Bone Turnover Markers in Patients With Ossification of the Posterior Longitudinal Ligament in the Thoracic Spine

STUDY DESIGN

A prospective, single-center, observational study.

OBJECTIVE

To explore the association between serum levels of bone turnover markers and ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine.

SUMMARY OF BACKGROUND DATA

The relationship between bone turnover markers, such as N-terminal propeptide of type I procollagen (PINP) or tartrate-resistant acid phosphate 5b (TRACP-5b), and OPLL has previously been examined. However, the correlation between these markers and thoracic OPLL, which is more severe than cervical-only OPLL, remains unclear.

METHODS

This prospective study included 212 patients from a single institution with compressive spinal myelopathy and divided them into those without OPLL (Non-OPLL group, 73 patients) and those with OPLL (OPLL group, 139 patients). The OPLL group was further subdivided into cervical OPLL (C-OPLL, 92 patients) and thoracic OPLL (T-OPLL, 47 patients) groups. Patients' characteristics and biomarkers related to bone metabolism, such as calcium, inorganic phosphate (Pi), 25-hydroxyvitamin D, 1α,25 dihydroxyvitamin D, PINP, and TRACP-5b, were compared between the Non-OPLL and OPLL groups, as well as the C-OPLL and T-OPLL groups. Bone metabolism biomarkers were also compared after adjusting for age, sex, body mass index, and the presence of renal impairment using propensity score-matched analysis.

RESULTS

The OPLL group had significantly lower serum levels of Pi and higher levels of PINP versus the Non-OPLL group as determined by propensity score-matched analysis. The comparison results between the C-OPLL and T-OPLL groups using a propensity score-matched analysis showed that T-OPLL patients had significantly higher concentrations of bone turnover markers, such as PINP and TRACP-5b, compared with C-OPLL patients.

CONCLUSIONS

Increased systemic bone turnover may be associated with the presence of OPLL in the thoracic spine, and bone turnover markers such as PINP and TRACP-5b can help screen for thoracic OPLL.

Reliability and head-loading effects in imaging diagnosis of vertical subluxation in patients with rheumatoid arthritis

OBJECTIVES

The purpose of this study was to examine the reproducibility of vertical subluxation (VS) parameters using X-ray, computed tomography (CT), and tomosynthesis (TS) while comparing the head-loading effects.

METHODS

The VS parameters of 26 patients (retrospective review) were evaluated. Using the intra-class correlation coefficient, we statistically examined the intra-rater and inter-rater reliabilities of the parameters. Head-loaded and -unloaded imagings were compared using a Wilcoxon signed-rank test.

RESULTS

The intra-rater reliability of TS and CT showed intra-class correlation coefficients of ≥0.8 (X-ray range: 0.6-0.8), with similar results for the inter-rater reliabilities. Furthermore, in head-loading imaging, the TS had significantly higher VS scores than that of CT (P < .05).

CONCLUSIONS

In comparison with the X-ray, TS and CT were more accurate and reproducible. In terms of head loading, the VS values for TS were worse than those for CT, indicating that TS was more effective than CT in diagnosing VS.

Total knee arthroplasty for knee osteoarthritis associated with abnormal patellar tendon deformity: a case report

There have been no earlier reports of knee osteoarthritis with valgus knee deformity in which the patellar tendon infiltrates the tibial bone marrow instead of attaching to the tibial tubercle. This case report describes a total knee arthroplasty (TKA) performed for the treatment of a primary knee osteoarthritis resulting from a valgus knee joint position attributed to an abnormality of the patellar ligament attachment. During a TKA, the tendon tissue in the tibial medullary canal interfered with the reamer used to prepare for the stem extensions needed to improve the fixation of the component on the tibia, which had a cortical defect. The arthroplasty succeeded, and good clinical results have been maintained over the 3 years since the surgery. Surgeons should consider careful preoperative examinations by magnetic resonance imaging or CT when an abnormal bone defect is observed at the tibial tubercle on plain X-ray images.

Outcomes of Joint-Preserving Surgery for Forefoot Deformities in Patients With Rheumatoid Arthritis

BACKGROUND

With the advent of effective disease-modifying medications, the surgical treatment of forefoot deformities in patients with rheumatoid arthritis (RA) has evolved from joint-sacrificing to joint-preserving surgery. However, it is unclear whether joint-preserving surgery is effective for the full range of metatarsophalangeal joint involvement. Hence, this study investigated the postoperative outcomes of joint-preserving surgery for rheumatoid forefoot deformities with a wide range of joint destruction.

METHODS

This retrospective observational study included 68 feet from 68 patients with RA who underwent joint-preserving surgery for forefoot deformities between 2014 and 2020. The Larsen grade classification was used to assess the first metatarsophalangeal joint destruction and classify patients into 4 groups as follows: 0 and 1 (n = 14), 2 (n = 21), 3 (n = 19), and 4 and 5 (n = 14). The Self-Administered Foot and Ankle Evaluation Questionnaire (SAFE-Q) score, hallux valgus angle (HVA), and intermetatarsal angle (IMA) were determined before surgery and at the last follow-up visit.

RESULTS

The median observation duration was 40 (range, 24-78) months. SAFE-Q scores of all groups significantly improved in all subscales at the last observation, with no significant differences among the study groups. Radiographic evaluations of all groups revealed significant improvements in HVA and IMA after surgery, with no significant differences among the groups.

CONCLUSION

In patients using the surgical approaches described in this study, joint-preserving surgery for rheumatoid forefoot deformities led to satisfactory clinical and radiographic improvements, regardless of the severity of joint destruction.

LEVEL OF EVIDENCE

Level III, case-control study.

Impact of support instruments in medial closed-wedge distal femoral osteotomy: a finite element analysis

INTRODUCTION

Medial closed-wedge distal femoral osteotomy (MCWDFO) is a valuable treatment approach for lateral knee osteoarthritis with femoral valgus deformity. Improved results have been reported with the upgrade of surgical techniques and locking plates. However, the risk of nonunion and loss of correction increases in cases of lateral hinge fractures. This study aimed to evaluate the mechanical impact of hinge fractures and support instruments in MCWDFO using finite element analysis (FEA).

MATERIALS AND METHODS

Five femur models were developed using Mechanical Finder 11.0 FEA software. We simulated the following models: only a medial locking plate (MLP) (group A); an MLP with a lateral support screw (group B); and an MLP with a lateral support plate (group C). The equivalent stress around the hinge was evaluated and the percentage of the plastic deformation zone was calculated for the hinge area in the no-hinge fracture model. The equivalent stress of the MLP and the degree of displacement were calculated using the hinge fracture model.

RESULTS

The percentages of the plastic deformation zone in groups A, B, and C were 18.0 ± 11.7%, 3.3 ± 2.4%, and 2.3 ± 2.8%, respectively. The percentages tended to be lower in groups B and C than in group A. In the hinge fracture model, the mean equivalent stress of the MLP in group C was significantly less than that in group A. In terms of the mean degree of displacement, group A showed more than 1 mm of displacement, which was significantly larger than that of the other groups.

CONCLUSION

The support instruments provided stability to the hinge site and reduced the equivalent stress of the main plate in the MCWDFO with hinge fractures. No significant difference was observed between the two instruments in terms of stability.

Short-term efficacy and limitations of foot care in patients with rheumatoid arthritis

OBJECTIVES

Foot and ankle impairments are major issues in patients with rheumatoid arthritis (RA). Foot deformities often lead to skin disorders, such as callosities, ingrown toenails, and interdigital tinea pedis. This study was aimed at investigating the efficacy and limitations of foot care by experts in patients with RA.

METHODS

Thirty-one patients with RA who began receiving foot care from nurses at our institution between September 2020 and February 2023 were included. Responses to a survey using the self-administered foot evaluation questionnaire (SAFE-Q) for patient-reported outcome measures were compared at baseline, the second visit (1.3 ± 0.5 months after baseline), and the third visit (3.6 ± 1.6 months after baseline).

RESULTS

Scores for 'Pain and pain-related' and 'General health and well-being' components of SAFE-Q markedly improved after foot care. On the other hand, there were no significant differences in the scores for 'Physical functioning and daily living', 'Social functioning', and 'Shoe-related' components during observation periods.

CONCLUSIONS

Foot care for rheumatoid feet is effective in providing pain relief and improving general health and well-being. However, physical and social functioning and footwear issues did not improve. Clinicians must understand the effects and limitations of foot care in patients with RA.

Intensive treatment for the progression of joint damage in rheumatoid arthritis patients with low disease activity or remission

OBJECTIVES

To investigate the effects of intensive treatment on joint damage in patients with rheumatoid arthritis (RA) showing progression of joint damage and low disease activity or remission.

