Journal of Orthopaedic Science最新文献

Objectives: Assessment of distraction osteogenesis (D.O.) regenerates has traditionally relied on qualitative assessment on plain radiographs. The commonly employed methods are qualitative and are prone to inter-observer bias. Quantitative methods like the pixel density ratio have been described, but these have certain limitations. This study aimed to describe a novel technique to quantify regenerates from plain digital radiographs and compare it with the conventional Bone Mineral Density.

Methods: This was a prospective study. Eleven subjects underwent distraction osteogenesis; each patient was followed up monthly with digital radiographs and regenerate bone mineral density (BMD ratio) assessment by DEXA scan monthly for a minimum of 6 months. Quantitative analysis was performed by a novel technique using the ImageJ software, and the Area Fraction (AF) & Fractal Dimension (FD) of the regenerates were determined and compared with the BMD ratio.

Results: AF increased steadily and FD decreased steadily as the regenerate matured. A weak negative correlation was found between the BMD ratio and FD (AP view: r = -0.28, p = 0.1 and lateral view: r = -0.16, p = 0.36). A moderate correlation was found between BMD ratio and AF (AP view: r = 0.46, p = 0.005 and lateral view: r = 0.34, p = 0.004). There was a significant difference in AF and FD values in the initial and final regenerates.

Conclusion: Our novel quantitative image-based analysis technique using AF and FD has the potential to efficiently quantify and monitor distraction osteogenesis regenerates. However, these results must be validated in larger patient cohorts before this technique can be used in routine clinical practice.

Background: Chemonucleolysis with condoliase is a minimally invasive treatment for lumbar disc herniation (LDH). However, optimal patient selection criteria remain unclear. This study aimed to identify predictive factors for successful condoliase therapy in LDH, focusing on low back pain (LBP) and leg pain improvement.

Methods: This multi-institutional observational study included 238 patients who underwent intradiscal condoliase injection for LDH. Demographic and clinical data were collected, including pain intensity using the Numeric Rating Scale (NRS) for leg and back pain at baseline, 3-6 months, and 12 months. MRI assessments evaluated disc height, Pfirrmann grade, and herniation occupancy ratio. The primary outcome was defined as achieving the minimum clinically important difference (MCID) on the 0-10 NRS, defined as an improvement of ≥2 points at 3-6 months or 12 months, without additional surgery during follow-up. Multivariable logistic regression was used to identify predictors of MCID achievement.

Results: Condoliase was effective, with over 70 % of patients achieving MCID for leg pain and over 50 % for LBP. For LBP at 3-6 months, higher baseline back pain intensity (OR 3.09, 95 % CI 2.00-4.78), lower MRI slip (OR 0.59, 95 % CI 0.38-0.92), higher MRI occupancy rate (OR 1.74, 95 % CI 1.19-2.54), and L5/S1 injection level (OR 2.20, 95 % CI 1.06-4.54) predicted MCID achievement. At 12 months, higher baseline back pain intensity (OR 2.26, 95 % CI 1.49-3.44), higher MRI occupancy rate (OR 1.85, 95 % CI 1.24-2.79), shorter disease duration (OR 0.57, 95 % CI 0.38-0.86), and absence of X-ray posterior slip (presence: OR 0.18, 95 % CI 0.04-0.91) were associated with MCID achievement. For leg pain at 3-6 months, lower MRI slip (OR 0.60, 95 % CI 0.41-0.89) and higher baseline leg pain intensity (OR 1.72, 95 % CI 1.23-2.41) were associated with MCID achievement. For leg pain at 12 months, shorter disease duration (OR 0.61, 95 % CI 0.42-0.88), lower X-ray slip (OR 0.54, 95 % CI 0.30-0.97), higher baseline leg pain intensity (OR 1.94, 95 % CI 1.30-2.88), and lower Pfirrmann grade (OR 0.48, 95 % CI 0.23-0.99) were predictive of MCID achievement.

Conclusions: This study identified key factors associated with successful outcomes of condoliase in LDH. Baseline pain intensity, MRI findings (herniation occupancy rate, slip), injection level, and disease duration were significant predictors of treatment outcomes. These findings may aid clinicians in patient selection and improve treatment success.

Background: Adult spinal deformity (ASD) surgery involves instrumentation, which can lead to implant-related complications (IRCs) and unplanned returns to the operating room (UPROR). Older patients often have risk factors like osteoporosis and multiple comorbidities, but research on how age-related factors affect IRCs and UPROR across age groups is limited. The aim of this study was to evaluate the characteristics of UPROR due to IRCs between older and non-older patients following ASD surgery.

Methods: A retrospective analysis of patients (≥20 years) who underwent spinal fusion with instrumentation from 2010 to 2019 based on a multi-center database. Medical records were reviewed to identify ASD diagnoses and details of IRCs, including UPROR timing. UPROR timing was classified as early (<30 days), intermediate (30-90 days), and late (>90 days) postoperatively. Patients were stratified into older (≥65 years) and non-older (<65 years) groups to compare the characteristics of UPROR between the groups.

