Risk factors for local recurrence after total en bloc spondylectomy for metastatic spinal tumors: A retrospective study

Background

The aim of this study was to evaluate local recurrence and survival outcomes after frozen autograft total en bloc spondylectomy for metastatic spinal tumors.

Comparison with the osteoconductivity and bone-bonding ability of the iodine supported titanium,titanium with porous oxide layer and the titanium alloy in the rabbit model

Background

One of the serious postoperative complications associated with joint replacement is bacterial infection. In our recent investigations, iodine supported titanium implants demonstrated antibacterial activity in both in vitro and in vivo studies. The surfaces of the implants have porous anodic oxide layer with the antiseptic properties of iodine. According to the literature the titanium with porous anodic oxide have good osteoconductivity. But it is not clear whether the properties of iodine influence bone bonding of implants.

The optimal combined anteversion pattern to achieve a favorable impingement-free angle in total hip arthroplasty

BackgroundThere have been no studies on the differences in impingement-free angle that result from different combined anteversion (CA) patterns. The aim of this study was to find the optimal CA pattern for achieving a favorable impingement-free angle, including bony and prosthetic impingement, in total hip arthroplasty.MethodsWe evaluated 100 patients with no hip arthritis. We investigated the impingement-free angle (flexion, internal rotation with 90° flexion, extension, and external rotation) after changing the stem and cup anteversions to satisfy several CA patterns [cup anteversion + stem anteversion = 30°, 40°, 50°, and 60°; cup anteversion + 0.7 × stem anteversion = 37.3° (:Widmer's theory); and cup anteversion + 0.77 × stem anteversion = 43.3° (:Yoshimine's theory)] using 3-dimensional templating software.ResultsThe impingement-free angle changed dramatically among the various CA patterns. The optimal CA was changed by various stem anteversion. Only CA: Widmer with stem anteversion of 20° satisfied daily-life range of motion (ROM) requirements (flexion ≥130°, internal rotation with 90° flexion ≥ 45°, extension ≥ 40°, external rotation ≥ 40°).ConclusionGood impingement-free angle cannot be obtained with single fixed CA. Different CA patterns should be used, depending on the differences in the stem anteversion. A CA of 30° with 0° ≤ stem anteversion ≤10°; a CA:Widmer with 20° of stem anteversion; a CA of 40° or Widmer with 30° of stem anteversion. When stem anteversion is ≥40°, CA should be decided by each patient's state. Among them, a stem anteversion of 20° with cup anteversion of 23.3° was found to be the best CA pattern.     

Quantitative analysis of the Trendelenburg test and invention of a modified method

Background

While the Trendelenburg test has been used for 120 years to detect hip abductor muscle weakness, the methodology has not been standardised.

Treatment of bone tumor using external fixator

External fixation has been widely used for the treatment of limb length discrepancy, deformity correction, and bone defect using distraction osteogenesis. We have been using this technique for the treatment of obstacles due to benign bone tumor and reconstruction after malignant bone tumor resection. In this paper, we introduce the usefulness of external fixation for the treatment of various benign bone tumors and limb salvage surgery for reconstruction after tumor resection using distraction osteogenesis, according to the tumor site. The advantages of external fixation for the treatment of benign bone tumor include a possibility of complex deformity correction without treating the tumor itself and reconstruction of the aggressive benign bone tumor as well as solid fixation with wires, even for weak bone due to benign bone tumors. The advantages of treating malignant bone tumor include regeneration of living bone of sufficient strength and durability, biological affinity, resistance against infection, and lifelong restored function. The disadvantages include delayed union at the docking site and pin-or wire-tract infection, patient's psychological stress, and the procedure is time consuming. We conclude that external fixation is very efficient for the treatment of benign and malignant bone tumors.     

Reliability of radiographic evaluations of the stage of osteoarthritis of the hip joint and an approach to improve the staging criteria

Background

A few reports have shown that the reliability of the Japanese Orthopaedic Association stage classification of hip osteoarthritis was not high. The objective of this study was to assess the reliability of the stage classification of coxarthrosis, and to evaluate whether a modification of the classification improves reliability.

Comparison of transportal and outside-in techniques for posterolateral femoral tunnel drilling in double-bundle ACL reconstruction -three-dimensional CT analysis of bone tunnel geometry

Purpose

To comparatively analyze the geometry of the posterolateral femoral (PL) tunnel in double-bundle ACL reconstruction between far anteromedial transportal (TP) and outside-in (OI) drilling techniques based on three-dimensional computed tomography (3DCT) image analysis.