METHODS

Eighty-nine patients who had change in the van der Heijde modified total Sharp score (TSS) of >0.5 points at baseline when compared with the score 1 year ago were enrolled and categorized into two groups to receive intensive (intensive group) or current (current group) treatment. The intensive and current groups were compared for change (Δ) from baseline to 1 year of erosion score, joint space narrowing score, and TSS.

RESULTS

The ΔTSS values at 1 year in the intensive and current groups were 0.67 ± 1.09 and 1.79 ± 1.70, respectively (P < 0.001). In the intensive and current groups, the ΔTSS ≤ 0.5 at 1 year were 66.7% and 32.4%, respectively (P = 0.010).

CONCLUSIONS

The intensive treatment was more effective at suppressing joint damage than the current treatment. The progression of joint damage is an important target to consider for intensive treatment.

Long-Term Implant Fracture Rates Following Silicone Metacarpophalangeal Joint Arthroplasty in Rheumatoid Arthritis

PURPOSE

The primary objective of this study was to compare the long-term survival rates of silicone metacarpophalangeal (MCP) arthroplasties between two major implants in patients with rheumatoid arthritis, using implant fracture as an end point. We also evaluated the difference in postoperative function between patients with fractured and intact implants as a secondary objective.

METHODS

A retrospective cohort study was conducted on 372 fingers of 133 hands that underwent silicone MCP arthroplasty between January 2000 and June 2019 (mean follow-up, 7.6 years). The survival rates of Swanson-type and Sutter-type implants were compared, using implant fracture as the end point after a radiographic evaluation. Clinical measures and upper limb functional assessments using the Disabilities of the Arm, Shoulder, and Hand (DASH) score were performed in the nested cohort.

RESULTS

The 10.6-year survival rates for implant fracture of Swanson- and Sutter-type implants were 86.2% and 9.4%, respectively, with significantly higher survival noted for Swanson-type implants. The Sutter-type implant showed increased susceptibility to fracture in all four fingers compared to the Swanson-type implant. Implant fractures were primarily observed at the stem-hinge junction. There were no significant differences in upper limb function between the fractured and intact implant groups.

CONCLUSIONS

Sutter-type implants were found to be more prone to fracture compared with Swanson-type implants. However, implant fractures did not significantly affect upper limb function.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognosis IV.

Usefulness of post-operative endoscopic score for optimal treatment selection in recurrent eosinophilic chronic rhinosinusitis

OBJECTIVE

This study retrospectively analysed post-operative endoscopic scores to determine the optimal post-operative treatment in patients with eosinophilic chronic rhinosinusitis undergoing functional endoscopic sinus surgery.

METHODS

In total, 339 adults who underwent initial bilateral functional endoscopic sinus surgery for eosinophilic chronic rhinosinusitis were enrolled. Patients were divided into group A, which required no additional post-operative treatment; group B, which required local/systemic steroids post-operatively; and group C, which further required dupilumab and/or revision surgery.

RESULTS

Sixty-five per cent of patients could be treated with initial functional endoscopic sinus surgery (group A). Post-operative steroids were required in 35 per cent of patients with a post-operative endoscopic score of 30 per cent (group B). Further advanced treatments with dupilumab and/or revision functional endoscopic sinus surgery were required in 10 per cent of patients with a post-operative endoscopic score of 65 per cent (group C).

CONCLUSION

The post functional endoscopic sinus surgery endoscopic score can be used as an index to determine treatment at the time of eosinophilic chronic rhinosinusitis recurrence.

Estimation Failure Risk by 0.5-mm Differences in Autologous Hamstring Graft Diameter in Anterior Cruciate Ligament Reconstruction: A Meta-analysis

BACKGROUND

Because grafts are made in 0.5-mm increments clinically for anterior cruciate ligament (ACL) reconstruction, it is important to clarify how the failure rate decreases as the diameter increases. Moreover, it is important to know whether even a slight increase in the graft diameter decreases the risk of failure.

HYPOTHESIS

The risk of failure decreases significantly with each 0.5-mm increase in hamstring graft diameter.

STUDY DESIGN

Meta-analysis; Level of evidence, 4.

METHODS

The systematic review and meta-analysis have estimated the diameter-specific failure risk for each 0.5-mm increase in ACL reconstruction using autologous hamstring grafts. We searched for studies describing the relationship between graft diameter and failure rate published before December 1, 2021, in leading databases, such as PubMed, EMBASE, Cochrane Library, and Web of Science, according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We included studies using single-bundle autologous hamstring grafts to investigate the relationship between failure rate and graft diameter of 0.5-mm intervals with >1-year follow-up. Then, we calculated the failure risk caused by 0.5-mm differences in autologous hamstring graft diameter. Assuming Poisson distribution for the statistical model, we employed an extended linear mixed-effects model in the meta-analyses.

RESULTS

Five studies containing 19,333 cases were eligible. The meta-analysis revealed that the estimated value of the coefficient of diameter in the Poisson model was -0.2357 with a 95% CI of -0.2743 to -0.1971 (P < .0001). With every 1.0-mm increase in diameter, the failure rate decreased by 0.79 (0.76-0.82) times. In contrast, the failure rate increased by 1.27 (1.22-1.32) times for each 1.0-mm decrease in diameter. The failure rate significantly decreased with each 0.5-mm increase in graft diameter in the range of <7.0 to >9.0 mm from 3.63% to 1.79%.

CONCLUSION

The risk of failure decreased correspondingly with each 0.5-mm increase in graft diameter in the range of <7.0 to >9.0 mm. Failure is multifactorial; however, increasing the graft diameter as much as possible to match each patient's anatomic space without overstuffing is an effective precaution that surgeons can take to reduce failures.

Surgical outcomes of intraoperative O-arm versus C-arm fluoroscopy in occipitocervical fixation: a retrospective analysis

PURPOSE

This study aims to compare the effect of using O-arm and C-arm fluoroscopy on the surgical outcomes of occipitocervical fixation.

METHODS

The study included patients who underwent occipitocervical fixation using O-arm or C-arm between 2005 and 2021. Of 56 patients, 34 underwent O-arm-assisted surgery (O-group) and 22 underwent C-arm-assisted surgery (C-group). We assessed surgical outcomes, including operative time, intraoperative blood loss, perioperative complications, and bone union.

RESULTS

Almost half of the patients had rheumatoid arthritis-related disorders in both groups. Sixteen cases (47.1%) in the O-group and 12 cases (54.5%) in the C-group were fixed from occipito (Oc) to C3, 12 cases (38.2%) in the O-group and 7 cases (31.8%) in the C-group from Oc to C4-7, 5 cases (14.7%) in the O-group, and 3 cases (13.6%) in the C-group from Oc to T2 (p = 0.929). There was no significant difference in operative time (p = 0.239) and intraoperative blood loss (p = 0.595) between the two groups. Dysphagia was the most common complication in both groups (O-group vs. C-group, 11.7% vs. 9.1%). Regarding implant-related complications, occipital plate dislodgement was observed in four cases (18.2%) in the C-group (p = 0.02). The bone union rate was 96.3% in the O-group and 93.3% in the C-group (P = 1).

CONCLUSIONS

O-arm use is associated with a reduced rate of occipital plate dislodgment and has a similar complication incidence compared with C-arm-assisted surgery and does not prolong operative time despite the time needed for setting and scanning. Accordingly, an O-arm is safe and useful for occipitocervical fixation surgery.

Incidence and Distribution of Deep Vein Thrombosis Following Total Hip Arthroplasty Using an Anterolateral Supine Approach

Purpose

Venous thromboembolism (VTE) is a potential major complication in patients undergoing total hip arthroplasty (THA). However, the incidence of VTE following THA using anterolateral supine approach (ALS) has not been reported. The purpose of this study was to investigate the incidence of perioperative VTE and the distribution and characteristics of deep vein thrombosis (DVT) following ALS THA.

Patients and Methods

This retrospective single-arm study analyzed the 182 consecutive hips of 164 patients who underwent primary ALS THA. Pharmacological prophylaxis consisted of enoxaparin 20 mg twice daily for approximately 6 days starting 24 h postoperatively until duplex ultrasonography was performed to determine whether postoperative DVT was present. DVT was assessed by whole-leg Doppler ultrasound, and the location and characteristics of any thrombus were recorded. If pulmonary thromboembolism was suspected, contrast-enhanced computed tomography was performed.

Results

The overall incidence of VTE was 9.9% for DVT (18/182 hips) and 0.5% for pulmonary thromboembolism (1/182 hips). Most DVTs were in the soleal vein on the affected side and showed isoechoic or hypoechoic echogenicity. All thrombi were non-floating.

Conclusion

Following ALS THA with standard pharmacological prophylaxis and an early weight-bearing protocol, the incidence of perioperative DVT was approximately 10%, mostly occurring in the lower leg.

