Effects of porous tantalum on periprosthetic bone remodeling around metaphyseal filling femoral stem: a multicenter, prospective, randomized controlled study.

Periprosthetic bone loss due to adaptive bone remodeling is an important unresolved issue in cementless total hip arthroplasty (THA). The use of porous tantalum on the proximal surface of the femoral stem is expected to decrease postoperative bone loss around the prosthesis through early fixation. We conducted a multicenter randomized controlled study to determine if porous tantalum could reduce periprosthetic bone loss after THA. From October 2012 to September 2014, 118 patients (mean age, 61.5 years; 107 females and 11 males) were prospectively enrolled and were randomly allocated at a ratio of 1:1 to either a metaphyseal filling stem with a proximal porous tantalum coating (Trabecular Metal) or a conventional metaphyseal filling stem with fiber mesh coating (VerSys). Patients underwent dual-energy x-ray absorptiometry scans within 1 week after surgery (baseline) and at 6, 12, and 24 months after surgery to assess periprosthetic bone mineral density (BMD) in the 7 Gruen zones. In addition, the Japanese Orthopaedic Association hip score was assessed before surgery and at 6, 12, and 24 months after surgery. In the proximal periprosthetic region (zones 1 and 7), the Trabecular Metal group had significantly smaller reductions in BMD than the VerSys group throughout the study period. In the VerSys group, significant reductions in BMD compared to baseline were seen at each measurement point in all regions, except in zone 6 at 24 months. In the Trabecular Metal group, no significant reductions in BMD relative to baseline were seen in zones 1, 5, or 6 throughout the study period. Both groups demonstrated similar improvement in Japanese Orthopaedic Association hip scores over the study period. This study demonstrated that a proximally coated stem with porous tantalum has superior results over a conventional stem with titanium fiber mesh in terms of periprosthetic bone remodeling.

In Asian women undergoing total knee arthroplasty, lower leg morphology in those with rheumatoid arthritis differed from those with osteoarthritis.

Objectives: This retrospective, single-center study aimed to compare leg morphology between patients with rheumatoid arthritis (RA) and those with osteoarthritis (OA) undergoing total knee arthroplasty (TKA).Methods: We enrolled 70 RA and 327 OA female patients undergoing TKA. Hip-knee-ankle angle (HKA), femorotibial angle (FTA), valgus correction angle (VCA), and femoral/tibial bowing were measured using full-length radiographs. Femoral bowing of more than 3° or tibial bowing more than 2°, either laterally or medially, was considered substantial. Distribution of these results and the incidence of substantial bowing in RA and OA were compared.Results: HKA, FTA, and VCA were significantly smaller in RA than those in OA. Femoral bowing was significantly smaller in RA (mean angle: 0.04° ± 3.1°) than that in OA (mean angle: 2.1° ± 3.6°) (p < .05). In almost half of the patients with RA (48.6%), femoral bowing occurred medially, whereas femoral bowing occurred laterally in approximately three quarters of OA patients (73.1%). Tibial bowing did not differ. The incidence of substantial femoral bowing was significantly lower in RA (27.1%) than that in OA (43.0%) (p < .05).Conclusion: RA patients undergoing TKA had different leg morphology than OA patients. These findings have implications for surgical planning.

Joint line convergence angle predicts outliers of coronal alignment in navigated open-wedge high tibial osteotomy.

