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Kubota Y, Tsubouchi Y, Anan M, Kawano M, Iwasaki T, Itonaga I, Ikeda S, Kataoka M, Tsumura H, Kaku N, Tanaka K. Gait analysis of a patient after femoral nerve and malignant soft tissue tumor resections: a case report. BMC Musculoskelet Disord 2024; 25:131. [PMID: 38347547 PMCID: PMC10860307 DOI: 10.1186/s12891-024-07258-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/04/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Malignant femoral soft tissue tumors are occasionally resected together with the femoral nerves, but this can cause loss of knee extensor muscle activity. To the best of our knowledge, no previous reports have detailed the gait analysis of such cases in combination with electromyography. Herein, we report the gait analysis of a patient who underwent left groin synovial sarcoma and left femoral nerve resection 12 years ago. CASE PRESENTATION We analyzed the gait of a 38-year-old man who was able to walk unaided after the resection of a synovial sarcoma in the left groin together with the ipsilateral femoral nerve. The muscle activities of the affected medial (MH) and lateral hamstrings (LH), and lateral heads of the gastrocnemius (GL) were increased during 50-75% of the stance phase. The hip flexion angle of the affected limb was smaller, and the ankle plantar flexion angle of the affected limb was larger than that of the non-affected limb. This means that in the affected limb, the hip and ankle angles were adjusted to prevent knee collapse, and the MH, LH, and GL muscles contributed in the mid- and late-stance phases. Moreover, we found that the hamstring and gastrocnemius of the affected limb worked together to keep the ipsilateral knee extended in the mid-stance phase and slightly flexed in the late-stance phase. CONCLUSIONS Patients capable of walking after femoral nerve resection may control their hamstrings and gastrocnemius muscles collaboratively to prevent ipsilateral knee collapse in the mid- and late-stance phases.
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Affiliation(s)
- Yuta Kubota
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama, Yufu City, Oita, 879-5593, Japan
| | - Yuta Tsubouchi
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama, Yufu City, Oita, 879-5593, Japan
- School of Physical Therapy, Faculty of Rehabilitation, Reiwa Health Sciences University, 2-1-12 Wajirogaoka, Higashi-Ku, Fukuoka, 811-0213, Japan
| | - Masaya Anan
- Physical Therapy Course of Study, Faculty of Welfare and Health Sciences, Oita University, 700 Dannoharu, Oita-City, Oita, 870-1192, Japan
| | - Masanori Kawano
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama, Yufu City, Oita, 879-5593, Japan
| | - Tatsuya Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama, Yufu City, Oita, 879-5593, Japan
| | - Ichiro Itonaga
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama, Yufu City, Oita, 879-5593, Japan
| | - Shinichi Ikeda
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama, Yufu City, Oita, 879-5593, Japan
- Department of Rehabilitation Medicine, Beppu Rehabilitation Center, 1026-10 Tsurumi, Beppu-Shi, Oita, 874-8611, Japan
| | - Masashi Kataoka
- Physical Therapy Course of Study, Faculty of Welfare and Health Sciences, Oita University, 700 Dannoharu, Oita-City, Oita, 870-1192, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama, Yufu City, Oita, 879-5593, Japan
| | - Nobuhiro Kaku
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama, Yufu City, Oita, 879-5593, Japan
| | - Kazuhiro Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama, Yufu City, Oita, 879-5593, Japan.
- Department of Advanced Medical Sciences, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama, Yufu City, Oita, 879-5593, Japan.
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Matsuda S, Hirakawa M, Nagashima Y, Akase H, Kaku N, Tsumura H. Exploring the extension quantities of a medial collateral ligament pie-crusting model using a finite element method. Comput Methods Biomech Biomed Engin 2024:1-8. [PMID: 38317625 DOI: 10.1080/10255842.2024.2310725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/20/2024] [Indexed: 02/07/2024]
Abstract
Medial collateral ligament (MCL) pie-crusting can balance the soft tissue during total knee arthroplasty but requires more studies with the finite element method (FEM). We have developed three models of MCL pie-crusting utilizing FEM, treating the MCL in the following ways: (1) as a singular elastic body with both ends attached to the bone (model A), (2) as 19 bundled elastic bodies, each attached to both ends of the bone (model B), and (3) as 19 bundled elastic bodies with an adhesive component in the gap, attached to both ends of the bone (model C). The pie-crusting model was created by adding a cut around the center of each model. The left side of the model was fixed and forces of 80 and 120 N in the positive direction of the x-axis were applied. Model A was extended by 0.0068 and 0.010 mm for approximately 10 punctures. Model B-2 was extended by 1.34 and 2.01 mm, approximately twice as much as model B-1. Model C was extended by 0.34 and 0.50 mm for every 10 punctures added. These findings clarify that the model composed of aggregates of fibers with adhesive parts (model C) is suitable for MCL pie-crusting analysis.
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Affiliation(s)
- Shogo Matsuda
- Department of Orthopaedic Surgery, Oita University, Yuhu City, Oita, Japan
| | - Masashi Hirakawa
- Department of Orthopaedic Surgery, Oita University, Yuhu City, Oita, Japan
| | - Yu Nagashima
- Department of Orthopaedic Surgery, Oita University, Yuhu City, Oita, Japan
| | - Hiroya Akase
- Department of Orthopaedic Surgery, Oita University, Yuhu City, Oita, Japan
| | - Nobuhiro Kaku
- Department of Orthopaedic Surgery, Oita University, Yuhu City, Oita, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Oita University, Yuhu City, Oita, Japan
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Shibuta Y, Kaku N, Hosoyama T, Tsumura H. Two Healthy Elderly Females with Contemporaneous Subchondral Insufficiency Fractures of Bilateral Femoral Heads: A Case Report. J Orthop Case Rep 2024; 14:70-75. [PMID: 38420253 PMCID: PMC10898708 DOI: 10.13107/jocr.2024.v14.i02.4222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/08/2023] [Indexed: 03/02/2024] Open
Abstract
Introduction Unilateral subchondral insufficiency fractures (SIF) of the femoral head have been reported in many cases; however, bilateral cases occurring simultaneously are very rare. Case Report We report two cases of relatively active elderly females (aged 73 and 67 years), in which bilateral hip pain appeared simultaneously without any specific triggers. There were no notable lifestyle or medication histories. Imaging and histopathology of the bone excised surgically supported the diagnosis. In Case 1, there was a decrease in bone mineral density and poor congruency between the femoral head and acetabulum. In Case 2, the posterior tilt of the pelvis with aging decreased coverage of the femoral head, and the poor congruency between the femoral head and acetabulum was thought to have contributed to uneven distribution and increased stress in the loading zone. Conclusion We encountered two unusual cases with contemporaneous bilateral SIF in the elderly. In recent years, the number of highly active elderly people has increased with the increase in healthy life expectancy. The combined effect of factors such as bone fragility, posterior pelvic tilt, and high activity level likely caused bilateral SIFs, and we should be careful as we expect to see an increase in such cases in the future.
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Affiliation(s)
- Yutaro Shibuta
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Nobuhiro Kaku
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Tsuguaki Hosoyama
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Hiroshi Tsumura
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Oita, Japan
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Miyazaki M, Ishihara T, Abe T, Kanezaki S, Tsumura H. Effectiveness of gelatin matrix with human thrombin for reducing blood loss in palliative decompressive surgery with posterior spinal fusion for metastatic spinal tumors. J Orthop Sci 2024; 29:88-93. [PMID: 36599740 DOI: 10.1016/j.jos.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 11/10/2022] [Accepted: 12/19/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND This study aimed to investigate the effect of gelatin matrix with human thrombin (GMHT) on blood loss and survival time in patients with metastatic spinal tumors treated with palliative decompression surgery with posterior spinal fusion. METHODS We retrospectively reviewed 67 consecutive patients with metastatic spinal tumors who underwent palliative decompression surgery with posterior spinal fusion. We compared patients in whom GMHT was not used during surgery with those in whom GMHT was used. The following baseline characteristics were evaluated: age, height, weight, sex, metastatic tumor diagnosis, medical history, use of antiplatelet drug, use of anticoagulant drug, use of NSAIDs, smoking, preoperative PLT value, preoperative APTT, preoperative PT-INR, Karnofsky Performance Status score, Charlson comorbidities index score, the percentage of patients who received perioperative chemotherapy, main tumor level, Frankel category, revised Tokuhashi score, spinal instability neoplastic score (SINS), number of fusion segments, operation time, intraoperative blood loss, drainage blood loss, red blood cell transfusion, hemoglobin level, total protein (TP), albumin values, total blood loss (TBL), hidden blood loss, postoperative bed rest and postoperative survival time. Perioperative complications were assessed. RESULTS Age, height, weight, sex, metastatic tumor diagnosis, medical history, use of antiplatelet drug, use of anticoagulant drug, use of NSAIDs, smoking, preoperative PLT value, preoperative APTT, preoperative PT-INR, CCI score, main level of tumors, SINS score, preoperative Tokuhashi score and number of fusion segments did not differ significantly between the two groups. Operation time, intraoperative blood loss, postoperative drainage blood loss, and TBL were significantly decreased in the group with GMHT than in the group without GMHT. The total number of perioperative complications was significantly lesser in the group with GMHT than in the group without GMHT. The median postoperative survival time was significantly longer in the GMHT group than in the group without GMHT. CONCLUSION GMHT should be considered a valid option for the treatment of patients with metastatic spinal tumors with a short life expectancy.
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Affiliation(s)
- Masashi Miyazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan.
| | - Toshinobu Ishihara
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Tetsutaro Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Shozo Kanezaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
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Kubota Y, Kawano M, Iwasaki T, Itonaga I, Tsumura H, Kaku N, Tanaka K. Sequential treatments with TRK inhibitors in a patient with NTRK fusion-positive sarcoma: A case report. Medicine (Baltimore) 2023; 102:e36232. [PMID: 38065851 PMCID: PMC10713097 DOI: 10.1097/md.0000000000036232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/31/2023] [Indexed: 12/18/2023] Open
Abstract
RATIONALE Precision medicine and tumor-agnostic treatment strategies have recently been promoted for clinical use. One of the most successful treatments in patients with neurotrophic tyrosine receptor kinase (NTRK) fusion-positive tumors is targeting the tropomyosin receptor kinase (TRK) with an inhibitor. The TRK inhibitors, larotrectinib, and entrectinib, have been approved in many countries. Nevertheless, the most effective administration regimen for these TRK inhibitors is uncertain. To date, no reports have shown the efficacy of sequential treatment with larotrectinib and entrectinib in patients with NTRK fusion-positive tumors. In this report, we present a patient with NTRK fusion-positive sarcoma arising from the anterior mediastinum, with tumor progression after 4 months of entrectinib use. The patient took larotrectinib subsequently and maintained disease control for more than 21 months. PATIENT CONCERNS A 48-year-old female visited a physician because she experienced difficulty in breathing and chest and back pain with no obvious cause 2 months ago. Computed tomography (CT)-guided biopsy was performed at a district general hospital, and histopathological examination revealed a small round cell tumor. She was referred to our hospital, and a second CT-guided biopsy was performed to confirm the pathological diagnosis. Considering the results of the histopathological examination, Ewing sarcoma was suspected, but a specific fusion gene was not detected due to poor quality specimens. DIAGNOSES After 3 regimens of cytotoxic chemotherapy, biopsy was repeated, and specimens were analyzed using next-generation sequencing. The PHF20-NTRK1 fusion gene was detected, and the tumor was finally diagnosed as an NTRK fusion-positive sarcoma. INTERVENTIONS She was administered the TRK inhibitor entrectinib, but the tumor started to grow after 4 months of medication, and she stopped taking entrectinib. After 1 cycle of cytotoxic chemotherapy, another TRK inhibitor, larotrectinib, was administered. OUTCOMES Her stable disease was maintained for more than 21 months. Here, we have shown that sequential administration of both drugs can be effective. LESSONS In the treatment of NTRK fusion-positive tumors, there are cases in which 2 approved first-generation TRK inhibitors can be used sequentially.