Assessment of unloading effects after open wedge high tibial osteotomy using quantitative bone scintigraphy

IntroductionWe evaluated changes in bone tracer uptake (BTU) in open wedge high tibial osteotomy (OWHTO) and determined if BTU correlates with clinical symptoms, postoperative alignment, or cartilage regeneration after OWHTO.Materials and methodsSeventy-five knees in 64 patients who underwent OWHTO for medial compartment osteoarthritis were enrolled in this retrospective study. All cases were assessed preoperatively and at plate removal using bone scintigraphy. Visual analog scale (VAS), Japanese Orthopedic Association (JOA) score, Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and the weight-bearing line ratio (WBLR) were assessed preoperatively and at plate removal. In addition, cartilage regeneration was evaluated at plate removal. We assessed changes in BTU for the medial and lateral compartment after OWHTO and the correlations between BTU of the medial compartment and all other parameters were analyzed.ResultsPostoperatively, all outcome measures significantly improved: mean VAS 61.4 ± 18.3 to 9.5 ± 8.2, mean JOA score 65.1 ± 11.5 to 94.7 ± 6.0, mean OKS 29.4 ± 8.1 to 42.3 ± 4.1, mean KOOS 57.0 ± 14.3 to 83.7 ± 9.6, mean WBLR 22.8 ± 10.9 to 70.0 ± 9.4. Cartilage regeneration was observed in 53 knees (70.7%). BTU of the medial compartment significantly decreased after OWTHO, whereas no increased postoperative BTU was found in the lateral compartment. Postoperative BTU of the medial compartment significantly correlated with VAS, KOOS, and WBLR. No statistically significant associations were found between BTU and cartilage regeneration.ConclusionsOWHTO significantly decreased BTU of the medial compartment, which correlated with knee pain and postoperative mechanical alignment. Unloading effects of OWHTO led to pain relief after surgery, regardless of cartilage regeneration.     

The influence of pre-operative antiplatelet and anticoagulant agents on the outcomes in elderly patients undergoing early surgery for hip fracture

BackgroundEarly surgery improves the prognosis of elderly patients with hip fractures. However, many patients take antiplatelet and anticoagulant therapies for comorbidities. This study compared perioperative outcomes and 1-year mortality rates with early surgery in elderly patients with hip fractures taking or not taking these agents preoperatively.MethodsAmong 418 patients undergoing surgery for hip fractures at our institution from 2014 to 2016, 266 patients over 65 years who had surgery within 48 hours of admission were enrolled. We excluded patients with high-energy injuries, multiple or pathological fractures, and patients undergoing osteosynthesis for femoral neck fractures. The study population was divided into those who underwent hemiarthroplasty for neck fractures and those who underwent osteosynthesis for trochanteric fractures. We also divided the population into patients receiving chronic anticoagulation therapy (medicated group: 19 hemiarthroplasty, 70 osteosynthesis) and patients not receiving anticoagulation therapy (non-medicated group: 47 hemiarthroplasty, 130 osteosynthesis). Comorbidities, intraoperative blood loss, estimated blood loss from admission to the first and seventh day after surgery, transfusions, length of stay, complications, and 1-year mortality rates were evaluated.ResultsDiabetes mellitus and cerebrovascular disorders were significantly more common in the medicated group for both surgery types. In the osteosynthesis group, estimated blood loss on the first day was 710 ml in the medicated group and 572 ml in the non-medicated group (P = 0.015). In the hemiarthroplasty group, corresponding values were 668 and 480 ml, respectively (P = 0.016). Estimated blood loss on the seventh day, complications, length of stay and 1-year mortality rate were not increased significantly.ConclusionsThe medicated group had an increase in estimated blood loss on the first day. However, there was no significant increase in transfusions, complications and 1-year mortality rates. Early surgery for elderly patients with hip fractures is recommended, even for those taking antiplatelet and anticoagulant agents.     

Practical use of imaging technique for management of bone and soft tissue tumors

Imaging modalities including radiography, computed tomography (CT), and magnetic resonance imaging (MRI) are necessary for the diagnosis of bone and soft tissue tumors. The history of imaging began with the discovery of X-rays in the 19th century. The development of CT, MRI, ultrasonography, and positron emission tomography (PET) have improved the management of bone and soft tissue tumors. X-ray imaging and CT scans enable the evaluation of bone destruction, periosteal reaction, sclerotic changes in lesions, condition of cortical bone, and ossification. MRI enables the assessment of tissue characteristics, tumor extent, and the reactive areas. Functional imaging modalities including ²⁰¹thallium (²⁰¹Tl) scintigraphy can be used to differentiate benign lesions from malignant lesions and to assess chemotherapeutic effects. Real-time assessment of soft tissue tumors by ultrasonography enables accurate and safe performance of surgery and biopsy. This article describes useful imaging modalities and characteristic findings in the management of bone and soft tissue tumors.     