Feasibility and applicability of locomotive syndrome risk test in elderly patients who underwent total knee arthroplasty

OBJECTIVES

The concept of locomotive syndrome (LS) and its evaluation method, the LS risk test, have been applied in an integrated manner to capture the decline in mobility resulting from musculoskeletal disorders. The purpose of this study was to evaluate the impact of total knee arthroplasty (TKA) in the elderly with knee osteoarthritis, a common disorder found in LS.

METHODS

A total of 111 patients were registered prior to TKA and postoperatively followed up for 1 year. Three components of the LS risk test (the two-step test, stand-up test, and Geriatric Locomotive Function Scale-25) were assessed pre- and postoperatively.

RESULTS

After surgery, all three components of the test showed significant improvements from the baseline. The ratio of Stage 3 LS patients (progressed stage of decrease in mobility) reduced from 82.3% to 33.9% postoperatively. There was no significant difference in the degree of change in the scores between the younger (60-74 years) and older (≥75 years) age groups.

CONCLUSIONS

We found that TKA has a major impact in preventing the progression of LS in patients with knee osteoarthritis. The LS risk test is a feasible tool for the longitudinal evaluation of patients with musculoskeletal diseases of varying severity and with multiple symptoms.

Lateral joint tightness in flexion following cementless mobile-bearing total knee arthroplasty decreases patient-reported outcome measures and postoperative range of motion

PURPOSE

The purpose of this study was to clarify the association between clinical outcomes and the flexion joint gap following rotating concave-convex (Vanguard ROCC) total knee arthroplasty (TKA).

METHODS

This consecutive retrospective series included 55 knees that underwent ROCC TKA. All the surgical procedures were performed using a spacer-based gap-balancing technique. To evaluate the medial and lateral flexion gaps, axial radiographs of the distal femur were obtained using the epicondylar view with a distraction force to the lower leg at 6 months postoperatively. Lateral joint tightness was defined as the lateral gap being greater than the medial gap. To evaluate clinical outcomes, patients were asked to complete patient-reported outcome measures (PROMs) questionnaires preoperatively and during at least 1 year of follow-up postoperatively.

RESULTS

The median follow-up duration was 24.0 months. Overall, 16.0% of patients had postoperative lateral joint tightness in flexion. The postoperative range of motion and PROMs were lower in patients with lateral joint tightness than in those with a balanced flexion gap or lateral joint laxity. No serious complications, including bearing dislocations, occurred during the observation period.

CONCLUSION

Lateral joint tightness in flexion following ROCC TKA decreases PROMs and postoperative range of motion.

LEVEL OF EVIDENCE: 4

Smoking, Serum Albumin and 25-hydroxy Vitamin D Levels, and Bone Mineral Density Are Associated with Tooth Loss in Patients with Rheumatoid Arthritis

Objectives This study investigated factors associated with tooth loss in patients with rheumatoid arthritis (RA). Methods A total of 429 patients with RA were enrolled in the study. We examined tooth loss and clinical data. Patients were classified into two groups: a group with tooth loss (tooth loss-positive group), and a group without tooth loss (tooth loss-negative group). Patients were included in the tooth loss-positive group if they had fewer remaining teeth than the number defined by the Ministry of Health, Labour and Welfare in Japan to be the normal number teeth for that age and sex. Factors associated with tooth loss were analyzed by comparing the tooth loss-positive and loss-negative groups. Results The frequency of patients with tooth loss was 39.6%. The factors associated with tooth loss were smoking [odds ratio (OR) 1.638; 95% confidence interval (CI) 1.165-2.302], serum levels of albumin (OR 0.325; 95% CI 0.149-0.707) and 25-hydroxy vitamin D (OR 0.947; 95% CI 0.915-0.980), and total hip T score (OR 0.713; 95% CI 0.535-0.950). Conclusion This study revealed that tooth loss is associated with smoking, serum levels of albumin and 25-hydroxy vitamin D, and the total hip T score in patients with RA. Our findings may help prevent tooth loss in patients with RA.

Hindfoot Alignment and Ankle Stability Following Arthroscopic Lateral Ankle Ligament Repair

BACKGROUND

Hindfoot varus deformity is a known risk factor for chronic lateral ankle instability (CLAI). The impact of this deformity on clinical results following arthroscopic lateral ankle ligament repair (ALLR) for CLAI has not been studied.

METHODS

Sixty-three ankles from 62 patients who received ALLR for CLAI were retrospectively examined. Preoperative plain radiographs were used to measure tibial articular surface (TAS) angles, and long axial hindfoot alignment radiographs were used to measure tibiocalcaneal angles (TCAs) pre- and postoperatively. Results included ratings on the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) and recurrent ankle instability (respraining of the operated ankle following surgery).

RESULTS

Recurrent ankle instability, defined as incidence of any new ankle sprain after surgery reported in the follow-up period, occurred in 13 ankles. The TAS angles of these patients were significantly low, and their preoperative TCA was significantly high. Multivariate analysis showed that preoperative TCA was an independent risk factor for recurrent ankle instability. The threshold values for preoperative TCA for recurrent instability were determined via the receiver operating characteristic curve analysis to be 3.4 degrees. Patients were assigned to a low- or high-TCA group based on the reported average TCA (2.7 degrees) of healthy patients. In the high-TCA group, recurrent instability was significantly more frequent, and the scores on the pain subscale of the postoperative SAFE-Q were significantly lower.

CONCLUSION

Hindfoot varus alignment was associated with pooreroutcomes after ALLR.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

Awareness of Stress Concentration Points for Prevention and Management of Periprosthetic Fractures Following Plate Installation Reinforcement: A Case Report

Introduction

In an aging society, the incidence of periprosthetic fractures will increase owing to the increasing number of patients undergoing joint replacement surgery. We experienced a case of recurrent periprosthetic fracture in a patient who had undergone ipsilateral hip bipolar hemiarthroplasty (BHA) and total knee arthroplasty. Based on our experience, we discuss the treatment strategy for periprosthetic fractures in patients at a high risk of fall.

Case Report

An 84-year-old woman, who had undergone total knee arthroplasty 9 years ago and ipsilateral hip BHA 2 years ago, sustained a knee condylar fracture (Su classification type III) due to fall. This knee periprosthetic fracture posed a challenge for osteosynthesis; therefore, revision total knee arthroplasty was performed using a hinge-type prosthesis. During this surgery, we installed a reinforcement plate on the femoral shaft to prevent fractures because of the short stem tip distance between the hip and knee prosthesis (53 mm). The procedure was successful, and the patient regained her walking ability. However, 6 months after surgery, the patient sustained a hip periprosthetic fracture (Vancouver type B2) due to a fall, despite precautionary plate installation. In case of hip stem insertion, the stress caused by fall is concentrated on the infratrochanteric region, as reflected in her fracture site. From a mechanical perspective, this fracture was not accidental. The plate reinforcement procedure may have been inadequate because the top of the plate was located at the infratrochanteric region.

Conclusion

Periprosthetic fractures may occur despite the installation of a plate for fracture prevention. With a total hip arthroplasty or hip BHA stem inserted, a fall could result in a subtrochanteric fracture.

Open-wedge high tibial osteotomy with a slight valgus correction from neutral limb alignment achieves clinical improvements comparable with those for knees with varus deformity

PURPOSE

The effect of open-wedge high tibial osteotomy (OWHTO) on the preoperative neutral alignment of the knee is unknown. The purpose of this study was to clarify the clinical outcome of OWHTO with neutral alignment, defined as within 4 degrees of varus.

METHODS

This retrospective study included 72 knees with varus that underwent medial OWHTO. The knees were divided according to the preoperative hip-knee-ankle angle into a neutral alignment group (≤ 4° of varus alignment) and a varus alignment group (> 4° of varus alignment). The Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Forgotten Joint Score-12 (FJS-12) were evaluated preoperatively and during at least 2 years of follow-up postoperatively.

RESULTS

There were no significant differences between the preoperative FJS-12 (17.9 versus 23.7; p = 0.16) and postoperative FJS-12 (57.3 versus 60.6; p = 0.52) or KOOS subscale scores (p > 0.05) in the neutral alignment group or the varus alignment group. Each group had a mean change in the KOOS subscale scores that exceeded the minimum clinically important difference.

CONCLUSION

The short-term clinical results of OWHTO for neutral alignment were as favourable as those for varus malalignment.

LEVEL OF EVIDENCE

IV.

Ten-Year Follow-Up of a Customized Total Talar Prosthesis for Revision Total Ankle Arthroplasty: A Case Report

CASE

A 74-year-old woman with rheumatoid arthritis had undergone total ankle arthroplasty (TAA) for severe ankle joint destruction at our hospital 14 years earlier. Radiographs of the ankle revealed displacement of the tibial component and subsidence of the talar component. Revision TAA was performed using a customized alumina ceramic total talar prosthesis.