INTRODUCTION: Using a navigation system in open-wedge high tibial osteotomy (OWHTO) has higher accuracy than using the conventional method. However, unintentional over- and under-correction still exist. This study aimed to compare various factors related to over- and under-correction and to assess their predictive factors in the preoperative radiographs. MATERIALS AND METHODS: This study involved 96 knees. The difference in the hip-knee-ankle angle (HKA) between the intraoperative navigation system and postoperative radiograph was termed navigation correction loss (NCL). Knees with absolute values of NCL (|NCL|) ≦ 1.5° and |NCL| > 1.5° were categorised into acceptable (n = 46) and outlier (n = 50) groups, respectively. The differences in joint line convergence angle (JLCA) between varus and valgus radiographs, varus JLCA, valgus JLCA, standing JLCA and standing HKA were compared between the two groups. Clinical results were evaluated using the American Knee Society (AKS) scores. RESULTS: The mean intraoperative HKA in the navigation system was - 3.8 ± 1.8°, and that in the postoperative standing radiograph was - 4.2 ± 2.5° (p = 0.033). Preoperative varus, valgus and standing JLCA were higher in the outlier group (p = 0.018, p = 0.020 and p = 0.001, respectively). Logistic regression analyses for preoperative factors of |NCL| ≦ 1.5° showed that standing JLCA was a determining factor, with an odds ratio of 1.334 (confidence interval was 1.087-1.637, p = 0.006). AKS score was higher in the acceptable group (p = 0.040) postoperatively. CONCLUSIONS: Higher preoperative standing JLCA was the predictive factor of |NCL| > 1.5°. This factor reduced the rates of under- and over-correction and resulted in better AKS score in OWHTO.

Spondylolysis repair using a pedicle screw hook or claw-hook system. -a comparison of bone fusion rates.

INTRODUCTION: To assess the bone fusion rates and clinical results of two surgical methods (pedicle screw claw-hook fixation and pedicle screw hook fixation) of lumbar spondylolysis repair. METHODS: A multicenter database of surgical patients with lumbar spondylolysis was reviewed. All patients < 20 years old with a minimum of 6 months of follow-up and computed tomography images were included. Operation time and blood loss amount were investigated. Visual analogue scale (VAS; 0-10) scores for lower back pain were evaluated to assess clinical results. RESULTS: A total of 17 patients met the inclusion criteria. Pedicle screw hook fixation was performed in five patients (the hook group), and pedicle screw claw-hook fixation was performed in 13 patients (the claw-hook group). One patient was included in both groups because each method was performed at different lumbar levels (L4 and L5). The bone fusion rates at 3, 6, and 9 months after surgery were significantly higher in the claw-hook group than those in the hook group. Operation time and blood loss amount were not significantly different between the groups. VAS scores improved in the claw-hook group but not in the hook group because of a small number of patients. CONCLUSIONS: Pedicle screw claw-hook fixation was more effective than pedicle screw hook fixation in terms of bone fusion rates.

Retraction Note: Relationship between bone density and bone metabolism in adolescent idiopathic scoliosis.

[This retracts the article DOI: 10.1186/s13013-015-0043-x.].

Relationship between bone density and bone metabolism in adolescent idiopathic scoliosis.

Several authors have confirmed that 27 to 38 % of AIS patients had osteopenia. But few studies have assessed bone metabolism in AIS. This study assessed bone mineral density and bone metabolism in AIS patients using the bone metabolism markers, BAP and TRAP5b. The subjects were 49 consecutive adolescent AIS patients seen at our institutes between March 2012 and September 2013. Sixty-five percent of AIS patients had osteopenia or osteoporosis and 59 % of AIS patients had high values for TRAP5b. The AIS patients with high values of TRAP5b had lower Z scores than those with normal values of TRAP5b. Higher rates of bone resorption are associated with low bone density in AIS patients.

Relationship between bone density and bone metabolism in adolescent idiopathic scoliosis.

Several authors have confirmed that 27 to 38% of AIS patients had osteopenia. But few studies have assessed bone metabolism in AIS. This study assessed bone mineral density and bone metabolism in AIS patients using the bone metabolism markers, BAP and TRAP5b. The subjects were 49 consecutive adolescent AIS patients seen at our institutes between March 2012 and September 2013. Sixty-five percent of AIS patients had osteopenia or osteoporosis and 59% of AIS patients had high values for TRAP5b. The AIS patients with high values of TRAP5b had lower Z scores than those with normal values of TRAP5b. Higher rates of bone resorption are associated with low bone density in AIS patients.

