JKOM or objective outcomes between the younger and older age groups, despite an 8.9-year difference in the average age. CONCLUSIONS: This was the first longitudinal study to evaluate QOL and objective outcomes after staged bilateral TKA for a period of at least five years. Improvements in QOL and objective outcomes reached a plateau one year after staged bilateral TKA and were prolonged for more than five years. No significant differences were observed in outcome scores between the younger and older age groups.