CONCLUSION

The 10-year outcome of revision TAA with a total talar prosthesis was satisfactory, with no postoperative complications, such as displacement of the tibial component, dislocation of alumina ceramic artificial talus, or progression of degenerative changes in the talonavicular and subtalar joints.

Robotic-assisted total knee arthroplasty is not associated with increased risk of postoperative deep vein thrombosis

PURPOSE

Prolongation of operation time due to registration and pin insertion has been reported with robotic-assisted total knee arthroplasty (RATKA), and there has been concern about an increase in the postoperative incidence of deep vein thrombosis (DVT). In this study, we compared the incidence of DVT after RATKA with that after conventional manual TKA (mTKA).

METHODS

This consecutive retrospective series included 141 knees that underwent primary TKA using the Journey II system. The CORI robot was used. There were 60 RATKAs and 81 mTKAs. Doppler ultrasound was performed in all patients on postoperative day 7 to determine whether DVT was present.

RESULTS

The operation time was longer in the RATKA cohort (99.5 min vs 78.0 min, p < 0.001). The overall incidence of DTV was 43.9% (62/141 knees), all of which were asymptomatic. There was no significant difference in incidence of DVT between RATKA and mTKA (50.0% vs 39.5%, p = 0.23). Use of the robot did not affect the incidence of DVT following TKA (odds ratio 1.02, 95% confidence interval 0.40-2.60; p = 0.96).

CONCLUSION

The incidence of DVT was not significantly different between RA-TKA and mTKA. Multiple logistic regression indicated that RATKA is not associated with increased risk of postoperative DVT.

LEVEL OF EVIDENCE

IV.

Clinical Outcomes of Selective Single-Level Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression of Multilevel Lumbar Spinal Stenosis and Risk Factors of Reoperation

STUDY DESIGN

Retrospective cohort study.

OBJECTIVES

To investigate the usefulness of selective single-level lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) in patients with radiological multilevel lumbar spinal stenosis (LSS) and clarify the predictive factors of reoperation.

METHODS

A total of 128 patients who underwent LE-ULBD of radiological multilevel LSS were retrospectively examined. Single-level decompression was selected clinically and supplemented radiologically. Clinical outcomes were assessed with the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), numeric rating scale (NRS), and Macnab criteria (mean follow-up period, 28.6 months [range, 24-63 months]). Stenosis severity was classified as grades M (moderate) and S (severe) based magnetic resonance imaging findings. Multilevel LSS was classified as SS, SM, and MM according to the number of grade S levels.

RESULTS

The follow-up rate was 74.2%. All domains of the JOABPEQ and NRS significantly improved during follow-up. The Macnab outcome classification was "excellent" or "good" in 77.9% of the patients. The reoperation rate was 10.2%. None of the patients with unilateral symptoms required reoperation. The SS type was a significant risk factor of reoperation for multilevel LSS with bilateral symptoms. Additional LE-ULBD was performed for all the reoperation with the "excellent" or "good" results of the Macnab criteria in 69% of the patients.

CONCLUSIONS

Selective single-level LE-ULBD provided favorable results for multilevel LSS. However, information about the risks of reoperation for multilevel severe stenosis with bilateral symptoms should be shared between surgeons and patients.

Nonresponder Considerations for Romosozumab Treatment

Romosozumab can increase bone mineral density (BMD) in patients with osteoporosis, but some patients do not respond to it. This study aimed to identify risk factors for being a nonresponder to romosozumab treatment. This retrospective observational study included 92 patients. Romosozumab (210 mg) was subcutaneously administered to the participants every 4 weeks over 12 months. We excluded patients who previously underwent treatment for osteoporosis to assess the impact of romosozumab alone. We evaluated the proportion of patients who did not respond to romosozumab treatment to the lumbar spine and hip with increased BMD. Nonresponders were defined as those with a bone density change of < 3% after 12 months of treatment. We compared demographics and biochemical markers between responders and nonresponders. We found that 11.5% of patients were nonresponders at the lumbar spine, and 56.8% were nonresponders at the hip. A risk factor for nonresponse at the spine was low type I procollagen N-terminal propeptide (P1NP) values at 1 month. The cutoff value for P1NP at month 1 was 50 ng/ml. We found that 11.5% and 56.8% of patients experienced no significant improvement in the lumbar spine and hip BMD, respectively. Clinicians should use nonresponse risk factors to inform decisions about romosozumab treatment for patients with osteoporosis.

Bone marrow-derived fibroblast migration via periostin causes irreversible arthrogenic contracture after joint immobilization

Joint contracture causes distressing permanent mobility disorder due to trauma, arthritis, and aging, with no effective treatment available. A principal and irreversible cause of joint contracture has been regarded as the development of joint capsule fibrosis. However, the molecular mechanisms underlying contracture remain unclear. We established a mouse model of knee joint contracture, revealing that fibrosis in joint capsules causes irreversible contracture. RNA-sequencing of contracture capsules demonstrated a marked enrichment of the genes involved in the extracellular region, particularly periostin (Postn). Three-dimensional magnetic resonance imaging and immunohistological analysis of contracture patients revealed posterior joint capsule thickening with abundant type I collagen (Col1a2) and POSTN in humans. Col1a2-GFP^TG ; Postn^-/- mice and chimeric mice with Col1a2-GFP^TG ; tdTomato^TG bone marrow showed fibrosis in joint capsules caused by bone marrow-derived fibroblasts, and POSTN promoted the migration of bone marrow-derived fibroblasts, contributing to fibrosis and contracture. Conversely, POSTN-neutralizing antibody attenuated contracture exacerbation. Our findings identified POSTN as a key inducer of fibroblast migration that exacerbates capsule fibrosis, providing a potential therapeutic strategy for joint contracture.

Clinical results of autologous protein solution injection for knee osteoarthritis with severe disease grade is inferior to mild or moderate grade

Autologous protein solution (APS) is made from platelet-rich plasma that extracts high-concentration growth factors and cytokines. Intra-articular APS injection was reported to improve knee osteoarthritis (KOA) pain and function. However, efficacy differences regarding osteoarthritis severity remained unknown. This retrospective study clinically assessed 220 knees with KOA in the Kellgren-Lawrence (KL) grades 2-4 that underwent APS injection using the Knee Injury and Osteoarthritis Outcome Score (KOOS). A telephone survey was performed for patients who dropped out to check symptom changes. The recalculated estimated responder rate included the telephone survey results. The 12-month follow-up was completed with 148 knees (67%), whereas 72 knees dropped out. The follow-up rate was significantly lower in KL4 than KL2 and 3. The KOOS significantly improved in 148 knees, whereas the KOOS was lower in KL4 than in KL2. The responder rate was 55% total, 58% in KL2, 57% in KL3, and 47% in KL4; however, the estimated responder rate, including the telephone survey, was 49% total, 55% in KL2, 54% in KL3, and 36% in KL4. This study showed improved clinical symptoms 1-year after APS injections for KOA, with a lower responder rate in KL4 than in KL2 or KL3.

Combination treatment with Janus kinase inhibitor and nintedanib for rheumatoid arthritis with progressive interstitial lung disease: A case report

Interstitial lung disease (ILD) is a common extra-articular manifestation of rheumatoid arthritis (RA). Nintedanib has been approved for the treatment of idiopathic pulmonary fibrosis. Herein, we described the case of an 87-year-old woman treated with Janus kinase inhibitor (JAKi). Chest computed tomography revealed increased honeycombing; she was administered nitedanib while continuing RA treatment. The combination treatment (JAKi and nintedanib) controlled the RA disease activity, without ILD deterioration. This case shows the potential of combination treatment with JAKi and nintedanib for prevention of worsening of disease activity in RA and ILD.

Similar short-term KOOS between open-wedge high tibial osteotomy and total knee arthroplasty in patients over age 60: A propensity score-matched cohort study

OBJECTIVES

The purpose of the present study was to evaluate improvement in the Knee Injury and Osteoarthritis Outcome Score (KOOS) after open-wedge high tibial osteotomy (HTO) in comparison with total knee arthroplasty (TKA) in cohorts over age 60 matched by pre-operative age, gender, body mass index (BMI), hip-knee-ankle angle (HKAA), KOOS sub-scores, and osteoarthritis (OA) grade.

METHODS

Propensity score matching was performed between 162 HTO patients and 134 TKA patients. When calculating the propensity score by multivariate logistic regression analysis, the following pre-operative confounders were included: age, gender, BMI, HKAA, KOOS sub-scores, and OA grade. Consequently, a total of 55 patients were included in each group. The Student's t-test was used to analyse differences in the post-operative KOOS sub-scores between groups.

