Satomi Abe

The impact of the leg-lengthening total hip arthroplasty on the coronal alignment of the spine

BackgroundCoronal imbalance of the pelvis is recognized to lead to the development of degenerative lumbar scoliosis. We hypothesized that an abrupt change of pelvic obliquity may show a reproducible trend of coronal compensation in the lumbosacral spine. The aim of the study was to classify the change of coronal alignment of spine after THA.MethodsThis is a retrospective study based on the radiological analysis of 195 patients who underwent THA between 2009 and 2010. The mean age at surgery was 61.5 years old, and minimum follow up period was 24 months. Pelvic obliquity (POb) and Cobb’s angle of lumbar scoliosis (LS) in coronal plane were measured. Over 3.5 degrees of change in POb was regarded as ΔPOb(+) and over 10 degrees of lumbar scoliosis was regarded as LS(+). The change of LS were classified into 3 subtypes; ΔLS(+), over 5 degrees of progress in LS, ΔLS(-), over 5 degrees of improvement in LS, and ΔLS(n), changes in LS within 5 degrees.ResultsOver 3.5 degrees of change in POb was significantly correlated with the change in LS. Among195 patients, 120 patients improved their pelvic obliquity (ΔPOb(+)), and 75 patients did not have an improved pelvic obliquity (ΔPOb(-)). 99 patients out of 120 ΔPOb(+) patients did not show changes (54, ΔLS(n)) or improvement in scoliosis (45, ΔLS(-)).The remaining 21 patients showed progress or development of de novo scoliosis. Patients who failed to compensate for the POb change at lumbosacral area developed de novo lumbar scoliosis (7 cases), showed progression in lumbar scoliosis (7 cases) or developed coronal trunk shift over 20mm (7 cases)ConclusionsThe patterns of compensation in lumbar or lumbosacral spine in coronal plane after leg lengthening THA were classified with regards to pelvic obliquity and Cobb’s angle. 89.2% of 195 patients showed acceptable compensation in lumbar spine, 21 patients developed coronal imbalance. THA therefore is considered to be safe, as regards to spinal balance in coronal plane. However we have to keep in mind that preoperative rigid scoliosis could have a risk in progress for spinal imbalance.

Using the transverse acetabular ligament as a landmark for acetabular anteversion: an intra-operative measurement.

Purpose. To measure the transverse acetabular ligament (TAL) anteversion in hips with severe deformity, using fluoroscopy–computed tomographic navigation. Methods. 31 hips in 10 men and 19 women aged 40 to 78 (mean, 58.7) years who underwent total hip arthroplasty for primary osteoarthritis (n=6) or osteoarthritis secondary to developmental hip dysplasia (n=19) or congenital hip dislocation (n=6) were included. The severity of hip dislocation was classified according to the Crowe classification; 15 hips were grade 1, 7 were grade 2, 3 were grade 3, and 6 were grade 4. The TAL anteversion was measured using fluoroscopy–computed tomographic navigation. The difference in TAL anteversion between non-dislocated hips (Crowe grade 1, n=15) and dislocated hips (Crowe grades 2–4, n=16) was compared. Results. In all 31 hips, the TAL could be visualised intra-operatively. No patient reported severe pain, early wear, loosening, or dislocation after 2 years. The mean TAL anteversion and inclination angles measured by the navigation system were 26.5° (SD, 8.9°; range, 8°–42°) and 41.5° (SD, 4.6°; range, 32°–49°), respectively. 22 of the 31 hips were in the safe zone. TAL anteversion in non-dislocated and dislocated hips was not significantly different. Inter- and intra-observer mean absolute differences in TAL anteversion were 0.3° and 0.4°, respectively. Conclusion. The TAL is a useful anatomic landmark for total hip arthroplasty in dislocated hips.

Alloreactivity and immunosuppressive properties of articular chondrocytes from osteoarthritic cartilage.