Results: IRCs occurred in 56 of 565 ASD cases (9.9 %) within 2 years postoperatively. UPROR was required in 38 patients (6.7 %), with implant breakage being the most frequent cause (23 cases), followed by screw malposition (14 cases). Screw-related complications predominated early, whereas implant breakage was most common in the late postoperative period. No significant differences in overall IRC or UPROR prevalence were observed between age groups. However, younger patients exhibited a higher rate of early UPROR (44.4 % vs. 20.0 % within 30 days).

Conclusions: These findings highlight the distinct characteristics of IRCs between older and non-older patients, particularly in terms of UPROR timing. Understanding temporal patterns of these complications can inform surgical strategies and enhance patient outcomes by reducing UPROR.

Background: This study aimed to evaluate the predisposing factors for Su type 2 femur periprosthetic fractures. Moreover, we compared the mid- and short-term outcomes of patients who had undergone single-plate and double-plate fixation for Su type 2 fractures.

Methods: A retrospective review was conducted on 3817 patients who had undergone knee replacement surgery at our hospital between January 2009 and December 2022. Of these, 39 patients (Group 1: fracture group) developed periprosthetic femoral Su type 2 fractures. A control group of 40 patients (Group 2: non-fracture group) without fractures was selected using propensity score matching for comparison. To minimize potential confounding, propensity score matching (PSM) was conducted using age, sex, body mass index, and comorbidities. Preoperative Kellgren-Lawrence grading, postoperative hip-knee-ankle (HKA) angles, weight-bearing line (WBL) ratios, femoral component angulation in anteroposterior and lateral views, and femoral notch status were evaluated. Body mass index, vitamin D levels, calcium levels, bone mineral density, and comorbid conditions were recorded and compared.

Results: No statistically significant differences in femoral notching, HKA angle, and femoral component angulation in the coronal plane were observed between the fracture (Group 1) and nonfracture (Group 2, control group) groups (p > 0.05). However, statistically significant differences in WBL ratio and femoral component angulation in the sagittal plane were observed between the two groups (p < 0.05). Vitamin D and calcium levels also significantly differed between the two groups (p < 0.05). Five patients who underwent single-plate fixation experienced refractures after a mean of 19 ± 8.1 (12-33) months, whereas no refractures occurred in patients with double-plate fixation.

Conclusion: Perioperative and postoperative calcium and vitamin D supplementation and close follow-up of high-risk patients (those with low femoral component sagittal plane angulation and WBL ratio) may help prevent fractures. Double-plate fixation is more advantageous than single-plate fixation for Su type 2 periprosthetic stable fractures.

Level of evidence: Level III, retrospective comparative study.

Background: The number of adult spinal deformity (ASD) surgery has increased in recent years; however, it remains associated with significant hospitalization cost. The purpose of this study is to evaluate the total hospitalization cost associated with ASD surgery in Japan and to identify cost-related factors.

Methods: This multicenter prospective observational study included patients aged 50-79 years who underwent corrective fusion of more than 5 vertebral segments between March 2021 and March 2024. Demographic, surgical, and radiographic data were collected. Total hospitalization cost, including surgical procedure, surgical supplies, implants, anesthesia, transfusion, rehabilitation, and bundled hospitalization cost were obtained from medical billing data. Univariate and multivariate analyses were performed to determine factors independently associated with total cost.

Results: A total of 194 patients (25 males, 169 females; mean age 69.4 ± 6.7 years) were included. The average total hospitalization cost was $47,923.8 ± 8631.1, with implant cost accounting for the largest proportion. Multivariate linear regression analysis identified staged surgery as the most significant independent predictor of increased total cost, followed by the number of fused vertebrae, surgical time, and the use of lateral lumbar interbody fusion (LLIF). Staged surgery was associated with longer surgical time, more fused vertebrae, and more frequent use of LLIF, resulting in approximately 10,000 USD higher total cost than single surgery.

Conclusions: This multicenter prospective study revealed that the total hospitalization cost for ASD surgery exceeded USD 47,000 per patient. Staged surgery was identified as the most significant independent factor associated with increased costs, primarily due to higher surgical procedure and implant-related cost.

Background: Rotational instability of the proximal fragment in intertrochanteric femoral fractures increases the risk of fixation failure. However, most prior research has focused on the analysis of bony structures. To confirm the characteristics of rotational instability in intertrochanteric femoral fractures, this study evaluated the fracture morphology and soft tissue attachment relationship at the fracture site using computed tomography.

Methods: The anteroposterior fracture line of the proximal fragment and the attachment of capsular ligaments were compared between patients with confirmed rotational instability during cephalomedullary nailing for 372 intertrochanteric fractures and 1 to 1 matching controls. Rotational instability was defined based on whether the proximal fragment rotation occurred during lag screw insertion. The anterior fracture line was classified as medial, lateral, or crossing, according to its positional relationship with the femoral intertrochanteric line. Concerning the posterior fracture line of the proximal fragment, the study evaluated whether the posterior fracture line was located at the medial base of the intertrochanteric crest. In addition, separation of the greater and lesser trochanters was evaluated.

