Search

Stress shielding-related proximal femoral bone loss after total hip arthroplasty occurs because of the different stiffness of metallic alloy stems and host bone. To overcome this, we fabricated a low-modulus cementless hip stem from β-type Ti-33.6Nb-4Sn alloy (TNS). Then we evaluated its stiffness, stress shielding, and initial stability compared with a similar Ti-6Al-4V alloy stem. Stiffness was determined by axial compression and cantilever-bending tests. Thirteen triaxial strain gages measured cortical strain. Stress shielding was defined as the percentage of intact strain after stem insertion. To evaluate initial stability, displacement transducers measured axial relative displacement and rotation. Intact and implanted femurs underwent single-leg-stance loading. Axial stiffness was 56% lower in the TNS stem than in the Ti-6Al-4V stem, and bending stiffness of the TNS stem decreased gradually from the proximal region to the distal region, being ≤ 53% that of the Ti-6Al-4V stem, indicating gradation of Young's modulus. The TNS stem decreased stress shielding in the proximal calcar region (A1: 83%, B1: 85% relative to intact cortical strain) without affecting the proximal lateral region (B3: 53%). The initial stabilities of the stems were comparable. These findings indicate that the TNS stem with gradation of Young's modulus minimizes proximal femoral bone loss and biological fixation, improving long-term stability.

The molecular and morphologic features of herniated human intervertebral disc tissues are of particular importance to clarify the pathogenesis. The present study analyzed the biochemical and morphological features of herniated intervertebral disc tissues to determine the constituent factors responsible for intervertebral disc herniation. A total of 32 herniated disc specimens and 4 control disc samples were analyzed. Collagen subunit composition, collagenase activity, lipid peroxidation level, caspase-3 activity, metal levels, morphologic studies, and genetic analysis were performed on herniated disc tissues of chronic (group A) and acute (group B) group and compared with findings of control group. Nick translation analysis in situ revealed apoptotic-positive stained DNA fragments as black-brown spots in herniated disc tissues. The presence of type II collagen in control disc samples and its absence in herniated samples were confirmed immunohistochemically. The increased caspase-3 activity, the apoptotic-positive stained DNA fragments, and the electron microscopic findings suggest enhanced programmed cell death in herniated discs. The significant increase in lipid peroxidation levels and collagenase activity, and the low metal levels suggest the enhancement of cell death signals in herniated discs, caused by oxygen stress. Linkage analysis of herniated disc tissues in Japanese individuals may suggest ethnic variation. These findings may be helpful in understanding the pathogenesis of herniated disc disease.

We studied three-dimensional motion analysis of trunk rotation in baseball pitching. Six male baseball players (two experienced pitchers and four experienced field players) and an inexperienced player were studied. The subjects were filmed pitching from six directions with six motion cameras, and synchronized with each other. The angle, angle velocity of trunk rotation, duration of LFC (lead foot contact), MinR (minimum rotation), MAV (maximum angular velocity), BR (ball release), and MaxR (maximum rotation) were calculated.

我々は疼痛や可動域制限を有する変形性肘関節症に対して関節鏡視下関節形成術を行なっている．今回，その短期成績を報告する．症例は変形性肘関節症に対し肘関節鏡を施行し術後4ヶ月以上経過観察可能であった5例5肘で男性5肘を対象とした．手術時平均年齢は54.0歳，平均経過観察期間は14.2ヶ月であった．評価方法として，術前後の日本整形外科学会肘機能評価法（JOAスコア）および可動域，合併症の有無で評価した．JOA肘スコアは平均69.0点から91.2点に，可動域は屈曲が平均106.4度から115.6度に，伸展が平均－12.4度から－3.6度と改善が見られたが，術前可動域制限が強い症例での改善度が低い傾向にあった．術後合併症は全例なかった．変形性肘関節症に対する鏡視下手術は組織への侵襲が少なく，有効な手術法であるが，術前可動域制限が強い症例では手術手技の更なる検討が必要である．

Autogenous bone grafting has been used to reconstruct acetabulum in dysplastic hips during primary Total Hip Arthroplasty (THA). We experienced 5 joints in 5 patients (1 male and 4 females) and examined the results of cases where more than 3 years have passed after THA combined with an autogenous bone graft. The mean age at the time of surgery was 63.8 years. Clinical evaluation by JOA score and radiographic evaluation were carried out. JOA score improved from the preoperative mean of 34.4 points to the postoperative mean of 86.6 points. Bone fusion was established in all the bone grafts and neither migration of the cup nor crush of the bone grafts were found. Bone resorption was observed in some bone grafts but no clinical problems were raised.Our study indicates that acetabular bone graft is useful for obtaining the stability of the cup.

