Neglected Infected Charcot neuroarthropathy (CN) of the ankle remains one of the most challenging problems in orthopaedic surgery. Traditionally, below-knee amputation (BKA) has been regarded as a common approach for these complex cases, reflecting the morbidity associated with prolonged and often unsuccessful reconstruction. However, advances in the principles of distraction histogenesis and circular external fixation offer a feasible option for limb salvage. We report our experience with a specialized management protocol characterized by a one-stage procedure, the “corticotomy-first” technique, and non-radical debridement, applied in a series of 55 patients with Eichenholtz stage III Charcot neuroarthropathy of the ankle. Osteomyelitis was suspected clinically and radiographically in all patients, with active infection present in 45.5
Aseptic loosening remains a leading cause of revision in total hip arthroplasty (THA), with polyethylene wear representing a key contributing factor. Vitamin E–blended highly cross-linked polyethylene (VEPE) has been introduced to improve oxidative stability and long-term wear performance; however, long-term clinical data remain limited. This retrospective study evaluates long-term polyethylene wear and component positioning in a cohort of patients who underwent primary THA using a vitamin E–blended polyethylene monoblock acetabular component (RM Pressfit vitamys®). Patients were followed for a minimum of ten years. Radiographic assessment was performed using a fully automated, observer-independent CAD-based software (RayMatch®), enabling measurement of cup inclination, anteversion, and polyethylene wear through 2D–3D registration of implant CAD models. A total of 57 hips with complete radiographic follow-up were analyzed. Mean polyethylene wear rates were 26.9 µm/year at five years and 18.2 µm/year at ten years, remaining well below commonly reported thresholds associated with osteolysis. Cup inclination remained stable over time, whereas a gradual increase in measured anteversion was observed during follow-up. At a minimum ten year follow-up, the investigated vitamin E–blended polyethylene monoblock cup demonstrated favorable long-term wear characteristics and stable component positioning. Further comparative studies are warranted to compare its long-term performance with other acetabular cup and liner designs.
Hip resurfacing arthroplasty(HRA) is an attractive alternative to total hip arthroplasty(THA) for different reasons: femoral bone stock preservation, large femoral head reducing the risk of dislocation, restoration of physiological hip biomechanics and absence of thigh pain. There is a paucity of data about evolution after revision of HRA to THA(RTH). The aim of this study was to evaluate the functional outcomes after RTH and compare them with matched patients undergoing primary THA on hip osteoarthritis. A retrospective case–control study was conducted including patients who underwent revision from HRA to THA with a minimum follow-up of three years. Among 5268 HRAs performed by a single surgeon, 22 required revision(0.42
Osteonecrosis of the femoral head (ONFH) frequently affects young and middle-aged adults and may progress to collapse. This guideline provides evidence-informed, expert-panel recommendations for minimally invasive hip preservation in adults, generally aged 60 years or younger, with early- to mid-stage nontraumatic ONFH. A multidisciplinary panel formulated nine clinical questions. PubMed/MEDLINE, Europe PMC, and OpenAlex were searched from inception to May 1, 2025. Systematic reviews, clinical trials, observational studies, prognostic cohorts, case series, and relevant guidelines were included. Evidence was graded using the 2009 Oxford Centre for Evidence-Based Medicine framework, and recommendations were finalized through expert consensus. The guideline primarily applies to adults aged ≤ 60 years with glucocorticoid-associated, alcohol-associated, or idiopathic ONFH at ARCO stages I–IIIA. Nine recommendations were developed; all were graded C or D. Individualized ONFH hip-preserving regimens shall be built into dynamic multi-dimensional pathways centered on disease staging with integrated consideration of patient age, lesion classification and personal demands. Asymptomatic hips require imaging-based risk stratification, and surgery is not indicated solely because a lesion is asymptomatic. Routine combined postoperative pharmacological therapy is not supported. Core decompression is mainly indicated for pre-collapse disease and is preferably combined with regenerative or structural augmentation when appropriate. Bone grafting is one of the key methods to reinforce or reconstruct the lateral pillar, though relevant recommendations on bone grafting and surgical approaches are only low-level expert consensus principles. Osteotomy may be considered in selected young patients when sufficient intact weight-bearing surface can be restored. Post-operative evaluation should combine imaging and patient-reported clinical outcomes. These evidence-informed recommendations provide a nonmandatory framework for selected adults with nontraumatic ONFH. Most statements rely on heterogeneous or indirect evidence and should be applied through individualized assessment and shared decision-making.