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Affiliation(s)
- Yuta Kubota
- Department of Orthopaedic Surgery, Oita University Faculty of Medicine, Yufu City, Oita, Japan
| | - Masanori Kawano
- Department of Orthopaedic Surgery, Oita University Faculty of Medicine, Yufu City, Oita, Japan
| | - Tatsuya Iwasaki
- Department of Orthopaedic Surgery, Oita University Faculty of Medicine, Yufu City, Oita, Japan
| | - Ichiro Itonaga
- Department of Orthopaedic Surgery, Oita University Faculty of Medicine, Yufu City, Oita, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Oita University Faculty of Medicine, Yufu City, Oita, Japan
| | - Nobuhiro Kaku
- Department of Orthopaedic Surgery, Oita University Faculty of Medicine, Yufu City, Oita, Japan
| | - Kazuhiro Tanaka
- Department of Orthopaedic Surgery, Oita University Faculty of Medicine, Yufu City, Oita, Japan
- Department of Advanced Medical Sciences, Oita University Faculty of Medicine, Yufu City, Oita, Japan
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Kawano M, Tanaka K, Itonaga I, Iwasaki T, Kubota Y, Tsumura H. Tumor-suppressive microRNA-152 inhibits the proliferation of Ewing's sarcoma cells by targeting CDK5R1. Sci Rep 2023; 13:18546. [PMID: 37899376 PMCID: PMC10613623 DOI: 10.1038/s41598-023-45833-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 10/24/2023] [Indexed: 10/31/2023] Open
Abstract
We elucidated the mechanism through which the reduced expression of miR-152 leads to the overexpression of its target cyclin-dependent kinase-5 activator 1 (CDK5R1) in Ewing's sarcoma (ES) cells and the role of this mechanism in the proliferation of ES cells. To explore possible oncogenic factors in ES, we conducted microarray-based investigation and profiled the changes in miRNA expression and their effects on downstream mRNAs in five ES cell lines and human mesenchymal stem cells (hMSCs). miR-152 was significantly downregulated, while cyclin-dependent kinase-5 activator 1 (CDK5R1) expression was significantly upregulated in all tested ES cells as compared to hMSCs. The overexpression of CDK5R1 led to the activation of CDK5, enabling the phosphorylation of retinoblastoma protein and persistent overexpression of CCNE. Moreover, miR-152 suppressed cell proliferation via cell cycle retardation, and its upregulation reduced tumor size and CCNE expression in tumor tissues. The overexpression of cyclin E (CCNE) has been detected in ES cells, but the detailed mechanisms have not been previously elucidated. These findings identify the miR152-CDK5R1 signaling axis as a critical mechanism for tumorigenesis that may serve as a new therapeutic target in Ewing's sarcoma. We believe that our results will aid in the development of effective treatment strategies for patients with ES.
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Affiliation(s)
- Masanori Kawano
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, 879-5593, Japan
| | - Kazuhiro Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, 879-5593, Japan.
| | - Ichiro Itonaga
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, 879-5593, Japan
| | - Tatsuya Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, 879-5593, Japan
| | - Yuta Kubota
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, 879-5593, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, 879-5593, Japan
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Kanezaki S, Miyazaki M, Sakamoto T, Hino A, Abe T, Sako N, Tsumura H. Dome impaction classification in acetabular fractures: Identifying atypical dome impactions with absence of the gull sign: A retrospective descriptive study. Medicine (Baltimore) 2023; 102:e35523. [PMID: 37861513 PMCID: PMC10589566 DOI: 10.1097/md.0000000000035523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 09/15/2023] [Indexed: 10/21/2023] Open
Abstract
We aimed to describe variations of dome impaction fractures and their characteristics using a new classification system, to explore the relationship between dome impaction and the gull sign. The present study was a retrospective descriptive study. All 104 cases of acetabular fracture that were treated in our institution from 2013 to 2022 were enrolled. Of these, 22 had dome impaction fractures. The primary outcome variable was to describe the variations and characteristics of dome impaction fractures. They were classified into 3 major subgroups based on reconstructed axial, coronal, and sagittal computed tomography findings: anteromedial, superomedial (SM), and posteromedial. The secondary outcome variable was to explore the relationship between dome impaction on computed tomography findings and the gull sign on plain radiographs. There were 4 cases of anteromedial (18.2%), 13 of SM (59.1%), and 5 of posteromedial (22.7%). There were 15 cases (68.2%) with the gull sign and 7 cases (31.8%) without the gull sign on plain radiographs. Twelve of fifteen cases (80.0%) with the gull sign had dome impaction fractures of the SM type. We found a variety of patterns of dome impaction fracture. Surgeons should be aware of atypical dome impactions not showing the gull sign.
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Affiliation(s)
- Shozo Kanezaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
- Advanced Trauma, Emergency, and Critical Care Center, Oita University Hospital, Oita, Japan
| | - Masashi Miyazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Tomonori Sakamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
- Advanced Trauma, Emergency, and Critical Care Center, Oita University Hospital, Oita, Japan
| | - Akihiro Hino
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
- Advanced Trauma, Emergency, and Critical Care Center, Oita University Hospital, Oita, Japan
| | - Tetsutaro Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Noriaki Sako
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
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Kaku N, Hosoyama T, Shibuta Y, Tsumura H. Femoral Bowing Increases Early Postoperative Stress around the Femoral Stem in Humans: A Finite Element Analysis. Clin Orthop Surg 2023; 15:725-733. [PMID: 37811508 PMCID: PMC10551689 DOI: 10.4055/cios22392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/05/2023] [Accepted: 04/29/2023] [Indexed: 10/10/2023] Open
Abstract
Background This study aimed to clarify the characteristics of stress distribution caused by the placement of tapered wedge stems in bowed femurs compared with that in normal femurs and the effect of varus stem placement. Methods Models with normal and enhanced bowing were created from the right-side computed tomography data of a 17-year-old woman with the least bowing among 40 participants who underwent anterior cruciate ligament reconstruction or operative treatment for trauma in our hospital between January 2017 and May 2018. Finite element analysis was performed, assuming the tapered wedge stem was placed in the neutral and varus positions. Results Varus stem placement on a femur with normal bowing showed a deviation and increase of von Mises stresses in the medial femur. Stem placement on a bowed femur, even when placed in the neutral position, increased stress across the periprosthetic bone. When the stem was placed in the varus position, von Mises stress across the periprosthetic bone increased. Zone 7, with strong bowing, demonstrated 3.6-fold increased stress compared with normal femurs. The maximum tensile principal stress was greatest in zone 6 and increased in zones 3 and 4. Conclusions Surgeons should assess femoral bowing preoperatively and pay particular attention to intraoperative stem alignment for femurs with high bowing.
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Affiliation(s)
- Nobuhiro Kaku
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Tsuguaki Hosoyama
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Yutaro Shibuta
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
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Miyazaki M, Abe T, Sako N, Kanezaki S, Tsumura H. Analysis of accuracy of pedicle screw placement in dysplastic pedicles in adolescent idiopathic scoliosis using the pedicle expansion technique with CT-based navigation. J Orthop Sci 2023:S0949-2658(23)00089-1. [PMID: 37045687 DOI: 10.1016/j.jos.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/27/2023] [Accepted: 03/30/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND This study aimed to study the accuracy of pedicle screw (PS) insertion into dysplastic pedicles in adolescent idiopathic scoliosis (AIS) comparing cannulated screw using the pedicle expansion technique (PET) versus conventional technique. METHODS Forty-two AIS patients with 766 PSs were evaluated. In total, 236 screws were inserted into dysplastic pedicles: 138 and 98 screws were inserted using the PET (PET group) and standard technique (conventional group), respectively. Both methods used CT-based navigation to determine the insertion point. In the PET, a rigid ball tip feeler was tapped with a mallet to create an insertion route, a guide wire was passed through the tap, the pedicle was enlarged, and then a cannulated PS with a diameter of 4.35 mm was inserted. Postoperative CT was used to compare the accuracy of PS insertion. RESULTS In total, 23/236 (9.7%) perforations occurred. Regarding overall perforation, there were six (4.3%) and 17 (17.3%) cases in the PET and conventional group, respectively (P = 0.008). In terms of medial perforation, the PET group (n = 2, 1.4%) was significantly better than the conventional group (n = 7, 7.1%) (P = 0.021). In terms of lateral perforation, the PET group (n = 4, 2.9%) was significantly better than conventional group (n = 10, 10.2%) (P = 0.030). Only grade 1 perforation had occurred in the PET group, whereas grades 2 and 3 perforation occurred in the conventional group. CONCLUSION Use of the PET with CT-based navigation significantly increased the accuracy and safety of PS insertion in dysplastic pedicles in AIS.
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Affiliation(s)
- Masashi Miyazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan.
| | - Tetsutaro Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Noriaki Sako
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Shozo Kanezaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
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Kaku N, Hosoyama T, Shibuta Y, Kimura M, Tsumura H. Influence of femoral bowing on stress distribution of the proximal femur: a three-dimensional finite element analysis. J Orthop Surg Res 2023; 18:82. [PMID: 36721221 PMCID: PMC9890711 DOI: 10.1186/s13018-023-03559-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/23/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Whether femoral bowing or its direction has a mechanical effect on the proximal femur is unclear. This study aimed to define the changes in stress distribution in the proximal femur associated with femoral bowing using finite element analysis. METHODS We created four femoral models: original, entire lateral bowing, entire anterior bowing, and the middle of both (50% anterolateral bowing) from computed tomography data of women with standard bowing. Each model's stress distribution was compared by two-layering the stress distribution under loading conditions during walking. We also evaluated displacement vectors. RESULTS In all directions of femoral bowing, the stress increased in the femoral neck and the femoral trochanter in the 50% anterolateral bowing. The direction of deformation of the vector for the femoral head increased anteroinferiorly in the 50% anterolateral bowing. CONCLUSIONS This study showed that the stress distribution at the proximal femur shifted laterally. The high-stress area increased at the femoral neck or trochanter due to increasing femoral bowing. Femoral bowing also increases the anteroinferior vector in the femoral head. This study provides valuable insights into the mechanism of proximal femoral fractures in older adults.
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Affiliation(s)
- Nobuhiro Kaku
- grid.412334.30000 0001 0665 3553Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hazama-Machi, Yufu City, Oita 879-5593 Japan
| | - Tsuguaki Hosoyama
- grid.412334.30000 0001 0665 3553Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hazama-Machi, Yufu City, Oita 879-5593 Japan
| | - Yutaro Shibuta
- grid.412334.30000 0001 0665 3553Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hazama-Machi, Yufu City, Oita 879-5593 Japan
| | - Makoto Kimura
- grid.412334.30000 0001 0665 3553Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hazama-Machi, Yufu City, Oita 879-5593 Japan
| | - Hiroshi Tsumura
- grid.412334.30000 0001 0665 3553Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hazama-Machi, Yufu City, Oita 879-5593 Japan
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Kaku N, Pramudita JA, Yamamoto K, Hosoyama T, Tsumura H. Stress distributions of the short stem and the tapered wedge stem at different alignments: a finite element analysis study. J Orthop Surg Res 2022; 17:530. [PMID: 36494735 PMCID: PMC9733097 DOI: 10.1186/s13018-022-03425-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The mechanical effects of stem length reduction and stem alignment on the surrounding femur remain unknown. This study directly compared the stress distribution on the surrounding femur of existing tapered wedge stems and short stems and examined the properties of stress distribution at different stem alignments in three dimensions. METHODS Finite element analysis was conducted for standing and walking. The cementless stem was appropriately sized to ensure adequate contact with the medial cortical bone line that contours the medullary cavity. The stem neck axis was aligned with the femoral neck axis in the mid-position and placed in 2° of the varus and valgus, 3° of flexion and extension, and 10° and 40° of anteversion. RESULTS Regardless of stem length, the trend of stress distribution was similar. The short stem generated less stress around the stem than the tapered wedge stem. In the coronal plane, the effect of varus and valgus deflection was small. In the sagittal plane, the stress generated around the stem was higher in the extended position than in the flexed position. In the horizontal plane, the stress generated around the stem was higher when the stem anteversion was smaller. CONCLUSIONS Depending on the design, short stems can reduce the stress on the surrounding bone, compared to a longer tapered wedge with similar stress distribution. Additionally, a short stem can reduce the effect of the varus position. Stems should be placed to achieve stable initial fixation while noting that stresses increase with extension and reduced anteversion.
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Affiliation(s)
- Nobuhiro Kaku
- grid.412334.30000 0001 0665 3553Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama-Machi, Yufu City, Oita 879-5593 Japan
| | - Jonas A. Pramudita
- grid.260969.20000 0001 2149 8846Department of Mechanical Engineering, College of Engineering, Nihon University, 1 Nakagawara, Tokusada, Tamura, Koriyama, Fukushima 963-8642 Japan
| | - Kansei Yamamoto
- grid.260969.20000 0001 2149 8846Department of Mechanical Engineering, College of Engineering, Nihon University, 1 Nakagawara, Tokusada, Tamura, Koriyama, Fukushima 963-8642 Japan
| | - Tsuguaki Hosoyama
- grid.412334.30000 0001 0665 3553Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama-Machi, Yufu City, Oita 879-5593 Japan
| | - Hiroshi Tsumura
- grid.412334.30000 0001 0665 3553Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama-Machi, Yufu City, Oita 879-5593 Japan
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12
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Ikeda S, Kaku N, Hosoyama T, Tsumura H. Survival rates of different bearing surfaces with the same model of stem in total hip arthroplasty: predictive factors for revision surgery. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04706-9. [PMID: 36443614 DOI: 10.1007/s00402-022-04706-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Few studies have examined the survival rates of total hip arthroplasty (THA) with the same femoral stem, and the predictive factors leading to the revision of stemmed metal-on-metal (MoM) THA remain unknown. We determined the long-term survival rate of stemmed MoM THA compared with that of metal-on-polyethylene (MoP) bearing THA, the effect of head size and cup placement angle on revision rate, and predictors of revision. MATERIALS AND METHODS A total of 130 hips in 110 patients who underwent primary THA by the same surgeon were included. M2a-RingLoc with a metal-on-polyethylene bearing (group P, 53 hips), M2a-Taper with MoM bearing (group T, 44 hips), and M2a-Magnum with MoM bearing (group M, 33 hips) were used. The mean age at surgery was 63.1 ± 9.5 years, and the mean postoperative follow-up duration was 133.7 ± 39.1 months. Whole blood metal ion concentrations were measured preoperatively and postoperatively, and magnetic resonance imaging was performed to identify aseptic local tissue reactions (ALTRs). Kaplan-Meier survivorship analysis and multiple logistic regression analysis were performed. RESULTS The THA survival rate up to the maximum postoperative follow-up period was 96.2% at 173 months, 46.6% at 179 months, and 47.8% at 145 months in groups P, T, and M, respectively, with revision as the endpoint. The stemmed MoM THA recorded a very low survival rate (p < 0.001). The ALTR rates were 70.5% and 63.6% in groups T and M, respectively. The risk factor for revision was the use of MoM bearing, and there was no difference in the results based on the head size in group M. Cobalt levels continued to increase postoperatively, although they were not accurate predictors of revision. CONCLUSIONS Stemmed MoM THA has a very low survival rate and should be used with caution. It is important to monitor the patient's symptoms and perform appropriate imaging to ensure timely revision.