Utility of noninvasive endothelial function test for prediction of deep vein thrombosis after total hip or knee arthroplasty.

BACKGROUND: Venous thromboembolism (VTE) is a common and sometimes lethal postoperative complication of arthroplasty. Endothelial dysfunction is important in the pathogenesis of thrombus formation. Reactive hyperemia-peripheral arterial tonometry (RH-PAT) can noninvasively evaluate endothelial function. This study investigated the predictive value of RH-PAT for deep vein thrombosis (DVT) after lower limb arthroplasty. METHODS AND RESULTS: A prospective observational study of 126 osteoarthritic patients who underwent total knee arthroplasty (TKA) or hip arthroplasty (THA) was conducted. The RH-PAT index (RHI) was measured on the day before surgery, and presence of DVT was checked by ultrasonography or phlebography before and after surgery. Following arthroplasty, DVT was diagnosed in 51 patients (40.5%). RHI in the DVT group (0.58±0.25) was significantly lower than in the non-DVT group (0.71±0.25, P=0.004). RHI was a significant and independent predictor of postoperative DVT in multivariate logistic regression analyses and improved a net reclassification index (23.8%, P=0.022). Subgroup analyses according to operation site with adjustment for Qthrombosis score demonstrated that RHI significantly predicted postoperative DVT in the THA group (odds ratio per 0.1, 0.77; 95% confidence interval 0.60-0.98; P=0.03), but did not reach statistical significance in the TKA group. CONCLUSIONS: Low RHI was significantly associated with DVT after lower limb arthroplasty. Endothelial dysfunction, as assessed by RH-PAT, is potentially useful for identifying patients at high risk for VTE especially after THA.

Long-term results of porous-coated anatomic total hip arthroplasty for patients with osteoarthritis of the hip.

Between 1986 and 1997, 136 porous-coated anatomic (PCA) total hip arthroplasties were performed for patients with osteoarthritis of the hip, and data were available for 60 hips at final follow-up (mean follow-up, 15.2years). Of these, 18 hips had undergone revision: 12 for the acetabular component, 10 for the femoral component, and 4 for both components. Survival rate at 23years postoperatively was 60% for the acetabular component and 82% for the femoral component. Multivariate Cox proportional hazards regression showed that annual polyethylene wear rate, size, and abduction angle of the acetabular component were significantly associated with acetabular component revision surgery, and that annual polyethylene wear rate and filling ratio of the femur were associated with femoral component revision surgery.

Clinical and radiographic evaluation of total hip arthroplasties using porous tantalum modular acetabular components: 5-year follow-up of clinical trial.

OBJECTIVES: Porous tantalum is a biomaterial newly applied for artificial joints. We present here 5-years follow-up report of a multicenter clinical trial of total hip arthroplasties (THA) with porous tantalum modular acetabular component (modular PTC). METHODS: Study participants received 82 hips in 79 cases, with 61.2 months follow-up on average. Age at operation was 60.9 years. Clinical results were evaluated using Merle d'Aubigne Postel score. Presence of implant loosening, periacetabular radiolucency, osteolysis, and gap filling were examined for radiographic results. RESULTS: Merle d'Aubigne Postel score improved from 10.0 to 16.4 points. All PTC were radiographically stable, with no evidence of progressive radiolucencies. Average polyethylene wear rate was 0.004 mm/year, with no periacetabular osteolysis. Fifteen hips (18.3%) showed a gap >1 mm; however, all showed bone filling within 12 months. PTC with oversized reaming was significantly less likely to have a gap. No implant failure was noted related to modularity. Resulting survival rate of modular PTC was 100% at 5 years. CONCLUSIONS: Modular PTC showed excellent results at 5-years of follow-up. Some hips showed periacetabular gaps, which were filled with bone within 1 year. Further follow-up was needed to determine long-term efficacy.