The objective of this study was to compare implant subsidence at 12 months following vertebral body replacement (VBR) with 3D-printed patient-specific polyetheretherketone (PEEK) implants versus off-the-shelf titanium mesh cages after spondylectomy for spinal tumours. Prospective non-randomized controlled cohort study. Adult patients with thoracic or lumbar spine tumours requiring VBR were enrolled between April 2022 and February 2025. Patients received either fused filament fabrication PEEK implants (n = 30) or titanium mesh cages (n = 30), with group allocation determined by manufacturing queue availability. The primary endpoint was subsidence exceeding 3 mm at 12 months. Secondary endpoints included osseous integration, segmental height, quality of life (SOSGOQ2.0), neurological status, and complications. Fifty-three patients completed follow-up (PEEK n = 27, Ti Mesh n = 26). Subsidence occurred in one of 27 PEEK patients (3.7
Bone and soft tissue sarcomas are rare, heterogeneous malignancies presenting major diagnostic and therapeutic challenges. Over the past century, Japanese orthopaedic surgeons have occupied a unique position as both primary surgeons and comprehensive oncologists. On the occasion of the Centennial of the Japanese Orthopaedic Association (JOA), this review synthesizes the key historical milestones and future prospects of Japanese orthopaedic oncology. A narrative synthesis was structured across five consolidated domains: (1) Surgical Innovation; (2) Advanced Basic Research and Novel Therapeutics; (3) The Japan Bone and Soft Tissue Tumor Registry (JBSTTR); (4) Nationwide Collaborative Research Groups and Multidisciplinary Platforms; and (5) Onco-Orthopaedics and Future Musculoskeletal Care. Japanese orthopaedic oncologists established quantitative surgical margin concepts, pioneered Total En Bloc Spondylectomy (TES) for spinal tumours, and developed recycled treated autografts (freezing, pasteurization, and irradiation). Translational research milestones encompass caffeine-potentiated chemotherapy, peptide-based immunotherapy, oncolytic viral therapies, Japan’s first investigator-initiated clinical trial in oncology, and carbon-ion radiotherapy. Furthermore, a robust nationwide infrastructure has been forged through six decades of the JBSTTR alongside collaborative research engines—the Japanese Musculoskeletal Oncology Group (JMOG), the Japan Clinical Oncology Group Bone and Soft Tissue Tumor Study Group (JCOG-BSTTSG), and the Japan Ewing Sarcoma Study Group (JESS)—and the multidisciplinary platform Japanese Association of Sarcoma Treatment and Research (JSTAR). Expanding beyond primary sarcoma care, the conceptual framework of Onco-Orthopaedics has pioneered a holistic paradigm for managing locomotive syndrome in cancer patients "Cancer Locomo". The surgeon-led collaborative ecosystem in Japan bridges surgical precision, translational science, and nationwide multidisciplinary platforms, offering a sustainable model for advancing musculoskeletal oncology.