Von Willebrand Factor Deposition and ADAMTS-13 Consumption in Allograft Tissue of Thrombotic Microangiopathy-like Disorder After Living Donor Liver Transplantation: A Case Report

Background

Thrombotic microangiopathy (TMA) pathogenesis after living donor liver transplantation (LDLT) is thought to be caused by release of unusually large von Willebrand factor multimers (UL-vWFMs) resulting from sinusoidal endothelial cell damage and induction of platelet adhesion and aggregation. A decrease in a disintegrin-like and metalloproteinase with thrombospondin type 1 motifs-13 (ADAMTS-13) that cleave UL-vWFMs might cause excessive UL-vWFMs activity and result in platelet thrombus formation. However, this phenomenon has not undergone a full pathologic assessment.

Prognostic factors and optimal management for patients with cervical spinal cord injury without major bone injury

Background

Even though the number of patients with cervical spinal cord injury (CSCI) without major bone injury is increased, the treatment with either surgery or conservative measures remains controversial. The aim of this study was to assess its prognostic value in the prediction of useful motor recovery and to clarify whether the patients should be treated surgically are present.

Early response assessment of re-ossification after palliative conventional radiotherapy for vertebral bone metastases

Background

To evaluate the therapeutic outcomes in patients with bone metastases receiving radiotherapy (RT), it is important to use objective radiological response criteria. The aim of this study was to investigate the changes in pain and re-ossification after RT for painful vertebral bone metastases without paralysis by malignant spinal cord compression.

How does anteroposterior cup placement affect bone coverage and range of motion in primary total hip arthroplasty for hip dysplasia?

Background

Due to anterior bone defects, high and/or posterior placement of an acetabular cup is often required to achieve sufficient coverage in patients with hip dysplasia. We examined whether posterior cup placement affected the postoperative range of motion (ROM) in primary total hip arthroplasty (THA).

Supplying osteogenesis to dead bone using an osteogenic matrix cell sheet

Purpose

To evaluate whether osteogenic matrix cell sheets can supply osteogenesis to dead bone.

Early response assessment of palliative conventional radiotherapy for painful uncomplicated vertebral bone metastases

Background

Radiation therapy (RT) is the common treatment for painful vertebral bone metastases without paralysis by malignant spinal cord compression. However, no studies have focused on the time course of pain after RT. Then, we investigated the change of pain after RT for painful vertebral bone metastases without paralysis.

Practical use and utility of fluorescence in situ hybridization in the pathological diagnosis of soft tissue and bone tumors

During routine pathological examination, fluorescence in situ hybridization (FISH) plays a significant role in the genetic analysis of samples. FISH can detect genetic abnormalities such as chromosomal translocations, gene amplifications, and deletions in formalin-fixed, paraffin-embedded (FFPE) specimens. Due to its practical advantages, FISH is already used in many pathology laboratories. It is especially useful for the diagnosis of translocation-related sarcomas (TRSs), which comprise about 25% of soft tissue sarcomas. Because TRSs have specific chimeric genes derived from characteristic chromosomal translocations, their diagnosis would not be possible without FISH. FISH significantly contributes to the genetic confirmation of TRS. Analysis using next-generation sequencing (NGS), the latest powerful method for comprehensive genomic analysis, has recently revealed many kinds of chromosomal translocations in various TRSs. We often use experimental results to create custom probes for FISH and have applied NOCA2 split probes and CIC split, CIC-FOXO4 fusion probes to the pathological diagnosis of soft tissue angiofibroma and CIC-rearranged sarcoma, respectively. Some chimeric fusions detected by NGS induce the expression of related proteins and their detection using immunohistochemistry is beneficial for pathological diagnosis. We previously identified characteristic FOSB expression in pseudomyogenic hemangioendothelioma (PHE) with a specific SERPINE1-FOSB fusion, revealing the usefulness of FOSB immunohistochemistry in the differential diagnosis of PHE and its mimics. Finally, we participated in a central review of a clinical trial of trabectedin monotherapy. We guaranteed an accurate diagnosis by using FISH and genetic confirmation to select appropriate TRS patients and thereby confirm the accuracy of the patient enrollment of the clinical trial. FISH is an essential tool for the pathological diagnosis of soft tissue and bone tumors. It can detect various genetic abnormalities in an “in situ” fashion using FFPE specimens on glass slides during routine examination. It is also an excellent tool for translating the latest experimental findings to practical use in routine pathological diagnosis. Further instrumental improvements in FISH will help it to become the universal method for the genetic analysis of pathological diagnoses.