Kenji Takenouchi

Recent trends in orthopedic surgery performed in Japan for rheumatoid arthritis

The aim of this report was to review the use of orthopedic surgeries performed to manage rheumatoid arthritis (RA). Our review of studies published in English indicates that there has been a decrease in RA-associated surgeries in Western countries. Improvements in medical treatment may partly explain the reduction in numbers of orthopedic joint surgeries, which also suggests a worldwide trend toward improved long-term outcomes. However, the results of our multicenter study in Japan indicate that the number of RA-associated operations has not decreased, and that the numbers of operations performed annually have been relatively stable from 1998 to 2008. Although there definitely has been a decline in the numbers of synovectomy surgeries, the numbers of operations on the upper limbs and foot arthroplasties have increased. With the trend toward milder disease because of improved medical treatment, we speculate that RA patients may want and need better function for the activities of daily living. The combination of medical treatment and surgical intervention is thought to improve outcomes in RA patients who will develop joint destruction. Additional studies, including analyses of RA databases containing long-term data on a variety of surgical interventions, are needed.

A modified Hohmann method for hallux valgus and telescoping osteotomy for lesser toe deformities in patients with rheumatoid arthritis

To preserve the function of metatarsophalangeal joints and to ensure forefoot stability in patients with rheumatoid arthritis (RA), we performed a modified Hohmann method for hallux valgus (HV) and telescoping osteotomy of lesser toe deformities instead of fusion of HV or resection of all metatarsal heads. From October 1995 through March 2001, 47 RA patients (90 feet) with severe HV and forefoot deformities were examined. The indication for the procedure in all the patients was disabling foot pain secondary to intractable plantar callosities below the lesser metatarsal heads, painful HV deformities, and the severe deviation of the sesamoid complex diagnosed by the basis of X-ray images. The HV and intermetatarsal (M1M2 and M1M5) angles and sesamoid complex were measured on the preoperative and postoperative roentgenograms. According to the results of a questionnaire survey, the patients were divided into three groups using the visual analogue scale; group 1: satisfied, group 2: fair and or no pain, group 3: dissatisfied. HV and M1M2 angles significantly improved compared between pre- and postoperative or preoperative and the follow-up periods. Out of the 47 patients, 78.9% were satisfied with the results of the operation and 8.9% were dissatisfied. Of these patients, 12.2% reported fair results. There were several complications, such as painful callosity, which was recurrent in seven feet, and delayed wound healing was observed in two out of 90 feet. A modified Hohmann method and abductor hallucis correction are effective in relieving pain and ensuring the bony union of the great toe in spite of severe osteoporosis.

Pseudotumor and deep venous thrombosis due to crevice corrosion of the head-neck junction in metal-on-polyethylene total hip arthroplasty

After the implantation of metal-on-metal hip prostheses, pseudotumors or soft-tissue reactions—so-called adverse local tissue reactions (ALTRs)—have frequently been reported [1–7]. However, there are limited reports on the development of a pseudotumor due to crevice corrosion after insertion of a metal-on-polyethylene hip prosthesis. Here we describe a case of pseudotumor and deep venous thrombosis (DVT) causing persistent left hip pain as a result of crevice corrosion of the head–neck junction that required revision surgery in a metal-on-polyethylene hip prosthesis.

Proteomic analysis of bone marrow-adherent cells in rheumatoid arthritis and osteoarthritis.

To elucidate the pathophysiology of rheumatoid arthritis (RA) as well as osteoarthritis (OA), we analyzed protein profiles of bone marrow‐derived adherent cells (BMACs) from patients with these diseases.

Serum KL‑6 Elevation and Possible Pulmonary Involvement in Patients with Rheumatoid Arthritis Treated with Biological Agents

BACKGROUNDS Interstitial lung disease (ILD) is associated with rheumatoid arthritis (RA) itself and is also induced by biological and non-biological disease-modifying antirheumatic drugs. The glycoprotein Krebs von den Lungen-6 (KL-6) is reported to be a marker for the activity of ILD. OBJECTIVES To elucidate the relationship between serum KL-6 levels in patients with RA treated with biological agents and pulmonary involvement on computed tomography of the chest. METHODS The subjects were 307 patients with RA treated with infliximab, etanercept, adalimumab, or tocilizumab. Medical records were reviewed to investigate serum KL-6 levels, disease activity, and pulmonary imaging findings. RESULTS Levels of KL-6 were abnormally elevated in 25 patients (8.1%): 15 patients (11.2%) treated with infliximab, 6 patients (4.4%) treated with etanercept, and 4 patients (22.2%) treated with adalimumab, but in no patients treated with tocilizumab. However, no clinical pulmonary events developed. Computed tomography of the chest showed the start or progression of interstitial fibrotic change in 5 of 25 (20%) patients with abnormal KL-6 values. The changes in disease activity did not differ significantly between patients who showed elevated KL-6 values and those who did not. CONCLUSIONS Serum KL-6 levels were elevated in 8.1% of patients with RA treated with biological agents. Careful observation is necessary for these patients regarding lung fibrosis.