To evaluate the long-term clinical, functional, and radiological outcomes, implant retention, and revision requirements after total arthroplasty of the first metatarsophalangeal (MTP) joint for hallux rigidus. This retrospective single-center study included 41 patients who underwent first metatarsophalangeal joint total arthroplasty for hallux rigidus between January 2010 and December 2015 and had a minimum follow-up of ten years. Long-term clinical and functional outcomes, including the Visual Analog Scale (VAS), the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal–Interphalangeal (AOFAS Hallux-MTP-IP) score, and dorsiflexion range of motion, were analyzed exclusively in the 35 patients with retained implants who completed more than ten years of follow-up, whereas implant retention, revision rates, and radiological outcomes were assessed in the entire cohort of 41 patients. A formal time-to-event survival analysis was not performed. Outcomes at postoperative one and ten years were compared. The mean age was 53.7 ± 8.4 years, and the mean follow-up period was 12.8 ± 3.7 years. Mean VAS scores improved from 7.5 ± 0.8 preoperatively to 2.6 ± 0.8 at one year and 3.4 ± 0.8 at ten years. Mean AOFAS scores increased from 37.8 ± 8.8 preoperatively to 84.3 ± 9.8 at one year and remained 76.4 ± 9.0 at final follow-up. Mean dorsiflexion improved from 7.2 ± 2.2° to 24.2 ± 8.2°. At final follow-up, the implant was retained in 35 patients (85.4
Hip dysplasia and secondary hip osteoarthritis are common in Asian populations, and are major causes of hip arthroplasty. Periacetabular osteotomy (PAO) is a joint-preserving surgical option for young patients with symptomatic hip dysplasia, aimed at preventing progression to end-stage arthritis. This study aimed to analyze the ten year trends in hip dysplasia diagnosis and PAO utilization in South Korea using national health insurance claims data. This nationwide retrospective study analyzed data from the Health Insurance Review Assessment Service (HIRA) covering 10-year period (2014–2023). The diagnostic trend of hip dysplasia was investigated alongside the trends in PAO surgeries. Population-based PAO rates were examined as the primary analysis, while PAO frequency relative to the cumulative number of diagnosed cases was additionally assessed as a secondary analysis, along with regional distributions and trends across age groups. Over the ten year period, a total of 48,890 patients (63.7
This study aimed to comprehensively compare the effects of peroneus longus tendon (PLT) and semitendinosus tendon (ST) autografts on knee and ankle isometric strength asymmetries, jump performance, postural stability, and patient-reported outcome measures (PROMs) in patients 12 months after isolated anterior cruciate ligament reconstruction (ACLR). In this retrospective study, 98 eligible patients underwent propensity score matching. After dropouts, 60 patients (ST: n = 30; PLT: n = 30) were evaluated 12 months postoperatively. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC), Lysholm, Tegner, and American Orthopaedic Foot and Ankle Society (AOFAS) scales. Functional assessments included single-leg hop tests (SLHTs), countermovement jump (CMJ), drop jump (DJ), single-leg jump (SLJ), single-leg drop jump (SLDJ), land-and-hold (LH), and single-leg stance (SLS) tests. Isometric strength for knee flexion/extension and ankle plantar flexion/eversion was measured. Two separate 2 × 2 mixed-design ANOVAs were utilized to evaluate time-dependent and inter-limb (operative vs. contralateral) differences across groups. Both groups demonstrated significant time-dependent improvements in IKDC, Lysholm, and Tegner scores (p < 0.05), with no significant inter-group differences. However, the PLT group showed significantly higher inter-limb functional asymmetry in SLHTs (14.06