Purpose To determine whether articular chondrocytes derived from osteoarthritic knee joints could evoke alloreactive proliferation of peripheral blood mononuclear cells (PBMC) and inhibit mitogenic activity of polyclonally activated CD4+ major histocompatibility complex (MHC) class II–restricted T cells in vitro. Methods Osteoarthritic cartilages of 17 patients aged 61 to 85 years were harvested during total knee arthroplasty. Chondrocytes were cultured for experiments. PBMCs, CD4+ T cells, CD8+ T cells, and CD14+ monocytes from healthy subjects were also used. To investigate the allogeneic response and immunosuppressive properties of chondrocytes, assays for one-way mixed lymphocyte reaction (MLR), apoptosis, activated CD4+ T-cell proliferation, and cytotoxic CD8+ T-cells were performed. Chondrocyte cell-surface antigens were examined using flow cytometry. Results Chondrocytes failed to trigger an allogeneic PBMC reaction and did not induce apoptosis of allogeneic PBMCs in the MLR assay. Chondrocytes inhibited the proliferation of polyclonally activated CD4+ T cells via cell-cell contact and escaped the allogeneic cytotoxic reactivity of CD8+ T cells. Chondrocytes expressed MHC class I but not MHC class II molecules or B7-1/-2-positive co-stimulatory molecules. Conclusion Chondrocytes from osteoarthritic knees in older patients exhibited similar immunomodulatory properties in vitro to those in juveniles or adults.

Successful limb salvage through staged bypass combined with free gracilis muscle transfer for critical limb ischemia with osteomyelitis after failed endovascular therapy

BackgroundCritical limb ischemia with osteomyelitis is so difficult to treat that even appropriate revascularization and wound therapy cannot achieve limb salvage because of uncontrollable infection. It is still difficult to judge the possibility of limb salvage before revascularization.Case presentationA 73-year-old male complained of a small ulcer on his left toe, which was treated with multiple endovascular therapy. After failed endovascular therapy, he suffered extensive tissue loss with tibial osteomyelitis. We carried out staged surgery that was composed of dual bypass to the sural artery and posterior tibial artery. After intensive debridement and wound care, insertion of a subsequent free gracilis muscle flap to cover the exposed tibial bone was performed, achieving functional limb salvage.ConclusionEven in the threatened limb with extensive tissue loss and osteomyelitis, intensive and multidisciplinary treatment with staged revascularization, muscle transfer, and appropriate wound care achieved functional limb salvage.

Long-term inhibition of radiographic joint damage by tofacitinib monotherapy in rheumatoid arthritis patients with rapid radiographic progression about eight cases

Abstract Eight rheumatoid arthritis patients with rapid radiographic progression [(RRP) baseline: mean yearly ΔmTSS (mTSS: modified total Sharp score) 16.5, mean yearly Δ joint erosion score 5.4, mean yearly Δjoint space narrowing score 11.1] and inadequate response to non-biological disease-modifying antirheumatic drugs, who had completed a 3-month randomised study A39211040 (the 1040) were retrospectively investigated for the radiographic outcomes after tofacitinib (TOF) monotherapy. The patients used TOF 5 mg twice daily (BID) followed by TOF 10 mg BID over a 48-month long-term extension A39211041 (the 1041) study. Radiographic outcomes in hands and feet measured by mTSS in seven patients improved after 12 months and were sustained for 48 months. However, RRP was still observed in one patient, although yearly progression of mTSS improved. Radiographic outcomes in middle and large joints measured by Larsen score did not deteriorate in six patients during 48 months. Herpes zoster infections occurred 9, 30 and 39 months after 10 mg BID TOF prescription. No severe adverse events were observed during the study.

