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Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_5 | Pages 61 - 61
1 Apr 2018
Takakubo Y Ito J Oki H Momma R Kawaji H Sasaki K Ishii M Takagi M
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Background

The rate of elderly people over 65 year-old increased from 18.5 % in 2004 to 26.0% in 2015 in Japan. Northern part of Japan is a head of the super-aging society, and the rate already reached 30.9% in 2015. Along with aging society, rapid increase of total hip arthroplasties (THA) has been predicted. The aim of this study is to estimate the trend of total hip arthroplasties in our super-aging area in Northern Japan.

Methods

Trend on number and rate of THA in one of the local area of leading super-aging society were surveyed in the last decade using the database of diagnostic procedure and surgical records from 2004 to 2015. The cause of revision THA was analyzed in 2004–2009 versus in 2010–2015. Spearman's rank-correlation coefficient and student's t-tests were performed using the PASW 18 software (SPSS Institute Inc). Values of p < 0.05 were considered statistically significant.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_2 | Pages 43 - 43
1 Jan 2016
Hirayama T Sasaki K Takakubo Y Ito J Takagi M
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Background

Large head metal on metal total hip arthroplasty MOM THA have been consistently shown substantial improvement in wear performance compared with metal on polyethylene articulations. Large diameter femoral heads theoretically can reduce dislocation risk by increasing range of motion before impingement, increasing prosthetic jump distance. However, early failure associated with adverse local tissue reactions (ALTRs) to metal debris is an emerging problem after MOM THA. The purpose of this study was to evaluate mid-term results of MOM THA.

Materials and Methods

Twenty-five patients, 28 hips were included in this study. The average age of the patients at the time of surgery was 66.9 years. Three patients were men and 22 were women. MOM THAs were performed using 28 PINNACLE Cup system (DepPuy) (C-STEM: 23, S-ROM: 5) with posterior approach and head size of 36mm. Twenty-five primary THAs due to osteoarthritis in 22 cases and rheumatoid arthritis (RA) in one, and two revisions due to recurrent dislocation THA patients, were performed. The average follow up was 56.7 months. Evaluation items are JOA score, cup anteversion /lateral opening angle, and complications. Indication of the system were applied for patients with high risk of dislocation such as recurrent dislocation in primary and/or THAs, posterior pelvic tilt, elderly, RA and mental disorders.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_1 | Pages 30 - 30
1 Jan 2016
Asano T Takagi M Narita A Takakubo Y Suzuki A Sasaki K Oki H
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Background

A navigation system is useful tool to evaluate the intraoperative knee kinematics. Rheumatoid arthritis (RA) patients often need to have TKA operation, however, there are few TKA kinematics studies comparing RA and Osteoarthritis (OA) patients.

Objective

The purpose of this study was to evaluate intraoperative TKA kinematics, and to describe the difference of kinematics between RA and OA patients.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_2 | Pages 95 - 95
1 Jan 2016
Kawaji H Ishii M Tamaki Y Sasaki K Dairaku K Takakubo Y Naganuma Y Oki H Takagi M
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Introduction

Patients undergoing total hip arthroplasty (THA) stand in the danger, a particularly high risk for venous thromboembolism (VTE). Fondaparinux and edoxaban, which inhibit FXa, indirectly and directly, respectively, have been used for prevention of VTE after THA in Japan. The aim of this study was to compare the efficacy of fondaparinux and edoxaban for VTE after elective THA in Japanese patients.

Materials and methods

We randomly assigned 320 patients underdoing elective cemented THA to receive postoperative 2.5 mg fondaparinux once daily for first postoperative 3 days and 1.5 mg once daily for the subsequent 7 days (FPX group) [1], postoperative 15 mg edoxaban once daily for postoperative 10 days (EDO15mg group), 30 mg edoxaban once daily for postoperative 10 days (EDO30mg group), and 30 mg edoxaban once daily for first postoperative 3 days and 15 mg once daily for the subsequent 7 days (EDOmix group). Deep venous thrombosis (DVT) was diagnosed by ultrasonography at postoperative day 3 and 14. Computed tomography to detect pulmonary thromboembolism was performed to all patients who had proximal DVTs. The χ2 test with Bonferroni correction was used to compare variables of the incidence of DVT between each group. The intention-to-treat analysis was performed for statistical analysis in each group. The EDO30 mg group and EDOmix group were regarded as one group in the assessment at the postoperative day 3, and named as the EDO30mg+mix group.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_3 | Pages 73 - 73
1 Jan 2016
Naganuma Y Takakubo Y Hirayama T Tamaki Y Oki H Yang S Sasaki K Kawaji H Ishii M Takagi M
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Introduction

Macrophages phagocytes implant wear debris and produce various cytokines to evoke inflammation and periprosthetic osteolysis of aseptic loosening. It had been reported that expression of Toll-like receptor (TLR) 2 and other TLRs increased in periprosthetic tissues of aseptic loosening. Pathogen-associated molecular patterns (PAMPs) and damaged-associated molecular patterns (DAMPs) have been known as ligands of TLRs and considered to be involved in the osteolytic reactions via TLRs. Another type of immune sensors, nucleotide-binding and oligomerization domain (NOD)-like receptors (NLR) with a pyrin domain 3 (NLRP3) can also recognize PAMPs and DAMPs as their lignds, which has been presumed to participate in the local host response of macrophage cascade via phagocytosis of implant wear particles. However, the contribution of NLRP3 in periprosthetic tissues of aseptic loosening and the correlation between TLR2 and NLRP3 are still unclear.

