Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 22
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
J Orthop Sci ; 2020 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-32173180

RESUMO

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.

2.
Sci Rep ; 9(1): 13985, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31562376

RESUMO

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.

3.
Knee Surg Sports Traumatol Arthrosc ; 27(8): 2460-2467, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30374574

RESUMO

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.


Assuntos
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/classificação
4.
Int Orthop ; 43(10): 2309-2314, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30302495

RESUMO

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.

5.
J Biomed Mater Res B Appl Biomater ; 107(3): 700-707, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29920923

RESUMO

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.

6.
J Orthop Sci ; 23(5): 801-806, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30213365

RESUMO

BACKGROUND: The efficacy of morphine added to periarticular multimodal drug injection (PMDI) for pain management after total knee arthroplasty (TKA) is controversial. Adding morphine to spinal anesthesia has reportedly improved pain relief for the first 24 h. We examined the effect of morphine added to PMDI or spinal anesthesia on pain management and functional recovery after TKA. METHODS: A total of 97 patients were randomized into three groups: in Group A (34 patients), 10 mg morphine was added to PMDI; Group B (31 patients), 0.1 mg morphine was added to spinal anesthesia; and Group C (32 patients), morphine was added to neither the PMDI nor spinal anesthetic. To evaluate the efficacy of added morphine for pain management, we assessed rest pain, the number of times analgesics were used, and the time period until the first analgesic use. The adverse effects of morphine were assessed by counting the numbers of times vomiting occurred and antiemetics were used. Functional recovery was evaluated by recording the range of motion of the knee and the date of ability to walk. RESULTS: Rest pain was the least in Group B at 6 and 12 h after operation. The number of times analgesics were used was the least in Group B. The time period until the first analgesic use was the longest in Group B. The number of vomiting episodes was the least in Group C. The number of times antiemetics were used was higher in Group A than in Group C. There were no significant differences in the range of motion and date of ability to walk among the three groups. CONCLUSIONS: The efficacy of morphine added to PMDI was limited, and that of morphine added to spinal anesthesia disappeared within 20 h postoperatively. Adding morphine to PMDI or spinal anesthesia did not improve functional recovery and caused some adverse effects.


Assuntos
Analgésicos Opioides/uso terapêutico , Raquianestesia , Artroplastia do Joelho/efeitos adversos , Morfina/uso terapêutico , Osteoartrite do Joelho/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Combinada , Feminino , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Caminhada
7.
J Biomed Mater Res B Appl Biomater ; 106(8): 2841-2848, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29360240

RESUMO

The influence of Young's moduli of materials on the fracture healing process remains unclear. This study aimed to assess the effects of intramedullary nails composed of materials with low Young's moduli on fracture repair. We previously developed a ß-type Ti-Nb-Sn alloy with low Young's modulus close to that of human cortical bone. Here, we prepared two Ti-Nb-Sn alloys with Young's moduli of 45 and 78 GPa by heat treatment, and compared their effects on fracture healing. Fracture and nailing were performed in the right tibiae of C57BL/6 mice. The bone healing process was evaluated by microcomputed tomography (micro-CT), histomorphometry, and RT-PCR. We found larger bone volumes of fracture callus in the mice treated with the 45-GPa Ti-Nb-Sn alloy as compared with the 78-GPa Ti-Nb-Sn alloy in micro-CT analyses. This was confirmed with histology at day 14, with accelerated new bone formation and cartilage absorption in the 45-GPa Ti-Nb-Sn group compared with the 78-GPa Ti-Nb-Sn group. Acp5 expression was lower in the 45-GPa Ti-Nb-Sn group than in the 78-GPa Ti-Nb-Sn group at day 10. These findings indicate that intramedullary fixation with nails with a lower Young's modulus offer a greater capacity for fracture repair. Our 45-GPa Ti-Nb-Sn alloy is a promising material for fracture treatment implants. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2841-2848, 2018.