We evaluated the clinical and radiographic results of total knee arthroplasty in 17 patients using the Duracon System. 13 knees of 10 patients had osteoarthrosis and 8 knees of 7 patients had rheumatoid arthritis. The mean age at the time of operation was 68.3 years. The mean follow-up period was 5.0 years. The mean JOA score improved from 42 to 77 points in the OA group and from 41 to 76 points in the RA group. The mean extension changed from -17° to -4° in the OA group and from -6° to -1° in the RA group. Obvious loosening was not confirmed on the radiographs.

Biomechanical analyses under compressive load, flexion, and extension torque were performed, using a nonlinear three-dimensional finite element method, to evaluate stability in posterolateral fusion. Effects of facet fusion and disc denucleation on posterolateral fusion were also examined. Using an initially prepared L4-5 motion segment model, we prepared a denucleation model, posterolateral fusion models classified by presence or absence of denucleation and facet fusion, and an interbody fusion model. In the denucleation model, rigidity was less than in the normal model, and maximum rigidity was analyzed for the interbody fusion model. The effect of denucleation on posterolateral fusion was also analyzed. Taking into account the instability of the anterior elements, including the intervertebral disc, appears to be clinically important. In the posterolateral fusion model under compressive load, the axis of rotation moved principally toward the fusion mass, and axial displacement and flexion rotation were induced. Sagittal rotation angles under flexion and extension torque were 1.5 degrees -2.3 degrees at a maximum moment of 15 N-m, demonstrating elasticity of posterolateral fusion. When combined with facet fusion, posterolateral fusion yielded increase of load transfer across the lamina and decrease of rotation angle of about 10% under flexion-extension torque. Adjunctive clinical use of facet fusion should permit more solid posterolateral fusion.

Acetabular reconstructions using acetabular reinforcement ring with hook were analyzed after an average follow-up period of 19.6 months (range: 2-28 months) in 9 patients/hips. The deficiencies, according to the American Academy of Orthopaedic Surgeons classification, were 2 segmental, 4 cavitary and 3 combined cavitary and segmental. Bone grafts were packed into bone defects, a hook was placed around the bone in the acetabular notch and then a reinforcement ring was fixed with cancellous screws. Postoperative management was with partial weight-bearing on 2 crutches usually starting one week after surgery. Radiographic evaluation revealed acetabular component migration of more than 2mm in 1 hip. The overall Japan Orthopaedic Association score (JOA score) of 36.5 points improved to a follow-up examination score of 73.6 points. Short-term results were good. In arthroplasty with bone stock of poor quality and quantity, the reinforcement ring with hook serres as a good method for reconstructing the acetabulum.

The usefulness of arthro-MRI with direct injection of Gd-DTPA into the hip joint cavity principally for discrimination of limbus rupture was examined for 33 joints of 25 patients. In 26 joints, contrast in the periphery of the limbus was clearer than on T1 and T2-weighted images, and in 12 joints limbus rupture which was not apparent on T1 and T2-weighted images was clearly depicted. In comparison to T1 and T2-weighted images, arthro-MRI yielded more information about the acetable, bone head cartilage surface, articular limbus and intraosseous cysts, bursa, and intra-articular free bodies. Arthro-MRI enables discrimination between rupture and degeneration of the joint limbus, which is difficult using T1 and T2-weighted images, and is therefore useful for diagnosis of diseases of the limbus.

Reports of congenital abnormalities of the lateral meniscus include discoid meniscus, accessory meniscus, double-layered meniscus and ring-shaped meniscus. We present a rare case of an unusual abnormality of the bilateral lateral meniscus, which was completely separated and duplicated at the midportion, although different from an accessory meniscus, with an anomaly of the anterior horn of the medial meniscus as well as a double-layered medial meniscus. This type of abnormality of the lateral meniscus and double-layered medial meniscus has not previously been described in the literature. We have designated the abnormality of the bilateral lateral meniscus a separated meniscus.