Mid- term results of stryker® scorpio plus mobile bearing total knee arthroplasty.

BACKGROUND: The mobile bearing knee system was introduced to lessen contact stress on the articular bearing surface and reduce polyethylene wear. The purpose of the current study was to investigate the mid-term results of patients undergoing total knee arthroplasties (TKAs) using Scorpio Plus Mobile Bearing Knee System (Stryker, Mahwah, NJ), and compare the outcomes between patients with osteoarthritis and osteonecrosis (OA·ON group) and patients with rheumatoid arthritis (RA group). METHODS: Eight males and 58 females were followed up for a period of 4.4- 7.6 years from June 1, 2003 to December 31, 2005. There were 53 knees with osteoarthritis, 17 knees with rheumatoid arthritis, and 6 knees with osteonecrosis. Clinical and radiographic follow- up was done using The Japanese Orthopedic Association knee rating score (JOA score) and Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System. RESULTS: With regard to the JOA score, there was significant improvement in both groups. The postoperative range of motion was between 0.8°and 116.8° in OA·ON group, and between 0.0° and 113.7° in RA group. There were no significant differences with the radiographic evaluation between two groups. Spontaneous dislocation of a polyethylene insert occurred in one patient, and deep infection was occurred in one patient. CONCLUSION: There was significant improvement with regard to the clinical and radiographic results of patients undergoing TKAs using the model. The risk of polyethylene insert dislocation related to the mobile bearing TKA is a cause for concern.

Low bone mineral density is associated with the onset of spontaneous osteonecrosis of the knee.

BACKGROUND AND PURPOSE: The primary event preceding the onset of symptoms in spontaneous osteonecrosis in the medial femoral condyle (SONK) may be a subchondral insufficiency fracture, which may be associated with underlying low bone mineral density (BMD). However, the pathogenesis of SONK is considered to be multifactorial. Women over 60 years of age tend to have higher incidence of SONK and low BMD. We investigated whether there may be an association between low BMD and SONK in women who are more than 60 years old. METHODS: We compared the BMD of 26 women with SONK within 3 months after the onset of symptoms to that of 26 control women with medial knee osteoarthritis (OA). All the SONK patients had typical clinical presentations and met specified criteria on MRI. The BMDs measured at the lumbar spine, ipsilateral femoral neck, and knee condyles and the ratios of medial condyle BMD to lateral condyle BMD (medial-lateral ratios) in the femur and tibia were compared between the two groups. The medial-lateral ratios were used as parameters for comparisons of the BMDs at both condyles. RESULTS: The mean femoral neck, lateral femoral condyle, and lateral tibial condyle BMDs were between x% and y% lower in the SONK patients than in the OA patients (p < 0.001). The mean femoral and tibial medial-lateral ratios were statistically significantly higher in the SONK patients than in the OA patients. INTERPRETATION: A proportion of women over 60 years of age have low BMD that progresses rapidly after menopause and can precipitate a microfracture. These findings support the subchondral insufficiency fracture theory for the onset of SONK based on low BMD.

Medial versus lateral condyle bone mineral density ratios in a cross-sectional study: a potential marker for medial knee osteoarthritis severity.

