著者

河原 郁生 大根田 豊 田中 康仁

出版者

日本関節病学会

雑誌

日本関節病学会誌 (ISSN:18832873)

巻号頁・発行日

vol.36, no.4, pp.461-465, 2017 (Released:2018-12-15)

参考文献数

18

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Introduction: Although posterior soft tissue repair reduces the incidence of dislocation after posterior-approach total hip arthroplasty (THA), little is known about the importance of tendon repair of the obturator externus muscle. This study makes a comparison for dislocation rates after the posterior-approach THA in two different procedures for short external rotators fixation.Methods: We retrospectively reviewed 725 patients who underwent primary THAs via the posterior approach. In 541 patients we detached the piriformis muscle and the conjoined tendon from the greater trochanter backed with the capsule, and repaired to the posterior margin of the gluteus medius muscle (Group A). In this series the obturator externus muscle was cut with capsule incision far from the insertion at the greater trochanter, so we were unable to repair it effectively. In another 184 patients we released all external rotators (including the obturator externus muscle) from the insertion backed with the capsule in an L-shaped incision along the superior part of femoral neck and the trochanteric crest. The L-shaped flap was repaired back to the superior capsule and the posterior margin of the gluteus medius muscle (Group B). In each group we used two different head size (28 mm and 36 mm) according to the operation period and the cup size. We compared the dislocation rate between two groups at least one year after the operation. We also made a comparison for the dislocation rate in different head size within the two groups.Results: The overall dislocation rate was 5.7% in Group A and 1.1% in Group B, respectively. The dislocation rate with the 28 mm head size was 6.9% and 3.1%, and with the 36 mm head size was 1.7% and 0%, for Groups A and B respectively.Conclusions: The obturator externus muscle plays an important role in preventing posterior dislocation after THA. Anatomically it runs from the obturator foramen to the greater trochanter passing the posteroinferior part of the capsule like a sling. It gives dynamic pressure on the femoral head especially in flexion and during internal rotation in the natural hip. This function can be now be reproduced after THA as we have demonstrated, which gives low rates of dislocation.

著者

小林 哲夫

出版者

日本関節病学会

雑誌

日本関節病学会誌 (ISSN:18832873)

巻号頁・発行日

vol.36, no.2, pp.97-101, 2017 (Released:2018-07-31)

参考文献数

29

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Bacteremia occurs through the translocation of oral bacteria from subgingival biofilms into the systemic circulation following daily oral hygiene activities and dental procedures. Bacteremia is caused more frequently in the treatment of periodontal disease than in other dental procedures. Periodontal treatment involves mechanical debridement, which consists of plaque control, scaling and root planing, and periodontal surgery. The debridement of bacterial biofilms in close proximity to the ulcerated epithelium of the gingival sulcus or periodontal pocket may lead to bacteremia. Therefore, it is essential to maintain oral hygiene and periodontal health in order to decrease the risk of bacteremia. It has long been debated by the American Academy of Orthopaedic Surgeons (AAOS) and the American Dental Association (ADA) whether or not the risk of prosthetic joint infection (PJI) is related to bacteremia after professional dental treatments. Currently, there is strong evidence of such an association. In addition, the indirect evidence obtained from multiple moderate-strength studies suggests that the use of prophylactic antibiotics reduces the incidence of post-dental procedure bacteremia. However, there have been no studies regarding the relationship between bacteremia and PJI. In summary, it is necessary to consider the risk of dental procedure-induced bacteremia and patient characteristics when prescribing prophylactic antibiotics for patients with prosthetic joints who are undergoing dental procedures. It may be particularly beneficial for these patients to maintain good oral hygiene.