This paper discusses the biomechanics and long-term results of posterolateral (PL) lumber fusion for degenerative lumbar spinal diseases. In the biomechanical study, the geometry of the finite element model is based on the L4-5 motion segment. The disc degeneration model was simulated by changing the interbody material properties. The behavior of the PL fusion model and the effects of the anterior elements on PL lumber fusion were studied in compression, flexion, and extension. In the clinical study, 40 patients with a mean age of 39 years (19 to 63) were treated with PL fusion and the mean follow-up period was 14 years. Clinical evaluation was made by the Japanese Orthopaedic Association (J.O.A.) score. Fusion success was determined by X-ray radiographs. Stress distribution results indicate that there were high stresses in the upper part of the grafted bone for PL fusion. The axial displacement of the L4 vertebral body and the stress of the grafted bone for PL fusion increased in the disc degeneration model. In flexion, the extension load stress concentrated on the L4 side of PL fusion model between transverse processes. Clinically, the J.O.A. score improved by 24 points postoperatively. Radiographically, the success rate of the fusion was 93%. The long-term results were so good that this technique can be recommended. It is suggested that the instability including the degree of disc degeneration is one of the important factors in PL lumbar fusion.

We examined the clinical and radiographic results of femoral head replacement. We studied a group of 46 patients, 47 joints (18 males and 28 females) consisting of 35 cases of femoral medial neck fracture, 10 cases of avascular necrosis of the femoral head and 2 cases of coxarthrosis. They were treated by femoral head replacement during 1977-1996 and were typed as follows: Austin-Moore (5 cases), Harris-Galante (2 cases), Omnifit (4 cases), Omniflex (6 cases) and HA-TCP (30 cases). Age distribution of these cases were 18 to 89 years (mean: 67.9 years), and they were followed from 1 year to 19 years and 9 months (mean: 4 years and 7 months). The mean postoperative JOA score was 80.0 points (Moore: 76.6, H/G: 75, Omnifit: 76, Omniflex: 75.5, HA-TCP: 81). Radiographically, loosening was frequently seen in all patients except HA-TCP type.

In recent years, surgical treatments have been applied to cases with intense pain due to bone metastases of a malignant tumor and to those with pathological bone fractures. In the present study, we examined the postoperative result of cases in which osteosyn thesis combined with bone cement was performed in our department for metastatic bone tumors, aiming at improvement in QOL. Subjects were three men and one woman with the mean age of 66 years, with metasttic bone tumors in long cavity bones for which osteosynthesis combined with bone cement was performed. The observation period varied from 2 months to 13 months with a mean of 5 months. The regions were the femur in two cases, tibia in one and humerus in one, and the primary foci were renal carcinoma in two, bladder cancer in one and malignant neurinoma in one. During surgery, the metastatic focus was curetted and the bone fixed with a plate or an intermedullary rod and reinforced bone cement. In regard to QOL, pain was relieved in all cases and the patients recovered to the ADL level before appearance of symptoms. In the aspect of surgical indication, this technique had little surgical invasion with satisfactory short-term postoperative results leading to a marked improvement in QOL.

Bone density of the calcaneus, lumbar vertebrae, femoral neck was measured and the correlation between age, body height and body weight assessed.Evaluation of the calcaneal bone density was examined.Subjects comprised 42 cases, all female, ranging in age from 22 to 66 years (mean, 49.3 years).For all cases, bone density of calcaneal, lumbar vertebrae, femoral neck was measured using DEXA of Lunar company.The calcaneal bone density was measured in the area containing calcaneal side cortical bone.Significant correlations were recognized between calcaneus and weight, calcaneus and age, calcaneus and neck of femur, calcaneus and lumbar vertebrae.Significant correlation wasnot recognized between calcaneus and height.The coefficient of variation of calcaneal bone density was 0.398%.In regard to calcaneus bone density, there was a correlation with the other measurement locus.Measurements of BMD using DEXA were shown to be useful, but it is necessary to consider the infwence of weight.

Periprosthetic bone remodeling is commonly seen after total hip arthroplasty, but the remodeling pattern differs among patients even in those implanted with the same stem. Remodeling occurs mainly because of the difference in load transmitted from the stem to the femur. In this study, we evaluated the load-transfer pattern in eight female patients implanted with an anatomical stem on an individual basis by patient-specific finite element analysis that is based on pre- and postoperative computed tomography images. Load transfer was evaluated using interface stress between the stem and bone. One of eight patients demonstrated proximal dominant load transfer, while the other patients demonstrated a distal dominant pattern. The results of our biomechanical simulations reveal the differences in load-transfer pattern after surgery among patients with the same anatomical stem.