Human Articular Chondrocytes Induce Interleukin-2 Nonresponsiveness to Allogeneic Lymphocytes

Introduction We previously showed that articular chondrocytes (ACs) have immune privilege and immunomodulatory functions like those of mesenchymal stem cells. To elucidate these mechanisms, we focused on interleukin-2 (IL-2), which plays critical roles in lymphocyte mitogenic activity. The purpose of this study was to explore whether ACs affect the role of IL-2 underlying immunomodulatory functions. Material and Methods Irradiated human ACs from osteoarthritis donors were used. Third-party ACs were added to the mixed lymphocyte reaction (MLR) with or without recombinant human IL-2 (rhIL-2), and the levels of IL-2 and the soluble form of the IL-2 receptor α (sIL-2Rα) protein in supernatant were measured by enzyme-linked immunosorbent assay. Recombinant human IL-2 (rhIL-2) was also added to the MLR. To detect the expression of IL-2 receptor α (CD25) on lymphocytes in the MLR, flow cytometric analysis was performed. Last, ACs and allogeneic activated CD4+ T cell were co-cultured, and the expression of CD25 on activated T cells was examined by flow cytometry. Results Third-party ACs significantly inhibited the MLR and reduced the level of sIL-2Rα in a dose-dependent manner, but did not affect the concentration of IL-2. Exogenous rhIL-2 accelerated MLR but did not rescue the inhibitory effect of ACs. ACs inhibited the expression of CD25 on activated CD4+ T cells. Discussion Our results showed that third-party ACs inhibited the proliferation of allogeneic activated lymphocytes, thereby inhibiting production sIL-2Rα, although ACs did not affect IL-2 secretion from lymphocytes. Also, ACs inhibited CD25 expression on activated CD4+ T cells. Thus, ACs inhibited the immune response of allogeneic lymphocytes by inducing IL-2 nonresponsiveness.

SAT0046 Extensive MRI Osteitis is Associated with RAPID Radiographic Progression in Early but not Advanced Rheumatoid Arthritis

Background Predictor for rapid radiographic progression (RRP) is still unknown. It has been reported that MRI osteitis is a strong independent predictor for radiographic joint damage (RJD) especially in early rheumatoid arthritis (RA) patients (1). Joint inflammation detected by MRI and ultrasound (US) is also a predictor for further RJD. It has been reported that MRI osteitis is associated with high grade US findings (2). However, little is known about the relationship between MRI osteitis, US inflammatory findings and RJD. Moreover, there has been no data to indicate MRI osteitis is essential for RRP in early or advanced RA patients. Objectives (1) To investigate the relationship between MRI osteitis and US finding (2) To find association between MRI osteitis, US finding and RJD (3) To clarify MRI osteitis is associated with RRP in early or advanced RA. Methods Twenty-nine RA patients with extensive MRI osteitis were further analyzed. Patients consist of 14 early RA below 36 month disease duration (mean 12.2±9.2 months) and 15 advanced RA above 37 months disease duration (mean86.9±58.9 months). Gd-enhanced MRI (0.3T) of affected hand were evaluated by the Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS). We designated more than 10 osteitis score as extensive MRI osteitis. Joint erosion (JE) and joint space narrowing (JSN) score in both hands and feet by the conventional radiography (CR) were also evaluated by the modified total sharp score (m-TSS). Gray scale (GS) and power Dopper (PD) images of articular synovitis in metacarpophalngeal (MCP) and wrist joints were evaluated by the method proposed by EULAR. Data was expressed as the sum of the scores. Sperarmans correlation coefficient was used to investigate the correlation and Wilcoxons rank sum test was used to compare continuous data. Results Patients demographics (mean) were as follows: age, 63 years old; disease duration, 50.8 months; male/female, 5/24; PSL dose, 0.9mg/day, anti-CCP antibody, 115.1U/ml; DAS28-ESR, 4.11; mTSS, 24 (5-194); ΔmTSS/year, 10.8 (0-53). Mean MRI osteitis and synovitis scores were 24.6 and 8.6, respectively. Mean US GS and PD scores were 10.8 and 5.0. Weak correlations were observed between MRI synovitis score and US PD score (r=0.36, p=0.06) and MRI osteitis score (r=0.31, p=0.10). ΔmTSS/year as index of RJD was only correlated with MRI osteitis (r=0.45, p=0.014). Finally, we compared the MRI osteitis score, ΔmTSS/year in early and advanced RA. As shown in the table, ΔmTSS/year in advanced RA was significantly less compared with that in early RA regardless of high osteitis score (p<0.0001). Percentage of RRP in early RA (14/14; 100%) was higher than that in advanced RA (2/15; 13.3%). Conclusions Extensive MRI osteitis reflect RJD compared with MRI synovitis, US GS and PDs inflammatory findings. Extensive MRI osteitis is associated with RRP in early RA, but not in advanced RA. References Colebatch AN et al. Ann Rheum Dis 2013;72:804-814 Kawashiri S et al. Eular meeting 2013, abstract SAT 489 Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4174