RESULTS

After propensity score matching, all matched pre-operative valuables were identical, with no significant differences between the HTO and TKA groups. None of the post-operative KOOS sub-scores at 1 year after surgery showed a significant difference between the HTO and TKA groups. Both groups demonstrated significant and comparable post-operative improvement in every KOOS sub-score.

CONCLUSIONS

In patients over age 60, there was no significant difference in short-term pain relief and improvements in activity and quality of life between HTO and TKA after propensity score matching including pre-operative age, KOOS sub-scores, and OA grade. HTO is a joint preservation procedure that is valid for knee OA even in individuals over age 60.

Radiological evaluation of interstitial lung disease in patients with rheumatoid arthritis treated with abatacept or JAK inhibitors for 1 year

BACKGROUND

We evaluated the radiological deterioration of interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA) treated with abatacept (ABT) or Janus-kinase inhibitors (JAKi) for 1 year.

METHODS

This study enrolled 84 patients with RA who had started treatment with ABT (48 patients) or JAKi (36 patients) between 2017 and 2020. All patients underwent chest CT before administration and at 1 year post-treatment.

RESULTS

In all patients, the rate of deterioration of ILD in ABT and JAKi was 4.2% and 5.6%, respectively (p = 0.847). In the patients with pre-existing ILD, the rates of deterioration of ILD in the ABT and JAKi groups were 10.5% and 18.2%, respectively (p = 0.611). Meanwhile, newly developed ILD did not occur in the two groups without pre-existing ILD.

CONCLUSION

The present study demonstrated that the safety of pulmonary toxicity with ABT and JAKi treatments was similar in patients with RA. JAKi may be a potentially acceptable treatment option for patients with RA.

Changes in SARS-CoV-2 antibody titers 6 months after the booster dose of BNT162b2 COVID-19 vaccine among health care workers

Purpose

In Japan, the data on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody titers after the booster dose of the coronavirus disease 2019 (COVID-19) vaccine are insufficient. The aim of this study is to evaluate changes in SARS-CoV-2 antibody titers before, 1, 3, and 6 months after the booster dose of the BNT162b2 COVID-19 vaccine among health care workers.

Materials and Methods

A total of 268 participants who received the booster dose of the BNT162b2 vaccine were analyzed. SARS-CoV-2 antibody titers were measured before (baseline) and at 1, 3, and 6 months after the booster dose. Factors associated with changes in SARS-CoV-2 antibody titers at 1, 3, and 6 months were analyzed. Cutoff values at baseline were calculated to prevent infection of the omicron variant of COVID-19.

Results

The SARS-CoV-2 antibody titers at baseline, and 1, 3, and 6 months were 1,018.3 AU/mL, 21,396.5 AU/mL, 13,704.6 AU/mL, and 8,155.6 AU/mL, respectively. Factors associated with changes in SARS-CoV-2 antibody titers at 1 month were age and SARS-CoV-2 antibody titers at baseline, whereas changes in SARS-CoV-2 antibody titers at 3 and 6 months were associated with the SARS-CoV-2 antibody titers at 1 month. The cutoff values of the SARS-CoV-2 antibody titers at baseline were 515.4 AU/mL and 13,602.7 AU/mL at baseline and 1 month after the booster dose, respectively.

Conclusion

This study showed that SARS-CoV-2 antibody titers increase rapidly at 1 month after the booster dose of the BNT162b2 vaccine and begin to decrease from 1 to 6 months. Hence, another booster may be needed as soon as possible to prevent infection.

Clinical utility of markerless motion capture for kinematic evaluation of sit-to-stand during 30 s-CST at one year post total knee arthroplasty: a retrospective study

BACKGROUND

Although the importance of kinematic evaluation of the sit-to-stand (STS) test of total knee arthroplasty (TKA) patients is clear, there have been no reports analyzing STS during the 30-s chair sit-up test (30 s-CST) with a focus on kinematic characteristics. This study aimed to demonstrate the clinical utility of kinematic analysis of STS during the 30 s-CST by classifying STS into subgroups based on kinematic parameters, and to determine whether differences in movement strategies are expressed as differences in clinical outcomes.

METHODS

The subjects were all patients who underwent unilateral TKA due to osteoarthritis of the knee and were followed up for one year postoperatively. Forty-eight kinematic parameters were calculated using markerless motion capture by cutting STS in the 30 s-CST. The principal components of the kinematic parameters were extracted and grouped by kinematic characteristics based on the principal component scores. Clinical significance was examined by testing whether differences in patient-reported outcome measures (PROMs) were observed.

RESULTS

Five principal components were extracted from the 48 kinematic parameters of STS and classified into three subgroups (SGs) according to their kinematic characteristics. It was suggested that SG2, using a kinematic strategy similar to the momentum transfer strategy shown in previous studies, performed better in PROMs and, in particular, may be associated with achieving a "forgotten joint", which is considered the ultimate goal after TKA.

CONCLUSIONS

Clinical outcomes differed according to kinematic strategies used STS, suggesting that kinematic analysis of STS in 30 s-CST may be useful in clinical practice.

TRIAL REGISTRATION

This study was approved by the Medical Ethical Committee of the Tokyo Women's Medical University (approval number: 5628 on May 21, 2021).

A survey on the usage of decellularized tissues in orthopaedic clinical trials

Orthopaedic surgery requires grafts with sufficient mechanical strength. For this purpose, decellularized tissue is an available option that lacks the complications of autologous tissue. However, it is not widely used in orthopaedic surgeries. This study investigated clinical trials of the use of decellularized tissue grafts in orthopaedic surgery. Using the ClinicalTrials.gov (CTG) and the International Clinical Trials Registry Platform (ICTRP) databases, we comprehensively surveyed clinical trials of decellularized tissue use in orthopaedic surgeries registered before 1 September 2022. We evaluated the clinical results, tissue processing methods, and commercial availability of the identified products using academic literature databases and manufacturers' websites. We initially identified 4,402 clinical trials, 27 of which were eligible for inclusion and analysis, including nine shoulder surgery trials, eight knee surgery trials, two ankle surgery trials, two hand surgery trials, and six peripheral nerve graft trials. Nine of the trials were completed. We identified only one product that will be commercially available for use in knee surgery with significant mechanical load resistance. Peracetic acid and gamma irradiation were frequently used for sterilization. Despite the demand for decellularized tissue, few decellularized tissue products are currently commercially available, particularly for the knee joint. To be viable in orthopaedic surgery, decellularized tissue must exhibit biocompatibility and mechanical strength, and these requirements are challenging for the clinical application of decellularized tissue. However, the variety of available decellularized products has recently increased. Therefore, decellularized grafts may become a promising option in orthopaedic surgery.

Comparison of different parameters between daily and twice-weekly teriparatide in postmenopausal women with severe osteoporosis

INTRODUCTION

Once-daily teriparatide (D-TPTD) and twice-weekly TPTD (W-TPTD), which are self-administered injections, are generally used in the treatment of severe osteoporosis. This study aimed to reveal the differences in the persistence, safety, and effectiveness of D-TPTD and W-TPTD.

MATERIALS AND METHODS

A total of 102 patients received D-TPTD (n = 51) and W-TPTD (n = 51). The bone mineral densities (BMD) of the lumbar spine, total hip, and femoral neck were measured using dual energy X-ray absorptiometry. The persistence and effectiveness of the two treatments were compared at 12 months.

RESULTS

The persistence in the D-TPTD and W-TPTD groups was 80.4% and 66.7% at 12 months, respectively (p = 0.178). The % changes (Δ) in BMD values from baseline for the lumbar spine in the D-TPTD were significantly higher than those in the W-TPTD (11.2% vs. 6.3%; p < 0.001) at 12 months. The ΔBMD values for the total hip (3.7% vs. 1.3%; p = 0.065) and femoral neck (2.2% vs. 1.6%; p = 0.489) did not differ significantly between the two groups at 12 months. The incidence of new morphological vertebral fractures in the D-TPTD and W-TPTD groups was 7.3% and 8.6%, respectively, at 12 months (p = 1.000).

CONCLUSIONS

Lumbar spine BMD (LS-BMD) was significantly increased. Moreover, ΔLS-BMD in the D-TPTD group was higher than that in the W-TPTD group. This study showed that the persistence, ΔTH-BMD, ΔFN-BMD and incidence of vertebral fractures did not differ between the two groups.