Assuntos
Ligas/química , Pinos Ortopédicos , Módulo de Elasticidade , Consolidação da Fratura , Fraturas da Tíbia/terapia , Animais , Camundongos , Nióbio/química , Estanho/química , Titânio/química
8.
Knee Surg Sports Traumatol Arthrosc ; 25(12): 3718-3722, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27225891

RESUMO

PURPOSE: The present study focused on the prevalence of incidental excision of the femoral footprint of the popliteus tendon during total knee arthroplasty and its associated risk factors. METHODS: A total of 275 knee arthroplasties were performed for 226 patients with varus knee osteoarthritis. The status of the femoral footprint of the popliteus tendon was intraoperatively evaluated and classified into three groups (preserved, partially excised, and completely excised), and the prevalence of the excision was identified. Femoral component size, the thickness of the resected distal femoral condyle, and preoperative patient demographic data were compared for the three groups. Ordinal logistic regression analysis was performed to reveal risk factors associated with the excision. RESULTS: The femoral footprint of the popliteus tendon was preserved in 132 knees (48.0 %), partially excised in 94 knees (34.2 %) and completely excised in 49 knees (17.8 %). The ordinal logistic regression analysis revealed thicker resection of the distal femoral condyle (p < 0.0001) and shorter body height (p = 0.0266) to be the independent risk factors for the excision. CONCLUSIONS: The incidental partial or complete excision of the femoral footprint of the popliteus tendon was identified in approximately half of the evaluated knees. Thicker resection of the distal femoral condyle and shorter body height were the most significant risk factors for the excision. LEVEL OF EVIDENCE: Case-control study, Level III.


Assuntos
Artroplastia do Joelho/efeitos adversos , Fêmur/fisiologia , Erros Médicos , Traumatismos dos Tendões/etiologia , Idoso , Estudos de Casos e Controles , Feminino , Fêmur/cirurgia , Humanos , Articulação do Joelho/cirurgia , Prótese do Joelho , Masculino , Pessoa de Meia-Idade , Medição de Risco
9.
Knee Surg Sports Traumatol Arthrosc ; 25(2): 362-367, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26740086

RESUMO

PURPOSE: Recent studies have suggested radial displacement of the medial meniscus as a cause of varus knee osteoarthritis (OA). Two anatomical studies reported that such displacement may be associated with anterior insertion of the medial meniscus anterior horn. It was aimed to evaluate the location and area of this insertion in patients with advanced knee OA. METHODS: Medial meniscus anterior horn insertions were classified into four types, as described in a previously reported classification during 225 total knee arthroplasty (TKA) in 184 patients. The incidence rates of insertion type were compared with previously reported rates in nearly normal or non-arthritic knees. The insertion surface area was also measured during 158 TKAs. RESULTS: Of the 225 knees, 82 (36.4 %), 93 (41.3 %), 35 (15.6 %), and 15 (6.7 %) were classified as I, II, III, and IV, respectively. An anteriorly inserted anterior horn was not more frequent in advanced varus OA knees than in previously reported nearly normal or non-arthritic knees. The insertion surface areas were 57.5 ± 18.9, 56.1 ± 16.0, and 56.4 ± 14.4 mm2 for types I, II, and III, respectively; these areas did not differ significantly. CONCLUSION: Since the incidence of an anteriorly inserted medial meniscus anterior horn was not higher in advanced varus OA knees than in normal or non-arthritic knees, an anteriorly inserted anterior horn may have little or no effect on the aetiology of varus OA knees. This study provides some information for clarifying the aetiology of knee OA. LEVEL OF EVIDENCE: IV.