Materials and methods

TLR1, TLR2, TLR6, NLRP3, TNF-α and IL-1β of macrophages in aseptic loose periprosthetic tissues were immnohistorically evaluated and compared to osteoarthritic synovium. RAW264.7 cells, macrophagic cell line, were stimulated by titanium particles (Ti) and lipoteichoic acid (LTA)-coated Ti. The celluar reaction associated with TLR2 and NLRP3 and the correlation of them were analyzed at mRNA expression levels with small-interfering RNA of Irak2, one of adaptor molecules in TLR2 cascades.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_4 | Pages 45 - 45
1 Jan 2016
Takakubo Y Sasaki K Narita A Oki H Naganuma Y Hirayama T Suzuki A Tamaki Y Togashi E Kawaji H Fukushima S Ishii M Takagi M
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Objectives

Biologic agents (BIO) drastically changed the rheumatoid arthritis (RA) therapy from starting to use biologics at 2003 in Japan. The rate of orthopaedic surgery, especially total joint arthroplasty (TJA) may reflect trends in disease severity, management and health outcomes.

Methods

We surveyed the number and rate of orthopaedic surgeries and TJA in RA treatment with BIO in the last decade, so called BIO-era.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_3 | Pages 144 - 144
1 Jan 2016
Sasaki K Ishii M Kawaji H Takakubo Y Tamaki Y Hirayama T Takagi M
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Background and Purpose

Although the treatment for infected total hip arthroplasty (THA) has been still controversial, some reports suggested two-stage revision THA seems to be more preferable rather than one-stage revision. The purpose of this study is to estimate the outcome of treatment for infected THA in our institutions.

Patients and methods

The medical records of patients who have been underwent surgical treatment for infected THA between 2006 and 2012 in two hospitals and followed more than one year after surgery were reviewed. 34 patients and 35 hips were included. Age at surgery, gender, a period until surgical treatment after diagnosis of infection, method of treatment (debridement, one-stage or two-stage revision THA) and the outcome are estimated for each hips. Remission was defined by the absence of local and systemic sign of implant related infection and the normalization of WBC and C-reactive protein value without antibiotics.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 428 - 428
1 Nov 2011
Takagi M Kobayashi S Sasaki K Takakubo Y Kawaji H Tamaki Y Ishii M
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Aim: To ameliorate surgical strategy of disabled rheumatoid hip joints, perioperative status and clinical features of the patients undergoing total hip arthroplasty (THA) were retrospectively evaluated.

Materials and Methods: 150 joints of 106 patients were studied (male/female rate; 1:6, mean age; 60 years and duration of the disease; 15 years). All patients received cemented THA (mean follow-up period; 8 years). Mode of bone defect with acetabular reconstruction type, femoral bone quality, survivorship, steroid use and complications were surveyed.

Results: In preoperative status, proturusio acetabuli was found in 37% with type I; 54%, II; 34% and III; 12% by Sotelo-Garza classification. Superior bone defect was recognized in 56%, collapse and/or defect of femoral head in 19%, and geode formation in 0.2%. Femoral medullar canal was classified as type A; 1%, type B; 53% and type C; 46% by Dorr classification. The presence of fracture before surgery was 5%. Anatomical reconstruction was achieved in all cases including application of 42% bone grafting (autogenous alone; 51%, application of artificial substitute; 39% and of cross-plating system; 10%). Acetabular revision rate due to aseptic loosening (%/years) was improved by graft methods (whole series; 5/8, any grafting; 6/8, autogenous alone; 8/8, artificial substitute; 4/8 and cross-plate system; 0/4). Revision rate for any reasons was 9% (aseptic acetabulum 5%, aseptic femur 5%, dislocation 2% and infection 1%). Dislocation (11%), infection (3%) and severe thrombotic events (1%) were experienced. Steroid use was found in 73%, associated with increased risk of protrusio acetabuli, superior bone defect with protrusio acetabuli and fractures.

Discussion and Conclusion: The study indicated that steroidal medication significantly related to the perioperative status of bone defects and perioperative fractures of rheumatoid patients undergoing THA. Improved ace-tabular procedures could promise better survivorship of the implant.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 121 - 121
1 Mar 2010
Asano T Matsuki H Narita A Takakubo Y Ogino T
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Introduction: It is difficult to measure the knee kinematics after TKA, navigation system can measure the knee kinematics during TKA operation. The purpose of this study is to describe the knee kinematic analysis in TKA using navigation system.