Objectives: The purpose of the current case presentation was to indicate the usefulness of long thoracic and lumbar (TL) spinal stabilization by percutaneous minimally invasive instrumentation. Materials and methods: From August 2012 to May 2013, we performed long TL spinal stabilization with VIPER 2 system (Depuy Spine, Inc., MA, US) by using a minimally invasive surgery (MIS) posterior approach in 4 patients. The first case was a 54 year old male who suffered from burst fracture of T12 (Frankel A) with brain contusion by a fall. The second case was a 68 year old male who developed incomplete paraplegia by metastatic renal cell carcinoma of T11 (Frankel C). The third case was a 79 year old male who affected Chance fracture of T12 (Frankel E) with an ankylosing spinal hyperostosis. And the fourth case was a 75 year old male who sustained pathological fracture of T8 (Frankel A) due to metastasis of prostatic carcinoma accompanied by an ankylosing spinal hyperostosis. The assessment included the clinical outcome of the patients and implant imaging evaluation. Results: Physical function was improved in all cases with quick pain relief. Mean operative time was 204 minutes. Mean estimated blood loss was 62.5 ml. In radiographic evaluation, spinal alignment was successfully maintained. One pedicle screw in case 3 cut out laterally in a pedicle-rib unit, but other pedicle screws in all cases were correctly inserted. No implant related complication was observed. And there were no conversions to open surgery. Discussion: In comparison with conventional open surgery, intraoperative blood loss, operative time, and postoperative pain were remarkably decreased in a MIS technique. Long TL spinal stabilization with a MIS technique is useful method for the patients who are desirable to avoid major surgical procedure.

Subsepsis allergica (Wissler-Fanconi syndrome) is a vary rare disease characterized by fever, exanthema amd arthralgia. A 39-years-old man with remittent fever and polyarthralgia visited our hospital in October 1994. His left knee joint and left second toe showed swelling and tenderness, but there were no signs of bone disease on Xray and MRI. Blood examination showed hyperleukocytosis with neutrophilia, hyperpositive CRP, hyperacceleration of ESR, and liver dysfunction. Exanthema with effusion appeared on his left elbow and left dorsum manus. The patient's symptoms were not remitted by antibiotics, but by steroids.In the majority of patients with these symptoms, the differential diagnosis is an infective disease, malignant tumor, collagen disease, toxic disease, and so on. This syndorome is labelled as adult Still's desease.

Regardless of advances in antibiotics and surgical treatment, bone and joint infections remain refractory diseases. We report on 5 patients treated with antibiotic impregnated PMMC beads. Subjects included 3 men and 2 women with a mean age of 49.4 years (range: 4-74 years) with an average follow-up of 4 years 1 month (range: 1 year 3 months to 7 years 4 months). We treated 3 cases of osteomyelitis and 2 cases of postoperative infections by mixing antibiotics at 3 times the maximum dose with PMMC beads, and inserted them for 3 to 11 weeks (mean 5.8 weeks). We measured the serum concentration of antibiotics after inserting the antibiotic-PMMC beads, and investigated the amount of antibiotic leaching into the surrounding tissue. All cases improved on clinical examination, and made satisfactory progress. We confirmed that the treatment of bone and joint infection by antibiotic-PMMC beads was safe ad effective.

We studied sports injuries in high school baseball players in Miyazaki prefecture via a questionnaire survey (711 players, 37 high schools). 672 players had started to play baseball before they entered high school. 515 players experienced pain when they were in elementary school or junior high school. 542 players suffered from injuries at the time of the questionnaire survey. Injuries were predoninantly elbow joint, low back, and shoulder joint. Except for pitchers, approximately 70 to 80% of the players with injuries continued training without changing their schedule. These results suggest that close contact between physicians, players, and their coaches is important in providing medical support.

Diclofenac suppository, a non-steroidal anti-inflammatory drug (NSAID), is used widely in rheumatoid arthritis (RA) patients with severe arthritic pain. As the binding percentage of diclofenac to serum proteins is high, its free (unbound) concentration after rectal administration is low. To increase temporarily the free concentration of diclofenac and to enhance its analgesic effect by inhibiting the protein binding of diclofenac, the analgesic effect of diclofenac was examined before and after the start of an inhibitor administration to RA patients with insufficient control of arthritic pain, and the protein binding capacity of diclofenac was evaluated. Binding experiments were performed by ultrafiltration, and arthritic pain was recorded by the face scale. Free fractions of diazepam and diclofenac were augmented by increasing 6-methoxy-2-naphthylacetic acid (6-MNA; the active metabolite of the NSAID nabumetone) concentrations. The free fraction of diazepam increased after the start of nabumetone administration to RA patients, and arthritic pain relief was observed. These results suggest that 6-MNA has an inhibitory effect on the protein binding of diclofenac and the free fraction of diazepam can be used to evaluate the binding capacity of diclofenac. It is considered that diclofenac suppository-nabumetone combination therapy and the method for protein binding monitoring by diazepam can positively benefit RA patients with insufficient control of arthritic pain.

