Kinematically Aligned Oxford Unicompartmental Knee Arthroplasty Using the Microplasty Instrumentation System

Takafumi Hiranaka,Takaaki Fujishiro,Motoki Koide,Koji Okamoto 대한정형외과학회 2023 Clinics in Orthopedic Surgery Vol.15 No.4

This technical note demonstrates kinematically aligned Oxford unicompartmental knee arthroplasty using the Microplasty instrumentation system with custom-made devices. The medial joint line is evaluated preoperatively; if it is aligned and parallel with the lateral joint line, they are considered to comprise the coronal knee joint line (CJL). In this case, the coronal inclination of a spoon gauge inserted into the medial joint space indicates the CJL. Otherwise, an accessory spoon is inserted and connected to the medial spoon to refer to the posterior condylar line, which is considered the CJL. The tibial cutting block is then connected without changing the inclination of the spoon and the coronal tilt of the tibial extramedullary rod is adjusted, which is implemented with a custom-made ankle yoke. The remainder of the steps is then identical to the conventional Microplasty procedure. This technique can imitate the cutting line to the CJL, which might be considered ideal from mechanical and kinematic perspectives.

A Novel Technique for Varus Tibial Cutting for Oxford Unicompartmental Knee Arthroplasty

Takafumi Hiranaka,Toshikazu Tanaka,Takaaki Fujishiro,Kenjiro Okimura,Rika Shigemoto,Shotaro Araki,Ryo Okada,Ryohei Nako,Koji Okamoto 대한정형외과학회 2020 Clinics in Orthopedic Surgery Vol.12 No.4

To reduce the stress on the medial tibial cortex and to decrease the risk of fracture, a varus cut of the tibia appears to be a reasonable alternative to the orthogonal cut by conventional methods. We present a new instrument and procedure, which enables a varus tibial cut for Oxford unicompartmental knee arthroplasty. We used a custom-made, slidable fixator instead of the standard fixator to set the extramedullary rod on the leg. We also made a numeric formula and a chart to arrange the varus cutting angle using the length of the mediolateral shift of the distal end and the longitudinal extension length of the extramedullary tibial rod. A varus cut up to 4.5° can be controlled. This technique is a simple and useful means of obtaining a varus tibial cut for Oxford unicompartmental knee arthroplasty.

A Modified Under-Vastus Approach for Knee Arthroplasty with Anatomical Repair of Soft Tissue

Takafumi Hiranaka,Toshikazu Tanaka,Takaaki Fujishiro,Kensuke Anjiki,Naosuke Nagata,Daiya Kitazawa,Ken Kotoura,Koji Okamoto 대한정형외과학회 2019 Clinics in Orthopedic Surgery Vol.11 No.4

The under-vastus approach (UVA) is a modification of the conventional subvastus approach for knee arthroplasty. Our modified UVA allows the muscles to be spared while offering good exposure of the operative field and facilitating anatomical repair of the capsule and fascia. A medial parapatellar incision is made and the vastus medialis fascia is incised along the same line. The muscle belly is not incised but detached from the surrounding fascia and retracted laterally. The suprapatellar pouch capsule is then laterally incised under the vastus muscles. The patella can then be easily retracted laterally and adequate exposure is possible. After the procedure, both capsule and fascia can be anatomically repaired. We use this approach for all primary arthroplasties in our practice. There has been no case in which an additional muscle incision was required, and there were no intraoperative complications. The modified UVA allows for excellent exposure of the operative field as well as muscle retention in both primary total and unicompartmental knee arthroplasties.

Is simultaneous bilateral unicompartmental knee arthroplasty and total knee arthroplasty better than simultaneous bilateral total knee arthroplasty?

( Naosuke Nagata ),( Takafumi Hiranaka ),( Koji Okamoto ),( Takaaki Fujishiro ),( Toshikazu Tanaka ),( Anjiki Kensuke ),( Daiya Kitazawa ),( Ken Kotoura ) 대한슬관절학회 2023 대한슬관절학회지 Vol.35 No.-

Introduction This retrospective study aims to clarify if there are benefits of performing unicompartmental knee arthroplasty (UKA) on just one indicated side in patients who undergo simultaneous bilateral knee arthroplasty. Materials and methods We compared 33 cases of simultaneous bilateral UKA/total knee arthroplasty (TKA) (S-UT) with 99 cases of simultaneous bilateral TKA (S-TT). Comparison included blood tests [C-reactive protein (CRP), albumin, and D-dimer], the incidence of deep vein thrombosis (DVT), range of motion (ROM), and clinical scores before and 1 year after surgery. Results Clinical scores were not significantly different between the groups. The postoperative flexion angle was significantly better in UKA sides. Blood tests showed that the S-UT had a significantly higher albumin value at 4 and 7 days after surgery. The CRP value at 4 and 7 days, and the D-dimer value at 7 and 14 days after surgery were significantly lower in the S-UT. The S-UT had significantly lower incidence of DVT. Conclusions In cases of bilateral arthroplasty, if there is an indication on only one side, a better flexion angle can be obtained by UKA on that side, and with less surgical invasion. Moreover, the incidence of DVT is low, which is considered to be a benefit of performing UKA on just one side.