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Affiliation(s)
- Shinichi Ikeda
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama-Machi, Yufu, Oita, 879-5593, Japan
| | - Nobuhiro Kaku
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama-Machi, Yufu, Oita, 879-5593, Japan.
| | - Tsuguaki Hosoyama
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama-Machi, Yufu, Oita, 879-5593, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama-Machi, Yufu, Oita, 879-5593, Japan
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Miyazaki M, Ishihara T, Kanezaki S, Hirakawa M, Iwasaki T, Abe T, Tsumura H. Relationship between K-line distance and surgical outcome in cases of laminoplasty for cervical ossification of the posterior longitudinal ligament. Medicine (Baltimore) 2022; 101:e31605. [PMID: 36451404 PMCID: PMC9704886 DOI: 10.1097/md.0000000000031605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Although previous studies indicate that changes in cervical alignment after laminoplasty and dynamic factors influence surgical outcomes of cervical ossification of the posterior longitudinal ligament (OPLL), the relationship between the surgical outcomes, the distance between the kyphosis-line (K-line) and OPLL, and dynamic factors have not yet been quantitatively evaluated. The purpose of the present study was to analyze the relationship between ΔK-line distance and surgical outcomes in cases of laminoplasty for OPLL of the cervical spine. We retrospectively reviewed 46 consecutive patients (33 men and 13 women) with cervical OPLL who underwent laminoplasty. "K-line distance" was measured as the minimum interval between the K-line and OPLL on lateral radiographs. The following factors were analyzed: K-line distance in neutral, flexion, and extension neck positions, ΔK-line distance, preoperative C2-7 range of motion (ROM), preoperative segmental ROM, preoperative C2-7 lordotic angle, occupying ratio of the OPLL, disease duration, preoperative and postoperative Japanese Orthopaedic Association (JOA) score, and recovery rate. Patients were divided into flexion K-line (+) and flexion K-line (-) groups. We then analyzed the influence of the K-line distance on surgical outcomes and conducted multivariate analysis to analyze the factors affecting surgical outcomes. The JOA score recovery rate in the flexion K-line (-) group was significantly lower than that in the flexion K-line (+) group (P = .024). The ΔK-line distance was significantly negatively correlated with the JOA score recovery rate (r = -0.531, P < .001). Additionally, multivariate analysis showed that ΔK-line distance (OR = -2.143, P = .015) was negatively correlated with the JOA score recovery rate. The ΔK-line distance is considered useful for the quantitative evaluation of dynamic factors and static compression factors due to OPLL through the measurement of dynamic radiographic images.
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Affiliation(s)
- Masashi Miyazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
- * Correspondence: Masashi Miyazaki, Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (e-mail: )
| | - Toshinobu Ishihara
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Shozo Kanezaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Masashi Hirakawa
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Tatsuya Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Tetsutaro Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
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Abe T, Miyazaki M, Kanezaki S, Hirakawa M, Iwasaki T, Tsumura H. Analysis of rotational deformity correction by lateral lumbar interbody fusion with two-staged anterior-posterior combined corrective fusion surgery for adult degenerative kyphoscoliosis. Medicine (Baltimore) 2022; 101:e30828. [PMID: 36123873 PMCID: PMC9478334 DOI: 10.1097/md.0000000000030828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The present study is retrospective analysis of consecutively collected data. Lateral lumber interbody fusion (LLIF) is widely used in cases of adult spinal deformities. However, the corrective effects of LLIF cage insertion on the vertebral rotation deformity in the axial plane and the individual effects of LLIF and direct vertebral rotation (DVR) on rotational correction are unclear. To individually examine the corrective effects of LLIF and posterior corrective fusion surgery with direct DVR on vertebral rotation deformities in adult degenerative kyphoscoliosis. We analyzed 21 patients (5 males and 16 females) who underwent two-staged anterior-posterior combined corrective fusion surgery for adult degenerative kyphoscoliosis. Surgical time, blood loss, facet joint osteoarthritis (OA) grade, disc degeneration, cage height, vertebral rotational angle, and various X-ray parameters were investigated as evaluation items. The X-ray parameters showed significant postoperative improvements. The mean vertebral rotation angle was 6.4° ± 5.2° preoperatively, 3.5° ± 3.3° after LLIF (P = .014, vs preoperative), and 1.6° ± 1.7° after posterior corrective fusion surgery with DVR (P = .011, vs preoperative). Correlation analysis between the vertebral rotation angle and various measured values revealed that the vertebral rotation angle after LLIF was correlated with the cage height (r = -0.46, P = .032). The vertebral rotation angle after DVR was correlated with the facet joint OA grade (r = -0.49, P = .018) and the wedge angle after posterior corrective fusion surgery with DVR (R = 0.57, P = .006). We conclude that the effects of rotational deformity correction with LLIF cage insertion and additional posterior corrective fixation with DVR can be useful for correcting vertebral rotation deformities.
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Affiliation(s)
- Tetsutaro Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Masashi Miyazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
- *Correspondence: Masashi Miyazaki, Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (e-mail address: )
| | - Shozo Kanezaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Masashi Hirakawa
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Tatsuya Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
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Tanaka K, Suzuki K, Miyashita K, Wakasa K, Kawano M, Nakatsu Y, Tsumura H, Yoshida MA, Oda S. Activation of recombinational repair in Ewing sarcoma cells carrying EWS-FLI1 fusion gene by chromosome translocation. Sci Rep 2022; 12:14764. [PMID: 36042341 PMCID: PMC9427769 DOI: 10.1038/s41598-022-19164-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 08/25/2022] [Indexed: 11/09/2022] Open
Abstract
Chromosome translocation (TL) is an important mode of genomic changes underlying human tumorigenesis, the detailed mechanisms of which are, however, still not well understood. The two major modalities of DNA double strand break repair, i.e. homologous recombination (HR) and non-homologous end-joining (NHEJ), have been hypothesized. In a typical TL+ human neoplasm, Ewing sarcoma, which is frequently associated with t(11;22) TL encoding the EWS-FLI1 fusion gene, NHEJ has been regarded as a model to explain the disease-specific TL. Using comprehensive microarray approaches, we observed that expression of the HR genes, particularly of RAD51, is upregulated in TL+ Ewing sarcoma cell lines, WE-68 and SK-N-MC, as in the other TL+ tumor cell lines and one defective in DNA mismatch repair (MMR). The upregulated RAD51 expression indeed lead to frequent focus formation, which may suggest an activation of the HR pathway in these cells. Furthermore, sister chromatid exchange was frequently observed in the TL+ and MMR-defective cells. Intriguingly, ionizing irradiation revealed that the decrease of 53BP1 foci was significantly retarded in the Ewing sarcoma cell lines, suggesting that the NHEJ pathway may be less active in the cells. These observations may support an HR involvement, at least in part, to explain TL in Ewing sarcoma.
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Affiliation(s)
- Kazuhiro Tanaka
- Department of Orthopaedic Surgery, Oita University, Yufu, 879-5593, Japan.
| | - Keiji Suzuki
- Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, 852-8523, Japan
| | - Kaname Miyashita
- Clinical Research Institute, Cancer Genetics Laboratory, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Kentaro Wakasa
- Clinical Research Institute, Cancer Genetics Laboratory, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Masanori Kawano
- Department of Orthopaedic Surgery, Oita University, Yufu, 879-5593, Japan
| | - Yoshimichi Nakatsu
- Department of Medical Biophysics and Radiation Biology, Faculty of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Oita University, Yufu, 879-5593, Japan
| | - Mitsuaki A Yoshida
- Clinical Research Institute, Cancer Genetics Laboratory, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan.,Department of Radiation Biology, Institute of Radiation Emergency Medicine, Hirosaki University, Aomori, 036-8560, Japan
| | - Shinya Oda
- Clinical Research Institute, Cancer Genetics Laboratory, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan.
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Takase R, Tsubouchi Y, Otsu T, Kataoka T, Iwasaki T, Kataoka M, Tsumura H. The effects of romosozumab combined with active vitamin D 3 on fracture healing in ovariectomized rats. J Orthop Surg Res 2022; 17:384. [PMID: 35962437 PMCID: PMC9373334 DOI: 10.1186/s13018-022-03276-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background In this study, we investigated the potential acceleration of fracture healing and bone mineral density-increasing effects of romosozumab and active vitamin D3 combination therapy for fractures in ovariectomized rats. Methods Ovariectomy was performed on 40 24-week-old female Sprague–Dawley rats. After 8 weeks, the rats were subjected to periosteum removal and osteotomy of the femoral shaft followed by osteosynthesis with intramedullary nailing to create fracture models. The rats were then divided into four groups: C group (control), R group (receiving romosozumab at 25 mg/kg once a month via subcutaneous injection), VD group (receiving active vitamin D3 at 0.2 µg/kg twice a week via subcutaneous injection), and R + VD group. Further, 10 rats were included in a sham group. At 10 weeks after the intervention, both femurs were removed and blood samples were collected from all rats. Soft X-ray imaging was used to evaluate bone union, and microcomputed tomography (micro-CT) was used for bone morphometric evaluation. Toluidine blue staining was used for the histopathological evaluation of the undecalcified specimens, and bone turnover marker levels were measured using enzyme-linked immunosorbent assay. Results Bone morphometry analysis via micro-CT revealed increased mineral density of the trabecular bone in the R + VD group femurs, demonstrating the effectiveness of romosozumab plus active vitamin D3 combination therapy. However, there were no differences in bone union evaluated using soft X-ray imaging, indicating no acceleration of fracture healing. Conclusions Although romosozumab and active vitamin D3 combination therapy increased trabecular bone volume, there was no evidence on its ability to accelerate fracture healing. Graphical abstract ![]()
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Affiliation(s)
- Ryota Takase
- Oita University Hospital Rehabilitation Center, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-city, Oita, 879-5593, Japan
| | - Yuta Tsubouchi
- School of Physical Therapy, Faculty of Rehabilitation, Reiwa Health Sciences University, 2-1-12 Wajirogaoka, Higashi-ku, Fukuoka, 811-0213, Japan
| | - Takefumi Otsu
- Division of Mechatronics, Department of Innovative Engineering, Faculty of Science and Technology, Oita University, 700 Dannoharu, Oita, 870-1192, Japan
| | - Takashi Kataoka
- Oita University Hospital Rehabilitation Center, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-city, Oita, 879-5593, Japan
| | - Tatsuya Iwasaki
- Department of Rehabilitation Medicine, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-city, Oita, 879-5593, Japan
| | - Masashi Kataoka
- Physical Therapy Course of Study, Faculty of Welfare and Health Sciences, Oita University, 700 Dannoharu, Oita-city, Oita, 870-1192, Japan.
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-city, Oita, 879-5593, Japan
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17
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Miyazaki M, Ishihara T, Abe T, Kanezaki S, Hirakawa M, Iwasaki T, Tsumura H. Analysis of treatment effect with teriparatide on device-related vertebral osteopenia after lumbar spinal interbody fusion using Hounsfield unit values: A retrospective cohort study. Medicine (Baltimore) 2022; 101:e29677. [PMID: 35839038 DOI: 10.1097/md.0000000000029677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of the present study was to investigate the effect of teriparatide on device-related vertebral osteopenia after single lumbar spinal interbody fusion and compare osteopenia in fused and nonfused spinal segments using Hounsfield unit (HU) values. The present study was a retrospective cohort study. We reviewed 68 consecutive patients (28 men and 40 women) who underwent single-segment (L4-5) transforaminal lumbar interbody fusion with cage and pedicle screw fixation. The patients were divided into 2 groups according to whether they were treated with teriparatide (teriparatide and nonmedication groups). The primary outcome measure was HU values measured on computed tomography images from each L1 to S1 vertebral body12-month postoperatively. Secondary outcome measures were femoral neck bone mineral density (BMD), T-score, osseous union, and clinical outcomes using the Japanese Orthopedic Association scoring system 12-month postoperatively. There were significant decreases in HU values of lumbar vertebral bodies at all levels and BMD and T-score values obtained using dual-energy X-ray absorptiometry of the femur between preoperative and postoperative 12-month computed tomography in the nonmedication group (P < .05). On the other hand, there were no significant differences between properative and postoperative 12-month HU values of each lumbar vertebral body and BMD values of the femur in the teriparatide group. Osseous fusion scores in the teriparatide group were significantly better than those in the nonmedication group. There were no significant differences in postoperative Japanese Orthopedic Association scores between the 2 groups. Administration of teriparatide during the perioperative period may prevent bone loss associated with spinal fusion surgery.
