Acromiohumeral distance changes with posture in healthy adults and patients while wearing a shoulder abduction brace.

[Purpose] To examine the humeral head positions while wearing an abduction brace in the sitting and supine positions in healthy adults and patients who have been operated on for shoulder joint diseases. [Participants and Methods] Thirty participants were included in the study, of which 15 were healthy adults (without any orthopedic diseases) and 15 had shoulder diseases (post-arthroscopic repair of a rotator cuff tear). The acromion and humeral head were observed on ultrasound. The acromiohumeral distance was measured once in two different positions while wearing the brace: edge sitting and supine. [Results] The mean acromiohumeral distance in the healthy group was 7.9 ± 1.1 mm while sitting and 7.2 ± 1.0 mm in the supine position. In the disease group it was 7.6 ± 0.9 mm while sitting and 6.3 ± 1.1 mm in the supine position. Multiple logical regression revealed that the acromiohumeral distance was not affected by the participant's age, height, or weight. [Conclusion] The acromiohumeral distance was significantly reduced in the supine position despite the use of an abduction brace. Therefore, patients must use a pillow/towel to support the shoulder joint to prevent unnecessary stress while the cuff tendons are healing.

Effect of single bout downhill running on the serum irisin concentrations in rats.

This study aimed to characterize the effect of different running modes on serum irisin concentrations in rats. A total of 18, 10-week-old rats were divided into three groups; control group, 16° uphill running group (concentric exercise; CON) and, -16° downhill running group (eccentric exercise; ECC). The running group's rats ran on the inclined treadmill at 16 m/min, for a total of 90 min. Blood was drawn from the rats, 48 h after running, after which the rats were anesthetized. The serum concentrations of irisin were measured using enzyme-linked immunosorbent assays. Vastus intermedius was collected for immunohistochemical analysis. After multiple comparisons, the ECC showed a significantly high serum irisin concentration (ECC: 28.42 ± 6.31 ng/ml, CON: 21.27 ± 3.03 ng/ml) and a larger irisin antibody reactive cross-sectional area in vastus intermedius compared to the CON (p < 0.05). This is the first study to reveal that single bout downhill running increases serum irisin concentrations in rats.

Less invasive modified Spitzy shelf procedure for patients with dysplasia of the hip.

The shelf procedure for developmental dysplasia of the hip (DDH) is a simpler technique compared with periarticular acetabular osteotomies. However, the most commonly used approach involves the exposure of a large section of the outer iliac surface via a long skin incision and is relatively invasive. We have developed a mini one-incision technique for shelf procedure using bioabsorbable material, based on a modified Spitzy method. In the present report, we describe this procedure and outcomes. For the procedure, the patients are positioned in the lateral position and a 6-8-cm skin incision is made. The interval between the gluteus medius and the tensor fascia lata is developed without any muscle splitting. Thereafter, image intensification is used for accurate positioning of a slot for the new shelf, and a bone graft for the new shelf is obtained from the internal cortex of the iliac wing. The patient is then positioned with the hip in flexion; through the same sliding skin incision, the bone graft is impacted into the slot, and bioabsorbable screws or plates are implanted to cover and stabilise the new shelf. Cancellous bone chips are packed into the triangular space surrounded by the outer iliac surface, the new shelf, and the bioabsorbable screws or plate. We performed this procedure in 9 patients (12 hips). No progression of osteoarthritis was observed during the follow-up period (mean 28 months). The advantages of this procedure include the small, single, skin incision and minimal removal of the gluteus medius from the outer iliac surface. Based on our results, we believe that this procedure could be effective for the treatment of DDH.

Accuracy of acetabular cup placement using an angle-adjusting alignment guide with laser pointer in total hip arthroplasty.

PURPOSE: To evaluate cup-positioning accuracy in total hip arthroplasty (THA) using a novel angle-adjusting alignment guide with laser pointer and determine whether level of surgical experience affects accuracy of cup placement or not. METHODS: We included 117 hips in 104 patients who underwent THA using the novel guide. We retrospectively reviewed 44 hips in 40 patients who underwent THA before the novel guide was introduced. We compared differences in cup angles between the novel guide group and the conventional guide group as well as the discrepancies in targeted angles between the experienced surgeon group and the inexperienced surgeon group. RESULTS: There were 114/117 hips (97.4%) within the Lewinnek safe zone in the novel guide group and 32/44 hips (72.7%) within the safe zone in the conventional guide group. There were significantly fewer outliers in the novel guide group (p < 0.001). In the experienced surgeon group, the mean absolute errors in inclination and anteversion were 2.0 ± 1.7° and 2.1 ± 2.3°, respectively; which were not significantly different from those in the inexperienced surgeon group (2.3 ± 2.1° and 2.8 ± 2.3°, respectively). CONCLUSION: The novel angle-adjusting alignment guide with laser pointer is a simple tool that provides better accuracy of cup position than that obtained using conventional guides. Accurate cup placement is possible using the novel guide, regardless of surgeons' experience.

Chronological changes in functional cup position at 10 years after total hip arthroplasty.