著者

大石 正信 中島 康晴 岡崎 賢 福士 純一 久保 祐介 播广谷 勝三 松本 嘉寛 林田 光正 岡田 誠司 小山田 亜希子 岩本 幸英

出版者

日本関節病学会

雑誌

日本関節病学会誌 (ISSN:18832873)

巻号頁・発行日

vol.35, no.4, pp.475-480, 2016 (Released:2017-12-15)

参考文献数

12

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Ankylosing spondylitis (AS) is a chronic inflammatory disorder characterized by bone formation, syndesmophytes, and ankylosis of the sacroiliac joints and spine. Recently, tumor necrosis factor inhibitors such as infliximab and adalimumab have been shown to be efficacious for AS. However, patients with AS often suffer from arthralgia and problems related to ankylosis of the spine due to the delay in the diagnosis of AS. Those patients often benefit from surgical treatments. We have treated total of 72 patients with AS in our hospital. Among them 32 operations were performed on total of 19 patients. Total hip arthroplasties were the most performed surgical procedure. Surgeries for spinal fractures and spinal deformity have also been performed.

著者

中村 洋

出版者

Japanese Society for Joint Diseases

雑誌

日本関節病学会誌 (ISSN:18832873)

巻号頁・発行日

vol.28, no.2, pp.183-188, 2009 (Released:2011-09-01)

参考文献数

31

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Glucosamine is an aminosaccharide with a molecular weight of 179.2 and the source of various aminosugars that make up the extracelluar matrix and glycoproteins. It also has biological effects on chondrocytes and other cells; for example, glucosamine is known to suppress the production of PGE 2 and MMPs from chondrocytes. Glucosamine has been used to treat osteoarthritis (OA) since the 1960s, however, clinical trials have reported inconsistent results. According to a recent meta-analysis, effect size of glucosamine was decreased to 0.35. The study showed the following two points; 1) only products of a specific company are effective and 2) glucosamine hydrochloride was ineffective. Regarding industry bias, controversy exists as to whether well-designed clinical studies supported by pharmaceutical companies thus show robust results on efficacy. Both glucosamine hydrochloride and its sulfate dissociate are absorbed as glucosamine in the oral mucosa. Careful analysis of clinical trials using glucosamine hydrochloride do not inevitably show that it is ineffective. Chondroitin sulfate is a high molecular weight compound composed of galactosamine and glucuronic acid. The meta-analysis showed negative results, partly because the quality of products is heterogeneous. To elucidate the efficacy of these products, investigation into the diagnosis and evaluation of OA is important.

著者

藤巻 洋 稲葉 裕 小林 直実 雪澤 洋平 鈴木 宙 池 裕之 手塚 太郎 平田 康英 齋藤 知行

出版者

Japanese Society for Joint Diseases

雑誌

日本関節病学会誌 (ISSN:18832873)

巻号頁・発行日

vol.32, no.1, pp.17-22, 2013 (Released:2014-06-26)

参考文献数

12

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Objective: The aims of the present study were first to investigate the frequency and location of bone cysts in the acetabulum of hip osteoarthritis (OA) patients and second to examine the influence of pelvic tilt on the location of bone cysts in the acetabulum.Methods: A total of 80 patients (65 women and 15 men) with hip OA who underwent primary total hip arthroplasty were included in this study. The mean age at surgery was 65 years (range, 43-83 years). The bilateral hips of these 80 patients were examined; however, 9 contralateral hips that had previously been implanted with prostheses were excluded. We evaluated the minimal joint space width (MJS) on preoperative antero-posterior radiographs of the pelvis in the standing position. We also obtained the digital imaging and communication in medicine (DICOM) data from the preoperative pelvic computed tomography (CT) images, and then three-dimensionally reconstructed the DICOM data using OrthoMap 3D software with reference to the anterior pelvic plane. We divided the acetabulum into six areas and examined the presence of bone cysts in each area. We also examined the degree of pelvic tilt with three-dimensionally reconstructed CT images.Results: The frequency of bone cysts on CT images increased when the MJS of the hip joint on radiographs of the pelvis was less than 2 mm (p < 0.05). In the total of 151 hips, the antero-lateral area of the acetabulum (88 hips, 58%) exhibited the highest frequency of bone cysts. Patients who had bone cysts in the anterior part of the acetabulum tended to have a larger value of pelvic retroversion than those who did not have cysts in the anterior part of the acetabulum; however, the difference was not significant.Conclusion: The antero-lateral area of the acetabulum, which exhibited the highest frequency of bone cysts, is thought to be susceptible to loading stress. We hypothesized that patients who have bone cysts in the anterior part of the acetabulum have larger retroversion of the pelvis than others; however, the difference was not significant. We need to investigate further to reveal the influence of pelvic tilt on the location of bone cysts.