Results: Rotational instability was confirmed in 40 patients (10.8 %). The patients included 4 men and 36 women with a mean age of 84.7 years (range: 63-97 years). In the group with rotational instability, the anterior fracture line was more commonly located medial or lateral to the femoral intertrochanteric line in 11 and 13 cases, respectively, whereas the group without rotational instability showed a fracture line crossing the femoral intertrochanteric line in 35 cases (P < 0.001). No significant differences were observed in the posterior fracture characteristics between the two groups.

Conclusions: In intertrochanteric femoral fractures, if the location of the anterior fracture line deviates from the femoral intertrochanteric line, there is a possibility of rotational instability, which seems to be related to the attachment of the anterior capsular ligament around the fracture. In these fractures, attention must be paid to the rotation of the proximal fragment during the insertion of a lag screw or blade during osteosynthesis.

Objectives: Hallux valgus (HV) is common in middle-aged and older adults. However, previous studies that linked HV to factors such as sex, knee osteoarthritis, footwear, and aging were mostly cross-sectional. This longitudinal study aimed to investigate HV risk factors and progression.

Materials and methods: Serial radiographs were assessed in Japanese mountain villagers aged ≥50 years who underwent at least two health checkups within an interval of 4 or more years. Demographic data, medical history, and radiographic measurements were collected.

Results: We included 271 participants (542 feet; mean age: 69.6 years); the mean follow-up period was 6.7 years. The average annual change in the HV angle (HVA) was 0.19°. In 16.1 % of the feet, the HVA increased by ≥ 1°/year. Lateral tibial sesamoid bone positioning was a significant risk factor for HV.

Conclusions: HVA progression was less likely in adults aged ≥50 years without tibial sesamoid bone malposition.

Background: We investigated the influence of abnormal magnetic resonance imaging findings and serum bone metabolism on varus deformity progression in the proximal tibia of women without radiographic abnormalities.

Methods: A hundred and forty-six participants without radiographic knee osteoarthritis were assessed using a 5-year longitudinal analysis of the Iwaki cohort. Participants were classified into a normal or an early radiographic knee osteoarthritis group based on the Knee Injury and Osteoarthritis Outcome Score, clinical examinations, and bilateral radiographs. The medial proximal tibial angle was measured on knee radiographs. Abnormal imaging findings were assessed using the whole-organ magnetic resonance imaging scoring method. Serum bone metabolic markers were also measured.

Results: Thirty-eight of the participants (26 %) were classified into the early radiographic knee osteoarthritis group. Variation in the medial proximal tibial angle was greater in participants with early radiographic knee osteoarthritis and bone marrow lesions than in those without either of them (p < 0.001). Varus deformity in the proximal tibia negatively correlated with tartrate-resistant acid phosphatase-5b (r = -0.192, p = 0.022) and N-telopeptide of type I collagen (r = -0.031, p < 0.001). Linear regression revealed that varus deformity was associated with bone marrow lesions (β = -0.252, p = 0.002), N-telopeptide of type I collagen (β = -0.249, p = 0.002), and early radiographic knee osteoarthritis (β = -0.163, p = 0.037).

Conclusions: Early radiographic knee osteoarthritis with bone marrow lesions and a high bone absorption metabolism are potential risk factors for the progression of varus deformity in the proximal tibia.

Background: Femoral shaft fractures represent common pediatric injuries. AO/OTA 32-A3 fractures pose significant challenges for closed reduction due to shortening displacement and muscular traction, frequently necessitating open reduction. This study describes a novel Kirschner-wire distractor-assisted technique and evaluates its efficacy versus traditional manual reduction in children with AO/OTA 32-A3 femoral shaft fractures.

Methods: A retrospective study was conducted on 33 pediatric patients with AO/OTA 32-A3 femoral shaft fractures treated at our hospital from October 2014 to January 2025. The patients were divided into two groups (Group A and Group B) based on the reduction methods used. Group A (n = 15) underwent closed reduction assisted by a Kirschner-wire distractor, whereas Group B (n = 18) received traditional manual reduction. Both groups underwent fracture stabilization using elastic stable intramedullary nailing. We compared closed reduction success rates between Group A and Group B. Group B was further subdivided into successful closed reduction cases (Subgroup B1) and failed closed reduction cases (Subgroup B2). Surgical parameters including incision length, operative time, number of intraoperative fluoroscopy exposures, intraoperative blood loss, postoperative pain scores, and bone union time were then compared between Group A and B.

Results: The K-wire distractor group (Group A) achieved 100 % closed reduction success (15/15) versus 66.7 % (12/18) in the manual reduction group (Group B) (P = 0.02). Compared to Group B1, Group A required significantly fewer fluoroscopies and less operative time (P = 0.01), no statistically significant differences were observed in the remaining postoperative parameters, include incision length, intraoperative blood loss, postoperative pain scores and bone union time. Compared to Group B's failed reduction subgroup (B2), Group A showed superior outcomes in all parameters (all P < 0.001): shorter incision, operative time, reduced Fluoroscopy, reduced blood loss, lower pain scores, and faster union.

Conclusion: Kirschner-wire distractor-assisted closed reduction demonstrates superior efficacy compared to conventional manual reduction for AO/OTA 32-A3 femoral fractures.