Assuntos
Genu Varum/patologia , Meniscos Tibiais/patologia , Osteoartrite do Joelho/patologia , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho , Feminino , Genu Varum/cirurgia , Humanos , Articulação do Joelho , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Osteoartrite do Joelho/cirurgia
10.
J Bone Miner Metab ; 35(1): 52-57, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26369319

RESUMO

The aim of this study was to determine the associations of disease activity and disease duration with the bone mineral density (BMD) in rheumatoid arthritis (RA) patients. We also evaluated the associations of biological drugs with bone loss. A total of 138 postmenopausal RA patients were retrospectively assessed to identify the associations of disease activity, disease duration, and biological drug use with BMD. We assessed the associations of disease duration, a C-reactive protein based disease activity score in 28 joints (DAS28), simplified disease activity index, clinical disease activity index, health assessment questionnaire scores, and the use of biological drugs with the lumbar spine, total hip, and femoral neck BMDs using univariate and multivariate linear regression analyses in bisphosphonate treatment and non-bisphosphonate treatment groups at 1 year of follow-up. The multivariate linear regression analyses showed that disease duration was significantly related to the BMD of the femoral neck and total hip regardless of bisphosphonate treatment. The use of biological drugs was not significantly associated with BMD. Hip BMD in postmenopausal women with RA depends on the disease duration regardless of bisphosphonate use. Biological drugs for RA treatment were not negatively associated with general bone loss.


Assuntos
Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/metabolismo , Densidade Óssea , Pós-Menopausa/metabolismo , Idoso , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
11.
Int Orthop ; 41(5): 931-937, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-27872980

RESUMO

PURPOSE: This study reports a case series of 44 primary total knee arthroplasties (TKAs) using autogenous morcellised bone grafting for large (≥10-mm-deep) medial tibial defects, which are generally repaired using metal augmentation. The bone-grafting technique is described in detail and the radiological outcomes are presented. METHODS: A total of 44 TKAs were followed up for a mean period of 58 months (range 24-139 months). Multiple drill holes were made in the sclerotic floor of the defect, followed by the impaction of morcellised cancellous bone grafts to fill the defects. Tibial components were fixed using the cemented or noncemented technique and no internal fixation devices were used. Stem extension of the tibial component was only used in one TKA. RESULTS: Radiograms revealed that the grafted bone was completely incorporated into the host bone within one year post-operatively. No grafted bone absorption or collapse was detected. A clear zone between the tibial component and grafted bone was observed in six knees, but it did not become enlarged thereafter. CONCLUSIONS: The presented technique provided favourable radiological outcomes and had several advantages: (1) it enables preservation of as much bone as possible for future revision surgery; (2) it is cost effective and simple because metal augments, internal fixation devices and stem extension are not needed; (3) it can be used in the same manner any defect to a depth ≥3 mm. Thus, this is an acceptable and reproducible alternative technique.


Assuntos
Artroplastia do Joelho/métodos , Transplante Ósseo/métodos , Artropatias/cirurgia , Articulação do Joelho/cirurgia , Tíbia/cirurgia , Idoso , Idoso de 80 Anos ou mais , Autoenxertos , Feminino , Humanos , Artropatias/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tíbia/diagnóstico por imagem , Transplante Autólogo
12.
J Orthop Sci ; 21(5): 635-9, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27380729

RESUMO

BACKGROUND: Precise matching of the tibial component and resected bony surfaces and proper rotational implanting of the tibial component are crucial for successful total knee arthroplasty. We aimed to analyze the exact anthropometric proximal tibial data of Japanese patients undergoing total knee arthroplasty and correlate the measurements with the dimensions of current total knee arthroplasty systems. METHODS: A total of 703 knees in 566 Japanese patients who underwent total knee arthroplasty for osteoarthritis were included. The bone resection in the proximal tibia was performed perpendicular to the tibial axis in the frontal plane. Measurements of the proximal tibia were intraoperatively obtained after proximal tibial preparation. RESULTS: There were significant positive correlations between the lateral anteroposterior and medial anteroposterior and mediolateral dimensions. A progressive decrease in the mediolateral/lateral anteroposterior ratio with an increasing lateral anteroposterior dimension or the mediolateral/anteroposterior ratio with an increasing anteroposterior dimension was observed. The lateral anteroposterior dimension was smaller than the medial anteroposterior dimension by a mean of 4.8 ± 2.0 mm. The proximal tibia exhibited asymmetry between the lateral and medial plateaus. A comparison of the morphological data and dimensions of the implants, one of which was a symmetric tibial component (NexGen) and the others were asymmetric (Genesis II and Persona), indicated that an asymmetric tibial component could be beneficial to maximize tibial plateau coverage. CONCLUSIONS: This study provided important reference data for designing a proper tibial component for Japanese people. The proximal tibial cut surface was asymmetric. There was wide dispersion in the lateral anteroposterior, medial anteroposterior, and mediolateral dimensions depending on the patient. Our data showed that the tibial components of the Genesis II and Persona rather than that of the NexGen may be preferable for Japanese people because of their asymmetric design.


