Ko Kato

EFFECT OF TOURNIQUET APPLICATION ON DEEP VEIN THROMBOSIS AFTER TOTAL KNEE ARTHROPLASTY

IntroductionThere is a great deal of controversy about the effect of tourniquets on development of deep vein thrombosis (DVT) after total knee arthroplasty (TKA).Patients and methodsWe investigated the incidence of postoperative DVT after TKA with or without the use of a tourniquet. The patients were 48 consecutive patients undergoing primary ipsilateral cemented TKA for osteoarthritis. Group A (21 patients) underwent the operation without a tourniquet, and Group B (27 patients) underwent the operation with a tourniquet. Ultrasonography to assess DVT was performed before and after the operation.ResultsGroup B had less intraoperative and total blood loss than Group A. Postoperative DVT was detected in 81.3% of all cases, and symptomatic pulmonary embolism occurred in 1.7%. Most of DVT was found in the calf vein. There was no significant difference in the incidence of postoperative DVT between the two groups.ConclusionWe conclude that the use of a tourniquet is beneficial, because it decreases perioperative blood loss and does not increase the risk of DVT. The incidence of DVT after TKA is considerably high with or without use of a tourniquet. Therefore, prevention and early detection of DVT are important for prevention of fatal pulmonary thromboembolism.

Human osteosarcoma-derived cell lines produce soluble factor(s) that induces differentiation of blood monocytes to osteoclast-like cells

When monocytes were cocultured with human osteosarcoma-derived cells (HOS cells), multinucleated giant cell formation of monocytes was induced. Intriguingly, even when a filter was interposed between monocytes and HOS cells, polykaryocytes also appeared. The multinucleated giant cells have characters similar to osteoclast-like cells. These findings indicate that soluble factor(s) secreted from HOS cells play an important role in polykaryocyte formation from monocytes. Twelve cloned cells were established from HSOS-1 cells and their capacities of inducing osteoclasts were investigated. Three cloned cells inducing nos. 4 and 9 had an ability of inducing osteoclasts (multinucleated giant cells, TRAP, calcitonin receptor and c-src mRNAs, osteoresorbing activity), and three cells, including nos. 1 and 5, did not show the ability. HOS cells and the cloned cells expressed several cytokine mRNAs. M-CSF was detected in the culture fluids of HOS cells, which also expressed RANK and RANK/ODF/OPGL mRNAs. Intriguingly, HOS cells secreting a soluble osteoclast inducing factors(s) expressed TNF-alpha converting enzyme mRNA. Furthermore, OCIF/OPG inhibited HOS cell-induced osteoclastogenesis and soluble RANKL could be detected in the culture fluids of HOS cells expressing TACE, suggesting that one of soluble osteoclast-inducing factor(s) is soluble RANKL. When blood monocytes were indirectly cocultured with HSOS-1 cells or cloned no. 9 cells in the presence of OCIF for 14 days, HOS cell-mediated osteoclastogenesis was suppressed, indicating that RANK-RANKL system is involved in the HOS cell-mediated osteoclastogenesis.

Functional Recovery of the Donor Knee After Autologous Osteochondral Transplantation for Capitellar Osteochondritis Dissecans

Background: Osteochondral autograft transplantation has been advocated to treat severe osteochondritis dissecans of the humeral capitellum in throwing athletes to reproduce the normal hyaline cartilage and achieve long-term elbow function. Although some authors have reported good outcomes, the current authors are concerned about functional recovery of the donor knee after osteochondral grafts have been harvested. Purpose: The present prospective study analyzed functional recovery of the donor knee after osteochondral graft harvest. Study Design: Case series; Level of evidence, 4. Methods: Twelve male patients (average age at surgery, 14.4 years) had severe osteochondritis dissecans of the humeral capitellum treated with osteochondral autograft transplantation from the contralateral knee joint. The donor knee of each patient was assessed for pain (visual analog scale), joint effusion, Lysholm score, radiographic findings, and muscle strength (60 and 180 deg/sec). Results: At 3 months after surgery, 10 patients were pain-free (visual analog scale score, 0); none had knee joint effusion; and 10 gained 100 points in the Lysholm score. However, muscle power (60 deg/sec) of the knee extensor revealed 8 patients with reduced muscle strength at 3 months compared with the preoperative level, although 11 patients reached preoperative knee extensor muscle strength at 12 months. Radiographic findings at 24 months showed that none of the patients had knee osteoarthritis. Conclusion: A time lag was evident in recovery between postoperative symptoms and muscle power at 3 months. However, harvesting osteochondral grafts did not exert adverse effects on donor knee function in young athletes at 2 years after undergoing osteochondral autograft transplantation for capitellar osteochondritis dissecans.