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Affiliation(s)
- Masashi Miyazaki
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
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Narita Y, Miyazaki M, Hirakawa M, Matsuda S, Nagashima Y, Tsumura H. Heat-Treated Osteochondral Allograft and Autologous Chondrocyte Implantation for a Large Osteochondral Defect: A Case Report. JBJS Case Connect 2022; 12:01709767-202209000-00020. [PMID: 35962731 DOI: 10.2106/jbjs.cc.22.00171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE A 21-year-old man presented with knee pain secondary to tibial plateau malunion and an osteochondral defect 1 year after open reduction and initial fixation. Two-stage reconstruction with transplantation of a bulk heat-treated osteochondral allograft and an autologous chondrocyte implantation was performed. CONCLUSION This technique may be a good choice for large defects in the articular cartilage in cases of tibial plateau malunion. It may be a viable alternative for defect reconstruction, resulting in favorable early clinical, functional, and radiological outcomes.
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Affiliation(s)
- Yasushi Narita
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
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Nakano M, Ishiyama H, Kawakami S, Sekiguchi A, Kainuma T, Tsumura H, Hashimoto M, Hasegawa T, Tanaka Y, Katakura T, Murakami Y. PO-1788 Radiomic and dosiomic prediction of biochemical failure after Iodine-125 prostate brachytherapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03752-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Kubota Y, Tanaka K, Hirakawa M, Iwasaki T, Kawano M, Itonaga I, Tsumura H. Patellar dislocation following distal femoral replacement after extra-articular knee resection for bone sarcoma: A case report. World J Clin Cases 2022; 10:3561-3572. [PMID: 35611187 PMCID: PMC9048549 DOI: 10.12998/wjcc.v10.i11.3561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/09/2022] [Accepted: 02/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND For the treatment of bone sarcoma in the distal femur, wide-margin resection and knee reconstruction with tumor endoprosthesis are standard therapies. Extra-articular knee resection is required in cases of tumor invasion of the knee joint; however, the incidence of complications, such as aseptic loosening, prosthesis infection, and implant failure, is higher than that following intra-articular knee resection. To the best of our knowledge, there are three reports of patellar dislocations after replacement of a tumor endoprosthesis.
CASE SUMMARY A 36-year-old man with no significant past medical history was admitted to our institution with continuous pain in his left knee for 4 mo. An open biopsy was performed, and the patient was diagnosed with a left distal femoral malignant bone tumor. Extra-articular knee resection and knee reconstruction with a tumor endoprosthesis were performed. Although the alignment of the tumor prosthesis was acceptable, knee instability was noticed postoperatively. The axial radiographic view of the patellar and computed tomography showed lateral patellar dislocation at 4 wk postoperatively. The patient had to undergo a lateral release and proximal realignment. He could perform his daily activities at 9 mo postoperatively. Radiography revealed no patellar re-dislocation.
CONCLUSION Proximal realignment may be considered during primary surgery if there is an imbalance in the forces controlling the patellar tracking.
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Affiliation(s)
- Yuta Kubota
- Orthopaedic Surgery, Oita University, Yufu City 879-5593, Oita, Japan
| | - Kazuhiro Tanaka
- Orthopaedic Surgery, Oita University, Yufu City 879-5593, Oita, Japan
| | - Masashi Hirakawa
- Orthopaedic Surgery, Oita University, Yufu City 879-5593, Oita, Japan
| | - Tatsuya Iwasaki
- Orthopaedic Surgery, Oita University, Yufu City 879-5593, Oita, Japan
| | - Masanori Kawano
- Orthopaedic Surgery, Oita University, Yufu City 879-5593, Oita, Japan
| | - Ichiro Itonaga
- Orthopaedic Surgery, Oita University, Yufu City 879-5593, Oita, Japan
| | - Hiroshi Tsumura
- Orthopaedic Surgery, Oita University, Yufu City 879-5593, Oita, Japan
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21
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Kawakami S, Tsumura H, Satoh T, Tabata K, Sekiguchi A, Kainuma T, Nakano M, Iwamura M, Ishiyama H. A phase II trial of stereotactic body radiotherapy in 4 fractions for patients with localized prostate cancer. Radiat Oncol 2022; 17:67. [PMID: 35379264 PMCID: PMC8978412 DOI: 10.1186/s13014-022-02037-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/19/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Purpose/objective(s)
To report results from our phase II study of stereotactic body radiotherapy (SBRT) delivering 36 Gy in 4 fractions for patients with localized prostate cancer.
Materials/methods
We enrolled 55 patients treated with SBRT delivering 36 Gy in 4 fractions between 2015 to 2018. All patients were categorized as low-risk (n = 4), intermediate-risk (n = 31) or high-risk (n = 20) according to National Comprehensive Cancer Network criteria. Median age was 73 years (range 54–86 years). Two-thirds of patients (n = 37) had received androgen-deprivation therapy for 3–46 months (median, 31 months). Median duration of follow-up was 36 months (range 1–54 months). We used Radiation Therapy Oncology Group and National Cancer Institute—Common Toxicity Criteria version 4 for toxicity assessments. Quality of life (QOL) outcomes were also evaluated using the Expanded Prostate Cancer Index Composite (EPIC).
Results
Protocol treatments were completed for all patients. Six patients experienced biochemical failures. Among these six patients, three patients experienced clinical failure. One patient showed bone metastasis before biochemical failure. One patient died of gastric cancer. The 3-year biochemical control rate was 89.8%. Acute grade 2 genitourinary (GU) and gastrointestinal (GI) toxicities were observed in 5 patients (9%) and 6 patients (11%), respectively. No grade 3 or higher acute toxicities were observed. Late grade 2 GU and GI toxicities were observed in 7 patients (13%) and 4 patients (7%), respectively. Late grade 3 GU and GI toxicities were observed in 1 patient (1.8%) each. EPIC scores decreased slightly during the acute phase and recovered within 3 months after treatment.
Conclusion
Our phase II study showed that SBRT delivering 36 Gy in 4 fractions was safe and effective with favorable QOL outcomes, although this regimen showed slightly more severe toxicities compared to current standards.
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Kaku N, Shimada T, Hosoyama T, Tsumura H. Microvascular system of hip joint constituents with special reference to ultrastructural findings and early arteriosclerosis. Med Mol Morphol 2022; 55:158-165. [PMID: 35244781 DOI: 10.1007/s00795-022-00316-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/18/2022] [Indexed: 11/26/2022]
Abstract
This study aimed to examine the ultrastructure of the arteries of the synovium, acetabular labrum, and ligamentum teres of the hip joint using light, scanning electron, and transmission electron microscopes to identify features of early arteriosclerosis. Tissues collected from three patients (under 40 years of age) with osteonecrosis of the femoral head were immersed in 8 N HCl at 60 °C for 20 min to digest collagen fibers for scanning electron microscopy. Tortuous arterioles and arteries were noted in the joint components, including the synovium, acetabular labrum, and ligamentum teres. The ultrastructure of the arterioles appeared normal; however, intimal thickening was found in most arteries. The thickened intima had abundant elastic fibers and many smooth muscle cells (which were of a synthetic phenotype because they had a few actin filaments and well-developed rough endoplasmic reticulum). This study illustrates that arteriosclerotic changes are present in tortuous arteries in the synovium, acetabular labrum, and ligamentum teres of the hip joint even from a relatively young age and suggests that meandering blood vessels may be the preferred foci of arteriosclerosis.
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Affiliation(s)
- Nobuhiro Kaku
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama-machi, Yufu City, Oita, 879-5593, Japan.
| | - Tatsuo Shimada
- Oita College of Judo Therapy and Acupuncture-Moxibustion, 1-1 Chiyo-machi, Oita City, Oita, 870-0033, Japan
| | - Tsuguaki Hosoyama
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama-machi, Yufu City, Oita, 879-5593, Japan
| | - Hiroshi Tsumura
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama-machi, Yufu City, Oita, 879-5593, Japan
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Kawagishi M, Kaku N, Shin S, Tsumura H. Generalized Tonic-clonic Seizure Caused by Tranexamic Acid Administration in Spinal Surgery: A Case Report and Literature Review. J Orthop Case Rep 2022; 12:5-9. [PMID: 37065511 PMCID: PMC10092394 DOI: 10.13107/jocr.2022.v12.i06.2842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/16/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction: Tranexamic acid, an antifibrinolytic solvent, has been widely used for perioperative hemostasis in orthopedic surgery. However, to the best of our knowledge, there have been no reports in the literature of seizures caused by tranexamic acid administration for orthopedic surgery. This report presents a case of generalized tonic-clonic seizure caused by tranexamic acid administration immediately after lumbar interbody fusion surgery for lumbar spinal canal stenosis. Case Report: A 66-year-old Japanese woman scheduled for lumbar interbody fusion surgery was administered an intravenous pre-operative dose (1000 mg) of tranexamic acid and 2000 mg immediately after the surgery. Generalized convulsive seizures occurred on awakening from anesthesia. Although the seizures disappeared after deepening the anesthesia, they recurred on awakening, and extubation could not be performed. A computed tomography scan was immediately performed, revealing an intracranial lesion, but there were no other obvious abnormal findings. The patient was then managed in the intensive care unit, and several convulsions occurred on the 2nd post-operative day. The convulsions disappeared on the 3rd post-operative day, and the patient has had no sequelae to date. Conclusion: This original case report will be of interest to orthopedic surgeons, anesthesiologists, neurologists, and pharmacologists. The information presented may also have a broader impact in the field of medicine for other types of surgeons. The details provided in the report will advance knowledge in the area of orthopedic surgery, neurology, pharmacology, and anesthesiology. Orthopedic surgeons should be aware that one of the major complications of tranexamic acid administration is seizure liability.
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Sako N, Kaku N, Kitahara Y, Kubota Y, Tagomori H, Tsumura H. Three-Dimensional Evaluation of Innominate Bone Rotation in Female Patients with Developmental Dysplasia of the Hip. Clin Orthop Surg 2022; 14:196-204. [PMID: 35685970 PMCID: PMC9152894 DOI: 10.4055/cios21032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 11/11/2022] Open
Abstract
Background Patients with developmental dysplasia of the hip (DDH) are known to have abnormal pelvic morphologies; however, rotation of innominate bone features remains unclear. Thus, we investigated innominate bone rotation in patients with DDH by measuring the associated angles and distances using three-dimensional (3D) computed tomography. Methods We defined four straight lines in pelvic 3D models: from the anterior superior iliac spine to the posterior superior iliac spine, from the anterior inferior iliac spine to the posterior inferior iliac spine, from the pubic tubercle to the ischial spine, and from the pubic tubercle to the ischial tuberosity. Similarly, we measured the angles formed by these lines using the vertical axis of the anterior pelvic plane on the horizontal plane and the horizontal axis on the sagittal plane. Additionally, we measured the distances between the femoral head centers and the acetabular centers in the coronal plane. Results The difference in internal rotation angle between the superior and inferior parts of the iliac bone was significantly lower, by approximately 1.7°, in the DDH group than in the control group (p = 0.007); the difference between the inferior and superior parts of the ischiopubic bone was significantly higher, by approximately 1.5°, in the DDH group (p < 0.001). In the sagittal plane, the sum of the superior aspect of the iliac bone and the inferior aspect of the ischium was significantly lower in the DDH group (p = 0.001) than in the control group. The distances between the femoral heads and the acetabula were significantly greater in the DDH group than in the control group (p = 0.03, p < 0.01, respectively). Conclusions Patients with DDH had a more internally rotated ilium and ischiopubic bone than normal individuals; however, it should be emphasized that internal rotation was reduced near the acetabulum, and the acetabulum was shifted laterally. Similarly, it was shown that patients with DDH had different rotations of the ilium and ischiopubic bone in the sagittal plane.
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Affiliation(s)
- Noriaki Sako
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Nobuhiro Kaku
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Yoshiki Kitahara
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Yuta Kubota
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Hiroaki Tagomori
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Hiroshi Tsumura
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
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Sako N, Kaku N, Tagomori H, Tsumura H. Is the Iliac Wing Curved Inward in Patients with Developmental Dysplasia of the Hip? Clin Orthop Surg 2021; 13:461-467. [PMID: 34868494 PMCID: PMC8609215 DOI: 10.4055/cios20230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/28/2021] [Accepted: 01/28/2021] [Indexed: 11/06/2022] Open
Abstract
Background There is a paucity of studies on the iliac curvature in developmental dysplasia of the hip (DDH). Here, we examined the iliac curvature in DDH using three-dimensional computed tomography. Methods We allocated cases with a center-edge angle of < 20° to the DDH group (55 cases) and cases with a center-edge angle of > 25° to the control group (57 cases) and measured the straight line (line A) between the anterior and posterior superior iliac spines. We examined which part of the iliac bone line A passes through and classified the results into 4 categories (type A, inside the iliac bone; type B, through the iliac bone; type C, outside the iliac bone; and type D, both inside and outside the iliac bone) to evaluate the iliac wing curvature. After measuring the area and internal surface of the iliac wing using line A, we examined the correlation between these values, the interspinous distance, the superior iliac angle, and the center-edge angle. Results Distributions of the four types were compared between the two groups; there was no significant difference. The length of the portion of line A inside the ilium and the area formed by line A and the iliac wing, which shows the degree of iliac wing curvature, were not significantly different between the groups. There were no correlations between these values and the center-edge angle; however, there were weak positive correlations among the interspinous distance, the superior iliac angle, and the center-edge angle. Conclusions The inward nature of the iliac bone in patients with DDH is mainly due to the internal rotation of the entire iliac bone and less likely due to the curvature of the iliac bone.