Intra-articular injection of culture-expanded adipose tissue-derived stem cells for knee osteoarthritis: Assessments with clinical symptoms and quantitative measurements of articular cartilage volume

BACKGROUND

Intra-articular administration of adipose tissue-derived stem cells (ADSC) is an alternative treatment option for knee osteoarthritis (OA) after conventional treatment fails; however, the clinical results related to the severity of OA grade and changes of cartilage volumes after the administration of ADSC is unknown. This study aimed to determine 1) clinical outcomes after the ADSC administration in knee OA with consideration of radiographic OA grades and 2) changes in cartilage volumes after ADSC administration.

METHODS

This observational study included 86 knees from 51 patients who underwent intra-articular administration of cultured ADSC; 47 patients (80 knees) completed follow-up for 6 months (follow-up rate: 93%). The Knee injury and Osteoarthritis Outcome Scores (KOOS) were reported at baseline and 1, 3, and 6 months after the administration. The efficacy rate in the Outcome Measures in Arthritis Clinical Trials-Osteoarthritis Research Society International (OMERACT-OARSI) was evaluated using the KOOS. Cartilage volume of the knee joint was measured using quantitative 3-dimensional magnetic resonance imaging (3D-MRI) software at baseline and 6 months in 52 knees in 31 patients (follow-up rate: 61%).

RESULTS

All items on the KOOS except "sports/recreation" improved significantly at 6 months with more significance in knees with a Kellgren-Lawrence (KL) grade 2 or 3 compared with KL grade 4 knees. The OMERACT-OARSI responder at 6 months was significantly greater in knees with KL grade 2 or 3 (64%) than in knees with KL grade 4 (42%, p = 0.045). Cartilage volume changes varied among patients and were not related to the changes in KOOS after ADSC administration.

CONCLUSIONS

Intra-articular administration of ADSC in knee OA improved KOOS at 6 months. The effects were more significant in knees with KL grade 2 or 3 than with KL grade 4. Changes in KOOS were not related to change in cartilage volumes after ADSC administration.

AP3×ML3 reduction quality classification for femoral trochanteric fractures: validation for reliability focusing on positive medial cortical support

INTRODUCTION

This study evaluated the validity of the AP3 × ML3 reduction quality classification, which applies the concept of positive medial cortical support.

METHODS

A total of 120 trochanteric fractures classified as AO Foundation/Orthopedic Trauma Association 31A1 and A2 were retrospectively analyzed. The validity of the AP3 × ML3 classification was evaluated by comparison with the Baumgaertner reduction quality criteria. When using the AP3 × ML3 classification, reduction quality was divided into three classes based on the degree of anterior cortical contact between the proximal and distal fragments. Reduction quality was also divided into three classes when using the Baumgaertner criteria. The frequency of mechanical complications, including cut-out, delayed union, and excessive migration of the lag screw, was retrospectively assessed. Intra-observer and inter-observer reliability was assessed using the intraclass correlation coefficient (ICC).

RESULTS

Mechanical complications included 4 cases of cutout (3.3%) and 1 of delayed union (0.8%). Mechanical complications occurred for all levels of reduction quality in both classifications, except for the acceptable of the Baumgaertner criteria. When reduction quality was rated as good, acceptable, and poor the incidence of mechanical complications was 2.5%, 5.7%, and 16%, respectively, under the AP3 × ML3 classification and 3.3%, 0%, and 15.0%, respectively, under the Baumgaertner criteria. The ICC was 0.80 for intra-observer reliability and 0.57 for inter-observer reliability when using the AP3 × ML3 classification and 0.85 and 0.34, respectively, when using the Baumgaertner criteria.

CONCLUSION

The AP3 × ML3 classification was reliable and easy to use compared with the widely used Baumgaertner reduction quality criteria. Level of evidence 4.

Radiographic factors associated with painful callosities after forefoot surgery in patients with rheumatoid arthritis

OBJECTIVES

Operative procedures for rheumatoid forefoot deformities have gradually changed from arthrodesis or resection arthroplasty to joint-preserving surgery. Although joint-preserving arthroplasty has yielded good outcomes, painful plantar callosities may occur post-operatively. This study aimed to reveal the radiographic factors associated with painful callosities after joint-preserving surgery for forefoot deformities in patients with rheumatoid arthritis (RA).

METHODS

We retrospectively evaluated 166 feet in 133 patients with RA who underwent forefoot joint-preserving arthroplasty, including proximal rotational closing-wedge osteotomies of the first metatarsal, between January 2012 and December 2015. Logistic regression analysis was performed with the objective variable set as the presence/absence of painful plantar callosities at the final observation and the explanatory variables set as several radiographic factors, including post-operative relative first metatarsal length (RML), amount of dorsal dislocation of the fifth metatarsal (5DD), and arc failure of the lesser toes.

RESULTS

At the final follow-up, 42 of the 166 feet (25.3%) had painful callosities under the metatarsal heads post-operatively. Logistic regression analysis showed that the RML, 5DD, and lesser toes' arc failure were significantly associated with painful callosities.

CONCLUSIONS

We identified that RML, 5DD, and arc failure of the lesser toes were associated with painful plantar callosities after the surgery.

Stress fractures in the forefoot after arthrodesis of the hindfoot in a patient with rheumatoid arthritis: A case report

Rheumatoid arthritis (RA) is an autoimmune disease that attacks multiple joints throughout the body. Ankle arthrodesis (AA) has been the gold standard surgery for end-stage ankle arthritis in patients with RA. Here, we report the case of a 67-year-old woman with RA who had displacement and loosening of total ankle arthroplasty. The ankle was converted to AA using a metal spacer and an intramedullary nail. The patient had no complications in perioperative terms of arthrodesis. However, multiple fractures were found in the metatarsal bones at the routine 3-year follow-up. Although the patient did not remember any symptoms, the clinical outcome deteriorated compared to that a year before. The hindfoot in this case report was fixed completely by an intramedullary nail, while the midfoot had already involved ankylosis because of severe joint destruction present before the surgery. As a result, the range of motion in the joints of the midfoot and hindfoot was lost, and it is probable that an excessive load was applied to the forefoot during push-off by the toes, resulting in a stress fracture. Patients with RA remain at risk of future progressive joint destruction in every joint of their body. Therefore, surgeons should choose a surgery that preserves ankle motion to decrease the rate of adjacent joint degeneration for severe ankle arthropathy in patients with RA.

Impact of amino acid 233 in Tax on bovine leukemia virus infection in Japanese Black cattle

Bovine leukemia virus (BLV) is an economically important pathogen that both causes fatal enzootic bovine leukosis (EBL) and reduces lifetime milk production, reproductive efficiency, carcass weight, and longevity in dairy cows. The virus can be divided into two categories based on the amino acid at position 233 in Tax protein, which activates viral transcription and probably plays crucial roles in leukemogenesis. We recently reported that early-onset EBL in Japanese Black (JB) cattle was frequently caused by L233-Tax-carrying virus. This study examined the impact of BLV infection, the proviral load (PVL), and amino acid 233 in Tax on the outcomes of JB cattle. We measured PVL in cattle enrolled between February 2016 and December 2018, determined the Tax type of the isolates, and performed follow-up until March 2022. The results demonstrated that BLV infection increased the risk of involuntary culling and mortality in JB cattle in a PVL-dependent manner. Infection with L233-Tax-carrying virus increased the likelihood of mortality by 1.6-fold compared with the effects of P233-Tax-carrying virus infection. Intrauterine and perinatal infections were frequently caused by L233-Tax-carrying virus, and these infections were likely to influence the early onset of EBL in JB cattle. Conversely, breeding cows infected with P233-Tax-carrying virus were often eliminated by involuntary culling. These findings indicate that amino acid 233 in Tax has importance in terms of preventing economic loss attributable to EBL in JB cattle.

Anterior talofibular ligament remnant quality is important for achieving a stable ankle after arthroscopic lateral ankle ligament repair

PURPOSE

The relationship between ligament remnant quality and postoperative outcomes after arthroscopic lateral ankle ligament repair for chronic lateral ankle instability is controversial. This study aimed to determine whether the signal intensity of the anterior talofibular ligament on preoperative magnetic resonance imaging and ligament remnant quality identified on arthroscopy are associated with recurrent ankle instability after arthroscopic lateral ankle ligament repair.

METHODS

A total of 68 ankles from 67 patients with chronic lateral ankle instability who underwent arthroscopic lateral ankle ligament repair were retrospectively studied. The signal intensity of the anterior talofibular ligament was evaluated using T2-weighted magnetic resonance imaging. Arthroscopy was used to evaluate the thickness and mechanical resistance of the anterior talofibular ligament by hook palpation and to classify ankles into two groups: the present anterior talofibular ligament group with adequate mechanical resistance and the absent anterior talofibular ligament group with no mechanical resistance. The outcomes included recurrent ankle instability (respraining of the operated ankle after surgery) and Self-Administered Foot Evaluation Questionnaire scores.

