Mako Hirano

Arthrotomy followed by Open Wound and Early Motion Exercise in Septic Arthritis of the Shoulder.

We report a case of septic arthritis of the shoulder joint treated by arthrotomy followed by open wound and early motion exercie. The patient was a 55-year-old male taxi driver. The infecting organism was methicillin-resistant staphylococcus aureus. At first he was treated by arthroscopic debridment which had no effect. Then we performed arthrotomy followed by open wound and early motion exercise. This open wound method was successful for infection. Concomitant antibiotics were administrated. We think arthrotomy followed by open wound and early motion exercise is a useful method for treating arthritis of the shoulder.

Critical Path in Rotator Cuff Tear

We applied critical path to rotator cuff tears. At the introduction of the path, we decided the criteria for discharge. The criteria were the removal of shoulder abduction brace and the activity level of patients for face-washing and eating. At the programming of the critical path, we improved the process in our hospital. After anesthesia, patients remained asleep for 6 hours, and antibiotics administration stopped 2 days after surgery. The surgical wounds were fixed with tape so that the thread did not need to be removed.We examined the patients who were 8 before and 9 after introduction of critical path. We examined the duration of brace use, average number of days of hospital stay, and JOA score.After the introduction of the critical path, the duration of wearing brace use and average number of days in the hospital became shorter. Doctors, nurses, and patients were all satisfied with the critical path.

Non-collar Fixation and Early Ambulation after Cervical Laminoplasty

We have been trying non-collar fixation and early ambulation after cervical laminoplasty since July 1998.The aim of this report is to evaluate this postoperative physical treatment.In the radiological evaluation, the range of motion of the neck after operation was more or less the same as before operation.This group did not complain of post operative neck pain and showed no complications.The course of postoperative rehabilitation without collar fixation was shorter than traditional rehabilitation.

Inconsistency between Preoperative and Postoperative Correction Angles in High Tibial Osteotomy

This study was performed to assess the accuracy of the operative correction angle in high tibial osteotomy and consider the possible causes for inconsistency between the preoperative and post operative correction the angles.We studied 40 knees in 31 cases (9 males and 22 females) treated by high tibial osteotomy between 1996 and 1998. The mean age was 66.2 years (45 to 81). We used five kirschner wires (∅ 1.8mm as the osteotomy guide, inserted them roentgenographically and performed interlocking wedge osteotomy. Preoperative and postoperative correction angles were measured and the postoperative correction angle was subtracted preoperatively. The inconsistency between the preoperative and postoperative correction angles was within ±2° in 31 knees (77.5%), +3° in 5 knees (12.5%), +4° in 2 knees (5.0%), +5° in 1 knee (2.5%), and -4° in 1 knee (2.5%). Satisfactory results were obtained in a majority of the patients.High tibial osteotomy requires operative technique taking into consideration inconsistency between the preoperative and postoperative correction angles.

Effects of Argatroban on Patients with Lumbar Canal Stenosis

The purpose of this study is to estimate the effects of the drip infusion therapy with argatroban and its sustenance.14 patients who had failed conservative treatment were administered argatroban (20mg/day) for 2 weeks. 12 patients showed some improvements in their symptoms following this treatment. No patients worsened. The mean JOA score significantly improved from 12.9 points to 19.4 points. Most subjective symptoms showed significant improvement, but not objective symptoms. 5 patients had continuous improvements for more than a mean of 17.8 months, but 4 patients showed recurrence after a mean follow-up of 3.7 months.These results suggest that drip infusion therapy with argatroban is recommended for lumbar spinal canal stenosis.