Patients and methods: TKA kinematics was measured in 24 patients (7 men and 17 women) 27 knees (7 rheumatoid arthritis knees and 20 osteoarthritis knees) in this study. Mean age was 72.8 (55–81). The TKA implant was Vanguard PS (Biomet, Warsaw) and navigation system was Vector Vision Knee ver. 1.6 (BrainLab Inc). All patients were operated using navigation system. This system was CT-based navigation system. We cut the bone independently and released medial collateral ligament, joint capsule and other tight structures to equal the joint balance. Femoral component was implanted parallel to clinical epicondylar line. Kinematic Analysis: We measured the joint gap (mm), coronal alignment (degree), antero-posterior translation (mm) and femoral rotation angle (degree) using navigation workstation just after all prostheses implantation and closure of joint capsule. The patient’s leg was held by operator and moved passively. All joint kinematic data were recorded at every 10 degrees in full range of motion (0 to 130 degrees). The joint gap is the distance between proximal tibial cut surface and that of distal femur (extension range: 0–40) and posterior femur (flexion range: 50–130). Medial and lateral distances were measured.

Results: In extension range, medial joint gap was 21.7mm at 0 degrees and decreased to 15.2mm with knee flexion. Lateral joint gap was 22.1mm at 0 knee extension, slightly decreased up to 40 degrees. Coronal alignment was 0.47 varus at 0 deg. and increased to 6.64 varus at 40 flexion. In flexion range, medial and lateral joint gap were increased 20.7 to 25.3, 17.2 to 31.2mm. Coronal alignment was c hanged from 4.94 valgus (60 flexion) to 8.94 varus (130 full flexion). Regarding to AP translation, femoral component was once moved 7.4 mm forward in early knee flexion and 15.2mm backward with flexion. Femoral components were rotated internally to 50 degrees flexion and then rotated externally with flexion.

Conclusion: The balance of TKA was still varus alignment after soft tissue release. Femoral components were moved backward and external rotation. Our results demonstrated that femoral rollback movement and medial pivot knee motion were recognized. The limitation of this study was the situation of under anesthesia and no muscle strain were loaded during the measurement of knee kinematics. However navigation system is available not only for the accurate implantation but also the measurement of intra operative knee kinematics.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 148 - 149
1 Mar 2010
Takagi M Sasaki K Kobayashi S Dairaku K Takakubo Y Ohki H Kawaji H Tamaki Y Ishii M
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Visualization of the femoral medullar canal is troublesome in revision surgery. To obtain better visual field of the canal and assist cement extraction and following reconstructive procedures, flexible endoscope was applied in femoral revision. Mean age and time to revision of fifteen cemented totally replaced hips were 69.3 (42–83) and 14.9 (3–25) years, respectively. Preoperative status of the revision regarding type of stem loosening was classified as possible in four cases, probable in two, and definite in five classified by Harris et al. No marked finding of loosening was in four. That of bone defect was type I in four cases, Type II in three, and Type III in three by Gustilo. Five cases showed no marked loss of the defect. Extraction of cement mantle was performed under flexible endoscopic inspection. Impaction bone grafting was performed in eight cases. Time for cement removal in association with type of loosening and bone defect were evaluated as well as analysis of periprosthetic complications.

Retained cement mantle was extractable in all cases under good exposure and with maintenance of efficient working space. Interfacial granulation and fibrous tissues between bone and cement were easily removed. Endoscopic time for cement removal was 41.7 ± 10.3 minutes in average. It was 51.8 ± 6.2 minutes in no loosening. 41.3 ± 11.1 minutes in possible loosening, 38.5 ± 9.2 minutes in probable loosening, and 35.4 ± 8.3 minutes in definite loosening, which depended on the status of fixation between bone and cement. Type of bone defect also influenced the time. It was 52.4 ± 5.6 minutes in the cases of no marked bone loss, 43.8 ± 3.5 minutes in Gustilo type I, 28.3 ± 3.5 minutes in Type II, and 34.7 ± 2.5 minutes in Type III. The procedure was effective to prepare suitable bone bed for reconstruction, which allowed proper stem settlement and facilitated recovery of bone stock in the cases of impaction bone grafting. Intra-operative blood loss was 377 ml (212 – 1430) and total amount of blood loss including post surgical drainage was 593 ml (316 – 1680). Type of loosening and bone defect did not affect both whole and intra-operative bleeding volume. However, three occult fractures happened, in which two revealed minor cement leakage and one required additional osteosynthesis with extensive approach.

The data indicated that flexible medullo-endoscope could provide good visual field with maintenance of working space, potentially contributing to less invasive femoral revision surgery, if it would be combined with refined device for cement extraction to improve accuracy of the procedure.