RESULTS

Thirteen ankles were diagnosed with recurrent ankle instability. Patients with a high anterior talofibular ligament T2 signal intensity experienced more recurrent ankle instability than those with a low intensity. As determined via arthroscopy, the absent anterior talofibular ligament group had a higher rate of recurrent ankle instability than the present anterior talofibular ligament group. There were no significant differences in Self-Administered Foot Evaluation Questionnaire scores between patients with high and low anterior talofibular ligament T2 signal intensity, as well as between absent and present anterior talofibular ligament groups based on arthroscopy.

CONCLUSION

Poor quality of the anterior talofibular ligament remnant could result in recurrent ankle instability after arthroscopic lateral ankle ligament repair. Therefore, when treating chronic lateral ankle instability, surgeons should consider ligament quality.

LEVEL OF EVIDENCE

IV.

Factors Associated with Five-year Deterioration of the Health Assessment Questionnaire-Disability Index in Patients with Rheumatoid Arthritis: A Retrospective Cohort Study

Objectives We investigated the factors associated with the deterioration of the Health Assessment Questionnaire-Disability Index (HAQ-DI) over five years in patients with rheumatoid arthritis (RA). Methods Clinical data were obtained from 391 patients who were classified into 2 groups: a group with HAQ-DI deterioration (in which the HAQ-DI had worsened) and a group without HAQ-DI deterioration. A multivariable logistic regression analyses of the age, sex, disease duration, body mass index, anti-cyclic citrullinated peptide antibody, the use of biological disease-modifying antirheumatic drugs or targeted synthetic disease-modifying antirheumatic drugs, methotrexate use, glucocorticoid use, C-reactive protein, pain visual analog scale (pain VAS), disease activity score 28 erythrocyte sedimentation rate (DAS28-ESR), the HAQ-DI, and van der Heijde modified total Sharp score was performed at baseline and five years to determine significant factors associated with the HAQ-DI. Results The significant factors associated with HAQ-DI deterioration were age (odds ratio [OR]: 1.05; 95% confidence interval [CI]: 1.02-1.08), glucocorticoid use (OR: 1.95; 95% CI: 1.03-3.71), DAS28-ESR (OR: 1.92; 95% CI: 1.33-2.79), change in pain VAS from baseline (OR: 1.02; 95% CI: 1.01-1.04), and change in DAS28-ESR from baseline (OR: 1.67; 95% CI: 1.15-2.44). Conclusion The present study suggests that glucocorticoid tapering as well as disease activity and pain control are required to prevent deterioration of the HAQ-DI in patients with RA.

Modern cementless posterior stabilized mobile-bearing total knee arthroplasty shows comparable clinical and radiographical results to its cemented predecessor at 1-year follow-up

PURPOSE

The purpose of this study was to evaluate perioperative and short-term clinical and radiographical results of a modern PS mobile-bearing cementless TKA system.

METHODS

A retrospective review of a consecutive series of TKAs was performed by a single surgeon using a cementless or cemented TKA of the same design (Attune, DePuy Synthes, Massachusetts, USA). The 2011 Knee Society Score, Forgotten Joint Score-12, Hip-Knee-Ankle angle, and the presence of radiolucent lines (RLLs) were reviewed 1-year postoperatively with 1:1 matching performed for age, gender, body mass index, and preoperative UCLA score. Fisher's exact test or independent Student's t-test were used for statistical analyses.

RESULTS

Forty-five cementless and 45 cemented TKAs were reviewed after 1:1 matching. The mean operative time was 8.8 min shorter (P < .01), and the mean amount of drainage was 40.0 ml greater (P = .04) in the cementless cohort. At 1-year postoperatively, there were no significant differences in both cohorts in 2011 Knee Scores and Forgotten Joint Scores-12, with no patients requiring revision surgery (NS). The incidence of RLLs was significantly higher in cementless TKAs (51%) than that in cemented TKAs (22%, P < .01). However, the mean width of RLLs in the cementless TKAs (0.2 mm) was significantly smaller (P < .01) than that in the cemented TKAs (0.8 mm) at 1-year postoperatively with no progression.

CONCLUSION

A recently introduced cementless PS mobile-bearing TKA design demonstrated comparable postoperative and radiographical results to its cemented predecessor at 1-year follow-up.

LEVEL OF EVIDENCE

Retrospective cohort study, Level III.

High tibial osteotomy for medial meniscus posterior root tears in knees with moderate varus alignment can achieve favorable clinical outcomes

Purpose

Favorable clinical results have been reported following high tibial osteotomy (HTO) for medial meniscus posterior root tear (MMPRT) in knees with varus alignment. However, the effect on the preoperative neutral alignment of the knee is not known. This study sought to evaluate the clinical outcomes of medial open-wedge HTO for MMPRT with neutral alignment.

Methods

We retrospectively reviewed 119 medial open-wedge HTOs and analyzed 22 knees with MMPRT. The knees were divided according to the preoperative hip-knee-ankle angle into a moderate varus alignment group (≤4° of varus alignment) and a varus alignment group (> 4° of varus alignment). The Knee Injury and Osteoarthritis Outcome Score (KOOS) and Forgotten Joint Score-12 (FJS-12) values were evaluated preoperatively and at the latest follow-up. The healing status of MMPRT at the time of second-look arthroscopy, performed at a mean of 15.4 ± 4.2 months, was compared with that after the primary HTO.

Results

There were 11 knees in the moderate varus alignment group and 11 in the varus alignment group. In terms of perioperative patient-reported outcome measures, there was no significant difference in the preoperative or postoperative KOOS subscale score or FJS-12 score between the moderate varus and varus alignment groups. The healing rate was significantly higher in the moderate varus alignment group.

Conclusion

Favorable clinical results were obtained by medial open-wedge HTO in knees with MMPRT and moderate varus alignment in the short term. Surgeons should consider the indications for medial open-wedge HTO, even with moderate varus alignment, when planning treatment for MMPRT with persistent knee pain.

Level of evidence

IV

Supplementary Information

The online version contains supplementary material available at 10.1186/s40634-022-00504-9.

Effect of bone morphology of the tibia plateau on joint line convergence angle in medial open wedge high tibial osteotomy

Background

Change in the joint line convergence angle (JLCA) of the knee after high tibial osteotomy (HTO) is difficult to predict accurately. Given that any change in JLCA is intra-articular, the shape of the articular surface, including the bone morphology of the proximal tibia, may affect the alignment of the knee joint postoperatively. The purpose of this study was to investigate the relationship between the shape of the tibial plateau and postoperative alignment of the knee joint by focusing on changes in JLCA.

Methods

One hundred and nine knees that underwent HTO were retrospectively reviewed. The shape of the tibial plateau was classified based on the slope of the medial and lateral articular surfaces as depressed, flat (within 3 degrees), or convex (pagoda-like). The relationship between the shape of the tibial plateau and radiological parameters was investigated.

Results

The shape of the tibial plateau was depressed in 38 knees, flat in 52 knees, and pagoda-like in 19 knees. There was a moderate correlation between the postoperative change in JLCA and the preoperative hip-knee-ankle angle for knees with a pagoda-shaped tibial plateau (r = 0.56) but not for the other two shapes.

Conclusions

These findings suggest that knees with marked varus deformity before HTO are likely to show more change in JLCA postoperatively if the tibial plateau is pagoda-shaped than if it has a depressed or flat shape. The advantage of focusing on the bone morphology of the proximal tibia is that surgeons can easily perform visual assessment using preoperative radiograph.

Comparison of Romosozumab Versus Denosumab Treatment on Bone Mineral Density After One Year in Rheumatoid Arthritis Patients with Severe Osteoporosis: A Randomized Clinical Pilot Study

OBJECTIVES

To investigate the effect of romosozumab versus denosumab treatment on bone mineral density (BMD), disease activity, and joint damage in patients with rheumatoid arthritis (RA) and severe osteoporosis.

METHODS

Fifty-one postmenopausal women were enrolled and randomized equally into two groups to receive either romosozumab or the denosumab. Changes (Δ) in the BMD (at lumbar spine, total hip, and femoral neck), disease activity score in 28 joints (DAS28)-erythrocyte sedimentation rate (ESR), and van der Heijde-modified Total Sharp Score (TSS) from baseline to 12 months after treatment were evaluated.

RESULTS

The ΔBMD at 12 months in the romosozumab and denosumab groups were 10.2 ± 5.6% and 5.0 ± 3.1% (p = 0.002) for the lumbar spine, 3.7 ± 4.9% and 3.5 ± 3.0% (p = 0.902) for total hip, and 3.6 ± 4.7% and 3.2 ± 4.9% (p = 0.817) for femoral neck, respectively. The ΔDAS28-ESR at 12 months in the romosozumab and denosumab groups was 0.14 and 0.22 (p = 0.643), respectively, whereas, the ΔTSS at 12 months was 0.33 and 0.29 (p = 0.927), respectively.