Non-Surgical Treatment of Full Thickness Tears of the Rotator Cuff

We report on the results of non-surgical management of 7 patients with full-thickness tears of the rotator cuff proven by arthrographic examination. Average age at first examination was 62.4 years. Patients were evaluated twice; average follow up year at first examination was 2.1 years and at second examination was 6.2 years. All patients were reviewed by direct examination at the time of final follow-up. Patients were evaluated-according to their JOA score. Pain, ADL, Angle of elevation and internal rotation scores were all improved and the mean JOA total score improved with time. At the first follow-up, muscle strength had worsened but at the last evaluation the average muscle strength score was higher than on first examination. This result is almost the same as the result found in the previous questionnaire study. Direct examination revealed that conservative treatment produces satisfactory results when given to patients who have a reasonable JOA score when first examined.

A Study of the Hypermobile Meniscus

We made a clinial study of 15 patients (16 knees) with hypermobile menisci. The mean age of patients was 16.3 years, ranging from 13 to 22 years. Three patients were male and 12 were female. All menisci were affected on the lateral side.McMurray test was positive in 87.5%, but the Apley test was only positive in 12.5%. These were considered to be characteristic findings. Arthroscopic partial meniscectomy was performed in 4 patients (4 knees), arthroscopic meniscoresis in 5 patients (5 knees), and 6 patients (7 knees) were treated conservatively. In principle conservative treatment is the treatment of choice for hypermobile menisci. Surgical treatment should be done only for cases with significant meniscal lesions and a long history.

Arthroscopic Debridement for Lateral Type Gonarthrosis

Between 1989 and 1991, we performed arthroscopic debridement for 10 patients (12 joints) with lateral type gonarthrosis. Fibrillation of chondral-bone was seen in 7 joints, erosion in 3 joints and large chondral-bone loss in 2 joints. Six of the 12 joints had a degenerative tear of the lateral discoid and the rest had severe degenerative tears of the lateral meniscus. All joints had a partial menisectomy with 2 joints additionally requiring drilling for chondral bone ulceration. Clinical evaluation was made using the Japanese Orthopaedic Assosiation (JOA score) criteria, with good results obtained. (Average score improved from 86.7±5.1 to 97.9±6.9, and the mean follow-up period was 30.0 months)

Treatment of Hypermobile Meniscus

Eleven patients (14 joints) of hypermobile meniscus were treated in our hospital in the last 6 years approximately. Their mean age was 16 years with a range from 13 to 22 years, and 4 patients were male and 7 patients were female. An affected side of meniscus was all lateral. Only 3 patients had traumatic episode on the knee joint. Giving way was seen in all patients but locking was seen in only one patient. McMurray test was positive in the majority of patients, but Apley test was positive in only one patient.The tendency of general joint laxity was seen in 6 patients (3 patients showed involvement in bilateral knee joints). These were considered to be characteristic findings and one of the geneses of hypermobile meniscus.Arthroscopic partial meniscectomy was performed in 6 patients (8 joints) and arthroscopic meniscoresis in 5 patients (5 joints). These results were more satisfactory in the cases of arthroscopic meniscoresis than the cases of arthroscopic meniscectomy. So, arthroscopic meniscoresis should be chosen in the case of hypermobile meniscus requiring surgery.

Clinical Results of Arthroscopic Lateral Release for Subluxation Syndrome of the Patella

From July 1983 to August 1986, arthroscopic lateral release was performed in sixteen patients (sixteen Rnees) of subluxation syndfrome of the patella. Their mean age at the time of operation was 20.1 years with a range from 12 to 20 years. Eight patients had osteochondral fracture of the patellar medial facet. Fragments of all patients were removed arthroscopically.Fifteen patients were available for follow up. The follow up interval ranged from three months to three years and four months (mean, 12.7 months).Roentgenographycal results were satisfactory in all patients, but clinical results were unsatisfactory in two patients (follow up interval of one patient was seven months and another was eight months). These patients were unable to play sports at the time of follow up.Arthroscopic findings of these patients showed more remarkable changes of chondromalacia patellae than those of other patients, and physiological findings showed remarkable genu valgum, and roentgenographycal findings showed remarkable dysplasia of the patellar groove.