Acetabular dysplasia (AD) appears to be a multi-factorial disease, which may involve both genetic and environmental factors and whose pathogenesis remains obscure. The present study aims to identify a genetic variation that might confer risk of AD. We performed whole-genome screening of a copy number variation (CNV) using a deCODE-Illumina CNV beadchip with 20 female AD patients and 131 control subjects. Subsequently, Agilent's region-targeted high-density oligonucleotide tiling microarray was used to analyze 64 female AD patients and 32 female control subjects. By sequential analyses, we found a copy number loss in 18 of 64 AD patients, but none in the 32 controls. The loss occurred within a 472 kb region on 9q22.2, which harbors the gene for Semaphorin 4D (Sema4D; 18/64 vs. 0/32, p = 4.81 × 10(-4) , OR = 25.86). We suggest that a copy number loss of the Sema4D gene region may play a role in the etiology of AD.

The objective of this study was to biomechanically determine the effect of the severity of acetabular dysplasia, number and positions of screws and type of bone graft material used on the initial fixation strength of the acetabular reinforcement ring with hook (Ganz ring) using the finite element method. Relative micromotion increased as the severity of acetabular dysplasia increased and tended to decrease as the number of screws increased, but varied according to screw placement position. Increased strength of the bone graft material led to decreased relative micromotion. Biomechanically, the Ganz ring can be placed securely using 3 screws in patients with Crowe 1 dysplasia. However, in patients with Crowe 2 or higher dysplasia, it is necessary to spread at least 4 screws across an area of good host bone.

Japan became a superaging society. We have been putting a new focus on locomotive syndrome and frailty. The prevention and treatment of locomotive syndromes, such as osteoarthritis, degenerative spondylosis, lumbar canal stenosis, osteoporosis, upper extremity diseases, rheumatoid arthritis, and many other disorders of the locomotive organs are important. Because, the locomotive syndrome results in deterioration of the exercise function and loss of mental and physical health. The aim of locomotive syndrome exercises are: to reduce pain, to restore and improve joint function. We need to take a comprehensive approach to locomotive syndrome, including lifestyle modification, muscle exercise, stretching and therapeutic exercise.

Background Recent years have seen anterior cruciate ligament (ACL) reconstruction being performed in a broad range of patients, regardless of age, sex and occupation, thanks to great advances in surgical techniques, surgical instruments and basic research. In cases of ACL reconstruction, bone-patellar tendon-bone (BTB) graft or hamstring graft are frequency used. However, potential complications associated with tunnel enlargement due to soft tissue graft such as hamstring were reported. On the other hand, an altered rotational axis resulting in significantly greater translation of the lateral compartment in the single bundle compared with double bundle ACL reconstruction was reported. Method and procedure A reconstruction procedure was modified for the ACL using a double bundle that is the combination of BTB and gracilis tendon composite autograft. Two tibial and two femoral bone tunnels are used to reconstruct two bundles of ACL; an anteromedial bundle (AMB) and a posterolateral bundle (PLB). The femoral bone tunnels are created just posterior to the resident's ridge. The tibial bone tunnels are created at the center of AM and PL tibial attachment, respectively. BTB is fixed in the AM tunnels produced on the anatomical points of tibia and femur. The gracilis graft is fixed in an anatomical PL tunnel produced. The mean width of BTB is 7 mm, since10 mm graft is sometimes not suitable for patients, especially small Asian people and females. For these patients, 10 mm graft is bigger than one third of patella tendon width. Conclusion The devised surgical procedure based on a combination of BTB and gracilis autograft is suitable reconstruction method for patients who have small or medium width of patellar tendon such as Asian people and females. This technique is also applicable to revision surgery.

