Journal of Orthopaedic Science最新文献

Background: Open-wedge high tibial osteotomy (OWHTO) is an established procedure for medial compartment knee osteoarthritis. However, postoperative progression of patellofemoral osteoarthritis (PFOA) and its clinical relevance remain uncertain. The objective of this study was to determine whether radiographic PFOA progression after OWHTO is associated with postoperative patient-reported outcomes and to identify factors associated with progression.

Methods: We retrospectively reviewed 116 knees in 104 patients who underwent OWHTO with ≥4 years of follow-up. PFOA progression could be evaluated in 114 knees (two lacked preoperative Merchant views) using a morphology-based, two-view radiographic assessment integrating Merchant and true lateral views and focusing on interval changes in osteophytes and joint-space narrowing. Knees were classified as progression (Group P) or non-progression (Group N). Clinical outcomes were assessed using the Japanese Knee injury and Osteoarthritis Outcome Score (J-KOOS). Factors associated with progression were examined using univariate and multivariable logistic regression.

Results: Radiographic PFOA progression was observed in 63/114 knees (55 %). At final follow-up, postoperative J-KOOS was significantly lower in Group P for Symptoms, Pain, Activities of Daily Living, and Quality of Life, whereas Sports/Rec did not differ significantly between groups. In multivariable logistic regression, greater preoperative knee extension loss and a higher PF Kellgren-Lawrence (KL) grade were independently associated with PFOA progression.

Conclusions: Radiographic PFOA progression after OWHTO, as classified using a morphology-based two-view radiographic assessment, was associated with inferior postoperative patient-reported outcomes despite comparable improvement from baseline. Greater preoperative knee extension loss and higher PF KL grade were associated with an increased likelihood of progression and may inform preoperative counseling and surgical planning.

Background: Distal radius fractures of OTA/AO types 23B and 23C have a high incidence, and inadequate treatment can lead to complications such as traumatic arthritis, joint pain, and limited wrist function. This study aimed to utilize three-dimensional computed tomography (3D-CT) reconstruction technology and fracture line mapping frequency charts to intuitively and clearly describe the morphological characteristics of distal radius fractures (OTA/AO types 23B and 23C), thereby deepening the understanding of such fractures and providing reference information for this clinical condition.

Methods: Patients with OTA/AO types 23B and 23C distal radial fractures who met the inclusion criteria at our hospital were retrospectively analyzed. A three-dimensional model of the fracture was established using CT scans. The articular surface fracture model and the articular depression area were superimposed on the standard model, and the fracture line map, frequency map, and articular depression map were generated.

Results: This study included 212 patients, comprising 67 males and 145 females. There were 104 left-hand fractures and 108 right-hand fractures. The mean age of the enrolled patients was 59.71 ± 13.21 years, ranging from 18 to 88. In terms of injury mechanisms, 172 (81.13 %) resulted from falls, 17 (8.02 %) from falls from height, 12 (5.66 %) from accidents, and 11 (5.19 %) from other factors. The main fracture lines and areas of high fracture frequency were located in the lunate fossa, scaphoid fossa, and its dorsal region. In the fracture frequency map, the high-frequency fracture area exhibited a clear "+" shape pattern, particularly in the dorsal and central regions of the scaphoid fossa, where the fracture involvement frequencies reached 76 % and 67 %, respectively. Conversely, the four corners of the nine segments of the articular surface of the distal radius were less frequently involved, with frequencies in the radial volar and ulnar volar regions at 18 % and 26 %, respectively. Compared to the palmar side, the dorsal side showed more depressions. The depressed area was the most frequently involved part, notably located in the center and dorsal area of the lunate fossa and scaphoid fossa.

Conclusions: The intra-articular fracture line map, frequency map, and articular depression map of the distal radius were created to reveal the morphological distribution characteristics of fracture lines of types 23B and 23C in the OA classification, allowing for the intuitive identification of prone fracture sites, which may aid clinical diagnosis and surgical guidance.

Background: Spontaneous posterior interosseous nerve (PIN) palsy is a rare condition with controversial clinical features. Although this palsy is conventionally treated conservatively, interfascicular neurolysis to release hourglass-like fascicular constrictions has also been recommended. This study aimed to clarify the clinical characteristics and treatment guidelines for this palsy.