PURPOSE: This study aims to clarify the chronological changes in functional cup position at a minimum follow-up of 10 years after total hip arthroplasty (THA), and to identify the risk factors influencing a significant difference in functional cup position during the postoperative follow-up period. METHODS: We evaluated the chronological changes in functional cup position at a minimum follow-up of 10 years after THA in 58 patients with unilateral hip osteoarthritis. Radiographic cup position was measured on anteroposterior pelvic radiographs with the patient in the supine position, whereas functional cup position was recorded in the standing position. Radiographs were obtained before, 3 weeks after, and every 1 year after surgery. RESULTS: Functional cup anteversion (F-Ant) increased over time, and was found to have significantly increased at final follow-up compared to that at 3 weeks after surgery (p<0.01). The maximum postoperative change in F-Ant was 17.0° anteriorly; 12 cases (21%) showed a postoperative change in F-Ant by >10° anteriorly. Preoperative posterior pelvic tilt in the standing position and vertebral fractures after THA were significant predictors of increasing functional cup anteversion. CONCLUSIONS: Although chronological changes in functional cup position do occur after THA, their magnitude is relatively low. However, posterior impingement is likely to occur, which may cause edge loading, wear of the polyethylene liner, and anterior dislocation of the hip. We believe that, for the combined anteversion technique, the safe zone should probably be 5°-10° narrower in patients predicted to show considerable changes in functional cup position compared with standard cases.

Diagnostic value of triple-phase bone scintigraphy for the diagnosis of infection around antibiotic-impregnated cement spacers.

INTRODUCTION: Two-stage revision arthroplasty is today considered as the gold standard for control of chronic deep prosthetic infection. Although the revision arthroplasty should only be considered when infection is eliminated, the diagnosis of residual infection prior to the revision remains a challenging problem. MATERIALS AND METHODS: We evaluated triple-phase bone scintigraphy as a useful diagnostic test for the detection of residual infection around the antibiotic-impregnated cement spacer in patients waiting for the second-stage revision hip or knee arthroplasty. Increased uptake of radioisotope in all three phases was considered positive for infection. The final diagnosis was based on histopathological results in addition to microbiologic examinations of surgical specimens. RESULTS: Histopathological examination showed positive in 17 and negative in 13 out of 30 examinations. Among 17 samples positive for histopathology, there were only 4 samples positive for bacterial culture. All samples negative for histopathology showed negative for bacterial culture. The positive and negative predictive values of triple-phase bone scintigraphy for the presence of infection were 80% and 90%, respectively. The diagnostic sensitivity was 94% and the specificity was 69%. CONCLUSION: Triple-phase bone scintigraphy was useful in the diagnosis of infection around the articulating cement spacer. In particular, when triple-phase bone scintigraphy shows negative, the residual infection around the cement spacer is unlikely.

Safe zone for the superior gluteal nerve in the transgluteal approach to the dysplastic hip: intraoperative evaluation using a nerve stimulator.

BACKGROUND: The superior gluteal nerve can be damaged during the transgluteal approach to the hip in total hip arthroplasty. METHODS: We studied 30 patients with hip dysplasia who underwent total hip arthroplasty through the transgluteal approach. The course of the inferior branch of the superior gluteal nerve was identified using a nerve stimulator. The distance between the nerve and the tip of the greater trochanter was measured. RESULTS: The mean distance was 37 (25-45) mm at the anterior third, 40 (30-50) mm at the middle third, and 44 (35-55) mm at the posterior third of the gluteus medius. The distance was influenced by the severity of hip dysplasia and decreased as the degree of hip dysplasia became more severe. INTERPRETATION: A 3-cm safe zone is appropriate in most dysplastic hips. In severely dysplastic hips, however, the superior gluteal nerve occasionally coursed within 3 cm of the tip of the greater trochanter. In such hips, a nerve stimulator can be used to identify the nerve.

Use of vascularized pedicle iliac bone graft combined with transtrochanteric rotational osteotomy in the treatment of avascular necrosis of the femoral head.

INTRODUCTION: A vascularized pedicle iliac bone graft combined with transtrochanteric anterior rotational osteotomy was performed in patients with extensive necrosis in whom the necrotic area occupied more than two-thirds of the weight-bearing zone of the femoral head. The purpose of this procedure is to supply vascularity and mechanical strength to the avascular femoral head. MATERIALS AND METHODS: Seventeen hips in 14 patients (8 male, 6 female) whose average age at surgery was 37.9 (range 21-51) years underwent this procedure between June 1992 and December 2002. These hips (stage 2 in 3 hips, stage 3A in 13 hips, and stage 3B in 1 hip) were examined for changes according to the Japanese Orthopedic Association (JOA ) score and the presence or absence of progression of the clinical stage at least 1 year after surgery. RESULTS: The mean JOA score improved from 67.8 points preoperatively to 78.1 points by 18-133 (mean 50.7) months postoperatively. There was no disease progression to a more advanced stage in 12 of 17 hips (71%) postoperatively. CONCLUSION: A vascularized pedicle iliac bone graft combined with transtrochanteric anterior rotational osteotomy to treat avascular necrosis of the femoral head is considered promising for joint preservation.

Anatomical reconstruction of chronic lateral ligament injury of the ankle using pedicle tendon of the extensor digitorum longus.

BACKGROUND: Since 1989, we have performed ligament reconstruction using the extensor digitorum longus tendon as a pedicle graft for patients with chronic lateral instability of the ankle. METHODS: Of those patients who underwent arthroscopy during the operation, thirteen joints were evaluated at an average follow-up of 7 years and 2 months. The overall average postoperative score was 95.4 points on Karlsson's score for the ankle ligament. Instability scores improved by 8.5-24.6 points. Our anatomical reconstructive surgery showed generally excellent functional results, with cosmetic advantages because of a short incision and preservation of the entire peroneus brevis tendon, which plays an important role in extra-articular dynamic stabilization. RESULTS: At final follow-up, pain was present in one joint in the group without chondral injury at the time of reconstruction ( n=6). However, pain was still present at the final follow-up in five of the group with chondral injury ( n=7). Chondral injury incurred during ligament reconstruction may have caused the residual ankle pain even after 7 years of postoperative follow-up. There was a statistically significant relationship between chondral injury and ankle pain at final follow-up.