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Affiliation(s)
- Noriaki Sako
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu City, Japan
| | - Nobuhiro Kaku
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu City, Japan
| | - Hiroaki Tagomori
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu City, Japan
| | - Hiroshi Tsumura
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu City, Japan
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Kitahara Y, Kaku N, Tagomori H, Tsumura H. Alkaptonuria with rapidly destructive arthropathy of the hip: A case report and literature review. Acta Orthop Traumatol Turc 2021; 55:563-568. [PMID: 34967747 DOI: 10.5152/j.aott.2021.21205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Alkaptonuria-related rapidly destructive arthropathy of the hip joint has not been reported in detail with both imaging and histopathological findings in the literature. We, herein, presented the case of a 79-year-old male patient who suddenly started experiencing marked right hip pain. Radiography showed that the femoral head was spherical; however, after 3 months, approximately half of the femoral head was destroyed despite there being almost no change in the acetabulum. Radiographs of the spine also showed fusion between multiple vertebrae. Significant osteoporosis was observed on roentgenography, together with decreased bone density. Urinary gas chromatography-mass spectrometry analysis revealed that a large amount of homogentisic acid was excreted. During total hip arthroplasty, gray and muddy contents were observed in the joint capsule, and the surface of the destroyed femoral head was black. Histopathologically, granulomatous foci containing fragmented bone and cartilage debris were found in the bone marrow space of the joint surface, and the cartilage tissue was pigmented brownish black. The patient was subsequently diagnosed with ochronotic hip joint destruction. The present case report is the first to demonstrate rapidly destructive coxopathy associated with alkaptonuria using both imaging and histopathological findings. These findings clearly show that severe hip joint destruction defined as rapidly destructive hip arthropathy can occur in a very short time period for patients with alkaptonuria.
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Affiliation(s)
- Yoshiki Kitahara
- Department of Orthopedic Surgery, Oita University, School of Medicine, Yufu City, Oita 879-5593, Japan
| | - Nobuhiro Kaku
- Department of Orthopedic Surgery, Oita University, School of Medicine, Yufu City, Oita 879-5593, Japan
| | - Hiroaki Tagomori
- Department of Orthopedic Surgery, Oita University, School of Medicine, Yufu City, Oita 879-5593, Japan
| | - Hiroshi Tsumura
- Department of Orthopedic Surgery, Oita University, School of Medicine, Yufu City, Oita 879-5593, Japan
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Matsumoto A, Shiraiwa K, Suzuki Y, Tanaka K, Kawano M, Iwasaki T, Tanaka R, Tatsuta R, Tsumura H, Itoh H. Sensitive quantification of free pazopanib using ultra-high performance liquid chromatography coupled to tandem mass spectrometry and assessment of clinical application. J Pharm Biomed Anal 2021; 206:114348. [PMID: 34509660 DOI: 10.1016/j.jpba.2021.114348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 10/20/2022]
Abstract
Pazopanib is widely used to treat renal cell carcinomas and soft tissue tumors in Japan. Although several reports demonstrated the usefulness of therapeutic drug monitoring (TDM) of pazopanib, those studies measured only total pazopanib concentration. For drugs with high protein binding rates such as pazopanib, measuring free concentrations may be clinically more useful than measuring total concentrations. In this study, we aimed to develop a high-throughput method for quantification of free pazopanib in human plasma using ultra-high performance liquid chromatography coupled to tandem mass spectrometry (UHPLC-MS/MS). Free pazopanib was separated by ultrafiltration. After a simple solid-phase extraction step using a 96-well plate, pazopanib was analyzed by UHPLC-MS/MS in positive electrospray ionization mode. The novel method fulfilled the requirements of the US Food and Drug Administration guidelines for assay validation, and the lower limit of quantification was 0.05 ng/mL. The calibration curve was linear over the concentration range of 0.05-50 ng/mL. The average recovery rate was 66.9 ± 2.1% (mean ± SD). The precision was below 7.02%, and accuracy was within 10.60% across all quality control levels. Matrix effect varied between 44.4% and 60.4%. This assay was successfully applied to measure trough free pazopanib concentrations in three patients treated with pazopanib for soft tissue tumors. We succeeded to develop a novel high-throughput UHPLC-MS/MS method for quantification of free pazopanib in human plasma. This method can be applied to TDM for patients receiving pazopanib in the clinical setting.
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Affiliation(s)
- Asami Matsumoto
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan
| | - Ken Shiraiwa
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan.
| | - Yosuke Suzuki
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan
| | - Kazuhiro Tanaka
- Department of Orthopaedic Surgery, Oita University Faculty of Medicine, Yufu-shi, Oita, Japan
| | - Masanori Kawano
- Department of Orthopaedic Surgery, Oita University Faculty of Medicine, Yufu-shi, Oita, Japan
| | - Tatsuya Iwasaki
- Department of Orthopaedic Surgery, Oita University Faculty of Medicine, Yufu-shi, Oita, Japan
| | - Ryota Tanaka
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan
| | - Ryosuke Tatsuta
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Oita University Faculty of Medicine, Yufu-shi, Oita, Japan
| | - Hiroki Itoh
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan
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Kimura M, Kaku N, Kubota Y, Tagomori H, Tsumura H. Fluorodeoxyglucose Positron-Emission Tomography/Computed Tomography and Magnetic Resonance Imaging for Adverse Local Tissue Reactions near Metal Implants after Total Hip Arthroplasty: A Preliminary Report. Clin Orthop Surg 2021; 13:320-328. [PMID: 34484624 PMCID: PMC8380523 DOI: 10.4055/cios20228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/24/2020] [Accepted: 12/28/2020] [Indexed: 11/06/2022] Open
Abstract
Background Plain computed tomography (CT) and magnetic resonance imaging (MRI) are useful for diagnosing adverse local tissue reactions after metal-on-metal total hip arthroplasty (THA), but metal artifacts can hamper radiological assessments near the implants. We sought to clarify the usefulness of 18F-fluorodeoxyglucose positron-emission tomography (18F-FDG-PET) CT and MRI in the periprosthetic region, which is difficult to assess after THA due to metal artifacts. Methods We performed preoperative 18F-FDG-PET/CT and 18F-FDG-PET/MRI, as well as plain CT and MRI, in 11 metal-on-metal THA patients who underwent revision surgery. Results Most patients showed high FDG uptake in the metal artifact areas and pseudotumors in the 18-F-FDG-PET/CT and 18-F-FDG-PET/MRI scans. Intraoperative intra-articular macroscopic and histopathological intra-articular granulation tissue findings were suggestive of adverse local tissue reaction. Conclusions The enhanced uptake in the metal artifact areas seemed to reflect adverse local tissue reaction. Therefore, 18F-FDG-PET/CT and 18-F-FDG-PET/MRI can be useful for the auxiliary diagnosis of adverse local tissue reactions after metal-on-metal THA.
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Affiliation(s)
- Makoto Kimura
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Nobuhiro Kaku
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Yuta Kubota
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Hiroaki Tagomori
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Hiroshi Tsumura
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
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Abe T, Miyazaki M, Ishihara T, Kanezaki S, Tsubouchi Y, Tsumura H. Optimal intermittent administration interval of parathyroid hormone 1-34 for bone morphogenetic protein-induced bone formation in a rat spinal fusion model. JOR Spine 2021; 4:e1168. [PMID: 34611590 PMCID: PMC8479526 DOI: 10.1002/jsp2.1168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/16/2021] [Accepted: 07/23/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Both bone morphogenetic protein 2 (BMP-2) and teriparatide (parathyroid hormone [PTH] 1-34) are used to enhance bone healing. There is still no established opinion regarding the optimum dose and administration method. We investigated the optimal administration method for the combination of BMP-2 and PTH 1-34 in a rat spinal fusion model. METHODS Group I was implanted with a control carrier. Groups II, III, and IV were implanted with a carrier containing 3 μg of recombinant human BMP-2 (rhBMP-2). In addition, following implantation, PTH 1-34 injections were administered to Group III thrice a week (total, 180 μg/kg/week) and Group IV six times a week (total, 180 μg/kg/week). The rats were euthanized after 8 weeks, and their spines were explanted; assessed by manual palpation, radiographs, and high-resolution micro-computed tomography (micro-CT); and subjected to histological analysis. Serum markers of bone metabolism were also analyzed. RESULTS Manual palpation tests showed that the fusion rates in Groups III and IV were considerably higher than those in Group I. They also had higher radiographic scores than Group I and II. Micro-CT analysis revealed Tb.Th in the Group IV had higher values than that in the Group I, II, III with significant differences and Tb.Sp in the Group IV had lower values than that in the Group I, II, III with significant differences. Serum marker analysis revealed that Group IV had higher osteocalcin and lower tartrate-resistant acid phosphatase-5b than Group III. Histological analysis indicated that Group IV had enhanced trabecular bone structure. CONCLUSIONS Frequent administration of PTH may be better in making thicker and strengthening the trabecular bone structure in newly formed bone in the rat spinal fusion model using insufficient BMP-2.
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Affiliation(s)
- Tetsutaro Abe
- Faculty of Medicine, Department of Orthopedic SurgeryOita UniversityOitaJapan
| | - Masashi Miyazaki
- Faculty of Medicine, Department of Orthopedic SurgeryOita UniversityOitaJapan
| | - Toshinobu Ishihara
- Faculty of Medicine, Department of Orthopedic SurgeryOita UniversityOitaJapan
| | - Shozo Kanezaki
- Faculty of Medicine, Department of Orthopedic SurgeryOita UniversityOitaJapan
| | | | - Hiroshi Tsumura
- Faculty of Medicine, Department of Orthopedic SurgeryOita UniversityOitaJapan
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Shiraiwa K, Suzuki Y, Tanaka K, Kawano M, Iwasaki T, Matsumoto A, Tanaka R, Tatsuta R, Tsumura H, Itoh H. Development of a High-Throughput Quantification Method for Pazopanib Using Ultra-Performance Liquid Chromatography-Tandem Mass Spectrometry and Its Clinical Application in Patients With Soft Tissue Tumors. Ther Drug Monit 2021; 43:416-421. [PMID: 33009287 DOI: 10.1097/ftd.0000000000000821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/03/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pazopanib is widely used to treat renal cell carcinomas and soft tissue tumors in Japan. Pazopanib has significant therapeutic efficacy but it is associated with frequent severe adverse effects. Therapeutic drug monitoring (TDM) may help to prevent adverse effects. A more convenient and rapid pazopanib assay is desirable for the application of TDM in clinical settings. In this study, the authors developed a high-throughput method for quantifying pazopanib in human plasma using ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS). METHODS After a simple solid-phase extraction step using a 96-well plate, pazopanib was analyzed by UHPLC-MS/MS in the positive electrospray ionization mode. RESULTS The novel method fulfilled the requirements of the US Food and Drug Administration and the European Medicines Agency guidelines for assay validation, and the lower limit of quantification was 0.5 mcg/mL. The calibration curves were linear over the concentration range of 0.5-100 mcg/mL. The average recovery rate was 102.0% ± 3.9% (mean ± SD). The precision was below 5.0%, and the accuracy was within 12.0% for all quality control levels. Matrix effect varied between 90.9% and 97.1%. This assay was successfully applied to TDM of pazopanib trough concentrations in 3 patients treated with the drug for soft tissue tumors. CONCLUSIONS The authors succeeded in developing a novel high-throughput UHPLC-MS/MS method for quantifying pazopanib in human plasma. This method can be applied to TDM of patients receiving pazopanib in clinical settings.
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Affiliation(s)
- Ken Shiraiwa
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan; and
| | - Yosuke Suzuki
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan; and
| | - Kazuhiro Tanaka
- Department of Orthopaedic Surgery, Oita University Faculty of Medicine, Yufu-shi, Oita, Japan
| | - Masanori Kawano
- Department of Orthopaedic Surgery, Oita University Faculty of Medicine, Yufu-shi, Oita, Japan
| | - Tatsuya Iwasaki
- Department of Orthopaedic Surgery, Oita University Faculty of Medicine, Yufu-shi, Oita, Japan
| | - Asami Matsumoto
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan; and
| | - Ryota Tanaka
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan; and
| | - Ryosuke Tatsuta
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan; and
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Oita University Faculty of Medicine, Yufu-shi, Oita, Japan
| | - Hiroki Itoh
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan; and
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Kaku N, Tagomori H, Tsumura H. Comparison of Cup Setting Angle Accuracy between Computed Tomography-Based and Computed Tomography-Free Navigation in the Same Patients with Crowe's Classification I or II Hip Dysplasia. Clin Orthop Surg 2021; 13:144-151. [PMID: 34094004 PMCID: PMC8173244 DOI: 10.4055/cios20145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/28/2020] [Accepted: 11/25/2020] [Indexed: 12/21/2022] Open
Abstract
Backgroud In total hip arthroplasty, the cup setting angle may affect the postoperative results. In recent years, both computed tomography-based navigation and computed tomography-free (imageless) navigation have been reported to produce high accuracy in cup installation; however, no direct comparison between these two methods has been performed. The present study aimed to directly compare the cup installation angle accuracy between computed tomography-based navigation and computed tomography-free navigation in patients with Crowe's classification stage I or II dysplastic osteoarthritis and to examine the factors affecting the cup installation accuracy. Methods Using both navigation systems for the same technique, primary total hip arthroplasty was performed by the same surgeon in 36 patients. A cup was installed using computed tomography-based navigation, and the installed cup was measured again using computed tomography-free navigation. We compared the error between the target angle and the intraoperative installation angle for each navigation method by performing statistical analyses. Results For computed tomography-based navigation, errors in the inclination and the anteversion angles compared to the target angle were 3.14° ± 1.55° and 1.47° ± 0.99°, respectively. For computed tomography-free navigation, the inclination and anteversion angle errors were significantly larger, i.e., 6.84° ± 4.78° and 5.43° ± 5.22°, respectively (p < 0.01). The inclination and anteversion angles of computed tomography-free navigation were correlated, and there were no significant factors influencing the error. Conclusions Computed tomography-based navigation is more accurate for cup installation than computed tomography-free navigation. When using computed tomography-free navigation, it is necessary to add technical schemes before and during surgery to improve the cup installation accuracy.