Osteoporosis, vertebral fractures and mortality in a Japanese rural community

Abstract Objectives. The present study aims to determine the relationship between osteoporosis (OP), vertebral fracture (VF) and mortality. Methods. We followed up 1024 residents of Miyagawa village every 2 years for a mean of 8.4 years between 1997 and 2009. The residents were assessed every 2 years. We defined OP as T scores for bone mineral density that were < 2.5 standard deviations below peak bone mass. VF was assessed by lateral radiography of the thoracic and lumbar spine. The participants were allocated as follows depending on the presence or absence of OP and VF: with OP and without VF (OP group), with VF and without OP (VF group), with OP and VF (OP + VF group) and without OP and VF (Control group). We determined survival/mortality rates until 2011 by reviewing medical histories and death certificates. Results. By 2011, 304 participants had died. The respective 5-year survival rates for the OP + VF, OP, VF and Control groups were 80.6%, 93.7%, 87.8% and 94.2%. Mortality rates were significantly worse for the OP + VF group than the Control group (OP + VF Hazard Ratio: 1.89; 95% CI, 1.27–2.77). Conclusion. Prevention of osteoporotic VF in elderly persons is very important from the viewpoint of increasing life expectancy.

The adverse effect of an unplanned surgical excision of foot soft tissue sarcoma

BackgroundMalignant soft tissue tumors of the foot are extremely rare and thus can be prematurely excised without appropriate preoperative evaluation. The present study compares adverse effects between unplanned and planned surgical excisions.MethodsWe retrospectively reviewed the clinical records, radiographs, pathology reports and pathological specimens of 14 consecutive patients with soft tissue sarcoma of the foot among 592 with sarcomas between 1973 and 2009. We then compared the incidence and clinical outcomes after unplanned (UT; n = 5) and planned (PT; n = 9) surgical excisions of foot sarcomas.ResultsThe most frequent diagnosis was synovial sarcoma (n = 4; 28.6%). The overall 5-year survival rates of the PT and UT groups were 65.6% and 60.0%, respectively, and the event-free 5-year survival rates were 63.5% and 40.0%, respectively. Event-free and overall survival rates did not significantly differ between the two groups. However, tumors were significantly larger in the PT group than in the UT group (p < 0.05).ConclusionsUnplanned resection lead to a relatively worse prognosis and a likelihood of recurrence despite additional resections. We recommend that soft tumors of the foot should only be excised after appropriate preoperative evaluation regardless of the size of the tumor.

Recurrent knee valgus deformity in Ellis-van Creveld syndrome.

We report a case of recurrent knee valgus deformity in a patient with Ellis-van Creveld syndrome. Varus osteotomy, distraction osteogenesis, or epiphyseal stapling is one treatment option for valgus malalignment to improve appearance, gait, and function. However, surgical correction of valgus knee deformity by varus osteotomies of the proximal tibia was not maintained postoperatively, necessitating additional varus osteotomies of the distal femur in this case. The main cause of recurrence was attributed to large bony defect of the anterior segment of the proximal tibia, in addition to depression of the lateral tibial plateau.