Clinical Results of Dual SC Screw: A Mini-Sliding Hip Screw with an Anti-rotating Screw for Femoral Neck Fractures

Takafumi Hiranaka,Toshikazu Tanaka,Kenjiro Okumura,Takaaki Fujishiro,Rika Shigemoto,Shotaro Araki,Ryo Okada,Ryohei Nako,Koji Okamoto 대한정형외과학회 2021 Clinics in Orthopedic Surgery Vol.13 No.4

Background: Dual SC screw (DSCS) is a unique concept internal fixation device consisting of a sliding screw and barrel assembly that enables compression force to be applied to the femoral neck fracture side. There are two types of barrels: a thread barrel and a plate barrel that has a one-holed side plate to prevent varus deformity. We report clinical results of the application of a DSCS with combined use of a thread barrel screw as an anti-rotational screw and a plate barrel screw as a compression hip screw. Methods: We used DSCS for femoral neck fractures in 196 hip joints of 190 patients between November 2005 and June 2017. Among them, 70 hips in 66 patients (13 men and 53 women; mean age, 73.2 years) were followed up for at least 24 months. There were 53 nondisplaced fractures (Garden’s classification stage 1 or 2) and 17 displaced fractures (stage 3 or 4). We evaluated the postoperative walking ability of the patients who were followed up for at least 24 months and examined details of all complications. Results: The mean follow-up period was 37.4 months (range, 24–144 months). Forty-two (64%) out of the 66 patients who were followed up for at least 2 years were able to walk independently with or without a cane. The incidence of complications was 11.5% in nondisplaced fractures and 17.5% in displaced fractures, and arthroplasty was required in 5.8% and 5.0%, respectively. The most frequent complication was secondary displacement including cutout and shortening of the femoral neck, but no implants showed varus displacement. Conclusions: The application of DSCS for the treatment of femoral neck fractures had satisfactory results. The complication rate was low, and there was no postoperative varus displacement of DSCS in either displaced or nondisplaced fractures. We suggest DSCS is a reliable option for both displaced and nondisplaced femoral neck fractures.

Accurate and Easy Measurement of Sliding Distance of Intramedullary Nail in Trochanteric Fracture

Nobuaki Chinzei,Takafumi Hiranaka,Takahiro Niikura,Takaaki Fujishiro,Shinya Hayashi,Noriyuki Kanzaki,Shingo Hashimoto,Yoshitada Sakai,Ryosuke Kuroda,Masahiro Kurosaka 대한정형외과학회 2015 Clinics in Orthopedic Surgery Vol.7 No.2

In daily clinical practice, it is essential to properly evaluate the postoperative sliding distance of various femoral head fixation devices (HFD) for trochanteric fractures. Although it is necessary to develop an accurate and reproducible method that is unaffected by inconsistent postoperative limb position on radiography, few studies have examined which method is optimal. Therefore, the purpose of this study is to prospectively compare the accuracy and reproducibility of our four original methods in the measurement of sliding distance of the HFD. Methods: Radiographs of plastic simulated bone implanted with Japanese proximal femoral nail antirotation were taken in five limb postures: neutral, flexion, minute internal rotation, greater external rotation, and flexion with external rotation. Orthopedic surgeons performed five measurements of the sliding distance of the HFD in each of the flowing four methods: nail axis reference (NAR), modified NAR, inner edge reference, and nail tip reference. We also assessed two clinical cases by using these methods and evaluated the intraclass correlation coefficients. Results: The measured values were consistent in the NAR method regardless of limb posture, with an even smaller error when using the modified NAR method. The standard deviation (SD) was high in the nail tip reference method and extremely low in the modified NAR method. In the two clinical cases, the SD was the lowest in the modified NAR method, similar to the results using plastic simulated bone. The intraclass correlation coefficients showed the highest value in the modified NAR method. Conclusions: We conclude that the modified NAR method should be the most recommended based on its accuracy, reproducibility, and usefulness.

Manipulation of Tibial Component to Ensure Avoidance of Bearing Separation from the Vertical Wall of Tibial Component in Oxford Unicompartmental Arthroplasty

Takafumi Hiranaka,Toshikazu Tanaka,Kenjiro Okimura,Takaaki Fujishiro,Rika Shigemoto,Shotaro Araki,Ryo Okada,Ryohei Nako,Tomoyuki Kamenaga,Koji Okamoto 대한정형외과학회 2021 Clinics in Orthopedic Surgery Vol.13 No.1

In Oxford unicompartmental knee arthroplasty, the relationship between the mobile bearing and the vertical wall of the tibial tray is important in preventing bearing dislocation. Separation of the bearing from the vertical wall can cause spinning of the bearing with an increased risk of subsequent dislocation. We report on intraoperative adjustment of the tibial tray performed to prevent the bearing from spinning. After tibial and femoral bone cutting and adjustment of the flexion and extension gap, the trial bearing is inserted and the bearing-vertical wall distance is evaluated before the preparation using the tibial template and bearing trial. In the case of separation, it can be resolved by medialization with or without rotational adjustment. The technique is useful and can be easily performed, it is therefore recommendable for all cases of Oxford mobile-bearing unicompartmental arthroplasty.

