Journal of Orthopaedic Science最新文献

Background: Central sensitization (CS), which is characterized by amplified nociceptive processing within the central nervous system, is a key mechanism underlying chronic pain disorders. Chronic pain is a significant global health issue; however, the relationship between CS and pain distribution in the general population remains unclear. This study aimed to investigate the association between CS and the number of locations of body pain in a representative sample of the general population.

Methods: This cross-sectional study included 739 participants (340 men, 399 women) from the Wakayama Health Promotion Study. CS was assessed using the Japanese version of the Central Sensitization Inventory (CSI-J), with scores of ≥30 indicating CS. Participants reported pain at 13 locations. Statistical analyses, including chi-square tests, Student's t-tests, and multiple regression analyses, were performed to determine the associations between Central Sensitization Inventory (CSI) scores and pain locations.

Results: Among the participants, 9.5 % were diagnosed with CS. Females had significantly higher CSI scores than males. Lower back pain (20.6 %) and shoulder pain (15.0 %) were most common in men, whereas shoulder pain (20.6 %), knee pain (20.1 %), and lower back pain (19.5 %) were most common in women. Multivariate analysis revealed that sex, headache, neck pain, shoulder pain, arm pain, lower back pain, hip pain, thigh pain, and knee pain were significantly associated with CSI scores. Participants with ≥3 locations were 14.4 times more likely to have CS.

Conclusions: This study highlights the significant prevalence of CS in the general population, with a higher prevalence in females. Specific locations of pain, particularly those close to the trunk, are strongly associated with CS. These findings underscore the importance of assessing CS in individuals with multisite pain for targeted management and treatment strategies.

Background: A lateral meniscal posterior root tear (LMPRT) is a known complication of anterior cruciate ligament (ACL) injury. Complete repair of meniscal posterior root tears is essential for preventing degenerative changes in the knee that may result from meniscal extrusion and rotational instability. This study aimed to assess the relationship between LMPRT morphology and preoperative lateral meniscal extrusion (LME) and to determine the cutoff value for complete LMPRT based on preoperative LME measurements.

Methods: We retrospectively analyzed 403 patients who underwent ACL reconstruction at our hospital between 2011 and 2021. The study finally included 35 patients with LMPRT and 20 with an intact lateral meniscus (LM) as controls. Based on the arthroscopic findings during ACL reconstruction, the 35 patients were divided into two groups: partial (type 1) and complete (types 2-5) LMPRT, in accordance with the LaPrade Classification. The degree of LME was measured using magnetic resonance imaging (MRI).

Results: The partial LMPRT group comprised 17 knees (10 male and 7 female patients), and the complete LMPRT group comprised 18 knees (9 male and 9 female patients). MRI revealed notably greater preoperative LME measurements in cases of complete LMPRT than in cases of both partial LMPRT and intact LM. Receiver operating curve analysis established the optimal cutoff threshold of 2.2 mm for a preoperative LME, with a sensitivity of 78 % and specificity of 71 % for predicting complete LMPRT.

Conclusions: The findings of this study indicate a higher degree of LME in complete LMPRT than in partial LMPRT in knees with ACL injury. Additionally, in patients with ACL injuries, a preoperative MRI measurement of LME ≥2.2 mm suggests a greater likelihood of complete LMPRT.

Background: L-shaped incision is the most widely used approach for treating calcaneal fracture; however, it has been associated with various complications, such as wound infection, skin edge necrosis, postoperative fracture malunion, and traumatic arthritis. Accordingly, this surgical approach should be re-examined. This study aimed to investigate the clinical effect and safety of the modified sinus tarsi approach in open reduction and internal fixation for Sanders type III-IV calcaneal fractures and compare it with the traditional L-shaped approach.

Methods: This retrospective study enrolled 72 patients with unilateral closed Sanders type III-IV calcaneal fractures treated with a modified sinus tarsi approach (38 patients) and L-shaped approach (34 patients) from May 2018 to June 2020. Postoperative complications and changes in calcaneal Böhler angle, Gissane angle, and Varus angle were observed and compared between the two groups before and 3 days, and 12 months after the operation. At 12 months after the operation, the Maryland foot function score, AOFAS score, and VAS score were used to evaluate the recovery of foot function in both groups.

