Toshiya Kanoh

ALDH2 polymorphisms and bone mineral density in an elderly Japanese population

IntroductionOsteoporosis is a multifactorial genetic disease which greatly increases the risk of bone fracture in elderly persons.MethodsFour hundred and three recipients of a community health screening program were examined for the presence/absence of osteoporosis and 11 kinds of gene polymorphisms as a means of determining the relation between these gene polymorphisms and osteoporosis. The gene polymorphisms screened were: alcohol sensitivity-associated polymorphisms of alcohol dehydrogenase (ADH2) Arg47His, aldehyde dehydrogenase (ALDH2) Glu487Lys, smoking sensitivity-associated polymorphisms of glutathione S transferase (GST) M1, (GST)T1, NAD(P)H quinone oxidoreductase 1 (NQO1) C609T, inflammation-associated polymorphisms of interleukin-1β (IL-1B)T-31C, tumor necrosis factor α (TNF-α) T-1031C, endothelial constitutive nitric oxide synthase (ecNOS) Glu298Asp, longevity-associated polymorphism of mitochondrial DNA (mtDNA) 5178 A/C, allergy-associated polymorphism of interleukin-4 (IL-4), and immunity-associated polymorphism of CD14.ResultsA significant association was found between the ALDH2Glu478Lys gene polymorphisms and osteoporosis. In the osteoporosis group of patients, a significant difference was noted between the Lys/Lys group and the group comprising Glu/Lys and Glu/Glu groups (namely, the genotypes including Glu alleles). In the Lys/Lys group, after age, sex, BMI, smoking history and alcohol consumption history had been adjusted for, the morbidity rate was significantly elevated [odds ratio (OR): 3.33; 95% confidence interval (95% CI): 1.28–8.71; p=0.014], and the effect was even more evident in the sub-group of women with osteoporosis (OR: 4.31; 95% CI: 1.24–14.92; p=0.021).ConclusionsThe present results suggest that active prophylactic interventions such as dietary, exercise, and pharmacological therapies should be offered to non-carriers of the Glu allele (Lys/Lys).

Total hip arthroplasty for Crowe type IV developmental dysplasia.

The purposes of this study were to evaluate the midterm clinical and radiographic results of total hip arthroplasty (THA) in patients with Crowe type IV developmental dysplasia and to evaluate whether low back pain would improve after THA. Eighteen consecutive patients (20 hips) were included in this study. The average age at the time of surgery was 58.5 years. The average follow-up was 10.2 years. The socket was placed at the level of the true acetabulum, and a femoral shortening osteotomy was performed. The average Harris hip score before surgery was improved from 56 to 85 points at the final follow-up. Revision was performed in 4 hips due to loosening of the femoral component in 1 hip and osteolysis in 3 hips. The midterm outcomes of THA in patients with Crowe type IV developmental dysplasia were satisfactory. The severity of low back pain was significantly reduced after THA.

Accurate Acetabular Component Orientation After Total Hip Arthroplasty Using an Acetabular Alignment Guide

Between February 2005 and August 2006, we recorded acetabular component orientation in 90 patients (100 hips) who underwent primary total hip arthroplasty (THA), to determine whether using an alignment guide ensures accurate acetabular positioning. In the alignment-guide group (46 patients; 48 hips), a guide was placed on the pelvis, a Kirschner wire (K-wire) was attached to the guide, and orientation of the acetabular component was confirmed by both the surgeon and an assistant. In the control group (44 patients; 52 hips), a K-wire was not used and the angle was confirmed by the surgeon alone. Radiographic acetabular component inclination and anteversion and computed tomography anteversion were determined. There was no significant difference in mean component orientation between the 2 groups. However, the SD was significantly smaller in the alignment-guide group, showing that consistent acetabular component orientation in primary THA is highly reproducible when an acetabular alignment guide with an attached K-wire is used.

Joint space wider than 2 mm is essential for an eccentric rotational acetabular osteotomy for adult hip dysplasia

BackgroundSatisfactory intermediate-term results after an eccentric rotational acetabular osteotomy (ERAO) for the treatment of early osteoarthritis secondary to developmental dysplasia of the hip (DDH) have been reported. The purpose of this study was to investigate whether a minimum joint space width (JSW) in patients with advanced osteoarthritis secondary to DDH influences intermediate-term clinical and radiographic outcomes after performing an ERAO.MethodsA total of 113 patients (116 hips) with a JSW of ≤3 mm were consecutively treated by ERAO for advanced osteoarthritis of the hip and then were followed for more than 5 years. Based on the preoperative JSW, the patients were divided into three groups: minimum JSW of ≤1 mm (JS1 group); JSW >1 mm but ≤2 mm (JS2 group); JSW > 2 mm but ≤3 mm (JS3 group). The average ages of the JS1, JS2, and JS3 patients were 40, 44, and 43 years, respectively. The average follow-up period was 10.6 years.ResultsOverall conversion to total hip arthroplasty (THA) was performed in 14 joints. According to a Kaplan-Meier survivorship analysis at 15 years after the index operation, 96% of the patients with a JSW of >2 mm (JS3 group) did not require conversion to THA.ConclusionsA JSW of >2 mm before surgery is considered essential to obtain an excellent intermediate-term result following performance of an ERAO.