著者

小関 弘展 尾﨑 誠

出版者

日本関節病学会

雑誌

日本関節病学会誌 (ISSN:18832873)

巻号頁・発行日

vol.37, no.2, pp.105-109, 2018 (Released:2019-07-31)

参考文献数

17

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Objective: The present study aimed to determine the generation and behavior of airborne particles that could carry microorganisms around the area of the feet while walking in a bio-clean operating room.Methods: Four surgical staff members performed four walking patterns comprising combinations of the following: independently or as a group, and entering or exiting the operating room.Results: Fine particle visualization and laser particle counts revealed large numbers of airborne particles on shoes, the hems of gowns, and the floor regardless of the walking pattern. Numerous airborne particles were generated by followers who walked in groups and even more particles were brought to the level of the operating table by groups compared to solitary walkers.Conclusion: Surgical staff should be aware of transferring airborne particles from non-sterile areas to reduce the incidence of contamination by airborne bacteria in bio-clean rooms.

著者

川島 史義 髙木 博 古屋 貴之 加藤 慎 佐藤 敦 前川 勝彦 浅井 聡司 中田 規之

出版者

日本関節病学会

雑誌

日本関節病学会誌 (ISSN:18832873)

巻号頁・発行日

vol.36, no.1, pp.15-19, 2017 (Released:2018-03-31)

参考文献数

10

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Introduction: Several methods have been proposed to determine proper femoral component rotation alignment in total knee arthroplasty (TKA). Usually the epicondylar axis, the posterior condylar axis and Whiteside’s line are used for landmarks. However, sometimes recognition of these landmarks is difficult intraoperatively. We decide on the rotation angle of the femoral component using the epicondylar view via a preoperative radiograph. The angle consists of the clinical epicondylar axis (CEA) and the posterior condyle line minus two degrees. We think the influence of the residual cartilage of the posterior lateral femoral condyle is about two degrees in varus osteoarthritis (OA).Objective: The objective of this study was to evaluate the rotation alignment of the femoral component after TKA, and the usefulness of our method for the decision of femoral component rotation alignment.Methods: There were 43 patients (7 males, 36 females) with varus OA who underwent primary TKA. The average age was 78.1 years (range, 64-87 years). The rotation angle of the femoral component was decided by the above-mentioned method. We evaluated the angle between the posterior border of the femoral component and the CEA, and the surgical epicondular axis (SEA) using postoperative computed tomography. These angles were expressed as∠CEA and∠SEA. External rotation was expressed as plus.Results: The mean∠CEA was−1.1 (−5-1)°. The mean∠SEA was 0.48 (−3-3)°. The mean angle of∠SEA−∠CEA was 1.5 (0-3)°. The femoral component was placed in internal rotation to CEA and parallel to SEA.Conclusion: Internal placement of the femoral component was considered to be caused abnormal patella tracking and dislocation and low value of Knee Society Knee scoring. We think that it can be difficult to recognize some landmarks intraoperatively. We decide on the rotation angle of the femoral component using the epicondylar view of preoperative radiographs. From the results of this study, the femoral component was placed in internal rotation to CEA and parallel to SEA. We conclude that our method for the decision of the femoral component rotation alignment is useful for TKA of varus OA of the knee.

著者

小浦 卓 高木 徹 横山 裕介 小西池 泰三

出版者

日本関節病学会

雑誌

日本関節病学会誌 (ISSN:18832873)

巻号頁・発行日

vol.38, no.2, pp.155-158, 2019 (Released:2020-04-28)