Results: The modified tarsal sinus approach group had significantly shorter incision healing time (9.8 ± 1.9 d) and operation time (75.53 ± 21.12 min), as well as fewer wound-healing complications (2.6 %) compared to the L-shaped approach group (P < 0.05). There were no significant differences in the Böhler, Gissane, and Varus angles between the two groups after the operation. At 12 months after the operation, no significant differences were observed in Maryland, AOFAS, and VAS scores.

Conclusion: The modified sinus tarsi and L-shaped approaches had similar clinical effects in the treatment of Sanders type III-IV calcaneal fractures. However, the treatment of modified sinus tarsi approaches in open reduction and internal fixation for Sanders type III-IV calcaneal fractures implies small incision, low degree of soft tissue injury, and low wound-healing complications, thus resulting in an effective minimally invasive treatment for Sanders type III-IV calcaneal fractures.

Background: A fifth metatarsal fracture is a common condition with various causes. The epidemiology of this condition is well established in certain populations such as athletes, and people from Western countries, but not in Japan. We aimed to study the epidemiology of fifth metatarsal fracture surgeries in Japan among various age groups from school age to elderly and hypothesized that they are more common in older Japanese patients.

Methods: Data was collected from the Japanese Diagnosis Procedure Combination inpatient database, which is a nationwide database containing discharge abstracts and administrative claims data from over 1500 hospitals in Japan. Patients hospitalized with a primary diagnosis of metatarsal fracture and who underwent open reduction and internal fixation between April 1, 2010, and March 31, 2021 were analyzed.

Results: Overall, a total of 2044 participants, with an average age of 17.93 years and a BMI of 22.63, were included in the analysis. Males exhibited a unimodal distribution, with a peak occurring during their late teens, while females displayed a bimodal distribution, with a peak at the age of 50. Additionally, the incidence of these injuries among both males and females peaked during high school, particularly at the age of 17 years.

Conclusions: The higher prevalence of fifth metatarsal fracture surgeries in elderly females and school age population was observed. This high prevalence may require fracture prevention and early screening. Further studies including patients who undergo conservative treatment are needed.

Levels of evidence: III.

Background: This sham-controlled multicenter, single-blind, dose-escalation, single-dose, phase I/IIa study aimed to validate the safety and exploratory efficacy of intradiscal administration of recombinant human (rh) MMP-7 (KTP-001) for patients with lumbar disc herniation.

Methods: The cohort consisted of three groups. Cohort 1 (C1): three patients in the Sham group, three patients in the KTP-001 X-μg group. Cohort 2 (C2): six patients in the KTP-001 2X-μg group. Cohort 3 (C3): six patients in the KTP-001 4X-μg group. Under X-ray guidance, KTP-001 was injected into center part of the intervertebral disc at the level of herniated disc. The patients between the ages of 20 and 60 years had a subligamentous extrusion type of lumbar disc herniation at the L3-L4, L4-L5, or L5-S1 level. Adverse events, vital signs, clinical tests, magnetic resonance imaging (MRI), X-ray images, and anti-KTP-001 antibodies were used as primary endpoints to evaluate the safety of the investigational drug. The secondary endpoints were low back and leg pain intensity, neurological findings, Oswestry Disability Index, serum keratan sulfate pharmacodynamics, and hernia size on MRI to evaluate exploratory efficacy. The observation period was up to 24 weeks after administration.

Results: A total of 19 patients participated in the trial. No adverse events resulted in death or led to treatment discontinuation. Furthermore, CTCAE Grade 3 or higher adverse events did not occur. No changes were observed in the intervertebral discs or endplates that could be strongly attributed to drug administration based on MRI and X-ray radiographic. All the subjects remained negative for anti-KTP-001 antibody. Early after the treatment, we observed statistically significant improvements in neurological findings, SLR test results, and ODI results.

Conclusions: Even if administered immediately after the onset of the disease and confirmation of the diagnosis, intradiscal treatment with KTP-001 may be safe and tolerable.

Background: Early detection of motor function issues in children is crucial for timely interventions and prevention of long-term health problems. We evaluated the effectiveness of the Kodomo Locomo check and the Single-Leg Stand-Up Test (SLSUT) in assessing motor function in children, using the standardized New Physical Fitness Test as a reference measure.