Methods: Fifty-eight limbs with spontaneous PIN palsy receiving conservative treatment or interfascicular neurolysis. The presence of pain as a premonitory symptom and the degree of muscle weakness were investigated. Patients were followed periodically from 3 months after palsy onset to either recovery or ≥36 months afterwards. Limbs recovering to manual muscle testing (MMT) grade 4 or better for both the extensor pollicis longus and extensor digitorum were rated as Good recovery, with all others judged as Poor.

Results: Good recovery was achieved in 31 of 34 limbs treated conservatively and 19 of 24 of limbs by interfascicular neurolysis. Younger age at onset was the factor significantly associated with achieving Good recovery in 58 limbs treated by conservatively or interfascicular neurolysis. In the 24 limbs treated by interfascicular neurolysis, early timing of surgery was the factor significantly associated with attaining Good recovery. All 27 limbs with conservative treatment displaying ≥1 grade of MMT improvement within 6 months after onset achieved Good recovery. In the 23 limbs with Poor recovery at 6 months by conservative treatment, Good recovery was attained in 4 of 7 limbs by continuing conservative treatment and in 12 of 16 limbs by subsequent interfascicular neurolysis. Although the latter treatment tended to produce better results, no significant difference was detected.

Conclusions: Diverse clinical characteristics of spontaneous PIN palsy are useful for diagnosis. Conservative treatment is advisable within 6 months after onset of palsy. If no improvement is observed, interfascicular neurolysis without delay is a reasonable option.

Background: Augmented reality (AR)-based navigation has gained popularity in total hip arthroplasty (THA) due to its imageless, user-friendly approach. However, factors influencing the accuracy of cup placement remain unclear. This study aimed to evaluate the accuracy of AR-guided cup placement and identify risk factors associated with placement error of 5°or more.

Methods: This retrospective, single-center study included 128 patients (132 hips) who underwent THA with AR-based navigation in the lateral decubitus position. Postoperative cup positioning was assessed via X-rays and computed tomography scans. Absolute errors in intraoperative and postoperative measurements, along with the achievement of the combined anteversion (CA) safe zone, were calculated. Patients were divided into two groups based on cup placement errors of ≥5°. The associations of patient demographics and spinopelvic parameters with cup anteversion and inclination malalignment were analyzed using logistic regression models with Firth's penalized likelihood.

Results: Mean absolute errors were 2.8° ± 2.2° for cup anteversion and 3.1° ± 2.8° for cup inclination, with 92 % of cases achieving the CA safe zone. Errors of ≥5° were found in 28 hips (21 %) for anteversion and 24 hips (18 %) for inclination. After adjusting for confounders, Firth's penalized multivariable logistic regression analysis identified significant associations between malaligned anteversion and body mass index (BMI) (odds ratio [OR], 1.16; 95 % confidence interval [CI], 1.03-1.32; P = 0.01) and pelvic obliquity (PO) (OR, 1.47; 95 % CI, 1.11-1.98; P = 0.01). Malaligned inclination was also significantly associated with PO (OR, 1.96; 95 % CI, 1.47-2.78; P < 0.001).

Conclusions: AR-based navigation achieved cup placement accuracy comparable to previous reports. However, PO was associated with greater differences between intraoperative navigation and postoperative radiographic measurements for both anteversion and inclination, while higher BMI was associated with anteversion differences. Careful pelvic landmark registration is advised in such patients.

Background: Valgus-impacted and nondisplaced femoral neck fractures in older adults are commonly treated with cannulated screw fixation. However, the optimal timing for initiating postoperative weight-bearing remains controversial. This study aimed to compare immediate weight-bearing (IWB) as tolerated versus delayed weight-bearing (DWB) to determine whether IWB could improve patient outcomes without increasing the risk of surgical complications.

Methods: A total of 136 patients aged 65 years or older with valgus-impacted or nondisplaced femoral neck fractures treated using three cannulated screws were retrospectively analyzed. The patients were divided into two groups: the IWB group, which began weight-bearing on the first postoperative day and the DWB group, which started weight-bearing six weeks after surgery. All patients were followed for a minimum of 12 months. Outcome measures consisted of surgical complications, perioperative complications, postoperative length of hospital stay (LOS), and functional recovery evaluated with the Modified Barthel Index (MBI) and the Harris Hip Score (HHS).