The Medial Eminence Line for Predicting Tibial Fracture Risk after Unicompartmental Knee Arthroplasty

Yoshikawa Ryo,Hiranaka Takafumi,Okamoto Koji,Fujishiro Takaaki,Hida Yuichi,Kamenaga Tomoyuki,Sakai Yoshitada 대한정형외과학회 2020 Clinics in Orthopedic Surgery Vol.12 No.2

Background: Tibial fracture after cementless Oxford unicompartmental knee arthroplasty (OUKA) is a rare but serious complication. It is reported more frequently in Asian countries. The aim of this retrospective study was to assess the morphological characteristics of the tibia by using a simple novel measurement method in patients with tibial fractures after OUKA. Methods: Six knees (all women) with tibial fractures after cementless OUKA (fracture group) and 150 knees without an obvious complication after cementless OUKA (control group) were examined retrospectively at our institution between January 2016 and April 2017. We drew a medial eminence line (ME line) defined as a line extending from the tip of the medial intercondylar eminence parallel to the tibial axis. The ME line was classified into two types (intramedullary type [type I] and extramedullary type [type E]), and the proportion of each type was compared between fracture patients and controls. Results: In the fracture group, there were four (66.7%) type E cases and two (33.3%) type I cases; in the control group, there were 18 (12%) type E cases and 132 (88%) type I cases. Fisher exact tests showed that the proportion of type E was higher in the fracture group than in the control group (p < 0.01). Conclusions: Measurement of the ME line can be recommended as a useful method to assess the risk of postoperative fracture after cementless OUKA.

Second-Look Arthroscopic Findings and Clinical Outcomes after Adipose-Derived Regenerative Cell Injection in Knee Osteoarthritis

Yuma Onoi,Takafumi Hiranaka,Yuichi Hida,Takaaki Fujishiro,Koji Okamoto,Tomoyuki Matsumoto,Ryosuke Kuroda 대한정형외과학회 2022 Clinics in Orthopedic Surgery Vol.14 No.3

Background: To evaluate the clinical outcomes and second-look arthroscopic findings after intra-articular adipose-derived regenerative cell (ADRC) injection as treatment for knee osteoarthritis (OA). Methods: ADRCs were administered to 11 patients (19 knees; mean age, 61.7 years) with knee OA. Subcutaneous adipose tissue was harvested by liposuction from both thighs, and arthroscopic lavage was performed, followed by ADRC injection (mean dose, 1.40 × 107 cells) into the synovial fluid. Outcome measures included the Knee Injury and Osteoarthritis Outcome Score, Lysholm score, and visual analog scale score. Arthroscopic examinations were performed to assess the International Cartilage Repair Society cartilage injury grade preoperatively and overall repair postoperatively. Noninvasive assessments were performed at baseline and at 1-, 3-, and 6-month follow-ups; arthroscopic assessments were performed at baseline and at 6 months. Results: All outcome measures significantly improved after treatment. This improvement was evident 1 month after treatment and was sustained until the 6-month follow-up. Data from second-look arthroscopy showed better repair in low-grade cartilage lesions than in lesions with a greater degree of damage. No patients demonstrated worsening of Kellgren-Lawrence grade, and none underwent total knee arthroplasty during this period. Conclusions: Clinical outcomes were improved in patients with knee OA after ADRC administration. Cartilage regeneration was more effective in smaller damaged lesions than in bigger lesions.

Robust Pelvic Coordinate System Determination for Pose Changes in Multidetector-row Computed Tomography Images

Kobashi, Syoji,Fujimoto, Satoshi,Nishiyama, Takayuki,Kanzaki, Noriyuki,Fujishiro, Takaaki,Shibanuma, Nao,Kuramoto, Kei,Kurosaka, Masahiro,Hata, Yutaka Korean Institute of Intelligent Systems 2010 INTERNATIONAL JOURNAL of FUZZY LOGIC and INTELLIGE Vol.10 No.1

For developing navigation system of total hip arthroplasty (THA) and evaluating hip joint kinematics, 3-D pose position of the femur and acetabulum in the pelvic coordinate system has been quantified. The pelvic coordinate system is determined by manually indicating pelvic landmarks in multidetector-row computed tomography (MDCT) images. It includes intra- and inter-observer variability, and may result in a variability of THA operation or diagnosis. To reduce the variability of pelvic coordinate system determination, this paper proposes an automated method in MDCT images. The proposed method determines pelvic coordinate system automatically by detecting pelvic landmarks on anterior pelvic plane (APP) from MDCT images. The method calibrates pelvic pose by using silhouette images to suppress the affect of pelvic pose change. As a result of comparing with manual determination, the proposed method determined the coordinate system with a mean displacement of $2.6\;{\pm}\;1.6$ mm and a mean angle error of $0.78\;{\pm}\;0.34$ deg on 5 THA subjects. For changes of pelvic pose position within 10 deg, standard deviation of displacement was 3.7 mm, and of pose was 1.28 deg. We confirmed the proposed method was robust for pelvic pose changes.