Methods: This cross-sectional study involved 871 children (436 boys, 435 girls) aged 6-15 years from rural Japan. Participants underwent the Kodomo Locomo check, the SLSUT, and the New Physical Fitness Test. We analyzed correlations between these assessments using Spearman's rank correlation coefficient and ordinal logistic regression.

Results: The Kodomo Locomo check identified 26.4 % of participants as having potential motor function issues, with significant sex differences (33.7 % boys, 19.1 % girls, p < 0.001). The SLSUT demonstrated moderate correlations with New Physical Fitness Test grades (ρ = 0.48 for boys, ρ = 0.46 for girls, p < 0.001), and the Kodomo Locomo check showed weak correlations (ρ = 0.22 for boys, ρ = 0.28 for girls, p < 0.001). Ordinal logistic regression analysis revealed that for every 10 cm increase in SLSUT height, the odds of being in a lower grade category in the New Physical Fitness Test were approximately two times higher for both sexes (OR 2.08, 95 % CI: 1.82-2.38 for boys; OR 2.00, 95 % CI: 1.75-2.27 for girls, p < 0.001 for both).

Conclusions: The SLSUT was shown to have a moderate correlation with overall physical fitness, suggesting its potential as a comprehensive tool for assessing motor function in children. The Kodomo Locomo check, while useful in initial screening, had significant sex-based discrepancies in rates of positivity, potentially causing bias in motor function assessments. Both tests are indicated to have potential in complementary roles in pediatric motor function assessment. Further research will seek to establish age- and sex-specific norms for the SLSUT and investigate the longitudinal predictive value.

Study design: Retrospective observational study of consecutive patients.

Objective: This study aimed to (1) develop a new surgical procedure using microendoscopy in anterior cervical decompression and fusion (ACDF), (2) compare the complications and postoperative courses in patients with the new microendoscopic and conventional ACDFs, and (3) confirm the efficacy and safety of the microendoscopic ACDF.

Summary of background data: ACDF is an excellent procedure that is minimally invasive to the muscle tissue and can improve alignment. However, it poses significant risks of complications such as postoperative acute airway obstruction. Retraction manipulation during surgery is considered the cause. Hence, we introduced microendoscopic surgery, which minimizes retraction manipulation. This study aimed to verify the safety and efficacy of microendoscopic ACDF.

Methods: We compared the anteroposterior thickness of the prevertebral soft tissue on the radiographs preoperatively and 1, 2, and 7 days postoperatively in 15 patients who underwent conventional ACDF with 8 patients undergoing microendoscopic ACDF. Additionally, we assessed the perioperative complications and postoperative course.

Results: Microendoscopic ACDF significantly reduced prevertebral soft tissue swelling 2 and 7 days postoperatively. No significant differences in surgical data, complications, or rates of symptom improvement were found between the two groups.

Conclusions: Microendoscopic ACDF reduces postoperative prevertebral soft tissue swelling. Surgical data and efficacy are comparable to those of conventional techniques, indicating the safety and effectiveness of the procedure.

Background: Advanced cirrhosis is associated with increased mortality in certain surgeries, but the impact of cirrhosis severity on outcomes in patients with hip fractures remains unclear.

Methods: In a large nationwide administrative database of hospitalized patients, we compared postoperative outcomes in patients with hip fractures across different Child-Pugh classes of cirrhosis in Japan. Using the Japanese Diagnosis Procedure Combination Database, we identified 833,648 eligible patients diagnosed with hip fractures and underwent surgery between July 2010 and March 2021. Three sets of 1:1 propensity-score matching were performed for four groups: non-cirrhosis cases and Child-Pugh classes A, B, and C. We compared in-hospital mortality, length of stay, hospitalization fees, readmission, and complications in non-cirrhosis cases vs. Child-Pugh class A, Child-Pugh class A vs. B, and Child-Pugh class B vs. C.