Quality of life following femoral osteotomy and total hip arthroplasty for nontraumatic osteonecrosis of the femoral head

BackgroundNontraumatic osteonecrosis of the femoral head (NOFH) frequently develops in active young persons. The affected femoral head collapses owing to weight-bearing, and the individual’s quality of life (QOL) can be predicted to deteriorate greatly with time. We undertook to determine the efficacy of surgery and to clarify whether patient QOL differs according to differences in the surgical method employed.MethodsWe cross-sectionally compared QOL in NOFH patients treated with femoral osteotomy, total hip arthroplasty (THA), or nonoperatively. A total of 81 cases were available for study, comprising 41 with osteotomy, 19 with THA, and 21 in the nonoperative group. The mean age was significantly higher in the THA group than in the other two groups. The Japanese Orthopaedic Association (JOA) hip score and Visual Analogue Scale (VAS) regarding hip pain were compared among the groups. These groups were also analyzed for their health-related QOL using the Short Form Health Survey (SF-36) with analysis of variance for age adjustment.ResultsThe mean JOA score was significantly lower in the nonoperative group than in the osteotomy group. The mean VAS scores showed no significant difference between any of the three groups. Regarding the subscales of SF-36, the physical functioning subscale in the nonoperative group showed a significantly lower value than was seen in the osteotomy group (P = 0.003). The physical component summary (PCS) scores were 39.4 (osteotomy group), 39.1 (THA group), and 27.8 (nonoperative group), with a significant difference between the osteotomy and nonoperative groups (P = 0.027). There was also a trend for a better PCS scores in the THA group than in the nonoperative group (P = 0.056). The mental component summary scores were 49.6 (osteotomy group), 50.3 (THA group), and 48.3 (nonoperative group), with no significant difference found among any of the three groups.ConclusionsAmong patients with NOFH, physical function impairment was a more potent factor than pain for decreasing QOL in the nonoperative group than in the surgical groups. Furthermore, osteotomy and THA were similar in regard to the evaluation of the postoperative QOL score if the indications for osteotomy were strictly applied.

Interleukin-1β gene polymorphism associated with radiographic signs of osteoarthritis of the knee

BackgroundOsteoarthritis is recognized as a noninflammatory, progressive condition, the principal cause of which is regressive changes associated with aging and which pursues a chronic course. Recently, the involvement of genetic factors has been widely reported. The purpose of this study was to identify polymorphisms at particular risk of osteoarthritis of the knee for community-living middle-aged and elderly people.MethodsFocusing on 359 participants (ages 44–56 years) of the comprehensive health examination program (CHEP), we investigated the presence/absence of radiographic osteoarthritis (ROA) of the knee, and 11 types of gene polymorphisms and their association with ROA.ResultsInterleukin-1β (IL1B) T-31C polymorphism was found to be associated with ROA. In the case of IL1B T-31C polymorphism in the ROA group, a significant difference was found between the groups combining the C/C genotype, the C/T genotype, and the T/T genotype. In particular, the genotypes with the C allele differed from the T/T genotype, with the morbidity rate being higher in the T/T group (odds ratio (OR) 2.04, 95% confidence interval (95%CI) 1.05–1.98, P = 0.036).ConclusionOur results confirm that in IL1B T-31C with the T/T genotype, the rate of ROA was significantly higher than that with the C/C and C/T genotypes. It might be possible to implement active preventative measures, such as avoidance of obesity and excessive exercise loads, for carriers of IL1B T/T.

