Hideto Harada

Anatomical study for SLAP lesion repair.

PurposeThe purpose of this study was to meticulously observe the structures around the origin of the long head of the biceps tendon (LHB) in order to propose a method of anatomical superior labrum anterior and posterior repair.MethodsTwenty-eight shoulders of 16 cadavers with intact LHB origin were macroscopically investigated. Among them, 20 shoulders with an intact superior labrum were additionally observed, to determine whether the anterior edge of LHB on the labrum (point ‘A’) was anterior to the supraglenoid tubercle. Serial sections vertical to LHB were observed using ordinary light and polarized microscopy in three glenoids and scanning acoustic microscopy in one.ResultsThe labrum had a meniscal appearance, and no LHB fibre was sent anterior to the anterior edge of the supraglenoid tubercle. ‘A’ was not located more posterior than the supraglenoid tubercle. All specimens had the so-called ‘the sheet-like structure’, in which the portion closer to the LHB origin tends to be stiffer. Fibres of the sheet-like structure ran vertically to LHB.ConclusionFibre orientation and the stiffness of the sheet-like structure suggest its support of LHB. As LHB fibres do not anteriorly cross over ‘A’, ‘A’ could be a landmark for the anterior border of LHB, independent from the sheet-like structure. Considering a previous report mentioning that the horizontal mattress suture maintains the meniscus-like structure which might be sufficient for proper motion of the normal superior labrum, the horizontal mattress suture not crossing over ‘A’ should be recommended from the viewpoint of functional anatomy.

A case report of idiopathic iliopsoas hematoma which occurred soon after transfer to the wheelchair after total hip arthroplasty

ABSTRACT A 79-year-old woman was diagnosed with osteoarthritis of the left hip and scheduled for total hip arthroplasty. As two lesions were detected in branches of the coronary arteries, she was treated with catheter treatment. The patient was receiving anticoagulant treatment, which was suspended eight days before the operation; however, heparin was started at 6 days before the operation and was stopped 9 hours before the operation. On the 2nd postoperative day soon after transfer to the wheel chair, she was feeling unwell and was suffering from severe pain in her left buttock and left thigh. Her blood pressure had decreased to 70 mmHg. During abdominal contrast-enhanced CT, a hematoma was detected in the left iliopsoas muscle. Catheter therapy was started by the cardiovascular department and bleeding had stopped spontaneously. The patient was able to walk with a cane and was discharged on the 40th postoperative day. Abbreviations: THA: total hip arthroplasty, CT: computed tomography, JOA score: Japanese Orthopaedic Association hip score, HA: hydroxyapatite, PMMA: polymethyl-methacrylate, APTT: activated partial thromboplastin time

A Novel Antero-Medial Cortical Window Technique for Removal of Well-Fixed Fully Porous Stem in Revision Total Hip Arthroplasty

Fully porous-coated cementless stem has the advantage of good initial metaphyseal to diaphysial fixation. However, it is very difficult to remove the stem when complications develop. Extraction of a stem may cause huge damage to the femur. A long stem may be required to ensure stability for subsequent femoral reconstruction. Here we present a case employing a novel technique of minimizing invasion to the femur when a wellfixed, extensively porous-coated cementless stem needs to be removed. A 58-year-old woman had a revision total hip arthroplasty for trunnionosis after the left total hip arthroplasty. In the operation we made two cortical windows to the femur. It enabled us to reach all circumferences of the stem. By this technique the stem could be easily removed and the femoral canal structure was preserved. The femur could then be reconstructed with a stem of normal length. The Anatomic Medullary Locking (AML) stem is a representative implant of a fully porous-coated cementless stem that brings out the problems of trunnionosis which leads to adverse reaction to metal debris and stem neck fracture. Revision total hip arthroplasty is on the increase because of these complications. It is considered that our technique is useful in such cases.