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Affiliation(s)
- Nobuhiro Kaku
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Hiroaki Tagomori
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
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Inoue N, Terabayashi T, Takiguchi-Kawashima Y, Fujinami D, Matsuoka S, Kawano M, Tanaka K, Tsumura H, Ishizaki T, Narahara H, Kohda D, Nishida Y, Hanada K. The benzylisoquinoline alkaloids, berberine and coptisine, act against camptothecin-resistant topoisomerase I mutants. Sci Rep 2021; 11:7718. [PMID: 33833336 PMCID: PMC8032691 DOI: 10.1038/s41598-021-87344-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 03/24/2021] [Indexed: 01/24/2023] Open
Abstract
DNA replication inhibitors are utilized extensively in studies of molecular biology and as chemotherapy agents in clinical settings. The inhibition of DNA replication often triggers double-stranded DNA breaks (DSBs) at stalled DNA replication sites, resulting in cytotoxicity. In East Asia, some traditional medicines are administered as anticancer drugs, although the mechanisms underlying their pharmacological effects are not entirely understood. In this study, we screened Japanese herbal medicines and identified two benzylisoquinoline alkaloids (BIAs), berberine and coptisine. These alkaloids mildly induced DSBs, and this effect was dependent on the function of topoisomerase I (Topo I) and MUS81-EME1 structure-specific endonuclease. Biochemical analysis revealed that the action of BIAs involves inhibiting the catalytic activity of Topo I rather than inducing the accumulation of the Topo I-DNA complex, which is different from the action of camptothecin (CPT). Furthermore, the results showed that BIAs can act as inhibitors of Topo I, even against CPT-resistant mutants, and that the action of these BIAs was independent of CPT. These results suggest that using a combination of BIAs and CPT might increase their efficiency in eliminating cancer cells.
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Affiliation(s)
- Naomi Inoue
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Takeshi Terabayashi
- Department of Pharmacology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Yuri Takiguchi-Kawashima
- Clinical Engineering Research Center, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan.,Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
| | - Daisuke Fujinami
- Division of Structural Biology, Medical Institute of Bioregulation, Kyushu University, Fukuoka, Japan
| | - Shigeru Matsuoka
- Department of Clinical Biology Ant Therapeutics, Faculty of Medicine, Oita University, Yufu, Japan
| | - Masanori Kawano
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Kazuhiro Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Toshimasa Ishizaki
- Department of Pharmacology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Hisashi Narahara
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Daisuke Kohda
- Division of Structural Biology, Medical Institute of Bioregulation, Kyushu University, Fukuoka, Japan
| | - Yoshihiro Nishida
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan.
| | - Katsuhiro Hanada
- Clinical Engineering Research Center, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan.
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Sako N, Kaku N, Kubota Y, Kitahara Y, Tagomori H, Tsumura H. Iliac anatomy in women with developmental dysplasia of the hip: Measurements using three-dimensional computed tomography. J Orthop 2021; 25:1-5. [PMID: 33897132 DOI: 10.1016/j.jor.2021.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/11/2021] [Accepted: 03/28/2021] [Indexed: 11/19/2022] Open
Abstract
Background We aimed to clarify the iliac anatomy in developmental dysplasia of the hip using three-dimensional computed tomography. Methods The distance between two points along each anatomical portion of the ilium, including the acetabular center, were compared between patients in the dysplasia and control groups. Results There were no significant differences in the upper part of the ilium between the groups. However, three distances that included the acetabular center were significantly shorter in the dysplasia group than in the control group. Conclusions Our study suggests that bone dysplasia occurs in the ilium near the acetabulum, not in the iliac wings.
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Key Words
- 3D-CT, three-dimensional computed tomography
- AC, acetabular center
- AIIS, anterior inferior iliac spine
- ASIS, anterior superior iliac spine
- Acetabulum
- Arthroplasty
- CE, center-edge
- DDH, developmental dysplasia of the hip
- Developmental dysplasia of the hip
- IC, iliac crest
- ICC, intraclass correlation coefficient
- Iliac bone
- PIIS, posterior inferior iliac spine
- PSIS, posterior superior iliac spine
- Tomography
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Affiliation(s)
- Noriaki Sako
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama-machi, Yufu City, Oita, 879-5593, Japan
| | - Nobuhiro Kaku
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama-machi, Yufu City, Oita, 879-5593, Japan
| | - Yuta Kubota
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama-machi, Yufu City, Oita, 879-5593, Japan
| | - Yoshiki Kitahara
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama-machi, Yufu City, Oita, 879-5593, Japan
| | - Hiroaki Tagomori
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama-machi, Yufu City, Oita, 879-5593, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama-machi, Yufu City, Oita, 879-5593, Japan
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Notani N, Miyazaki M, Kanezaki S, Ishihara T, Sakamoto T, Abe T, Kataoka M, Tsumura H. The fibrinogen levels on admission is a predictive marker of the contrast extravasation on enhanced computed tomography in sacral fracture. Medicine (Baltimore) 2021; 100:e25056. [PMID: 33725892 PMCID: PMC7969224 DOI: 10.1097/md.0000000000025056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 02/12/2021] [Indexed: 01/05/2023] Open
Abstract
Sacral fracture is the most frequent posterior injury among unstable pelvic ring fractures and is prone to massive hemorrhage and hemodynamic instability. Contrast extravasation (CE) on computed tomography (CT) is widely used as an indicator of significant arterial bleeding. However, while CE is effective to detect significant arterial bleeding but negative result cannot completely rule out massive bleeding. Therefore, additional factors help to compensate CE for the prediction of early hemodynamically unstable condition.We evaluated the risk factors that predict CE on enhanced computed CT in patients with sacral fractures. Patients were classified into 2 groups: CE positive on enhanced CT of the pelvis [CE(+)] and CE negative [CE(-)]. We compared age, sex, injury severity score (ISS), systolic blood pressure (sBP), type of sacral fracture based on Denis classification, platelet (PLT), base excess, lactate, prothrombin time-international normalized ratio, hemoglobin (Hb), activated partial thromboplastin time, D-dimer, and fibrinogen between the 2 groups.A total of 82 patients were treated for sacral fracture, of whom 69 patients were enrolled. There were 17 patients (10 men and 7 women) in CE(+) and 52 patients (28 men and 24 women) in CE(-). Age, ISS, and blood transfusion within 24 hours were significantly higher in the CE(+) group than in the CE(-) group (P = .023, P < .001, P < .001). sBP, Hb, PLT, fibrinogen were significantly lower in the CE(+) group than in the CE(-) group (P < .001, P < .001, P < .001, P < .001). D-dimer and lactate were higher in the CE(+) group than in the CE(-) group (P = .036, P < .001) with significant differences. On multivariate analysis, the level of fibrinogen was an independent predictor of CE(+). The area under the curve value for fibrinogen was 0.88, and the optimal cut-off value for prediction was 199 mg/dL.The fibrinogen levels on admission can predict contrast extravasation on enhanced CT in patients with sacral fractures. The optimal cut-off value of fibrinogen for CE(+) prediction in sacral fracture was 199 mg/dL. The use of fibrinogen to predict CE(+) could lead to prompt and effective treatment of active arterial hemorrhage in sacral fracture.
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Affiliation(s)
- Naoki Notani
- Department of Orthopaedic Surgery, Faculty of Medicine
| | | | | | | | | | - Tetsutaro Abe
- Department of Orthopaedic Surgery, Faculty of Medicine
| | - Masashi Kataoka
- Physical Therapy Course of Study, Faculty of Welfare and Health Sciences, Oita University, Oita, Japan
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Tanaka K, Anan M, Tsubouchi Y, Iwasaki T, Kawano M, Itonaga I, Ikeda S, Kataoka M, Suenobu S, Tsumura H. Gait analysis of a patient who underwent complete resection of the patella and quadriceps femoris for soft tissue sarcoma. Eur J Phys Rehabil Med 2021; 57:298-302. [PMID: 33619941 DOI: 10.23736/s1973-9087.21.06395-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The knee extension mechanism including the quadriceps femoris muscles and patella plays a crucial role in the stance phase of a normal gait cycle. We performed gait analysis of a patient who had undergone complete resection of the knee extension mechanism. An 8-month-old boy developed infantile fibrosarcoma of the right knee and underwent resection of the quadriceps femoris muscles, patella, and patellar tendon. The gait analysis performed at 8 years of age demonstrated that he could maintain the knee joint extension position during the stance phase. Increased muscle activities in the hamstring and gastrocnemius were observed. The results suggest that the hamstring and gastrocnemius muscles might play a role in maintaining the knee extension position during the stance phase. We suggest the importance of reinforcing these muscles in rehabilitation for patients who lost the knee extension mechanism.
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Affiliation(s)
- Kazuhiro Tanaka
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Oita, Japan -
| | - Masaya Anan
- Physical Therapy Course of Study, Faculty of Welfare and Health Sciences, Oita University, Oita, Japan
| | - Yuta Tsubouchi
- Oita University Hospital Rehabilitation Center, Oita University, Oita, Japan
| | - Tatsuya Iwasaki
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Masanori Kawano
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Ichiro Itonaga
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Shinichi Ikeda
- Department of Rehabilitation Medicine, Faculty of Medicine, Oita University, Oita, Japan
| | - Masashi Kataoka
- Physical Therapy Course of Study, Faculty of Welfare and Health Sciences, Oita University, Oita, Japan
| | - Souichi Suenobu
- Division of General Pediatrics and Emergency Medicine, Department of Pediatrics, Faculty of Medicine, Oita University, Oita, Japan
| | - Hiroshi Tsumura
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
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Tagomori H, Kaku N, Shimada T, Tsumura H. Effect of age and sex on femoral curvature in the Japanese population: three-dimensional computed tomography findings. Anat Sci Int 2021; 96:411-421. [PMID: 33537924 DOI: 10.1007/s12565-021-00606-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/18/2021] [Indexed: 11/25/2022]
Abstract
Age- or sex-related differences in femoral curvature affect the onset of trauma or degenerative diseases of the hip joints. This study aimed to investigate femoral curvature in detail in Japanese individuals using three-dimensional computed tomography, evaluate its effects on the position of proximal femur, and assess differences in femoral curvature according to age and sex. We measured sagittal and coronal femoral bowing in 40 elderly (mean age 85.2 years) and 40 adult (mean age 30.1 years) Japanese individuals using computed tomography. In adult individuals, the radii of the femoral curvatures of the distal end and shaft in the coronal planes were significantly smaller in women than in men. In contrast, no significant difference was observed in femoral curvature between the sexes in the elderly group. Furthermore, the radius of femoral curvature was significantly smaller in elderly individuals than in adult individuals, regardless of the sex and location of the measurement. The highest point of the greater trochanter of the femoral head center was 7.3 ± 5.6 mm in the elderly group and 2.2 ± 4.6 mm in the adult group (p < 0.05). Thus, the femoral curvature varies with age and sex in Japanese individuals. In addition, the femoral curvature could cause positional changes in the proximal femur, such as the highest point of the greater trochanter. Therefore, further studies investigating the biomechanical effects of these morphological changes are warranted.