Association of serum carotenoids, retinol, and tocopherols with radiographic knee osteoarthritis: possible risk factors in rural Japanese inhabitants

BackgroundThe consumption of antioxidant nutrients may influence the development and progression of osteoarthritis (OA). To determine the association between serum antioxidants and radiographic knee osteoarthritis, we undertook a cross-sectional investigation in a community-based study in Japan.MethodsA total of 562 subjects (224 male, 338 female) ≥40 years of age were enrolled in the Comprehensive Health Examination Program (CHEP, Yakumo Study) from 2003 to 2005. Subjects were categorized to the OA group (n = 140) if either knee was graded as Kellgren-Lawrence (K-L) grade ≥2. The no-OA group was defined as showing radiographic findings of K-L 0 or 1 in either knee (n = 422). The serum levels of retinol, β-/γ-tocopherols, α-tocopherol, zeaxanthin/lutein, canthaxanthin, cryptoxanthin, lycopene, α-carotene, and β-carotene were measured by high-performance liquid chromatography. The values of these antioxidants were divided into tertiles, and a logistic regression analysis was performed to analyze the association between them and radiographic knee OA, adjusting for potential confounders.ResultsLogistic regression analysis showed that compared to the lowest tertile of β-/γ-tocopherols the adjusted odds ratio (OR) was 0.52 [95% confidence interval (CI) 0.29–0.93] in the highest tertile; it also indicated a linear trend across tertiles. Furthermore, the adjusted OR was significantly decreased only in the middle tertile of α-tocopherol (OR 0.51, 95% CI 0.29–0.90). We reevaluated any independent association for these tocopherols after adjustment by entering them into the model simultaneously. The significance of β-/γ-tocopherols was maintained. In contrast, no associations were found with any carotenoids or retinol.ConclusionsHigh serum values of β-/γ-tocopherols were found to be significantly associated with a low OR for radiographic knee osteoarthritis. The decreasing risk with a high serum value of β-/γ-tocopherols may support the possible protective effects against knee OA.

A polyethylene liner scratch after revision hip arthroplasty performed to repair ceramic fracture.

A 61-year-old man who had undergone revision total hip arthroplasty in 2000 was evaluated at our clinic in 2008, 1 day after feeling an abnormal clicking sensation in his left hip. Radiographs showed a fracture of the alumina ceramic liner of his acetabular component. A second revision total hip arthroplasty was performed with a 28-mm highly crosslinked polyethylene acetabular liner and an alumina femoral head. Sixteen months after the second revision, the patient experience sudden-onset hip pain. Radiographs revealed a fatigue fracture of the neck of a displaced stem. Analysis by scanning electron microscopy of the surface of the retrieved alumina ceramic femoral head revealed no scratches or wear, but analysis of the highly crosslinked polyethylene socket revealed third-body wear, scratches, irregularly shaped dips, and white ceramic particles. Elemental analysis of the white particles by an x-ray microanalyzer revealed the presence of aluminum and oxygen.

Low signal intensity area by magnetic resonance imaging that disappeared after a curved intertrochanteric varus osteotomy for traumatic osteonecrosis of the femoral head

Joint-preserving treatment is recommended for young and active patients, including core decompression, vascularized or nonvascularized bone grafting from the fi bula or ilium, varus femoral osteotomy, and a transtrochanteric rotational osteotomy. Total hip replacement or hemiarthroplasty are usually selected for older patients or patients with severely collapsed hips. The longevity of total hip arthroplasty is not satisfactory for young and active people. As a result, we have been performing joint-preserving osteotomies and bone grafting for these patients. The purpose of the femoral osteotomy is not to treat the necrotic lesion but to move the lesion to the non-weight-bearing area. Therefore, complete healing of the necrotic lesion would not be expected. However, complete disappearance of the low signal intensity might be observed in a few patients. A case of complete disappearance of the low signal intensity area by magnetic resonance imaging (MRI) after a curved intertrochanteric varus osteotomy for traumatic osteonecrosis of the femoral head is herein reported.

Childbirth and sexual activity after eccentric rotational acetabular osteotomy

Pelvic osteotomy for symptomatic hip dysplasia usually is performed for young and adolescent females. Delivery after pelvic osteotomy is a concern for patients of childbearing age. We asked whether the clinical results differed before and after pregnancy, whether eccentric rotational acetabular osteotomy alters the bony birth canal, whether pelvic osteotomy impedes the ability to deliver vaginally, and whether sexual activity and quality of life improve if hip pain decreases after surgery. We retrospectively investigated 21 patients who experienced successful pregnancy and childbirth after eccentric rotational acetabular osteotomy. The mean age at the time of surgery was 25.7 years (range, 18-35 years) and 30.7 years (range, 23-40 years) at the initial delivery after surgery. Sixteen patients delivered 21 children vaginally and five patients delivered eight children by cesarean section. The clinical results were similar before and after childbirth. Eccentric rotational acetabular osteotomy caused no substantial difference in the bony birth canal before and after surgery. Vaginal delivery was possible in the majority of patients. Improvement of satisfaction with sexual activity and quality of life was related to less hip pain after surgery.Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.