参考文献数

6

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Background: Popliteal cysts are often observed in patients with rheumatoid arthritis (RA) . Complications of these cysts are rupture, dissection, pseudothrombophlebitis, leg ischemia, nerve entrapment, and compartment syndrome. We describe a patient suffering from RA with a ruptured popliteal cyst that was treated by surgery.Case: A 74-year-old patient with RA presented with sudden-onset pain and tense swelling in his right calf. Prior to hospital admission, a deep vein thrombosis (DVT) was suspected, and he was referred for evaluation and treatment. His C-reactive protein level was 3.78 mg/dL, and his D-dimer level was 3.7 μg/mL (normal level, <1.0 μg/mL) . During his evaluation for DVT, the diagnosis of a ruptured popliteal cyst (RPC) was made on enhanced computed tomography and magnetic resonance imaging. He resisted conservative management and was treated surgically. Postoperatively, the cyst disappeared completely and has not recurred.Conclusion: A popliteal cyst is a benign lesion that results from degenerative or inflammatory disease of the knee joint. This cyst may rupture causing severe pain in the calf, with warmth, erythema, and tenderness. This may be confused with other causes of swelling and pain in the calf including deep vein thrombosis. Hence it is also described as pseudothrombophlebitis. After surgical resection of such cysts, general as well as local signs of inflammation improved. In difficult cases, surgery is considered to be very effective for the treatment of RPCs. In the case of failure of conservative management, surgical treatment is a good option for the treatment of RPCs.

著者

川口 航平 山神 良太 河野 賢一 鹿毛 智文 村上 亮 武冨 修治 田中 栄 乾 洋

出版者

日本関節病学会

雑誌

日本関節病学会誌 (ISSN:18832873)

巻号頁・発行日

vol.42, no.2, pp.54-60, 2023 (Released:2023-07-31)

参考文献数

27

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はじめに:人工膝関節手術に対しての術後患者立脚型評価が標準化しているが,術後患者立脚型評価には術前の心理的因子が影響すると報告されている。しかしTKA,UKAにおいての術前の心理的因子の違いや術後患者立脚型評価に与える影響の違いなどは明らかではない。本研究の目的はTKAとUKAにおける術前の心理的因子の違いとその心理的因子が術後臨床成績に与える影響の違いを明らかにすることである。方法:2018年10月から2021年3月に当科にて人工膝関節手術を行った症例で,術後1年以上の臨床成績の評価が可能であったTKA192膝とUKA43膝を対象とした。術前心理的因子は痛みに対する中枢性感作の評価スコアであるCSIと破局的思考の評価スコアであるPCSにて評価した。術後患者立脚型評価として術後1年でのKOOS,New Knee Society Scoreを使用した。TKAとUKAでの術前心理的因子の違いと術前心理的因子と術後患者立脚型評価の関連の違いを評価し2群で比較した。結果:術前心理的因子であるCSIはTKA群23.5,UKA群21.5,PCSはTKA群27.3,UKA群26.1とともに両群で有意差はなかった。CSIと術後患者立脚型評価の関係は,TKA群では術後患者立脚型評価のすべての項目で負の相関を示したが,UKA群ではすべての項目と相関がなかった。PCSと術後患者立脚型評価の関係では,TKA群では立脚型評価のすべての項目で負の相関を示したが,UKA群ではKOOSのADLとNew Knee Society Scoreの満足度の項目のみ負の相関を示した。結論:TKAとUKAにおいては術前心理的因子(中枢性感作,破局的思考)には差がなかった。しかしTKAとUKAにおける術前心理的因子(中枢性感作,破局的思考)が術後患者立脚型評価に与える影響の程度は異なっていた。

著者

藤巻 洋 中澤 明尋 竹内 剛 門脇 絢弘 草山 喜洋 井出 学 金井 研三 金 由梨 松原 譲二 稲葉 裕

出版者

日本関節病学会

雑誌

日本関節病学会誌 (ISSN:18832873)

巻号頁・発行日

vol.40, no.1, pp.14-21, 2021 (Released:2021-03-31)

参考文献数

12

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目的 : 人工膝関節全置換術 (TKA) 前後の立位下肢アライメント左右差が脚長差に及ぼす影響を調査すること。方法 : 調査対象は初回片側TKAを施行した74例で手術時年齢は平均73歳。TKA術前および術後3週に両側の下肢全長立位2方向単純X線像を撮影し, 正面像で下肢機能軸 (大腿骨頭中心と足関節中心を結ぶ線) の長さ (MA長) および下肢機能軸の膝関節面通過点の膝関節中央からの偏移 (MAD) を, 側面像でknee flexion angle (KFA) を計測した。術前後での各計測値の左右差を調査し, さらに術前後それぞれでMADおよびKFA左右差がMA長左右差に及ぼす影響を単変量および多変量で解析した。結果 : 術前にMA長左右差と有意に関連したのは単回帰分析でMAD左右差 (R=−0.31, P=0.003) およびKFA左右差 (R=−0.51, P<0.001), 重回帰分析でもMAD左右差 (P<0.001) およびKFA左右差 (P<0.001) であった (修正R2=0.43)。術後にMA長左右差と有意に関連したのは単回帰分析でMAD左右差 (R=−0.39, P<0.001) およびKFA左右差 (R=−0.58, P<0.001) で, 重回帰分析でもMAD左右差 (P<0.001) およびKFA左右差 (P<0.001) であった (修正R2=0.50)。考察 : TKA前後で冠状面および矢状面の立位下肢アライメントが脚長差に影響しており, 片側TKA後には脚長差が生じる可能性を認識する必要がある。

著者

吉田 純 吉田 昌平 相馬 寛人 吉川 信人 橋尾 彩花 青島 早希 谷口 里奈 菅 寛之 毛利 尚史 辻原 隆是

出版者

Japanese Society for Joint Diseases

雑誌

日本関節病学会誌 (ISSN:18832873)

巻号頁・発行日

vol.33, no.1, pp.1-5, 2014 (Released:2015-06-10)

参考文献数

18

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Objective: We examined the relationship between isokinetic knee extensor strength and lower limb skeletal muscle mass measured by the impedance method. The objective of this study was to clarify the characteristics of knee extensor strength in patients with osteoarthritis of the knee.Methods: The osteoarthritis (OA) group was composed of thirty-six lower limbs of twenty females with OA of the knee, and the control group was composed of fifty lower limbs of twenty five healthy females, respectively. The mean age of the OA group was 68.1±4.9 years and that of the control group was 70.3±3.6 years, respectively. We measured lower limb skeletal muscle mass by the eight electrode body impedance analysis (BIA) method. In addition, we measured the peak torque of the knee extensor muscle strength in 60 deg/sec. Investigations were also carried on primary lower limb skeletal muscle mass and knee extensor strength obtained from the control group. We then predicted the knee extension strength of the OA group, which was obtained using a formula.Results: Lower limb skeletal muscle mass for the OA group was 6.2±0.6 kg, and for the control group was 6.3±0.5 kg (n.s.), respectively. Knee extensor torque for the OA group was 60.0±16.1 Nm, and for the control group was 77.7±13.7 Nm (p < 0.01), respectively. The primary regression equation in the control group was y = 11.016x + 8.63 (r = 0.428). Predictive value of knee extensor strength of the OA group obtained from the regression equation was 77.4±6.7 Nm.Conclusion: The ratio of muscle output for skeletal muscle mass decreases in the patients with OA. Therefore, we think instead of simply increasing the muscle mass in the rehabilitation of patients with OA, it is necessary to continue to improve the ratio of muscle to muscle mass output.

著者

海野 宏至 長谷川 正裕 鈴木 慶亮 松井 佑梨世 湏藤 啓広 今中(吉田) 恭子 吉田 利通

出版者

日本関節病学会

雑誌

日本関節病学会誌 (ISSN:18832873)

巻号頁・発行日

vol.35, no.2, pp.131-136, 2016 (Released:2017-07-31)

参考文献数

16

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Objective: Tenascin-C (TNC) is an extracellular matrix glycoprotein. In this study, we examined the effects of full-length TNC on joint cartilage protection in murine osteoarthritis (OA) models and on synovial inflammation in OA joints. In addition, we performed an in vitro study to reveal the mechanism of repairing cartilage using full-length TNC.Methods: In this in vivo study, fourteen male BALB/c strain mice (8-weeks-old) were used. Both knee joints were exposed and the anterior cruciate ligament and medial collateral ligament were transected. 10 μg/mL of TNC were injected into the knee joint (group Ⅰ). The control group had injection of phosphate buffered saline (PBS) (group Ⅱ). Mice were sacrificed at 4 days, 2 weeks, and 4 weeks postoperatively. Cartilage was evaluated using the Mankin score, and synovitis was evaluated using the Synovitis score. An in vitro study was also performed on human cartilage specimens, which were obtained from patients who underwent total knee arthroplasty for the treatment of OA. Chondrocytes were isolated and cultured, and they were treated with 0, 1, or 10 μg/mL of TNC. We also compared the expression of many kinds of messenger RNA after exposure at each dose by real-time polymerase chain reaction. We evaluated the expression of TNC, inflammatory cytokines [TNF-α, IL-1β, NFκB], anabolic factors [TGFβ, TIMP3, bFGF], and catabolic factors [ADAMTS-4, -5, and MMP-3, -13].Results: With the in vivo study, the average Mankin scores were significantly better in group Ⅰ than group Ⅱ at 4 weeks (group Ⅰ; 1.1, group Ⅱ; 3.2 (P<0.05)). At 4 days and 2 weeks, no development of OA was found in either of the two groups. Low-grade synovitis occurred in both groups at 4 days, 2 weeks, and 4 weeks. There were no significant differences in average synovitis scores between two groups at 4 days, 2 weeks, and 4 weeks. The in vitro study revealed that TNC upregulated the expression of endogenous TNC, TNFα, IL-1β, NFκB, TGFβ, TIMP3 and ADAMTS-4, MMP-3, and MMP-13. But 10 μg/mL of TNC downregulated the expression of ADAMTS-5.Conclusion: This study has demonstrated that 10 μg/mL of full-length TNC can prevent articular cartilage degeneration for 4 weeks without promoting synovitis. The in vitro study demonstrated that TNC upregulates itself and anabolic factors. However, TNC also downregulated the expression of ADAMTS-5 which contributed to cartilage degradation.

著者

加茂 健太 城戸 秀彦 城戸 聡 清原 壮登 太田 昌成

出版者

日本関節病学会

雑誌

日本関節病学会誌 (ISSN:18832873)

巻号頁・発行日

vol.36, no.4, pp.457-460, 2017 (Released:2018-12-15)

参考文献数

6

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Introduction: The superior approach (SA) in total hip arthroplasty (THA) is one of the muscle sparing posterior approaches. We describe this method and report the radiographic outcomes of the first 30 hip arthroplasties performed using a SA.Methods: The method for THA: The patient was placed in the lateral decubitus position with the operative leg in approximately 60° of flexion, 40° of adduction, and 20° of internal rotation. The gluteus medius muscle was retracted anteriorly, and the piriformis muscle posteriorly, to exposure the hip capsule. The femoral canal was entered at the trochanteric fossa with a round chisel. The femoral broaches were performed before the femoral neck osteotomy. The femoral head was removed after the osteotomy. The acetabular cup was impacted with anteversion of the transverse acetabular ligament. The method for hip hemi-arthroplasty (HA): First, the outer head was placed in the acetabular fossa; second, the femoral stem was placed and the inner head was impacted. The outer and inner head were set up in the acetabular fossa.Results: The SA group included 12 THAs and 18 HAs. In the THA group, the mean operative duration was 106±18 minutes, the mean varus angle of the stem was 0±1.5 degrees, the mean inclination of the cup was 45±8 degrees, the mean anteversion of the cup was 9±8 degrees and the mean limb length discrepancy was 6±4 mm. In the HA group, the mean duration was 60±17 minutes, the mean varus angle of the stem was 1±2 degrees and the mean limb length discrepancy was 0.5±4 mm. In four (33%) THAs, the piriformis muscles were resected and repaired. In all of the HAs, the piriformis and conjoint tendons were preserved.Conclusion: The piriformis muscles were resected in some THAs, but the short rotators muscles were preserved in the HA procedures.

著者

川口 浩

出版者

Japanese Society for Joint Diseases

雑誌

日本関節病学会誌 (ISSN:18832873)

巻号頁・発行日

vol.35, no.1, pp.1-9, 2016 (Released:2017-03-31)

参考文献数

8

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There are three representative international treatment guidelines for osteoarthritis (OA), each of which has different characteristics. These include the Osteoarthritis Research Society International (OARSI), the National Institute for Health and Clinical Excellence (NICE) from the National Health Service in the United Kingdom, and the American Academy for Orthopaedic Surgeons (AAOS). Among them, the OARSI guidelines are the most frequently revised with new evidence. Besides these international guidelines created by Western countries, there are Japanese OA treatment guidelines which were created by the Japanese Orthopaedic Association based on the OARSI guidelines (part Ⅱ). In some aspects, both guidelines are very similar. However, there are substantial differences, especially with respect to hyaluronic acid injection and supplements including glucosamine and chondroitin sulfate. In this paper, the newest 2014 OARSI treatment guidelines (part Ⅳ) are introduced in which the Author was a committee member as the Asian representative. There is also discussion about the present status of OA treatment in Western and Asian countries, especially when comparing between corticosteroid and hyaluronan intraarticular injections, and that between non-selective non-steroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 inhibitors, and the recent status of acetaminophen and topical NSAIDs.

著者

上西 蔵人 金山 竜沢 東 秀隆 吉居 啓幸 老沼 和弘 白土 英明

出版者

Japanese Society for Joint Diseases

雑誌

日本関節病学会誌 (ISSN:18832873)

巻号頁・発行日

vol.35, no.1, pp.37-43, 2016 (Released:2017-03-31)

参考文献数

17

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Objective: When the extension gap is smaller than the flexion gap during total knee arthroplasty (TKA), an additional osteotomy of the distal femur is needed, which results in joint line elevation. We hypothesized that the chief cause of a decrease in the extension gap is excessive tension of both the medial collateral ligament and posteromedial capsule during knee extension. Therefore, we introduced a new technique called the “posteromedial-longitudinal capsulotomy” (PMLC) in May 2013 that allowed the separation of the medial collateral ligament from the posteromedial capsule, making it possible to expand the extension gap selectively. Our objective in this study was to assess the relationship between PMLC and the joint line in total knee arthroplasty.Methods: We compared two groups: Group A (70 patients, 85 knees) who underwent TKA before May 2013 prior to the introduction of PMLC, and Group B (77 patients, 91 knees) who underwent TKA after its introduction after May 2013. The posterior cruciate ligament was preserved in all patients. We evaluated the joint line based on differences in thickness between the surgically removed femoral bone and femoral components. We adjusted the thickness of the bone saw accordingly.Results: Expansion of the extension gap was needed in 66 of the 85 Group A knees (78%) and in 75 of the 91 Group B knees (82%), respectively. The technique for expansion in Group A was additional distal femoral osteotomy in 20 cases and other soft tissue release in 46 cases. In Group B there was additional distal femoral osteotomy in 14 cases and PMLC in 61 cases. The amount of distal osteotomy was 2.9 mm in Group A and 1.1 mm in Group B, which was significantly smaller. The amount of differences in the joint line was 0.9±3.2 mm (medial) and 1.6±2.6 mm (lateral) in Group A and −0.4±2.2 mm (medial) and 0.6±1.9 mm (lateral) in Group B, respectively.Conclusion: PMLC significantly reduces the amount of osteotomy required in TKA, and makes it possible to control elevation of the joint line.

著者

小橋 由紋子 尾尻 博也 山添 真治 馬場 亮 辻本 博瑛 青柳 裕

出版者

日本関節病学会

雑誌

日本関節病学会誌 (ISSN:18832873)

巻号頁・発行日

vol.32, no.4, pp.409-415, 2013 (Released:2015-02-18)

参考文献数

3

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Objective: To evaluate availability of dual-source computed tomography (CT) for representative joint pathologies and to document the findings of each.Methods: We used dual-source CT to evaluate representative joint diseases. Dual-source CT has two X-ray tubes and can produce two different X-ray energies (80 KV and 140 KV) at the same time. We analyzed CT values of each structure obtained by dual-source CT, and distinguished one from the others using the three-material decomposition theory.Results: Dual-Energy Imaging produced virtual non-contrast (VNC) images, which detected several clinically important joint pathologies such as articular cartilage defect of the knee joint, labral tear of the hip, and triangular ligament tear of the wrist.Conclusion: VNC imaging obtained by dual-source CT is considered to be valuable in the evaluation of joint pathologies.