Vascular safety during arthroscopic all-inside meniscus suture

AbstractPurpose The purpose of the study is to assess the orientation and distance of the popliteal artery (PA) from both the anteromedial and anterolateral portals. MethodsThe records of 97 patients (100 knees) who underwent knee arthroscopy were reviewed. The shortest distance from the posterior tibial cortex to the PA on the lines from both the medial and lateral borders of the patellar tendon to the PA was evaluated by magnetic resonance imaging at full knee extension. The figure-of-four position was compared between patients with intact and deficient anterior cruciate ligaments (ACLs). The shortest distances from the posterior cruciate ligament (PCL) to the lines running from the medial and lateral borders of the patellar tendon to the PA were also measured.ResultsThe shortest distances from the posterior tibial cortex to the PA were significantly longer in the figure-of-four position than at full knee extension and during extension in the ACL-deficient than intact group. Distances did not significantly differ in the figure-of-four position. The PA was hidden from the anteromedial portal by the PCL, but remained vulnerable from the anterolateral portal.ConclusionsAll-inside meniscus suturing of the posterior horn of the lateral meniscus inserted through the anteromedial portal is safer when the knee is in the figure-of-four position than fully extended. Meniscus repairs should be completed before ACL reconstruction due to vascular positions and the ease of approach.Level of evidenceProspective correlation study, Level IV.

Bilateral subchondral insufficiency fracture of the femoral head.

Subchondral insufficiency fracture of the femoral head is a rarely reported lesion, often confused with osteonecrosis, transient osteoporosis of the hip, or rapidly destructive coxarthrosis. However, almost all the previous reports about this lesion have documented unilateral cases. We report the clinical and histological features of bilateral subchondral insufficiency fracture of the femoral head in a 68-year-old woman. She reported a sudden pain in her left hip without apparent trauma. An anteroposterior radiograph 2 weeks after the onset of pain in the left hip shows a subchondral collapse of the femoral head. The entire femoral head was depicted as a low intensity area on a T1-weighted image, and there was a subchondral linear pattern of low signal intensity with a convex shape to the articular surface. On T2-weighted image, the entire femoral head was depicted as a high intensity area, and on T1-weighted image, a linear low signal intensity pattern was noted. The patient underwent hemiarthroplasty. Cross-section of the femoral head showed a fracture line identified in the subchondral area. Although the patients postoperative course was favorable, she had idiopathic pain in the right hip. A lateral radiograph 3 weeks after the onset of pain in the right hip shows irregularity at the surface of the femoral head. Cross-section of the right femoral head showed a concave fracture line in the subchondral bone. Based on these findings, bilateral subchondral insufficiency fracture of the femoral head was diagnosed.

Arthroscopically assisted minimally invasive plate osteosynthesis for posterior fracture–dislocation of the shoulder

Proximal humeral fractures are becoming increasingly common, and treatment of displaced proximal humeral fractures remains a challenge. Minimally invasive plate osteosynthesis (MIPO), which provides early functional recovery, is a promising treatment option for proximal humeral fractures [1]. We report a patient with posterior fracture–dislocation of the shoulder who was successfully treated with arthroscopic reduction and plate fixation via a minimally invasive approach.

Intradural squamous cell carcinoma in the sacrum

BackgroundLeptomeningeal carcinomatosis occurs in patients with cancer at the rate of approximately 5%; it develops particularly in patients with breast cancer, lung cancer, melanoma, leukemia, or malignant lymphoma. We describe a rare case of leptomeningeal carcinomatosis in which spinal intradural squamous cell carcinoma with no lesions in the cerebral meninges and leptomeninx, was the primary lesion.MethodsA 64-year-old man complained of sacral pain. Although the patient was treated with analgesics, epidural block and nerve root block, sacral pain persisted. Since acute urinary retention occurred, he was operated on. The patient was diagnosed as having an intradural squamous cell carcinoma of unknown origin.ResultsSince the patient presented with a slightly decreased level of consciousness 2 months after surgery, he was subjected to MRI scanning of the brain and spinal cord, which revealed disseminated lesions in the medulla oblongata. The patient died of pneumonia and sepsis caused by methicillin-resistant Staphylococcus aureus 5 months after surgery.ConclusionWe report the first case of a patient with intradural squamous cell carcinoma with unknown origin that developed independently in the sacrum.