Assuntos
Antropometria , Artroplastia do Joelho/métodos , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Tíbia/anatomia & histologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Osteoartrite do Joelho/diagnóstico por imagem , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Resultado do Tratamento
13.
PLoS One ; 11(2): e0150081, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26914329

RESUMO

Ti-6Al-4V alloy is widely prevalent as a material for orthopaedic implants because of its good corrosion resistance and biocompatibility. However, the discrepancy in Young's modulus between metal prosthesis and human cortical bone sometimes induces clinical problems, thigh pain and bone atrophy due to stress shielding. We designed a Ti-Nb-Sn alloy with a low Young's modulus to address problems of stress disproportion. In this study, we assessed effects of anodic oxidation with or without hot water treatment on the bone-bonding characteristics of a Ti-Nb-Sn alloy. We examined surface analyses and apatite formation by SEM micrographs, XPS and XRD analyses. We also evaluated biocompatibility in experimental animal models by measuring failure loads with a pull-out test and by quantitative histomorphometric analyses. By SEM, abundant apatite formation was observed on the surface of Ti-Nb-Sn alloy discs treated with anodic oxidation and hot water after incubation in Hank's solution. A strong peak of apatite formation was detected on the surface using XRD analyses. XPS analysis revealed an increase of the H2O fraction in O 1s XPS. Results of the pull-out test showed that the failure loads of Ti-Nb-Sn alloy rods treated with anodic oxidation and hot water was greater than those of untreated rods. Quantitative histomorphometric analyses indicated that anodic oxidation and hot water treatment induced higher new bone formation around the rods. Our findings indicate that Ti-Nb-Sn alloy treated with anodic oxidation and hot water showed greater capacity for apatite formation, stronger bone bonding and higher biocompatibility for osteosynthesis. Ti-Nb-Sn alloy treated with anodic oxidation and hot water treatment is a promising material for orthopaedic implants enabling higher osteosynthesis and lower stress disproportion.


Assuntos
Ligas/farmacologia , Apatitas/metabolismo , Substitutos Ósseos/farmacologia , Módulo de Elasticidade/fisiologia , Fixação Interna de Fraturas , Animais , Fêmur/crescimento & desenvolvimento , Fêmur/fisiologia , Humanos , Masculino , Teste de Materiais , Nióbio/química , Oxirredução , Próteses e Implantes , Coelhos , Propriedades de Superfície , Estanho/química , Titânio/química , Titânio/farmacologia , Água/química
14.
J Bone Miner Metab ; 34(6): 606-614, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26369320

RESUMO

Fracture healing is a complex biological process involving the proliferation of mesenchymal progenitor cells, and chondrogenic, osteogenic, and angiogenic differentiation. The mechanisms underlying the proliferation and differentiation of mesenchymal progenitor cells remain unclear. Here, we demonstrate Dickkopf-related protein 3 (Dkk3) expression in periosteal cells using Dkk3-green fluorescent protein reporter mice. We found that proliferation of mesenchymal progenitor cells began in the periosteum, involving Dkk3-positive cell proliferation near the fracture site. In addition, Dkk3 was expressed in fibrocartilage cells together with smooth muscle α-actin and Col3.6 in the early phase of fracture healing as a cell marker of fibrocartilage cells. Dkk3 was not expressed in mature chondrogenic cells or osteogenic cells. Transient expression of Dkk3 disappeared in the late phase of fracture healing, except in the superficial periosteal area of fracture callus. The Dkk3 expression pattern differed in newly formed type IV collagen positive blood vessels and the related avascular tissue. This is the first report that shows Dkk3 expression in the periosteum at a resting state and in fibrocartilage cells during the fracture healing process, which was associated with smooth muscle α-actin and Col3.6 expression in mesenchymal progenitor cells. These fluorescent mesenchymal lineage cells may be useful for future studies to better understand fracture healing.