Computer-assisted navigation improves spatial orientation during pelvic bone tumour resection but provides no direct three-dimensional feedback regarding the distance between the tumour and planned osteotomy planes. This study evaluated the clinical value of automated dangerous region generation (ADRG) as an adjunct to computer-assisted surgery. We retrospectively analyzed 32 patients with pelvic bone tumours treated between May 2018 and February 2025. Sixteen underwent resection using automated dangerous region generation combined with computer-assisted surgery (ADRG + CAS group), and 16 underwent computer-assisted surgery alone (CAS-only group). Perioperative, oncological, survival, and functional outcomes were compared. Median operative time was shorter in the ADRG + CAS group than in the CAS-only group [212.5 min (161.3–325.0) vs 355.0 min (267.8–405.0); p = 0.013]. Median intraoperative blood loss was also lower [1,100 mL (850–1,475) vs 1,550 mL (1,050–2,750); p = 0.040]. Length of stay did not differ significantly [18.0 days (16.0–29.8) vs 17.0 days (14.3–22.0); p = 0.161]. Local recurrence occurred in no patient in the ADRG + CAS group and in three patients in the CAS-only group. Metastasis occurred in two and three patients, respectively, and two patients in each group died. Wide surgical margins were obtained in 14/16 (87.5
The increasing prevalence of Glucagon-like peptide-1 receptor agonists (GLP-1 RA) has raised concerns about their perioperative impact. Although database studies on GLP-1 RAs in total shoulder arthroplasty (TSA) have been published for diabetic and general TSA patients, results are conflicting, and the effects on patients across various obesity classes remain unexplored. This study aims to fill this gap. The PearlDiver database was used to identify patients who underwent primary TSA, grouped by GLP-1 use, obesity status, and obesity class. Post-operative outcomes included 90-day readmission and emergency department (ED) visit rates, medical complications (including thromboembolic, infectious, and renal events), and orthopaedic complications (including revision, periprosthetic joint infection, and instability). Cohorts were matched 10:1 by exact matching on age, sex, Elixhauser comorbidity index, diabetes, hypertension and overall obesity status, and multivariable regression was used to adjust for comorbidities that remained imbalanced after matching. Among 95,566 patients, 1,549 (1.62
This review outlines the concept of locomotive syndrome, as well as the current definition, diagnostic criteria, and management strategies for the condition. This paper begins by discussing the reasons behind the introduction of the concept of locomotive syndrome in Japan and its social context. This social context is characterized by Japan's population aging at the fastest rate in the world, changes in its industrial structure leading to a decrease in traumatic injuries such as workplace accidents, and a sharp increase in degenerative diseases. The prevalence of a relatively small number of musculoskeletal disorders is high among older adults, and the rate of co-morbidity is also high. Furthermore, these disorders and conditions are interlinked through a decline in motor function, such as reduced muscle strength and impaired balance. As multiple disorders and conditions often co-exist in a single older adult, their combined effect leads to a decline in mobility. The coexistence and interaction of these disorders are defining characteristics of musculoskeletal diseases in older adults and represent a major clinical challenge. The concept of locomotive syndrome was proposed precisely because it is necessary to consider such musculoskeletal problems in older adults comprehensively from the perspective of reduced mobility. Subsequently, the locomotive syndrome risk test and the locomotive syndrome stage are explained. Following this, locomotion training is introduced as a countermeasure against locomotive syndrome. Finally, this paper discusses the relationship between locomotive syndrome and other fields, such as cancer and metabolic syndrome, as well as future perspectives.