The mechanism of arthritis including rheumatoid arthritis (RA) has not been clarified enough in terms of its molecular biology. However, owing to advances in techniques to produce monoclonal antibodies and genetic engineering techniques to produce recombinant proteins, targeted therapies have progressed. Tumor necrosis factor-alpha (TNF-), interleukin-1 (IL-1), interleukin-6 (IL-6), and T-cells (CD28) are representative targets, and therapies targeting them have produced epoch-making results in the treatment of RA. In this text, we report the role and effects of therapy with adrenomedullin as a novel, promising targeted therapy. Adrenomedullin (ADM) is a peptide that was discovered by the assay-based monitoring of platelet cAMP activity (Kitamura et al., 1993). This protein shows not only marked vasodilatory but also in vivo and in vitro anti-inflammatory activities (Isumi et al., 1998). To determine the efficacy of ADM in patients with RA, we researched the plasma level of ADM and its correlation with the plasma CRP level. The result showed that the plasma ADM level in patients with RA was twice that in healthy controls and strongly correlated with the blood CRP level, and the ADM level in synovial tissue in patients with RA was 3 times that in patients with osteoarthritis (Chosa et al., 2003). Then, thorough research is needed to examine whether the cultured RA synoviocytes are related to the ADM in vitro. The result showed that ADM was produced from RA synoviocytes and reduced the IL-6 level in cultured media (Fig. 5). These results suggest the close involvement of ADM in arthritis in RA. Therefore, to examine the therapeutic efficacy of intra-articular ADM injection, we injected ADM into the joint of a rabbit model of adjuvant arthritis, and confirmed the inhibition of arthritis at an early stage. These findings suggest the potentiality of ADM as a novel drug for the treatment of arthritis in RA (Okura et al., 2008).

5 THE NEW ROLE OF CHROMATIN PROTEIN HMGB2 ON ADIPOGENESIS AND ROTATOR CUFF RUPTURE Noboru Taniguchi, Hiroaki Yano, Yasuyuki Ishida, Naoki Suenaga, Etsuo Chosa, Department of Orthopaedic Surgery, Miyazaki University, Hokushin Orthopaedic Hospital Fatty degeneration is observed in the ruptured rotator cuff, but the responsible genes for this mechanism are unknown.We have reported that chromatin protein HMGB2 is highly expressed in mesenchymal stem cells (MSC) and is involved in chondrogenesis. In this study we sought to clarify the possible role of HMGB2 on adipogenesis. We established bone marrow-derived MSC from wildtype and Hmgb2-/mice and found that Hmgb2-/MSC did not differentiate to adipocyte by oil-red staining and real-time PCR. DNAmicroarray analysis showed that adipogenesis related genes such as Pparg, Ppargc1a, Fabp4, and Lpl were apparently decreased in Hmgb2-/MSC. HMGB2 was augmented during early adipogenic differentiation of 3T3L1 cells, and this differentiation was attenuated by gene knockdown for Hmgb2. These results suggest a new role of HMGB2on adipogenesis that might regulate fatty degeneration in a ruptured rotator cuff.

Background Although most idiopathic scoliosis patients subject to conservative treatment in daily clinical practice, there have been no ideal methods to evaluate the spinal flexibility for the patients who are scheduled the brace treatment. The purpose of this study was to investigate the value of hanging total spine x-ray to estimate the indicative correction angle by brace wearing in idiopathic scoliosis patients. Methods One hundred seventy-six consecutive patients with idiopathic scoliosis who were newly prescribed the Osaka Medical College (OMC) brace were studied. The study included 14 boys and 162 girls with a mean age of 13 years and 1 month. The type of curves consisted of 62 thoracic, 23 thoracolumbar, 22 lumbar, 42 double major, 14 double thoracic, and 13 triple curve pattern. We compared the Cobb angles on initial brace wearing (BA) and in hanging position (HA). Of those, 108 patients who had main thoracic curves were selected and evaluated the corrective ability of OMC brace. These subjects were divided into three groups according to the relation between BA and HA (BA < HA group, BA = HA group, and BA > HA group), and then, maturity was compared among them. Results The average Cobb angle in upright position (UA) of all cases was 31.0 ± 7.8°. The average BA and HA of all cases were 20.3 ± 9.5° and 21.1 ± 8.4°, respectively. The average chronological age was lowest in BA < HA group. And also, maturity in BA < HA group was the lowest among each of them. The rate of BA < HA cases were decreased as the Risser stage of the patients were progressed. Conclusions The use of hanging total spine x-ray served as a useful tool to estimate the degree of correction possible curve within the OMC brace for main thoracic curve in idiopathic scoliosis. Maturity had some influence on the correlation between HA and BA. Namely, in immature patients, HA tended to be larger than BA. In contrast, in mature patients, HA had a tendency to be smaller than BA. With consideration for spinal flexibility based on maturity, in mature patients, larger BA than HA may be allowed. However, in immature patients, smaller BA than HA should be aimed.