Assuntos
Calo Ósseo/metabolismo , Rastreamento de Células , Fibrocartilagem/metabolismo , Consolidação da Fratura , Peptídeos e Proteínas de Sinalização Intercelular/metabolismo , Periósteo/metabolismo , Células-Tronco/metabolismo , Animais , Calo Ósseo/patologia , Fibrocartilagem/patologia , Proteínas de Fluorescência Verde/metabolismo , Peptídeos e Proteínas de Sinalização Intercelular/genética , Masculino , Camundongos , Camundongos Transgênicos , Periósteo/patologia , Células-Tronco/patologia
15.
J Orthop Sci ; 20(6): 1030-5, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26362655

RESUMO

BACKGROUND: During total knee arthroplasty (TKA), excision of the popliteus tendon leads to extensive static gaps and reduced mobility. The purpose of this study was to determine the positional relationship between the femoral insertion of the popliteus tendon and the bone cutting lines of various TKA systems. METHODS: This study included 21 cadaveric right femurs presenting no macroscopic deformity. The lateral image of the femur and the template of the femoral component were overlaid to determine the preservation/excision of the popliteus tendon insertion. TKA systems used were Genesis II, NexGen, low contact stress (LCS), PFC Σ, Scorpio, and Vanguard. The knees in which the insertion was preserved in all implants or excised in at least one implant were classified into intact or the high-risk groups, respectively. RESULTS: The popliteus tendon was preserved in all specimens with the LCS system. In contrast, the popliteus tendon insertion was excised in ≥1/3 of the specimens with the other systems. The anteroposterior diameter was significantly larger in the intact group than that in the high-risk group (58.1 ± 4.5 mm vs. 53.7 ± 2.7 mm; p = 0.018). The high-risk group included more knees from female cadavers than the intact group (70 vs. 9 %; p = 0.008). CONCLUSION: During primary TKA, the femoral insertion of the popliteus tendon could be inevitably excised, regardless of technical problems. We demonstrate that the unique design of the LCS system preserves the popliteus tendon insertion. In addition, small knees and females may be risk factors for excision of the insertion.


Assuntos
Artroplastia do Joelho/métodos , Instabilidade Articular/prevenção & controle , Articulação do Joelho/cirurgia , Tendões/cirurgia , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/efeitos adversos , Fenômenos Biomecânicos , Cadáver , Feminino , Fêmur/anatomia & histologia , Fêmur/cirurgia , Humanos , Masculino , Medição de Risco , Estatísticas não Paramétricas , Estresse Mecânico , Tendões/anatomia & histologia
16.
J Orthop Surg (Hong Kong) ; 23(2): 185-9, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26321547