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Affiliation(s)
- Hiroaki Tagomori
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Nobuhiro Kaku
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan.
| | - Tatsuo Shimada
- Oita College of Judo Therapy and Acupuncture-Moxibustion, 1-1 Chiyo-machi, Oita, Oita, 870-0033, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
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Kubota Y, Tanaka K, Hisaoka M, Daa T, Iwasaki T, Kawano M, Itonaga I, Tsumura H. Primary clear cell sarcoma of the femur: a unique case with RT-PCR and direct sequencing confirmation of EWSR1/ATF1 fusion gene. BMC Musculoskelet Disord 2021; 22:99. [PMID: 33478436 PMCID: PMC7819310 DOI: 10.1186/s12891-021-03969-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/11/2021] [Indexed: 12/18/2022] Open
Abstract
Background It is very rare for clear cell sarcomas (CCS) to arise in the bone. During diagnosis, it is important to distinguish primary CCS of bone from bone metastasis of melanoma because this difference fundamentally changes the therapeutic options. Recently, characteristic fusion genes of CCS have been detected using reverse transcription polymerase chain reaction (RT-PCR) or direct sequencing which allowed to distinguish CCS from melanoma. However, there was no study applying these analyses with positive results. In this case, we describe the use of fusion gene analysis to diagnose a primary CCS of the bone. Case presentation A 36-year-old male presented with a four-months history of left knee pain. Magnetic resonance imaging showed a lesion in the left femoral medial epicondyle. Histological examination of the biopsy specimen revealed proliferating oval or rounded cells. These cells had clear cytoplasm arranged in fascicles or compact nests with frequent deposits of brown pigment. Furthermore, immunohistochemistry analysis revealed that tumor cells were positive for S-100 protein, HMB-45, Melan-A, and SOX10. It stained negative for CD34 and BRAF v600e. Conclusively, detection of the EWSR1/ATF1 fusion gene using RT-PCR and direct sequencing confirmed that the lesion was a primary CCS of the bone. Wide-margin resection and reconstruction with a tumor endoprosthesis were performed. Conclusions Herein, we diagnosed a rare case of primary CCS of the bone by detecting EWSR1/ATF1 fusion gene using RT-PCR and direct sequencing. Since fluorescence-in situ hybridization (FISH) and RT-PCR could show false positive by mainly due to technical problems, it is better to perform direct sequencing to confidently diagnose the tumor as a primary CCS especially at very rare site such as bone.
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Affiliation(s)
- Yuta Kubota
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama, 879-5593, Yufu City, Oita, Japan
| | - Kazuhiro Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama, 879-5593, Yufu City, Oita, Japan.
| | - Masanori Hisaoka
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, 807-8555, Kitakyushu, Japan
| | - Tsutomu Daa
- Department of Diagnostic Pathology, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama, 879-5593, Yufu City, Oita, Japan
| | - Tatsuya Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama, 879-5593, Yufu City, Oita, Japan
| | - Masanori Kawano
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama, 879-5593, Yufu City, Oita, Japan
| | - Ichiro Itonaga
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama, 879-5593, Yufu City, Oita, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama, 879-5593, Yufu City, Oita, Japan
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Kimura M, Kaku N, Tagomori H, Tsumura H. Effectiveness of 18F-fluoro-deoxyglucose Positron Emission Tomography/Computed Tomography and Magnetic Resonance Imaging to Detect Iliopsoas Tendonitis after Total Hip Arthroplasty: A Case Report. Hip Pelvis 2020; 32:223-229. [PMID: 33335871 PMCID: PMC7724025 DOI: 10.5371/hp.2020.32.4.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/24/2020] [Accepted: 10/12/2020] [Indexed: 11/24/2022] Open
Abstract
Disorders involving artificial joints are difficult to evaluate due to metal artifacts hindering plain computed tomography (CT) or magnetic resonance imaging (MRI). In the current case study 18F-fluoro-deoxyglucose positron emission tomography (18F-FDG-PET)/CT and MRI were used to confirm iliopsoas tendonitis within the metal artifact area following total hip arthroplasty (THA). The patient was a 61-year-old woman who developed hip pain on flexion of the ipsilateral hip after THA. Imaging studies were performed to evaluate for iliopsoas tendonitis due to impingement with the cup. Assessment of the iliopsoas muscle near the artificial joint was difficult due to the metal artifact on plain CT and MRI. Imaging using 18F-FDG-PET/CT and 18F-FDG-PET/MRI showed uptake along the iliopsoas muscle. Therefore, revision was performed to resolve iliopsoas tendon impingement, and the preoperative pain resolved. The result of the current case study suggest 18F-FDG-PET/CT or 18F-FDG-PET/MRI will be useful to detect iliopsoas tendonitis within metal artifact areas after THA.
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Affiliation(s)
- Makoto Kimura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu City, Japan
| | - Nobuhiro Kaku
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu City, Japan
| | - Hiroaki Tagomori
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu City, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu City, Japan
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Miyazaki M, Ishihara T, Abe T, Kanezaki S, Notani N, Kataoka M, Tsumura H. Analysis of reciprocal changes in upper cervical profiles after posterior spinal fusion with the simultaneous double rod rotation technique for adolescent idiopathic scoliosis. Orthop Traumatol Surg Res 2020; 106:1275-1279. [PMID: 32409272 DOI: 10.1016/j.otsr.2020.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/25/2020] [Accepted: 03/02/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND The relationship between postoperative change of cervical lordotic alignment and restoration of thoracic kyphosis with adolescent idiopathic scoliosis (AIS) is still controversial. We investigated reciprocal changes in the sagittal profiles of the upper and middle-lower cervical spinal segments after posterior spinal fusion with the simultaneous double rod rotation technique (SDRRT) for AIS. HYPOTHESIS Occiput-C2 and C2-C7 sagittal profiles of patients with AIS could change significantly after surgical adequate increase of thoracic kyphosis with SDRRT. PATIENTS AND METHODS Twenty-seven consecutive patients with AIS treated with the SDRRT were retrospectively reviewed. We investigated the following parameters preoperatively, postoperatively, and at the 2-year follow-up: the Cobb angles of main thoracic curves; C7 sagittal vertical axis; thoracic kyphosis (TK) from T5 to T12; lumbar lordosis from L1 to S1; chin-brow vertical angle; McGregor's slope; occiput to C2 Cobb angle (O-C2angle); C2-C7 Cobb angle (C2-C7angle); T1-slope; and C2-C7 sagittal vertical axis. Additionally, the Scoliosis Research Society questionnaire was completed preoperatively and at the 2-year follow-up. Patients were categorized according to preoperative TK (T5-T12) into hypokyphotic (TK<20°) and normo-hyperkyphotic (TK≧20°) groups. To assess the effect of corrective surgery on sagittal profiles, we investigated correlations among the changes in sagittal parameters. RESULTS The mean preoperative TK was 6.1±3.7° in the Hypokyphotic group and 23.5±4.7° in the Normo-hyperkyphotic group (p<0.001), which was significantly improved postoperatively (22.3±4.4° and 26.1±2.6°, respectively; p=0.02) and at the 2-year follow-up (23.0±6.3° and 26.8±5.0°, respectively; p=0.04). The mean preoperative C2-C7angle reflected kyphosis (7.4±9.8°) in the Hypokyphotic group, and, in contrast, lordosis (-8.8±6.8°) in the Normo-hyperkyphotic group (p<0.001), which improved toward greater lordosis postoperatively (-3.7±5.8° and -14.8±5.1°, respectively; p<0.001) and at the 2-year follow-up (-5.1±4.4° and -15.3±6.4°, respectively; p<0.001). On the other hand, the mean preoperative O-C2angle was -20.5±6.5° in the Hypokyphotic group and -13.1±2.8° in the Normo-hyperkyphotic group (p=0.002), which was significantly changed postoperatively (-12.6±6.4° and -7.7±4.3°, respectively; p=0.04) and at the 2-year follow-up (-13.1±6.3° and -7.9±4.3°, respectively; p=0.04). ΔC2-C7 was negatively correlated with ΔT5-T12 (r=-0.298) and ΔO-C2angle (r=-0.332). DISCUSSION Lordotic reciprocal alignment changes in the C2-C7angle can occur after adequate restoration of TK. The O-C2angle compensates the C2-C7angle for a maintained horizontal gaze. O-C2 and C2-C7 sagittal profiles of patients with AIS changed significantly after corrective surgery with SDRRT. LEVEL OF EVIDENCE IV, Case-series.
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Affiliation(s)
- Masashi Miyazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, 879-5593 Oita, Japan.
| | - Toshinobu Ishihara
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, 879-5593 Oita, Japan
| | - Tetsutaro Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, 879-5593 Oita, Japan
| | - Shozo Kanezaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, 879-5593 Oita, Japan; Acute Trauma and Critical Care Center, Oita University Hospital, Oita, Japan
| | - Naoki Notani
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, 879-5593 Oita, Japan; Acute Trauma and Critical Care Center, Oita University Hospital, Oita, Japan
| | - Masashi Kataoka
- Physical Therapy Course of Study, Faculty of Welfare and Health Sciences, Oita University, Oita, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, 879-5593 Oita, Japan
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Kawakami S, Hayakawa T, Kainuma T, Tsumura H, Satoh T, Tabata K, Iwamura M, Hayakawa K, Ishiyama H. A Phase Ⅱ Trial of Stereotactic Body Radiotherapy Using 4 Fractions for Patients With Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yamada K, Ito YM, Akagi M, Chosa E, Fuji T, Hirano K, Ikeda S, Ishibashi H, Ishibashi Y, Ishijima M, Itoi E, Iwasaki N, Izumida R, Kadoya K, Kamimura M, Kanaji A, Kato H, Kishida S, Mashima N, Matsuda S, Matsui Y, Matsunaga T, Miyakoshi N, Mizuta H, Nakamura Y, Nakata K, Omori G, Osuka K, Uchio Y, Ryu K, Sasaki N, Sato K, Senda M, Sudo A, Takahira N, Tsumura H, Yamaguchi S, Yamamoto N, Nakamura K, Takashi Ohe. Reference values for the locomotive syndrome risk test quantifying mobility of 8681 adults aged 20-89 years: A cross-sectional nationwide study in Japan. J Orthop Sci 2020; 25:1084-1092. [PMID: 32173180 DOI: 10.1016/j.jos.2020.01.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/28/2019] [Accepted: 01/06/2020] [Indexed: 02/09/2023]
Abstract
BACKGROUND The locomotive syndrome risk test was developed to quantify the decrease in mobility among adults, which could eventually lead to disability. The purpose of this study was to establish reference values for the locomotive syndrome risk test for adults and investigate the influence of age and sex. METHODS We analyzed 8681 independent community dwellers (3607 men, 5074 women). Data pertaining to locomotive syndrome risk test (the two-step test, the stand-up test, and the 25-question geriatric locomotive function scale [GLFS-25]) scores were collected from seven administrative areas of Japan. RESULTS The reference values of the three test scores were generated and all three test scores gradually decreased among young-to-middle-aged individuals and rapidly decreased in individuals aged over 60 years. The stand-up test score began decreasing significantly from the age of 30 years. The trajectories of decrease in the two-step test score with age was slightly different between men and women especially among the middle-aged individuals. The two physical test scores were more sensitive to aging than the self-reported test score. CONCLUSION The reference values generated in this study could be employed to determine whether an individual has mobility comparable to independent community dwellers of the same age and sex.
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Affiliation(s)
- Keiko Yamada
- Departments of Sensory & Motor System Medicine, Faculty of Medicine, The University of Tokyo, Tokyo, Japan; Department of Planning, Information and Management, University of Tokyo Hospital, Tokyo, Japan; "Locomo Challenge!" Promotion Council, Tokyo, Japan.
| | - Yoichi M Ito
- Department of Statistical Data Science, The Institute of Statistical Mathematics, Tokyo, Japan.
| | - Masao Akagi
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka, Japan.
| | - Etsuo Chosa
- Department of Orthopaedic Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, Japan.
| | - Takeshi Fuji
- "Locomo Challenge!" Promotion Council, Tokyo, Japan; Department of Orthopaedic Surgery, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan.
| | | | - Shinichi Ikeda
- Department of Orthopaedic Surgery, Oita University, Oita, Japan.
| | - Hideaki Ishibashi
- "Locomo Challenge!" Promotion Council, Tokyo, Japan; Department of Orthopedic Surgery, Ina Hospital, Saitama, Japan.
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan.
| | - Muneaki Ishijima
- "Locomo Challenge!" Promotion Council, Tokyo, Japan; Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Norimasa Iwasaki
- "Locomo Challenge!" Promotion Council, Tokyo, Japan; Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan.
| | - Ryoichi Izumida
- "Locomo Challenge!" Promotion Council, Tokyo, Japan; Keiyu Joint Reconstruction Center, Edogawa Hospital, Tokyo, Japan.
| | - Ken Kadoya
- Department of Advanced Medicine for Locomotor System, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan.
| | - Masayuki Kamimura
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Arihiko Kanaji
- "Locomo Challenge!" Promotion Council, Tokyo, Japan; Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Hiroyuki Kato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan.
| | - Shunji Kishida
- "Locomo Challenge!" Promotion Council, Tokyo, Japan; Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Chiba, Japan.
| | - Naohiko Mashima
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Ehime, Japan.
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Yasumoto Matsui
- Center for Frailty and Locomotive Syndrome, National Center for Geriatrics and Gerontology, Aichi, Japan.
| | - Toshiki Matsunaga
- Department of Rehabilitation Medicine, Akita University Hospital, Akita, Japan.
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan.
| | - Hiroshi Mizuta
- Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
| | | | - Ken Nakata
- Medicine for Sports and Performing Arts, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Go Omori
- Department of Sports and Health, Faculty of Health and Science, Niigata University of Health and Welfare, Nigata, Japan.
| | | | - Yuji Uchio
- Department of Orthopaedic Surgery, Shimane University, Shimane, Japan.
| | | | | | - Kimihito Sato
- "Locomo Challenge!" Promotion Council, Tokyo, Japan; Sato Orthopaedic Clinic, Tokyo, Japan.
| | - Masuo Senda
- Okayama University Hospital, Division of Physical Medicine and Rehabilitation, Okayama, Japan.
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie, Japan.
| | - Naonobu Takahira
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Kanagawa, Japan.