Finite element analysis (FEA) has been applied for the biomechanical analysis of acetabular dysplasia, but not for biomechanical studies of periacetabular osteotomy (PAO) or those performing analysis taking into consideration the severity of acetabular dysplasia. This study aimed to perform biomechanical evaluation of changes in stress distribution following PAO and to determine the effect of the severity of developmental dysplasia of the hip (DDH) using three-dimensional FEA.A normal model was designed with a 25° center-edge (CE) angle and a 25° vertical-center-anterior margin (VCA) angle. DDH models were designed with CE and VCA angles each of 10, 0, or -10°. Post-PAO models were created by separating each DDH model and rotating the acetabular bone fragment in the anterolateral direction so that the femoral head was covered by the acetabular bone fragment, with CE and VCA angles each at 25°.Compared to the normal hip joint model, the DDH models showed stress concentration in the acetabular edge and contacting femoral head, and higher stress values; stress increased with decreasing CE and VCA angles. Compared to the DDH models, the post-PAO models showed near-normal patterns of stress distribution in the acetabulum and femoral head, with stress concentration areas shifted from the lateral to medial sides. Stress dispersion was especially apparent in the severe acetabular dysplasia models. PAO provided greater decreases in the maximum values of von Mises stress in the load-bearing area of the acetabulum and femoral head when applied to the DDH models of higher degrees of severity, although the values increased with increasing severity of DDH.PAO is expected to provide biomechanical improvement of the hip joint and to be particularly effective in patients with severe preoperative DDH, although the results also suggested a limitation in the applicability of PAO for these patients.

The results of open reduction of the severely slipped capital femoral epiphysis are reviewed for 6 hips. All cases of acute on chronic slip achieved good clinical and radiological results. We feel that a safe anatomical reconstruction by open reduction of the epiphysis is the best way to avoid hip deformity in adolescence and prevent the development of osteoarthritis of the hip in later life. The greater incidence of avascular necrosis is probably due to damage to the blood supply of the head at the time of the acute slip or kinking of the vessels before replacement. Accordingly we have tried selective angiography of the femoral medial circumflex artery to improve treatment and postoperative rehabilitation.

The total hip replacement was carried out on 15 patients with 15 severe coxarthrosis in 135 cases at a mean follow-up of more than 1 year which were surgically treated on account of hip pain, restricted range of hip motion or activity of daily life. The surgical procedures of transferring the greater trochanter laterally or muscle release were added in only 3 cases on another sides of affected hips. Our results at an average follow-up of 2 years and 2 months were clinically and radiologically evaluated according to JOA score and 4 departments of orthopaedic surgery in Japan. All the patients who were treated with THR were satisfactory to operative results.

The aim of this study was to investigate plasma adrenomedullin (AM) and proadrenomedullin N-terminal 20 peptide (PAMP) level in patients diagnosed with early rheumatoid arthritis (RA). Furthermore, several inflammatory cytokines were measured in those patients to clarify the roles of AM and PAMP. Forty patients diagnosed with early RA (women 46 +/- 8.5 years old) and 10 healthy controls (women 57 +/- 5 years old) were studied. Plasma levels of AM, PAMP, matrix metalloprotease 3 (MMP-3), interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-alpha), and C-reactive protein (CRP) were measured using an immunoradiometric assay and enzyme-linked immunosorbent asay (ELISA) methods. The plasma levels of AM (17.5 +/- 8.4 fmol/ml) and PAMP (2.01 +/- 0.57 fmol/ml) in patients exceeded those in healthy controls (AM 8.6 +/- 1.7, PAMP 1.17 +/- 0.34 fmol/ml). Moreover, plasma AM and PAMP levels demonstrated a significantly positive correlation with plasma MMP-3 and IL-6 levels. Nevertheless, CRP and TNF-alpha levels in these patients showed no significant correlation with plasma AM and PAMP levels. These data support the possible role for AM and PAMP in the pathophysiology of early RA.

