Anticoagulant medications have been widely used as prophylactic agents against deep vein thrombosis(DVT)in total knee arthroplasty. Yet, there are more factors we may need to consider when using such interventions including: drug selection, starting time, duration of administration and judgment of therapeutic effectiveness. In this study, we used enoxaparin sodium for prophylaxis of DVT, and examined the incidence rates of DVT from the time of commencing the drug administration.
Objective: We analyzed radiological results of Swanson implant surgery for rheumatoid arthritis affecting the forefoot. Special attention was paid to the incidence of recurrent hallux valgus deformity. Factors affecting such recurrences were analyzed. Methods: Postoperative radiological results with a minimum follow-up period of 12 months after surgery were analyzed in 54 cases (87 joints). The mean age at the time of surgery was 67.7 years (range, 53-84 years). The mean duration after surgery was 40.8 months (range, 12-93 months). Hallux valgus angle (HVA) and intermetatarsal M1-M2 angle (M1M2) were analyzed preoperatively, in the immediate postoperative period, at six months postoperatively, and at the final follow-up. The change of HVA from the immediate postoperative period to the final follow-up was calculated as the change of HVA (ΔHVA). The toe lengths of the hallux including soft tissue shadow were divided into three groups as follows: Type E (hallux length 3 mm longer than the second toe), Type G (hallux length 3 mm shorter than the second toe), and Type S (hallux length within 3 mm of the second toe). The relationship between toe length type and radiological findings were then analyzed. Results: The average preoperative HVA was 38.4±16.5°, and the average HVA in the immediate
Objective: The C-reactive protein (CRP) level and erythrocyte sedimentation rate (ESR) are common markers of inflammation in patients with rheumatoid arthritis (RA). The serum amyloid A (SAA) level is also a sensitive inflammatory marker, and biologic agents (BA) including tocilizumab (TCZ), an inhibitor of interleukin-6 (IL-6), have been reported to decrease the SAA level. However, to date, few reports have compared the SAA levels, disease activity, other inflammatory markers and prospective outcomes following treatment with BA. The aim of this study was to assess the disease activity and levels of SAA and other inflammatory markers in patients with RA receiving such agents. Methods: The subjects included 32 patients with RA who were commenced on biologic treatment during or after July 2008 (17 patients received tumor necrosis factor (TNF) inhibitors and 15 patients received TCZ). The swollen joint count, tender joint count, Disease Activity Score (DAS) 28-ESR score and levels of SAA, ESR, CRP and matrix metalloproteinase-3 were assessed before treatment and at two, four and six months after treatment, respectively. Results: No significant differences were found between the groups at baseline. At two, four and six months after treatment, the SAA, ESR and CRP levels in the TCZ group were significantly lower than those in the TNF inhibitor group, respectively. The DAS28-ESR scores obtained six months after treatment was significantly correlated with the SAA, ESR and CRP levels obtained two and four months after treatment in the TNF inhibitor group and with the SAA levels obtained two and four months after treatment in the TCZ group.
Objective: Recently, Dr. Yamamoto suggested that the cause of idiopathic osteonecrosis of the knee results from an insufficiency fracture. He showed that the necrotic lesion of the knee exists peripheral to the fracture line by using pathological methods. It appears that osteoporosis is related to spontaneous osteonecrosis of the knee (SONK). Therefore, we examined the bone mineral density (BMD) of patients with SONK for underlying osteoporosis. Patients and Methods: The study subjects comprised 50 patients treated in our hospital over a five-year period from April 2007 to April 2012. The age of the patients were 50‒89 years old (mean age 71.0 years), with there being eight males and 42 females. There were 41 patients with pathological changes in the medial femoral condyle, and nine patients with changes to the medial tibial plateau. These patients underwent BMD examinations of the vertebral column and femur with dual energy x-ray absorptiometry. They were all tested within six months after the onset of this disease, and in 17 cases, we examined the tibial plateau bone mineral density. Results: The rate of osteoporosis of these patients was 28%, using BMD, with there being only one male patient affected. In addition, 38% were considered osteoporotic with the use of femur BMD, with only female subjects being affected. The tibial plateau BMD of these patients were slightly lower than those of osteoarthritic patients. Conclusions: The ratio of osteoporosis in patients with SONK was higher than that of unaffected persons. In our study, male patients with SONK rarely had underlying osteoporosis. The use of BMD in patients with SONK may be a useful adjunct for assessing the underlying disease in af-
Objective: Conservative treatment is indicated for a proximal humeral fracture without displacement. It is difficult to maintain conservative treatment for some elderly patients because of spinal deformities and different levels of cognitive understanding. Usually, conservative treatment is indicated for elderly patients because of other co-morbidities. When fracture displacement is identified, it is not always possible to change the treatment plan because of the patients’ underlying general conditions, which can lead to nonunion of proximal humeral fractures. Methods: We analyzed three patient cases including one male and two females, with an average age of 86.5 years. We evaluated the waiting time until operation, Japan Orthopedic Association (JOA) score and radiographic studies. Results: One patient waited 1 year, another waited 2 years and another waiting time was unknown. The preoperative JOA score for pain was 5, for function it was 1.7, and for range of motion it was 4.3; the postoperative JOA score for pain was 23.3, for function it was 3.3, and for range of motion it was 10.3, respectively. We found the union of the greater tuberosity in one case on a follow-up postoperative radiograph. Conclusion: Hemiarthroplasty for nonunion of proximal humeral fractures can relieve a patient’s pain and improve their quality of life. Shoulder function depends on the tuberosities. Our cases could not establish complete union of the tuberosities, such that their shoulder functions were not improved. In order to get tuberosity union, it is important to improve intraoperative methods including a change of the implant.