RESUMO

PURPOSE: To evaluate the outcome of autologous morselised bone grafting for a medial tibial defect of ≥10 mm deep in 45 total knee arthroplasties (TKAs). METHODS: 38 patients aged 46 to 85 (mean, 73) years underwent 45 TKAs and autologous morselised bone grafting for a medial tibial defect of ≥10 (range, 10-25) mm in depth by a single surgeon. In the first 19 TKAs, 2 resected subchondral bone plates from the lateral tibial plateau were driven into 2 gutters made on the floor of the medial tibial defect as bony support posts. Morselised cancellous bone grafts were then impacted around these posts. In the remaining 26 TKAs, multiple drill holes were made on the floor of the defect to decrease the remodelling time. Morselised cancellous bone grafts were impacted to fill the defects. The tibial components were fixed with cemented (n=34) or non-cemented (n=11) technique. Internal fixation devices were not used; stem extension was used in only 2 TKAs (in a patient with Charcot joint and a patient undergoing revision TKA). RESULTS: After a mean follow-up duration of 65 (range, 24-174) months, no patient showed gait disturbance. The mean knee flexion angle was 113.8º (range, 90º-130º). No absorption or collapse of the grafted bone, or component loosening were noted on radiographs. The grafted bone completely incorporated into the host bone, with bony trabeculae crossing the interface within 2 years in the first 19 TKAs and within one year in the latter 26 TKAs. The margin of the grafted area resembled bony cortex in 30 TKAs. CONCLUSION: Autologous morselised bone grafting is a viable option for most medial tibial defects during TKA.


Assuntos
Artroplastia do Joelho/métodos , Transplante Ósseo/métodos , Articulação do Joelho/cirurgia , Tíbia/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Fatores de Tempo , Transplante Autólogo
17.
PLoS One ; 10(6): e0128210, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26030755

RESUMO

Osteoclasts play an important role in bone metabolism, but their exact role in fracture healing remains unclear. DAP12 is an immunoadaptor protein with associated immunoreceptors on myeloid lineage cells, including osteoclasts. Its deficiency causes osteopetrosis due to suppression of osteoclast development and activation. In this report, we assessed the impact of DAP12 on the fracture healing process using C57BL/6 (B6) and DAP12-/- mice. Healing was evaluated using radiography, micro-CT, histology, immunohistochemistry and real-time RT-PCR. Radiography showed lower callus volume and lower callus radiolucency in DAP12-/- mice during later stages. Micro-CT images and quantitative structural analysis indicated that DAP12-/- mice developed calluses of dense trabecular structures and experienced deteriorated cortical shell formation on the surface. Histologically, DAP12-/- mice showed less cartilaginous resorption and woven bone formation. In addition, prominent cortical shell formation was much less in DAP12-/- mice. Immunohistochemistry revealed lower invasion of F4/80 positive monocytes and macrophages into the fracture hematoma in DAP12-/- mice. The expression levels of Col1a1, Col2a1 and Col10a1 in DAP12-/- mice increased and subsequently became higher than those in B6 mice. There was a decrease in the gene expression of Tnf during the early stages in DAP12-/- mice. Our results indicate that DAP12 deficiency impairs fracture healing, suggesting a significant role of DAP12 in the initial inflammatory response, bone remodeling and regeneration.


Assuntos
Proteínas Adaptadoras de Transdução de Sinal/deficiência , Consolidação da Fratura , Animais , Feminino , Regulação da Expressão Gênica , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Tíbia/diagnóstico por imagem , Tíbia/lesões , Tíbia/metabolismo , Tíbia/patologia , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/genética , Fraturas da Tíbia/patologia , Fraturas da Tíbia/fisiopatologia , Microtomografia por Raio-X
18.
Case Rep Orthop ; 2015: 652096, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26000187

RESUMO

A 31-year-old construction worker had been suffering from both the motion pain and the restriction of elevation in his right shoulder due to severe varus deformity of humeral neck, which occurred after proximal humeral fracture. The angle for shoulder flexion and abduction was restricted to 50 and 80 degrees, respectively. Valgus closing-wedge osteotomy followed by the internal fixation using a locking plate was carried out at 12 months after injury. Postoperatively, the head-shaft angle of the humerus improved from 65 to 138 degrees. Active flexion and abduction angles improved from 80 to 135 degrees and from 50 to 135 degrees, respectively. However, the patient complained from a sharp pain with a clicking sound during shoulder abduction even after removal of the locking plate. Since subacromial steroid injection temporarily relieved his shoulder pain, we assumed that the secondary subacromial impingement was provoked after osteotomy. Thus, arthroscopic subacromial decompression was carried out at 27 months after the initial operation, which finally relieved his symptoms. In the valgus closing-wedge osteotomy, surgeons should pay attention to the condition of subacromial space to avoid causing the secondary subacromial impingement.