Endoplasmic reticulum (ER) stress response is important for protein maturation in the ER. Some murine models for bone diseases have provided significant insight into the possibility that pathogenesis of osteoporosis is related to ER stress response of osteoblasts. We examined a possible correlation between osteoporosis and ER stress response. Bone specimens from 8 osteoporosis patients and 8 disease-controls were used for immunohistochemical analysis. We found that ER molecular chaperones, such as BiP (immunoglobulin heavy-chain binding protein) and PDI (protein-disulfide isomerase) are down-regulated in osteoblasts from osteoporosis patients. Based on this result, we hypothesized that up-regulation of ER molecular chaperones in osteoblasts could restore decreased bone formation in osteoporosis. Therefore, we investigated whether treatment of murine model for osteoporosis with BIX (BiP inducer X), selective inducer BiP, could prevent bone loss. We found that oral administration of BIX effectively improves decline in bone formation through the activation of folding and secretion of bone matrix proteins. Considering these results together, BIX may be a potential therapeutic agent for the prevention of bone loss in osteoporosis patients.

Fibrous dysplasia of the femoral neck is a serious clinical problem because structural stability is destroyed.We experienced treating four patients with monostotic fibrous dysplasia of the femoral neck. One of the patients was male and three were female, whose ages were 16 to 41 years. Two patients were treated with curettage of lesions of fibrous dysplasia and autogenous cancellous bone-grafting, together with vascular bundle transpla ntation. One patient was treated with curettage and cortical bone-grafting, and the other with corrective osteotomy for coxa vara after a pathological fracture.In the treatment of symptomatic fibrous dysplasia several surgical approaches have been uesd with varying success. Curettage and autogenous cancellous bone-grafting are used primarily as a means of filling small defects and inducing bone formation. But radical excision is being abandoned, since it is now recognized that removal of all dysplastic tissue is not needed to achieve a satisfactory result. So autogenous cortical bone is chosen for reconstructing large defects that require strength and is used primarily as supporting struts. When a symptomatic deformity is continued, corrective osteotomy is indicated to obtain normal biomechanical values of the hip.Our treatment plans are as follows;1) prevention of deformity and fracture2) corrective osteotomy for a symptomatic deformity

The cause of osteochondritis dissecans of the hip is unknown. We examined the etiology based on the analysis of 6 cases, aged 11 to 25 years. Of these 6 cases, five patients had history of LCC and one had dysplasia.All X-ray revealed a dysplasia, deformity of the femoral head and a lesion in the weight bearing area. The patients made favorable progress after the spherical acetabular osteotomy in expectation of reparing the lesion. Therefore, osteochondritis dissecans seems to be caused by the disturbance of the healing biomechanism, because the overloaded forces are concentrated on an affected area of the femoral head adding to a vasucular disturbance and a repeated minor trauma.

Introduction Adrenomedullin is a potent vasodilatory and hypotensive peptide as well as an endogenous immunomodulatory factor with predominantly anti-inflammatory effects. The purpose of the present study was to evaluate the therapeutic effects of adrenomedullin in rabbits with antigen-induced arthritis, an experimental model of rheumatoid arthritis. Methods Following the induction of arthritis in both knee joints by ovalbumin injection into the joint spaces of pre-immunized rabbits, increasing daily doses of adrenomedullin were injected into the knee joint spaces or saline was injected into the contralateral knee joint spaces as the control. For time-course experiments, adrenomedullin and saline were injected into the knee joint spaces daily for 7 days and 20 days. The degree of joint swelling and the histological change in the knee joints injected with adrenomedullin were compared with the control knee joints. Histological evaluation of the infrapatellar fat pads and synovial tissue was performed. TNFα, IL-6, vascular endothelial growth factor and transforming growth factor-beta mRNA levels in the synovial tissue were measured using real-time quantitative PCR. Results Daily injections of adrenomedullin into the knee joint spaces of rabbits with antigen-induced arthritis decreased joint swelling. Histological examination revealed that adrenomedullin reduced edematous changes and the infiltration of inflammatory cells in the synovial tissues. Analysis of mRNA levels showed that adrenomedullin significantly reduced TNFα mRNA expression by 21% to 49% in a dose-dependent manner, and dose-dependently increased IL-6 mRNA expression by 45% to 121%. Conclusions These results suggest that daily injections of adrenomedullin into the knee joint spaces of rabbits with antigen-induced arthritis ameliorated the inflammatory response in arthritic joints. Adrenomedullin may thus be useful as a treatment for rheumatoid arthritis; however, the effect of adrenomedullin on IL-6 production in the synovial tissue may be an undesirable adverse effect in rheumatoid arthritis therapy.