To compare a triple-strand braided hamstring graft technique with the conventional quadruple-strand hamstring technique in anterior cruciate ligament reconstruction with respect to graft diameter, surgical parameters, and mid-term functional outcomes, and to determine whether the braided technique independently influences clinical success. This two-centre retrospective review included 94 adults undergoing hamstring autograft reconstruction for isolated ACL rupture with at least one year of follow-up. Thirty-eight received the braided and 56 the conventional technique. Graft diameter, operative time, additional procedures, and functional scores (International Knee Documentation Committee [IKDC], Lysholm, visual analogue scale [VAS]) were recorded pre-operatively and at final follow-up. Multivariate logistic regression identified independent predictors of a good functional outcome (final IKDC ≥ 90), adjusting for age, sex, body mass index (BMI), injury mechanism, injury-to-surgery interval, pre-operative IKDC, and graft diameter. Baseline characteristics were comparable (all p > 0.05). Graft diameter was significantly greater in the braided group (p < 0.001), whereas operative time did not differ (p = 0.638). Both groups improved significantly from baseline (all p < 0.001). At final follow-up, the braided group achieved higher IKDC (p < 0.001) and Lysholm (p = 0.009) scores; the VAS difference was not significant (p = 0.126). After adjustment, the braided technique remained an independent predictor of a good functional outcome (OR 3.719, 95
Anatomic anterior cruciate ligament (ACL) reconstruction has evolved substantially from procedures aimed primarily at restoring anterior stability toward strategies designed to restore both anterior and rotational stability by reproducing native ACL anatomy, biomechanics, and physiologic knee kinematics. This narrative review summarizes the surgical, biomechanical, and biological concepts underlying this evolution. A narrative review of the literature on the development of anatomic ACL reconstruction was performed, focusing on tunnel positioning, graft configuration, tensioning, remnant preservation, concomitant meniscal injury, extra-articular augmentation, and posterior tibial slope correction. The transition from isometric, transtibial single-bundle reconstruction toward anatomic techniques was driven by recognition of the ACL's dual-bundle structure and broad insertion morphology, leading to double-bundle reconstruction and later morphology-based rectangular tunnel bone–patellar tendon–bone reconstruction. Concurrently, graft tensioning philosophy shifted toward lower, more physiologic tension guided by reciprocal anteromedial-posterolateral bundle behavior, and remnant-preserving techniques emerged to enhance proprioception, vascularity, and graft integration. Concomitant meniscal injury, including ramp lesions and lateral meniscal posterior root tears, is now recognized as an integral determinant of knee kinematics and long-term joint health rather than an incidental finding, reinforcing the concept of ACL injury as a multi-structural pathology. Lateral extra-articular procedures and tibial slope-reducing osteotomy have further addressed graft failure and residual rotational instability in high-risk patients. Anatomic ACL reconstruction has progressively shifted from isolated ligament substitution toward individualized, anatomy- and biomechanics-based restoration of comprehensive knee stability, aiming to achieve durable, physiologic knee function through tailored surgical planning.
The Japanese Orthopaedic Association (JOA), founded in 1926, celebrates its centennial in 2026 as one of the world’s largest national orthopaedic societies. This article reviews the historical development of the JOA during its first century and highlights major scientific, clinical, educational, and public health achievements of Japanese orthopaedics. The JOA has played a central role in the development of Japanese orthopaedics through specialist education, clinical practice guidelines, nationwide registries, and the promotion of basic and clinical research. Japanese orthopaedic surgeons have contributed to modern orthopaedics through pioneering surgical techniques, technological innovations, and international academic exchange. These developments have expanded the role of orthopaedics beyond the treatment of musculoskeletal disorders to encompass broader public health challenges associated with population aging and the maintenance of mobility and quality of life. Over the past century, Japanese orthopaedics has evolved from a small academic discipline into an internationally recognized field, alongside profound demographic and epidemiological changes, particularly the emergence of a super-aged society.
Acetabular dysplasia is a leading cause of secondary hip osteoarthritis in Japan and has long been a major indication for joint-preserving surgery. Over the past decades, several unique pelvic osteotomy techniques have been developed in Japan. Representative procedures include Transposition Osteotomy of the Acetabulum, Rotational Acetabular Osteotomy, Eccentric Rotational Acetabular Osteotomy, Curved Periacetabular Osteotomy, and Spherical Periacetabular Osteotomy. Although these procedures share the common objective of improving femoral head coverage and preserving the native hip joint, each procedure has evolved independently with distinct surgical concepts, osteotomy designs, and technical characteristics. Numerous studies have demonstrated favourable clinical outcomes after these procedures when appropriate patient selection is performed. Recent advances in three-dimensional imaging, computer simulations, and computer-assisted surgery have further refined surgical planning and postoperative assessments. This review summarises the historical evolution, surgical concepts, indications, clinical outcomes, and future perspectives of pelvic osteotomies developed in Japan, highlighting their individual characteristics and continuing roles in contemporary joint-preserving hip surgeries.