OBJECTIVE: To assess the association of bone mineral density (BMD) of the femoral and tibial condyles with knee pain and disease severity in women with symptomatic medial knee osteoarthritis (OA). METHODS: We enrolled 192 women (ages 41-90 years) between April 2007 and March 2011. The subjects were divided into 2 groups according to joint space narrowing (JSN) on weight-bearing radiographs. BMD of the lumbar spine, proximal femur, and knee condyles was measured. Medial and lateral condyle BMDs of the femur and tibia as well as the medial versus lateral condyle BMD ratios were measured. RESULTS: Mean medial condyle BMDs, medial versus lateral condyle BMD ratios, and visual analog scale (VAS) pain in both the femur and the tibia were higher in the obliteration group compared with the narrowing group (P < 0.001 for all). A significant positive correlation was observed between the femoral and tibial condyles in the following parameters: medial condyle BMDs, lateral condyle BMDs, and medial versus lateral condyle BMD ratios (r = 0.791-0.844). In both the femur and the tibia, medial versus lateral condyle BMD ratios had significant positive correlations with femorotibial angle, medial osteophytes, lateral osteophytes, medial JSN, and VAS pain, and had significant negative correlations with the Knee Society pain and function scores. CONCLUSION: Although this study was a cross-sectional study, the femoral and tibial medial versus lateral condyle BMD ratios increased with more severe knee pain and might be a potential marker for monitoring disease severity in women with symptomatic medial knee OA.

Change in pelvic tilt angle 2 to 4 years after total hip arthroplasty.

The purpose of this study was to evaluate the change in pelvic tilt angle (PA) in the sagittal plane in the standing and supine positions for 2 to 4 years after total hip arthroplasty (THA). Anteroposterior pelvic radiographs of 21 male and 65 female patients were investigated before and after THA yearly over 2 to 4 years. Both the standing and supine PA significantly posteriorly tilted after THA. The difference in PA between the standing and supine positions (dPA) significantly increased after THA. Although the PA in the standing and supine positions plateaued 1 year after THA, the dPA gradually increased. In addition, the percentage of patients who showed a difference of more than 10° in dPA tended to increase yearly. In particular, elderly female patients who showed posterior tilt in PA in the standing or supine positions or a large dPA before THA tended to show a dPA of more than 10° after THA.

Clinical and radiological results of GSB III total elbow arthroplasty in patients with rheumatoid arthritis.

Total elbow arthroplasty (TEA) with the GSB III prosthesis was performed in 32 patients (36 elbows) with rheumatoid arthritis between 2001 and 2009. At final follow-up, 31 patients (35 TEAs) were available for clinical and radiological evaluation. The mean follow-up period was 6.3 (2.0-10.3) years, with a minimum follow-up of 2 years. The mean Mayo elbow performance score was significantly improved from 48 points preoperatively to 83 points at final follow-up. The radiographic loosening rate was 14.3% for humeral components and 5.7% for ulnar components. There were 4 cases of intraoperative fracture and 1 case of humeral shaft fracture at 4 months after surgery. The rates for loosening and fracture were relatively low when compared with those in other studies of linked TEA. There were 2 cases of ulnar nerve palsy, but there was no deep infection or triceps disruption. The clinical results of TEA using the GSB III prosthesis in patients with rheumatoid arthritis were found to be satisfactory.

Risk of postoperative complications in rheumatoid arthritis relevant to treatment with biologic agents: a report from the Committee on Arthritis of the Japanese Orthopaedic Association.

PURPOSE: Since biologic agents were introduced to treat rheumatoid arthritis (RA) in 2003, the number of orthopedic surgical procedures under treatment with biologic agents has been increasing in Japan. However, whether biologic agents cause an increase in the prevalence of postoperative complications is as yet unknown. The Committee on Arthritis of the Japanese Orthopedic Association investigated the prevalence of postoperative complications in patients with RA in teaching hospitals in Japan. METHODS: Between January 2004 and November 2008, surveillance forms about medications and surgical procedures in patients with RA were sent to 2,019 teaching hospitals. Data were analyzed by the Rheumatoid Arthritis Committee. RESULTS: Biologic agents were administered to RA patients in 632 of 1,245 hospitals (50.8%); 430 of the 1,245 hospitals (34.5%) used surgical intervention under treatment with biologic agents. The number of surgical procedures under treatment with biologic agents was 3,468, and the prevalence of infection was 1.3% (46 cases). The prevalence of infection was 1.0% (567 procedures) in 56,339 procedures under treatment with nonbiologic disease-modifying anti-rheumatic drugs. There were no significant differences between biological and nonbiological treatment groups with respect to the prevalence of infection. In the joint arthroplasty group, the number of procedures under biological and nonbiological treatment was 1,626 and 29,903, and the prevalence of infection was 2.1% (34 procedures) and 1.0% (298 procedures), respectively. There was a significant difference between groups. The odds ratio was 2.12 (95% confidence interval 1.48-3.03, P < 0.0001). CONCLUSION: The chance of having biological treatment with joint arthroplasty was more than twofold greater in patients with surgical-site infections compared with those treated with nonbiologic agents. Caution is required for surgical procedure, perioperative course, and obtaining consent for joint arthroplasty for patients with RA undergoing surgery under biological agents.