Results: No significant differences were observed in surgical complications between the two groups. The IWB group had a lower overall perioperative complication rate (6.2 % vs. 18.1 %, p = 0.035) and shorter postoperative LOS (4.9 ± 1.6 vs. 5.6 ± 1.9 days, p = 0.028) than the DWB group. The MBI and HHS were higher in the IWB group at 1 and 3 months postoperatively, while the differences were not statistically significant at 6 and 12 months.

Conclusion: For older patients with valgus-impacted or nondisplaced femoral neck fractures, immediate weight-bearing as tolerated following cannulated screw fixation may have a positive effect on reducing perioperative complications, shortening postoperative LOS, and promoting early functional recovery, without increasing surgical complications.

Background: Although cross-pinning is widely used to treat pediatric supracondylar humeral fractures, it involves risks of nerve injury, malunion, and compartment syndrome. In this two-center retrospective observational study, we compared the outcomes of humero-ulnar external fixation using an adult wrist fixator with those of conventional pinning for pediatric supracondylar humeral fractures. Given the technical complexity of Slongo lateral external fixation, we evaluated a simpler joint-spanning external fixation method.

Methods: This study enrolled 37 children: 19 treated with pinning between 2010 and 2017, and 18 treated with external fixation from 2018 onwards at two hospitals. All patients were followed up for at least 12 months. Clinical outcomes were assessed using Flynn's criteria. The Baumann, tilting, and carrying angles were measured.

Results: Patient backgrounds were comparable between the two groups. External fixation required a significantly longer surgical time (mean 65.3 vs. 38.9 min for pinning); however, postoperative immobilization with a plaster cast was not required. Radiographic parameters were similar between the groups; however, the pinning group demonstrated greater discrepancies in Baumann and tilting angles than the unaffected side. Flynn outcomes were good or excellent in 53 % of pinning cases and 61 % of external fixation cases. Varus deformities were slightly less frequent in patients who underwent external fixation. Complications included pin-site infections (four pinning, one external fixation) and transient preoperative nerve palsy in both groups, which were resolved spontaneously. No new nerve injuries or compartment syndrome occurred.

Conclusion: Humeral-ulnar EF provides safe and stable fixation with favorable outcomes and may therefore be a useful option for pediatric supracondylar humeral fractures, particularly in severely displaced cases.

Background: Intradiscal condoliase injection has become a minimally invasive therapeutic option for lumbar disc herniation (LDH) in Japan. However, the influence of symptom duration on its clinical and radiological effectiveness has not been fully established.

Methods: This multicenter retrospective study included 228 patients treated with either intradiscal condoliase injection (CD group, n = 180) or microendoscopic discectomy (MED group, n = 48) across nine academic institutions. Patients were stratified into four groups by symptom duration: ≤2 months, 3-5 months, 6-11 months, and ≥12 months. Clinical outcomes included changes in Numerical Rating Scale (NRS) scores for back and leg pain, responder rate (≥50 % leg pain reduction), and MRI-based disc resorption rate. Statistical analyses were adjusted for age, sex, and herniation level.

Results: In the CD group, longer symptom duration was associated with reduced treatment effectiveness. At 3-6 months, duration-dependent differences were modest; adjusted improvement showed no significant trend, while only the back pain responder rate decreased with longer duration (p for trend = 0.04). At 12 months, leg pain improvement showed a non-significant downward trend (p for trend = 0.11), whereas the responder rate declined from 84.6 % to 62.5 % (p for trend = 0.03), and the resorption rate dropped from 42.3 % ± 23.5 %-23.9 % ± 24.3 % (p for trend <0.01). In contrast, the MED group showed consistent outcomes regardless of symptom duration. Pfirrmann grades did not differ significantly across groups.

Conclusion: Longer symptom duration was associated with reduced clinical and radiologic response to intradiscal condoliase injection, with duration-dependent effects becoming more evident at 12 months than at 3-6 months. Early intervention-ideally within 6-12 months of symptom onset-may maximize therapeutic benefit. These findings support a time-sensitive approach to chemonucleolytic treatment for LDH.

Background: Osteosarcoma is a representative malignant bone tumor that typically occurs in adolescents, with a peak incidence in teenagers. However, osteosarcoma is rare in children younger than 10 years, and its clinical features and prognosis remain unclear.

Methods: Using data from the nationwide Bone Tumor Registry in Japan, we retrospectively analyzed patients aged ≤19 years diagnosed with osteosarcoma between 2006 and 2019. We compared the clinicopathological characteristics and outcomes between patients aged ≤9 years (group P) and those aged 10-19 years (group A).