CONCLUSIONS

Our results suggest that romosozumab treatment was more effective in increasing the BMD at the lumbar spine than denosumab, and may be selected for patients who require a significant increase in the lumbar spine BMD. Moreover, romosozumab may be not affect disease activity and joint damage in patients with RA.

Varus-Tilted Distal Tibial Plafond Is a Risk Factor for Recurrent Ankle Instability After Arthroscopic Lateral Ankle Ligament Repair

BACKGROUND

Although varus-tilted distal tibial deformity is an established risk factor for chronic lateral ankle instability (CLAI), no studies have reported whether this deformity influences ankle instability after arthroscopic lateral ankle ligament repair (ALLR) for CLAI.

METHODS

A total of 57 ankles from 57 patients who underwent ALLR for CLAI were retrospectively analyzed. Tibial articular surface (TAS) angles were measured on preoperative plain radiograph. After 12 months of follow-up, recurrent ankle instability and talar tilt angles on stress radiograph were evaluated as outcomes. Relationships between the TAS angle and these outcomes were assessed.

RESULTS

Recurrent ankle instability was observed in 10 ankles. The TAS angles of patients with recurrent instability were significantly lower (85.2 degrees vs 87.9 degrees). The receiver operating characteristic curve analysis revealed that the cutoff value of TAS angle for recurrent instability was 86.2 degrees. Based on this cutoff value, our patients were divided into 2 groups: low-TAS and high-TAS group. Univariate and multivariate analysis revealed that low TAS was an independent risk factor for recurrent ankle instability and greater postoperative talar tilt angles.

CONCLUSION

Varus-tilted distal tibial plafond appears to be a risk factor for recurrent ankle instability after ALLR.

Effect of the duration of previous osteoporosis treatment on the effect of romosozumab treatment

The effect of romosozumab is affected by previous osteoporosis treatment. Here we showed that the duration of the previous treatment just before romosozumab affects the therapeutic effect of romosozumab. Using denosumab and oral bisphosphonates for more than 1 year attenuates the effect of romosozumab.

INTRODUCTION

As an anti-sclerostin antibody, romosozumab suppresses bone resorption and stimulates bone formation. We investigated whether the effectiveness of 12 months of romosozumab treatment depended on the duration of previous treatment with teriparatide, denosumab, or oral bisphosphonates.

METHODS

In total, 259 osteoporosis patients received subcutaneous injections of romosozumab (210 mg) every 4 weeks during 2019 and 2020. This study was designed as a pre-post comparison. The end points were the percent changes of bone mineral density (BMD) after 12 months of romosozumab treatment. The patients were divided into seven groups depending on the type and duration of previous treatment before starting romosozumab as follows: non-previous treatment group, change from teriparatide used for 1 year or less/more than 1 year, change from denosumab used for 1 year or less/more than 1 year, and change from oral bisphosphonates used for 1 year or less/more than 1 year.

RESULTS

The effects of previous treatment with teriparatide on the effectiveness of 12-month romosozumab did not clearly depend on the duration of treatment (p > 0.05). In contrast, the effects of previous treatments with denosumab or oral bisphosphonates on the effectiveness of 12-month romosozumab depended on the previous treatment duration, which was reflected by the differences in percent change of the spine BMD (both p < 0.05), however, there were no significant differences in the percent change of the total hip BMD (both p > 0.05).

CONCLUSION

The duration of the previous treatment affected the effectiveness of romosozumab. Using denosumab and oral bisphosphonate for more than 1 year attenuated the effect of romosozumab.

Postoperative Complications and Survival Rate in Hemodialysis-Dependent Patients Undergoing Cervical Spine Surgery

Introduction

Spine surgery is challenging in hemodialysis (HD)-dependent patients owing to their poor general condition. However, postoperative complications and the mortality and survival rates have not been specifically evaluated in a wide series. This study aimed to elucidate postoperative complications and the survival rate in cervical spine surgery in HD patients.

Methods

This study included 109 HD patients (70 men, 39 women) who had undergone cervical spine surgery between July 1996 and May 2018. Based on radiological diagnosis, we divided them into the destructive spondyloarthropathy (DSA) and non-DSA groups. We investigated the causes of hemodialysis, postoperative complications, postoperative inpatient mortality rate, and survival rate.

Results

The DSA and non-DSA groups included 100 surgeries in 89 patients and 21 surgeries in 20 patients, respectively. The mean age at surgery was 62.9 years for the DSA and 55.9 years for the non-DSA group (P=0.97). The DSA group had a shorter hemodialysis period at surgery compared with the non-DSA group (21.7 vs. 26.5 years, P<0.05). The two most common causes of HD in both groups were chronic glomerulonephritis (DSA, 45%; non-DSA, 57.1%) and diabetes (DSA, 11%; non-DSA, 14.5%). Postoperative complications were observed in 23% (23/100) and 19% (4/21) of surgeries in the DSA and non-DSA groups, respectively (P=0.782). The total in-hospital mortality rate was 2.5% (3/121). The 1-, 3-, 5-, and 10-year postoperative survival rates of all patients were 89.6%, 75.5%, 67.1%, and 44.7%, respectively. The survival rates did not depend on the group (DSA vs. non-DSA), pre- and postoperative Japanese Orthopedic Association score for cervical myelopathy, hemodialysis period, sex, and age (P>0.05). However, significantly low survival rates were observed in HD caused by diabetes compared with that by chronic glomerulonephritis (P<0.001) and other causes (P<0.001).

Conclusions

Cervical spine surgery in HD patients is associated with postoperative complications. The postoperative survival rate was found to be low if the cause of hemodialysis was diabetes.

Surgical Intervention for Patients With Rheumatoid Arthritis is Declining Except for Foot and Ankle Surgery: A Single-Center, 20-Year Observational Cohort Study

OBJECTIVE

A global downward trend in the number of rheumatoid arthritis (RA)-related surgeries has been reported. The purpose of our study was to investigate the latest trends in RA-related surgeries in a single-center Japanese RA cohort.

METHODS

This study was a retrospective analysis of RA-related surgeries between 2001 and 2020 in the Institute of Rheumatology Rheumatoid Arthritis cohort. An average of 4,944 patients per semiannual survey was included in the study. The primary goal was to analyze the half-year period prevalence proportion (HPP) of RA-related surgeries in a 20-year period, and the secondary goal was to analyze the HPP of surgeries by site or by categories of disease activity.

RESULTS

There has been a downward trend in the HPP of RA-related surgeries in the 20-year study period. The total HPP of RA-related surgeries decreased by 50.3% during the 20-year study period. There was a significant decrease in knee, hip, shoulder/elbow, and hand procedures. Only foot/ankle joint surgeries significantly increased in volume during this period (p=0.001). The HPP of RA-related surgeries remained unchanged in patients with remission or low disease activity.

CONCLUSION

The number of RA-related surgeries decreased over a 20-year period, but foot/ankle joint surgeries increased in the site-specific evaluation.

Adopting the Joint Line Theory for Bone Resection in Cruciate-Retaining Total Knee Arthroplasty to Prevent Flexion Gap Tightness

BACKGROUND

During a conventional measured resection using the posterior reference method for total knee arthroplasty (TKA) in varus knees, proximal tibia is resected from the lateral joint surface for the same thickness as the implant. Distal femur is resected from the worn medial surface for the same thickness as the implant. Posterior femur is resected using the posterior reference method with an external rotation for appropriate degrees. In this situation, although the joint line of the tibia is leveled to the height of lateral joint surface, the posterior joint line of the femur is leveled to the center of medial and lateral posterior condyle, which is a few millimeters lower than the lateral posterior condyle. This discrepancy between the proximal tibia-posterior femoral joint line causes a tight flexion gap in cruciate-retaining TKA. Therefore, downsizing of the femur is necessary to adjust the posterior joint line to the level of the lateral condyle.

PERSPECTIVES

To avoid this circumstance, the postoperative joint line should be leveled to the center of the original medial and lateral joint surface. Proximal tibia is resected from the lateral joint surface 1 mm to 2 mm thicker than the implant. Distal femur is resected from the worn medial surface 1 mm to 2 mm thinner than the implant. Posterior femur is resected using the posterior reference method with an external rotation for appropriate degrees. In this situation, all the joint lines are leveled to the center of the medial and lateral joint surface. Otherwise, use of an anatomically shaped implant with a physiologic joint line is another option to avoid joint line discrepancy.

CONCLUSIONS

Adopting joint line theory for bone resection can prevent the flexion gap tightness that likely occurs in cruciate-retaining TKA.