AB0258 Persistence of Extensive MRI Osteitis Associates RAPID Radiographic Progression with Predominant Loss of Joint SPACE Narrowing and Hand Grip in Patients with Rheumatoid Arthritis Inadequate Response to Methotrexate

Background Magnetic resonance imaging (MRI) osteitis has been reported to be a strong independent predictor of radiographic joint damage (RJD) in rheumatoid arthritis (RA) (1). We reported continuation of MRI osteitis, especially extensive osteitis is prognostic factor for rapid radiographic progression (RRP) in Adalimumab + methotrexate (MTX) combination therapy (2). However, little has been known about the relationship between MRI osteitis and RRP. Moreover, there was no information about progression pattern of RRP. Objectives To investigate the association of extensive MRI osteitis and RRP and to clarify RRP progression pattern. Methods We retrospectively compared the clinical and imaging data at the first visit (mean 8.2 months after onset,) and after MTX therapy (average dose; 8.3mg/week, mean 19.5 months after onset) between one hand with extensive osteitis (osteitis (+)) and another hand with little or no osteitis (osteitis (−)) in 12 RA patients. Gd-enhanced MRI (0.3T) of both hands were evaluated by the Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS). Joint erosion (JE) and joint space narrowing (JSN) score in both hands and feet by the conventional radiography (CR) were also evaluated by the modified total sharp score (m-TSS). Bone mineral density (BMD) in both hands was measured by the DEXA (PRODIGY, en CORE, version. 11.4). Hand grip (HG) in both hands was measured by the hand dynamometer (max 300mm Hg) before blood examination. Wilcoxons rank sum test was used to compare continuous data. Results The ΔmTSS/year and the percentages of the RRP in the first visit (baseline) or after the MTX therapy (about 1year later) were 43.1 and 91.6%, 20.3 and 91.6%, respectively.At the first visit, extensive osteitis (p<0.001) and synovitis (p<0.01), JE score in CR (P<0.01) were significantly increased in hands with osteitis (+) compared with hands in osteitis (−). The severe loss of hand grip (less than 50% of osteitis (−) hands) was observed (p<0.01). About 1 year later, JSN in CR (p<0.01) and loss of HG (p=0.06) were increasing in hands in osteitis (+) with continuation of the extensive osteitis (p<0.05) and synovitis (p<0.05), JE in CR (p<0.01), prominent loss of HG (p<0.01) compared with hands in osteitis (−). As shown in table, in osteitis (+) hands, JSN in CR significantly increased during MTX thrapy (P<0.01) but JE did not increased (P=0.25). In osteitis (−) hands, JSN and JR in CR did not increased during MTX thrapy. Conclusions Extensive osteitis is highly associated with RRP. Continuation of MRI osteitis and synovitis, severe loss (less than 50%) of HG with progressive loss of JSN is characteristic. References Colebatch AN et al. Ann Rheum Dis 2013;72:804-814 Katayama K et al. Eular meeting 2012,SAT100 Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4181