19.
Knee Surg Sports Traumatol Arthrosc ; 23(1): 158-63, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24638975

RESUMO

PURPOSE: The objective of this study was to examine the association between clinical symptoms and arthroscopic meniscal findings in patients with early to moderate medial knee osteoarthritis. METHODS: One hundred and four patients (110 knees) were selected from a group of 132 patients (140 knees) aged ≥50 years who underwent arthroscopic surgery for medial meniscal tears. Inclusion criteria were as follows: (a) medial knee osteoarthritis and (b) simple medial meniscal tears extending to ≥1/4 of the meniscal margin. Subjective symptoms, location and nature of the pain, as well as the physical findings observed during initial assessment were evaluated using a standardized assessment chart. The relationship between arthroscopic meniscal findings and clinical symptoms was then analysed. RESULTS: Isolated meniscal tears were classified into four types: radial tear of the middle segment; posterior root tear; horizontal tear of the posterior segment; and flap tear. The following symptoms were reported at significantly higher frequencies: pain on standing and a catching sensation in patients with flap tears; pain on walking and nocturnal pain on rolling over in bed in patients with radial tears of the middle segment; and popliteal pain in patients with posterior root tears. CONCLUSIONS: This study demonstrates a relationship between the type of medial meniscal tear and characteristic clinical symptoms reported by patients with medial knee osteoarthritis. These results suggest that clinical symptoms in patients with osteoarthritis of the knee may be caused by meniscal tears. This evidence may help to better inform patients and surgeons regarding choice of treatment. LEVEL OF EVIDENCE: Case control study, Level III.


Assuntos
Artralgia/etiologia , Osteoartrite do Joelho/etiologia , Lesões do Menisco Tibial , Idoso , Artroscopia , Feminino , Humanos , Masculino , Meniscos Tibiais/cirurgia , Fatores Sexuais
20.
J Orthop Sci ; 19(4): 558-63, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24771138

RESUMO

BACKGROUND: The radiolucent zones in the patella are sometimes observed in patients who have undergone total knee arthroplasty (TKA) without patellar resurfacing. On the basis of radiological findings from our clinical experience, we hypothesize that the pathogenesis of this lesion may be similar to that of the lesions of spontaneous osteonecrosis, and this lesion may be due to both osteoporosis and stress concentration. The present study aimed to determine the incidence of the radiolucent zone after TKA without patellar resurfacing. Moreover, the roles of osteoporosis and patellar morphology, which are related to the stress distribution in the patella, were also investigated. METHODS: We studied 48 knees of 38 patients who underwent primary TKA using the Genesis II prosthesis. Axial radiographs taken 1 year postoperatively were used to assess the incidence of the radiolucent zone. The World Health Organization fracture risk assessment tool (FRAX) score and the preoperative patellar facet angle were compared between patients with and without the radiolucent zones. RESULTS: Five patellae (10.4%) showed the radiolucent zones postoperatively (the radiolucent group), whereas no such lesions were found in the remaining 43 patellae (the normal group). The major osteoporotic fracture risk of the radiolucent group calculated using the FRAX was 24.8% and significantly higher than that in the normal group (14.7%; p = 0.01). The average patellar facet angle in the radiolucent group was 123.6°, which was significantly smaller than that in the normal group (133.6°; p = 0.003). DISCUSSION AND CONCLUSIONS: The results of the present study suggest that both underlying osteoporosis and a steep patellar facet angle may play an important role in the pathogenesis of the radiolucent zones in patellae after TKA without patellar resurfacing. Patellar resurfacing may be considered, particularly in osteoporotic patients who have a steep patellar facet angle, to avoid the appearance of the postoperative radiolucent zone in the patella.


Assuntos
Artroplastia do Joelho/métodos , Osteoporose/diagnóstico por imagem , Patela/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/epidemiologia , Radiografia , Estudos Retrospectivos , Fatores de Risco
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA