Long-term clinical results of alumina ceramic medial pivot total knee arthroplasty: a 10-year follow-up study.

Background: The newly-designed alumina ceramic medial pivot total knee prosthesis was introduced to reduce polyethylene wear and better fit the anatomical morphology of the Asian population. This study aimed to clarify the long-term clinical results of alumina medial pivot total knee arthroplasty over a minimum follow-up period of 10 years.

Methods: The data of 135 consecutive patients who underwent primary alumina medial pivot total knee arthroplasty were analyzed in this retrospective cohort study.

The posterior tibial slope does not influence the flexion angle in posterior-stabilized mobile-bearing total knee arthroplasty.

Background: It remains uncertain whether an increase in the tibial slope leads to better flexion in posterior-stabilized (PS) total knee prostheses.

Purpose: To compare the intra-operative flexion angle between standard and an additional 10° posterior slope inserts.

Patients And Methods: Between December 2014 and February 2015, 22 patients (25 knees) who underwent PS mobile-bearing primary total knee arthroplasty (TKA) were included.

Clinical results of alumina medial pivot total knee arthroplasty at a minimum follow-up of 10years.

Background: The medial pivot total knee prosthesis with alumina ceramic femoral components was introduced to reproduce physiological knee kinematics and reduce polyethylene wear. The five-year clinical outcomes of alumina medial pivot total knee arthroplasties (TKA) have previously been reported. The purpose of this study was to provide the longer-term clinical results at a minimum follow-up of 10years.

Meniscal Bearing Dislocation of Unicompartmental Knee Arthroplasty with Faint Symptom.

We experienced two cases of atypical lateral dislocations of meniscal bearing in UKA (unicompartmental knee arthroplasty) without manifest symptoms. The dislocated bearing, which jumped onto the wall of tibial components, was found on radiographs in periodic medical examination although they could walk. Two thicker size bearing exchanges were promptly performed before metallosis and loosening of components.

Joint gap measurement in total knee arthroplasty using a tensor device with the same articulating surface as the prosthesis.

Background: We developed a new tensor to measure the joint gap throughout knee flexion during total knee arthroplasty (TKA). This tensor has the same articular shape as that of the tibial liner, including the post structure and the curvature of femorotibial articular surface, to measure the gap intraoperatively under the same conditions as after TKA. The present study aimed to examine the precision of the new tensor for gap measurement after implantation.

The intact posterior cruciate ligament not only controls posterior displacement but also maintains the flexion gap.

Background: The PCL is a strong stabilizer of the knee and provides posterior stability to the tibia. However, sagittal alignment of the PCL with the knee at 90° flexion suggests the PCL might play a role not only in posterior stabilization but also in maintaining the flexion gap.

Questions/purposes: We determined whether the intact PCL helps maintain the flexion gap.

Posterior condylar cartilage may distort rotational alignment of the femoral component based on posterior condylar axis in total knee arthroplasty.

Purpose: Among several anatomical references, the posterior condylar axis is the most apparent landmark to decide the femoral rotation for total knee arthroplasty. External rotation based on the posterior condylar axis requires condylar twist angle in order to set the femoral component parallel to trans-epicondylar axis although the angle is not constant. The angle during surgery differs from the pre-operative measurement on epicondylar view, because X-rays do not show the posterior condylar residual cartilage thickness.

Mid-term clinical results of alumina medial pivot total knee arthroplasty.

Purpose: The medial pivot total knee prosthesis has been designed to reproduce physiological knee kinematics. It has been reported that alumina ceramic femoral components reduce polyethylene wear. Thus, medial pivot total knee prostheses with alumina ceramic femoral components were introduced.

Anterior knee pain after total hip arthroplasty in developmental dysplasia.

Little has been reported on knee pain after total hip arthroplasty (THA). The purpose of this study was to investigate the incidence and mechanism of knee pain after THA. Two hundred fifty-two patients with hip dysplasia were clinically and radiographically assessed for knee pain before and after THA.

Low levels of steroid-metabolizing hepatic enzyme (cytochrome P450 3A) activity may elevate responsiveness to steroids and may increase risk of steroid-induced osteonecrosis even with low glucocorticoid dose.

Background: The main purpose of this study was to examine the relationships among osteonecrosis, steroid-metabolizing hepatic enzyme (cytochrome P450 3A; CYP3A) activity, and steroid dose to determine whether it is possible to prevent osteonecrosis in animals with low hepatic CYP3A activity by reducing exogenous steroid doses.

Methods: Japanese white rabbits (n = 103) were divided into three groups: a group with CYP3A activity induction (by intramuscular phenobarbital injection, n = 31), a group with CYP3A activity inhibition (by oral itraconazole administration, n = 30), and a control group (n = 42). Three weeks later, all rabbits received a methylprednisolone injection.

The risk of notching the anterior femoral cortex with the use of navigation systems in total knee arthroplasty.

Use of navigation systems has recently been introduced in total knee arthroplasty (TKA) to achieve more reliable prosthetic alignment. In the sagittal plane, there are two important requirements for navigation systems: (1) perpendicular cut to the femoral mechanical axis and (2) prevention of notching of anterior femoral cortex. These two requirements, however, may conflict.

Local delivery of rolipram, a phosphodiesterase-4-specific inhibitor, augments bone morphogenetic protein-induced bone formation.

Recombinant human bone morphogenetic protein (rhBMP) is a promising therapeutic cytokine for the induction of bone formation, but a weak response in humans remains a major hurdle in its therapeutic application. We have previously reported an rhBMP-2-induced increase in the bone mass of mice receiving systemic rolipram, a specific inhibitor of phosphodiesterase-4. To overcome the side effects of systemic administration of rolipram, we examined the effects of its local release.

Repair of experimentally induced large osteochondral defects in rabbit knee with various concentrations of Escherichia coli-derived recombinant human bone morphogenetic protein-2.

Effective therapies for the regeneration of large osteochondral defects are still lacking; however, various approaches have been used. We evaluated the efficacy of Escherichia coli-derived dimeric recombinant human BMP-2 (E-rhBMP-2) for the repair of large osteochondral defects in a rabbit model. Osteochondral defects made in the femoral patellar groove of the knee were treated by transplanting gelatin sponges onto which no or various doses of E-rhBMP-2 were loaded.

Arthroscopy for evaluation of polyethylene wear after total knee arthroplasty.

Background: The purpose of this report is to demonstrate the severity of polyethylene wear by arthroscopy after total knee arthroplasty (TKA).

Methods: Polyethylene wear of TKA prostheses was evaluated endoscopically in eight knees (six patients). Arthroscopy was indicated when the patients had persistent but slight hydroarthrosis and instability confirmed by stress radiography, but these findings were insufficient for a consensus on polyethylene revision.

Sagittal alignment of the lower extremity while standing in Japanese male.

There is little information available regarding the sagittal mechanical axis of the lower extremity of normal subjects under weight-bearing conditions. The purpose of this study was to determine the sagittal alignment of the lower extremity under such conditions. Anteroposterior and lateral radiographs were taken of the 20 lower extremities of 10 healthy male Japanese volunteers (mean age, 27 years) while standing.

Characteristics of Hylamer polyethylene particles isolated from peri-prosthetic tissues of failed cemented total hip arthroplasties.

Polyethylene wear particles are one of the most important factors affecting the results of total hip arthroplasty. Hylamer, a highly crystalized ultra-high-molecular-weight polyethylene, has been used in total hip arthroplasty for wear reduction, but has exhibited high wear rate and excessive osteolysis. The aim of the present study was to examine Hylamer wear particles in peri-prosthetic tissues with osteolysis obtained from two cases of failed cemented total hip arthroplasty at 8 and 6 years after operation.

Flexion gap preparation opens the extension gap in posterior cruciate ligament-retaining TKA.

It has been reported that preparation of the flexion gap results in significant widening of the prepared extension gap in posterior stabilized (PS) total knee arthroplasty (TKA). To date, there is a paucity of data regarding cruciate ligament-retaining (CR) TKA. Changes in the extension gap caused by preparation of the flexion gap were measured in 42 varus osteoarthritic knees undergoing CR TKA.

Preparation of the flexion gap affects the extension gap in total knee arthroplasty.

Changes in the extension gap caused by the preparation of the flexion gap were measured in 50 varus osteoarthritic knees undergoing total knee arthroplasty. The extension gap was first prepared and then measured before and after preparation of the flexion gap. The extension gap increased significantly on both the medial and lateral sides (19.

Polyethylene wear particle generation in vivo in an alumina medial pivot total knee prosthesis.

Polyethylene wear particle generation is one of the most important factors affecting mid- to long-term results of total knee arthroplasties. It has been reported that the medial pivot total knee prosthesis (MP) design and alumina ceramic femoral component reduce polyethylene wear. The aim of this study is to evaluate in vivo polyethylene wear particle generation in the newly introduced alumina MP, in comparison with a metal MP.

Axial radiography of the distal femur to assess rotational alignment in total knee arthroplasty.

A method for taking an axial radiograph of the distal femur was developed to see the epicondyles and posterior condyles of the femur. It was hypothesized that these radiographs would be acceptable for evaluating rotational alignment in total knee arthroplasty with comparable reproducibility and good correlation to the results obtained with computed tomography images. Radiographs were obtained of 50 knees in 32 patients having total knee arthroplasty.

Rotational deformity in varus osteoarthritis of the knee: analysis with computed tomography.

Unlabelled: Rotational deformities in varus osteoarthritis of the knee were evaluated with computed tomography. Preoperative computed tomography scans of 150 knees (114 patients) having total knee arthroplasty and 31 control knees (20 patients) were included. The femorotibial rotation was quantified using the clinical epicondylar axis of the femur and the tibial tuberosity (patella tendon) as the references.

Movement of the posterior cruciate ligament during knee flexion--MRI analysis.

The movement of the posterior cruciate ligament (PCL) during flexion of the living knee is unknown. The purpose of the present study was to analyze the movement of the PCL using magnetic resonance imaging (MRI). The posterior cruciate ligaments in 20 normal knees were visualized using MRI from extension to deep flexion.

Characteristics of polyethylene wear particles isolated from synovial fluid after mobile-bearing and posterior-stabilized total knee arthroplasties.

The size, shape, and number of polyethylene wear particles found in synovial fluids of patients 1 year after implantation of 22 well-functioning total knee prostheses (11 contemporary mobile-bearing type, 11 posterior-stabilized type) were determined. Polyethylene wear particles were isolated from synovial fluids and examined by scanning electron microscopy. Particle size (equivalent circle diameter) was 0.

Ankle arthroplasties generate wear particles similar to knee arthroplasties.

Second-generation total ankle arthroplasties have encouraging medium-term results, but the wear of the joint materials is of concern. The aim of the current study was to examine and compare the size, shape, and concentration of polyethylene particles in synovial fluid with total ankle arthroplasties and established posterior-stabilized total knee arthroplasties. Synovial fluid was obtained from 15 patients with well-functioning total ankle arthroplasties and 11 patients with posterior-stabilized total knee arthroplasties at least 6 months after surgery.