Results: Propensity-score matching created 1065 pairs for non-cirrhosis vs. Child-Pugh class A, 1012 for Child-Pugh class A vs. B, and 489 for Child-Pugh class B vs. C. In-hospital mortality did not differ between non-cirrhosis cases and those with Child-Pugh class A. However, in-hospital mortality was significantly higher in patients with Child-Pugh class B than in those with class A (1.5 % vs. 5.9 %; RD 4.45 %; 95 % CI: 2.79%-6.10 %), and higher in patients with Child-Pugh class C compared with class B (6.3 % vs. 28.4 %; RD 22.09 %; 95 % CI: 17.54%-26.63 %). Patients in more severe Child-Pugh classes had longer hospital stays, higher hospitalization fees, and higher complication rates.

Conclusion: Patients with hip fractures and cirrhosis who are at high risk of poor postoperative outcomes could be identified. This study highlights the significantly higher in-hospital mortality observed in patients with Child-Pugh class C cirrhosis undergoing hip fracture surgery compared to those with class B. These findings underscore the need for careful risk-benefit discussions, considering the severity of cirrhosis, surgical risks, and care goals for each patient.

Background: Although hearing loss in orthopaedic surgeons from exposure to hammering sounds have been previously reported, there are no reports on the noise environment during total hip arthroplasty (THA) in Japan. The aim of this study was to investigate the sound level generated by cementless THA in Japan, and to discuss the broader sound environment within this space.

Methods: 94 cementless THAs (94 patients with informed consent) performed by four surgeons were included. The equivalent continuous A-weighted sound levels (LAeq) in a series of 1086 continuous hammering maneuvers without pause and the maximum C-weighted sound levels (LCpeak) in 17,210 hammering sounds were investigated.

Results: Among the hammering sounds analysed in terms of LAeq, the sound pressure level associated with some procedures did result in non-scrubbed personnel being exposed to the 8-h sound levels exceeding the LAeq threshold (85 dB), while most procedures exceeded this threshold for scrubbed personnel. For scrubbed personnel, the maximum number of operations that could be safely attended per day were 16.1 and 1.6 operations under average and worst-case scenario conditions, respectively. For LCpeak, no sound was found to be above the threshold (135 dB) for either non-scrubbed or scrubbed personnel.

Conclusions: Although average sound levels in a standard operating theatre during cementless THA did not exceed recommended thresholds among non-scrubbed medical practitioners, our data are not sufficient to conclude that the sound environment is safe for scrubbed personnel close to the sound source. Further investigation is needed regarding sound exposure and the occurrence of hearing impairment in surgeons who perform total hip arthroplasties.

Background: Degenerative lumbar diseases (DLDs) often have significant impacts on patients' quality of life, particularly when cage retropulsion (CR) occurs following lumbar interbody fusion (LIF). In this study, we conducted a meta-analysis to assess the risk factors associated with CR after LIF.

Methods: We retrieved literatures analyzing the risk factors associated with CR following LIF from seven databases. We examined baseline characteristics, diagnosis, comorbidity, fusion level, surgical status, imaging assessment, and cage status to identify potential risk factors.

Results: Sixteen studies involving 8059 patients (251 in the CR group and 7808 in the Non-CR group) were included in the final analysis. The incidence of CR was 3.15 %. Results revealed that older age (mean difference [MD]: 2.35 [0.44, 4.26]), more fusion levels (MD: 0.64 [0.03, 1.25]), comorbidity-osteoarthritis (risk ratio [RR]: 2.02 [1.37, 2.98]), comorbidity-heart disease (RR: 2.95 [1.21, 7.21]), comorbidity-existing vertebral fracture (RR: 5.12 [2.52, 10.39]), endplate injury (RR: 2.93 [1.71, 5.02]), screw loosening (RR: 6.03 [1.90, 19.12]), pear-shaped disc (PSD, RR: 3.14 [1.46, 6.74]), greater mean disc height (MDH, MD: 1.65 [0.58, 2.72]), larger cobb angle (MD: 0.68 [0.10, 1.27] degrees), larger cage height (MD: 0.31 [0.01, 0.61]), and cage type-carbon (RR: 1.62 [1.16, 2.27]) were identified as risk factors for CR following LIF. The incidence of CR decreased with an increase in fusion level.

Conclusions: Older age, endplate injury, PSD, and nine other factors are identified as risk factors for CR following LIF. Patients with these factors should undergo close monitoring during follow-up to prevent serious complications, such as significant cage displacement.