Spontaneous dislocation of a mobile-bearing polyethylene insert after posterior-stabilized rotating platform total knee arthroplasty: a case report.

We describe a dislocation after Scorpio mobile-bearing total knee arthroplasty. This system is a rotating platform posterior-stabilized design and utilizes a single post as part of the metal tibial tray. Only one locking ring inside the socket of the polyethylene insert secures a tight connection with the post. Spontaneous dislocation between the polyethylene insert and the metal tray occurred at 22 months post surgery while rising from the supine position with slight knee flexion. Operative findings revealed failure of the locking ring and the original insert was replaced with a thicker insert. Our case and a duplicated saw bone model demonstrated that failure of the locking system resulted in the dislocation of the insert.

Dystrophic calcinosis in a patient with rheumatoid arthritis.

We report a rare case of dystrophic calcinosis in a patient with rheumatoid arthritis in bilateral buttock lesions and the right elbow joint. The calcinosis was surgically removed because it caused severe local pain, possible infection, and difficulty in sitting. Because no recommended standard pharmacotherapy exists for dystrophic calcinosis, surgical treatment should be taken into consideration when calcinosis causes severe local pain or restricts activities of daily life.

Simultaneous anterior cruciate ligament reconstruction and opening wedge high tibial osteotomy: Report of four cases.

Four patients, aged 37-50 years, with chronic anterior cruciate ligament (ACL) deficiency, medial compartment osteoarthritis and varus deformity, underwent simultaneous arthroscopic ACL reconstruction and opening wedge high tibial osteotomy using the TomoFix fixation device and hydroxyapatite wedges. The simultaneous procedure allowed our patients to perform a full weight-bearing exercise at 4 weeks after surgery. At device removal and concomitant second-look arthroscopy, all patients had either a cyclops-like lesion or partial tears at the point of contact between the reconstructed ACL and intercondylar notch. Therefore, subsequent notchplasty or re-notchplasty was required. Because of the small number of patients, the results should be considered preliminary. Given our findings of graft morbidity caused by the corrected postoperative alignment, adequate intercondylar notchplasty should be performed at the initial operation.

A case of SAPHO syndrome with destructive spondylodiscitis suspicious of tuberculous spondylitis.

We report a rare case of synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome in which the differential diagnosis included tuberculous spondylitis and the patient ultimately required reconstructive spinal surgery. The patient was a 60-year-old woman who presented with severe low-back and leg pain after treatment for tuberculosis. Roentgenography and magnetic resonance imaging of the lumbar spine revealed destructive changes suggestive of tuberculous spondylitis. [(18)F]-fluoro-2-deoxyglucose positron emission tomography/computed tomography showed uptake in the cervical spines, lumbar spines, and sacroiliac joints from which she was suspected of having SAPHO syndrome without skin manifestations. However, as her symptoms did not respond to conservative treatment, we performed reconstructive surgery of the lumbar spine. Spinal specimens obtained surgically showed nonspecific inflammation and fibrous hypertrophy of the bone marrow, confirming a diagnosis of the SAPHO syndrome. Her symptoms improved markedly after surgery, although she required occasional prednisolone for moderate polyarthralgia and leg pain.