Results: A total of 1035 patients were included in the study (group P, n = 121; group A, n = 914). The 5-year overall survival (OS) was 73.0 % in group P and 70.7 % in group A (p = 0.84). Among the non-metastatic extremity cases, the 5-year OS rate was 74.5 % in group P and 80.3 % in group A, with no significant difference. The event-free survival rates in surgically treated non-metastatic extremity cases were 60.3 % and 62.4 % in groups P and A, respectively. Amputation was significantly more frequent in group P (18.4 % vs. 7.9 %; p = 0.001).

Conclusion: Osteosarcoma in children ≤9 years accounts for approximately 10 % of cases in patients ≤19 years and demonstrates clinical characteristics and prognosis similar to those of adolescents. However, amputations are more frequently performed in younger children, highlighting the need for prosthetic and reconstructive options tailored for this age group.

Objective: Chronic pain in lumbar spinal stenosis (LSS) may play an important role in developing central sensitization (CS) symptoms. However, the relationship between CS severity and clinical parameters in LSS is unclear. This study aimed to compare pain intensity, pressure pain threshold (PPT), disability, pain catastrophizing, depression, and sleep quality across CS severity in LSS patients and to examine their relationships.

Methods: This cross-sectional study included 81 patients with LSS. Patients were divided into two groups according to Central Sensitization Inventory (CSI) scores: high CSI and low CSI. Pain intensity (Numeric Rating Scale (NRS)), PPT, disability (Oswestry Disability Index (ODI)), pain catastrophizing (Pain Catastrophizing Scale (PCS)), depression (Center for Epidemiologic Studies Depression Scale (CES-D)), and sleep quality (Pittsburgh Sleep Quality Index (PSQI)) were assessed.

Results: Patients with LSS with high CSI had statistically significantly higher NRS, ODI, PCS, CES-D, and PSQI scores (p < 0.05) and lower PPT (p = 0.010) values than those with low CSI. ODI (OR = 1.069) and PSQI (OR = 1.545) scores increase the risk of high CSI (p < 0.001). In addition, increases in ODI (B = 0.215), CES-D (B = 0.316), and PSQI (B = 1.563) scores and decreases in PPT (B = -2.033) are significant predictors of CSI score (p < 0.001).

Conclusions: LSS patients with high CSI have more pain, disability, pain catastrophizing, and depression, lower PPT, and worse sleep quality. Furthermore, decreased PPT, increased disability and depression, and worse sleep quality were associated with increased CSI score. Therefore, to effectively manage LSS, increased CS severity and its relationship to psychosocial factors that influence patients' pain experience should be assessed.

Background: Older adults who experienced post-disaster relocation are at risk of reduced muscle function and mobility due to changes in living environments. This study aimed to compare muscle morphology and physical function between older adults residing in disaster public housing (DPH) and those living in their own homes (Control: CON) in Kesennuma City, following relocation processes after the 2011 Great East Japan Earthquake.

Methods: Fifty-two older participants were recruited from three wards of Kesennuma City and divided into DPH (n = 18; age: 78.8 ± 7.2 y, height: 153.0 ± 9.6 cm, weight: 56.0 ± 11.8 kg, BMI: 23.8 ± 3.9 kg/m²) and CON (n = 34; age: 75.0 ± 6.6y, height: 153.2 ± 6.8 cm, weight: 54.4 ± 7.6 kg, BMI: 23.2 ± 2.7 kg/m²) groups based on the survey results. The measurement variables were blood pressure, heart rate, muscle cross-sectional area, muscle thickness, echo intensity, handgrip strength, maximal voluntary contraction (MVC), rate of force development (RFD; 0-50 ms, 0-100 ms, 0-150 ms, 0-200 ms, 0-250 ms, 0-300 ms) of knee extension, and locomotive syndrome risk test (comprising the two-step test, stand-up test, and 25-Question Geriatric Locomotive Function Scale).

Results: The MVC was significantly lower in the DPH group (p = 0.043). The RFD was significantly lower in the DPH group at each time point (p < 0.05). In addition, the two-step test was significantly lower in the DPH group (p < 0.001). The other variables did not show significant differences between the groups.

Conclusions: Residents in DPH were associated with decreased muscle strength and mobility, suggesting that post-disaster relocation environments may contribute to the decline of physical function and performance.