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Oita University, Oita, Japan.
| | - Satoshi Yamaguchi
- "Locomo Challenge!" Promotion Council, Tokyo, Japan; Collage of Liberal Arts and Sciences, Chiba University, Chiba, Japan.
| | | | - Kozo Nakamura
- "Locomo Challenge!" Promotion Council, Tokyo, Japan; Towa Hospital, Tokyo, Japan.
| | - Takashi Ohe
- "Locomo Challenge!" Promotion Council, Tokyo, Japan; Department of Orhtopaedic Surgery, NTT Medical Center, Tokyo, Japan.
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Kaku N, Tanaka A, Tagomori H, Tsumura H. Finite Element Analysis of Stress Distribution in Flat and Elevated-Rim Polyethylene Acetabular Liners. Clin Orthop Surg 2020; 12:291-297. [PMID: 32904112 PMCID: PMC7449856 DOI: 10.4055/cios19145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/31/2020] [Indexed: 11/12/2022] Open
Abstract
Backgroud No study has compared flat and elevated-rim polyethylene liners in terms of stress distribution on the bearing surface. The purpose of this study was to investigate the difference in stress distribution between flat and elevated-rim polyethylene liners. Methods A stress analysis was performed by using the 3-dimensional finite element method. The cup was placed at an open angle of 20°, the flat liner and the liner with a 10° elevation was placed at inclination angles of 80°, 70°, and 60°. Results Compared with the 60° flat liner, the 80° and 70° flat liners showed higher stress at the liner edge. In the elevated-rim liner, the stress was high at the liner edge along the cup edge. When the von Mises equivalent stress was applied to each element of the liner, the high stress area (volume) was the largest for the 80° flat liner, second largest for the 80° elevated-rim liner, and third largest for the 70° flat liner. The average contact pressure also followed the same order. Conclusions Elevated-rim liners affect the stress distribution by increasing the area of contact. However, since elevated-rim liners exhibit high stress at the cup edge, they are likely to result in new problems including liner failure. These findings could aid surgeons in the selection of liners and determination of revision methods such as isolated liner exchange vs. acetabular cup revision for a well-fixed metal cup with a higher inclination angle in revision total hip arthroplasty.
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Affiliation(s)
- Nobuhiro Kaku
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Ai Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Hiroaki Tagomori
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
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Kaku N, Shimada T, Nogami R, Tagomori H, Tsumura H. Three Dimensional Architecture of the Acetabular Transverse Ligament and its Connection with the Acetabular Labrum. Muscles Ligaments Tendons J 2020. [DOI: 10.32098/mltj.03.2020.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- N. Kaku
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu City, Oita, Japan
| | - T. Shimada
- Oita College of Judo Therapy and Acupuncture-Moxibustion, Oita City, Japan
| | - R. Nogami
- Oita University Graduate School of Medicine, Graduate School of Orthopedic Surgery, Yufu City, Oita, Japan
| | - H. Tagomori
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu City, Oita, Japan
| | - H. Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu City, Oita, Japan
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Tanaka K, Iwasaki T, Kawano M, Kubota Y, Itonaga I, Tsumura H. Osteomyelitis of the Distal Phalanx of the Thumb due to Parvimonas micra and Fusobacterium nucleatum: A Case Report. Open Forum Infect Dis 2020; 7:ofaa330. [PMID: 32851111 PMCID: PMC7442267 DOI: 10.1093/ofid/ofaa330] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/29/2020] [Indexed: 11/24/2022] Open
Abstract
We herein report a case of osteomyelitis of the distal phalanx of the thumb of a 55-year-old man caused by Parvimonas micra and Fusobacterium nucleatum. Osteomyelitis often occurs in long bones and rarely occurs in the bones of the fingers. In addition, osteomyelitis of the finger frequently occurs after trauma or surgery, and blood-borne infection is very rare. P. micra and F. nucleatum, normal flora of the oral cavity, are very rare pathogenic bacteria of osteomyelitis except in periodontal disease, and there are no previous reports regarding the occurrence of osteomyelitis due to P. micra and F. nucleatum in the finger bones.
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Affiliation(s)
- Kazuhiro Tanaka
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Tatsuya Iwasaki
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Masanori Kawano
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Yuta Kubota
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Ichiro Itonaga
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Hiroshi Tsumura
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Oita, Japan
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Tanaka K, Kawano M, Iwasaki T, Matsuda S, Itonaga I, Tsumura H. Surrogate endpoints for overall survival in randomised controlled trials of localised osteosarcoma: A meta-analytic evaluation. Sci Rep 2020; 10:8573. [PMID: 32444660 PMCID: PMC7244479 DOI: 10.1038/s41598-020-65591-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 05/07/2020] [Indexed: 12/05/2022] Open
Abstract
Event-free survival (EFS) is considered the most reliable surrogate endpoint for overall survival (OS) in randomised controlled trials (RCTs) of adjuvant therapies for malignant tumours. However, the surrogacy of intermediate endpoints such as EFS for OS in trials of patients with osteosarcoma has not been investigated to date. In this study, we investigated the correlation between OS and intermediate endpoints in RCTs of localised osteosarcoma. A systematic search identified 20 relevant RCTs. The correlations between the surrogate endpoints and OS were evaluated using weighted linear regression analyses and by calculating the Spearman rank correlation coefficients (ρ). The strength of the correlation was determined by calculating the coefficient of determination (R2). A total of 5,620 patients were randomly assigned to 45 treatment arms in the eligible 20 RCTs. The correlation between the hazard ratios for EFS and OS was moderate (R2 = 0.456, ρ = 0.440); this correlation tended to be weaker for patients with localised osteosarcoma excluding the patients with metastases. Overall, the trial-level correlation between the surrogate endpoints and OS was not robust in RCTs of osteosarcoma published to date. Hence, the suitability of the intermediate endpoints as surrogates for OS could not be confirmed.
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Affiliation(s)
- Kazuhiro Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan.
| | - Masanori Kawano
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Tatsuya Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Shogo Matsuda
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Ichiro Itonaga
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
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Tanaka K, Kawano M, Iwasaki T, Itonaga I, Tsumura H. A meta-analytic evaluation of the correlation between event-free survival and overall survival in randomized controlled trials of newly diagnosed Ewing sarcoma. BMC Cancer 2020; 20:379. [PMID: 32370741 PMCID: PMC7201711 DOI: 10.1186/s12885-020-06871-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 04/15/2020] [Indexed: 02/08/2023] Open
Abstract
Background In randomized controlled trials (RCTs) of adjuvant treatment for malignant tumors, event-free survival (EFS) is considered the most acceptable surrogate for overall survival (OS). However, even though EFS has repeatedly been selected as a primary endpoint in RCTs of Ewing sarcoma (ES), the surrogacy of EFS for OS has not been investigated. This study aimed to evaluate the correlation between EFS and OS in RCTs of chemotherapy for newly diagnosed ES using a meta-analytic approach. Methods We identified seven RCTs of newly diagnosed ES through a systematic review, and a meta-analysis was performed to evaluate the efficacy and adverse events associated with chemotherapy for previously untreated ES. The correlation between EFS and OS was investigated using weighted linear regression analysis and Spearman rank correlation coefficients (ρ). The strength of the correlation was evaluated using the coefficient of determination (R2). Results A total of 3612 patients were randomly assigned to 17 treatment arms in the eligible RCTs. The meta-analysis revealed that the hazard ratios for OS and EFS showed significantly better results in the experimental treatment groups with increasing toxicities. The correlation between the hazard ratios for EFS and OS was good (R2 = 0.747, ρ = 0.683), and the correlation tended to be more favorable in cases of localized ES (R2 = 0.818, ρ = 0.929). Conclusions Overall, the trial-level correlation between EFS and OS was good for newly diagnosed ES and was very good in cases of localized disease. EFS may be a useful endpoint in RCTs of ES chemotherapy, and it is worth verifying using individual patient data.
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Affiliation(s)
- Kazuhiro Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan.
| | - Masanori Kawano
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Tatsuya Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Ichiro Itonaga
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
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Notani N, Miyazaki M, Kanezaki S, Ishihara T, Sakamoto T, Abe T, Kataoka M, Tsumura H. Fibrinogen level on admission is a predictive marker of the need for massive blood transfusion after pelvic fracture. Am J Emerg Med 2020; 38:789-793. [DOI: 10.1016/j.ajem.2019.06.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/17/2019] [Accepted: 06/23/2019] [Indexed: 11/29/2022] Open
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Miyazaki M, Ishihara T, Abe T, Kanezaki S, Notani N, Sato S, Kataoka M, Tsumura H. Analysis of the reciprocal changes in upper cervical profile and the risk factors for increasing cervical sagittal vertical axis after laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine. Clin Neurol Neurosurg 2020; 194:105788. [PMID: 32222651 DOI: 10.1016/j.clineuro.2020.105788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/06/2020] [Accepted: 03/13/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to elucidate the reciprocal changes in the upper cervical profile and the risk factors for increasing cervical sagittal vertical axis (cSVA) after laminoplasty for ossification of the posterior longitudinal ligament (OPLL) of the cervical spine. PATIENTS AND METHODS This retrospective study included thirty-nine consecutive patients (30 men and 9 women) with cervical OPLL who underwent cervical laminoplasty. We recorded the operative time, blood loss, Japanese Orthopaedic Association (JOA) score recovery rate. Radiological measurements were performed to analyze the following parameters: pre and 1- year postoperative chin-brow vertical angle (CBVA), McGregor's slope (McGS), occiput to C2 Cobb angle (O-C2 angle), C2-C7 Cobb angle (C2-C7 angle), T1-slope (T1S), C2-C7 sagittal vertical axis (cSVA) and calculated the change (Δ). Patients were divided into two groups according to ΔcSVA: positive (ΔcSVA ≥ 0) and negative (ΔcSVA < 0). RESULTS Postoperative O-C2 angle (P = 0.028), ΔO-C2 angle (P = 0.019), ΔC2-C7 angle (P = 0.030) and T1S (P = 0.009) diff ;ered between the two groups. ΔcSVA showed a positive correlation with ΔO-C2 (R = 0.365, P = 0.022) and T1S (R = 0.472, P = 0.002). ΔO-C2 showed a positive correlation with T1S (R = 0.478, P = 0.002) and a negative correlation with ΔC2-C7 (R=-0.443, P = 0.005). ΔC2-C7 showed a negative correlation with T1S (R=-0.415, P = 0.009). Stepwise multiple linear regression analysis showed that ΔcSVA increased by 0.757 mm for each T1 slope and increased by 0.905 mm for each ΔMcGS. CONCLUSION Increasing the lordosis in the O-C2 segment compensates for the loss of lordosis in the C2-C7 segment after cervical laminoplasty. Higher T1S is a risk factor for increasing cSVA after laminoplasty for OPLL of the cervical spine.
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Affiliation(s)
- Masashi Miyazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan.
| | - Toshinobu Ishihara
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Tetsutaro Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Shozo Kanezaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan; Acute Trauma and Critical Care Center, Oita University Hospital, Oita, Japan
| | - Naoki Notani
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan; Acute Trauma and Critical Care Center, Oita University Hospital, Oita, Japan
| | - Shota Sato
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Masashi Kataoka
- Physical Therapy Course of Study, Faculty of Welfare and Health Sciences, Oita University, Oita, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
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Tagomori H, Kaku N, Tabata T, Kubota Y, Tsumura H. Comparison of cementless and cemented cups in revision total hip arthroplasty using a computed tomography-based navigation system. J Clin Orthop Trauma 2020; 11:S206-S210. [PMID: 32189941 PMCID: PMC7067992 DOI: 10.1016/j.jcot.2019.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 05/10/2019] [Accepted: 05/27/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Studies comparing cementless and cemented cups are lacking, especially for revision total hip arthroplasty (THA). The aim of this study was to investigate and compare the differences in implant accuracy between two fixation methods in revision THA. METHODS We conducted a retrospective study of 85 hips in 70 patients who underwent revision THA using a computed tomography (CT)-based navigation system. Among these, 53 hips underwent cementless THA and 32 hips underwent cemented THA. We measured cup inclination and anteversion using the Kyocera two-dimensional-template with X-ray (Japan-Kyocera, Shiga, Japan) and stem anteversion with CT. We calculated the combined anteversion [cup anteversion+0.7×stem anteversion]. RESULTS There were no significant differences between the two groups with respect to definitive cup inclination and anteversion. The mean deviations in the inclination and anteversion angle were 40.3 ± 4.3 and 19.6 ± 6.2° in the cementless group and 40.5 ± 3.3 and 17.1 ± 5.1° in the cemented group. There were 11 outliers with respect to the Lewinnek safe zone in the cementless group and two in the cemented group (P = 0.072). Although there was no statistically significant difference, the number of safe zone outliers in the cemented group was less than that in the cementless group. CONCLUSION We conclude that when using a navigation system for revision THA, high precision can be obtained for the cup placement angle with or without cement. However, it seems that a major error in the installation angle of the cup is less likely to occur when using a cemented cup than when using a cementless cup in revision THA with a navigation system.
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Affiliation(s)
| | - Nobuhiro Kaku
- Corresponding author. Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi Yufu city, Oita, 879-5593, Japan.
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Higashi T, Kaku N, Noda S, Tabata T, Tagomori H, Tsumura H. Effects of ball head diameter and stem neck shape in range of motion after total hip arthroplasty: A simulation study. J Orthop 2020; 18:104-109. [DOI: 10.1016/j.jor.2019.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/11/2019] [Indexed: 11/28/2022] Open
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