研究者詳細 - 原藤　健吾

論文 - 原藤　健吾

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What are the important manoeuvres for beginners to minimize surgical time in primary total knee arthroplasty?

Harato Kengo, Maeno Shinichi, Tanikawa Hidenori, Kaneda Kazuya, Morishige Yutaro, Nomoto So, Niki Yasuo

Knee Surgery, Sports Traumatology, Arthroscopy 2015年03月

ISSN 0942-2056

Purpose: It was hypothesized that surgical time of beginners would be much longer than that of experts. Our purpose was to investigate and clarify the important manoeuvres for beginners to minimize surgical time in primary total knee arthroplasty (TKA) as a multicentre study.Methods: A total of 300 knees in 248 patients (averaged 74.6 years) were enrolled. All TKAs were done using the same instruments and the same measured resection technique at 14 facilities by 25 orthopaedic surgeons. Surgeons were divided into three surgeon groups (four experts, nine medium-volume surgeons and 12 beginners). The surgical technique was divided into five phases. Detailed surgical time and ratio of the time in each phase to overall surgical time were recorded and compared among the groups in each phase. A total of 62, 119, and 119 TKAs were done by beginners, medium-volume surgeons, and experts, respectively.Results: Significant differences in surgical time among the groups were seen in each phase. Concerning the ratio of the time, experts and medium-volume surgeons seemed cautious in fixation of the permanent component compared to other phases. Interestingly, even in ratio, beginners and medium-volume surgeons took more time in exposure of soft tissue compared to experts. (0.14 in beginners, 0.13 in medium-volume surgeons, 0.11 in experts, P < 0.05).Conclusion: Beginners took more time in exposure and closure of soft tissue compared to experts. Improvement in basic technique is essential to minimize surgical time among beginners. First of all, surgical instructors should teach basic techniques in primary TKA for beginners.Level of evidence: Therapeutic studies, Level IV.

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Effects of Reduction Osteotomy on Gap Balancing During Total Knee Arthroplasty for Severe Varus Deformity

Niki Yasuo, Harato Kengo, Nagai Katsuya, Suda Yasunori, Nakamura Masaya, Matsumoto Morio

Journal of Arthroplasty 2015年01月

ISSN 0883-5403

This study aimed to assess the effects of down-sizing and lateralizing of the tibial component (reduction osteotomy) on gap balancing in TKA, and the clinical feasibility of an uncemented modular trabecular metal tibial tray in this technique. Reduction osteotomy was performed for 39 knees of 36 patients with knee OA with a mean tibiofemoral angle of 21° varus. In 20 knees, appropriate gap balance was achieved by release of the deep medial collateral ligament alone. Flexion gap imbalance could be reduced by approximately 1.7° and 2.8° for 4-mm osteotomy and 8-mm osteotomy, respectively. Within the first postoperative year, clinically-stable tibial component subsidence was observed in 9 knees, but it was not progressive, and the clinical results were excellent at a mean follow-up of 3.3years.

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Pseudogout at the knee joint will frequently occur after hip fracture and lead to the knee pain in the early postoperative period

Harato Kengo, Yoshida Hiroki

Journal of Orthopaedic Surgery and Research 10 （ 1 ） 2015年01月

Background: Symptomatic knee joint effusion is frequently observed after hip fracture, which may lead to postoperative knee pain during rehabilitation after hip fracture surgery. However, unfortunately, very little has been reported on this phenomenon in the literature. The purpose of the current study was to investigate the relationship between symptomatic knee effusion and postoperative knee pain and to clarify the reason of the effusion accompanied by hip fracture. Methods: A total of 100 patients over 65 years of age with an acute hip fracture after fall were prospectively followed up. Knee effusion was assessed on admission and at the operating room before the surgery. If knee effusion was observed at the time of the surgery, synovial fluid was collected into syringes to investigate the cause of the effusion using a compensated polarized light microscope. Furthermore, for each patient, we evaluated age, sex, radiographic knee osteoarthritis (OA), type of the fracture, laterality, severity of the fracture, and postoperative knee pain during rehabilitation. These factors were compared between patients with and without knee effusion at the time of the surgery. As a statistical analysis, we used Mann-Whitney U-test for patients' age and categorical variables were analyzed by chi-square test or Fisher's exact test. Results: A total of 30 patients presented symptomatic knee effusion at the time of the surgery. In patients with knee effusion, numbers of intertrochanteric fracture, radiographic knee OA, and postoperative knee pain were significantly large compared to those without effusion. In terms of synovial fluid analysis, calcium pyrophosphate dihydrate crystals were observed in 80% of patients with knee effusion. Conclusion: From our study, approximately 63% of patients with knee effusion at the time of the surgery had postoperative knee pain. In addition, this effusion was basically related to pseudogout.

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【変形性膝関節症の診断と治療】診断・評価の進歩歩行解析変形性膝関節症患者の歩行解析

原藤健吾，二木康夫，畔柳裕二，大谷俊郎，須田康文，名倉武雄

別冊整形外科 67 66 - 70 2015年

骨付き膝蓋腱を用いた前十字靱帯再々建術のMRI輝度変化とKT値の関係について

金子陽介，二木康夫，窪田秀次郎，箱崎彰裕，原藤健吾，戸山芳昭，須田康文

JOSKAS (日本関節鏡・膝・スポーツ整形外科学会雑誌） 40 134 - 135 2015年

血液型不適合生体肝移植後に人工膝関節全置換術を施行した1例

西村空也，石川雅之，藤田順之，原藤健吾，朝本俊司，西山誠，福井康之

JOSKAS (日本関節鏡・膝・スポーツ整形外科学会雑誌） 40 500 2015年

Effect of unstable meniscal injury on three-dimensional knee kinematics during gait in anterior cruciate ligament-deficient patients

Harato Kengo, Niki Yasuo, Kudo Yutaka, Sakurai Aiko, Nagura Takeo, Hasegawa Takayuki, Masumoto Ko, Otani Toshiro

Knee 2014年12月

ISSN 0968-0160

Background: Our purpose was to clarify the differences of three-dimensional knee kinematics in anterior cruciate ligament (ACL)-deficient patients between with and without meniscal injury using gait analysis. Methods: A total of 72 knees in 36 young athletes with primary and unilateral ACL injury, with a mean age of 22. years, participated. Gait analysis was done before surgery. According to the arthroscopic findings, patients were divided into two groups. The patients with an unstable meniscal tear were allocated to the meniscal injury group (ACL + M group), and the patients without a meniscal tear were allocated to the no meniscal injury group (ACL group). In the gait analysis, three-dimensional knee kinematics was evaluated and compared. Results: The patients in both groups exhibited lower sagittal plane knee excursions and peak knee extension angles on the affected limb than on the unaffected limb during the mid-stance. In terms of the axial plane, a rotation angle was significantly smaller in the affected knees than in the unaffected knees in the ACL group. On the other hand, an opposite phenomenon was observed in the ACL + M group. Moreover, a significantly larger rotation angle in the affected knees during the stance phase and the whole gait cycle was observed in the ACL + M group than in the ACL group. Conclusion: Increased rotational motion during the gait was observed in the ACL-deficient knees combined with unstable meniscal injuries. Meniscal condition may be a key factor for compensatory gait mechanics to prevent rotatory instability in ACL-deficient patients patients. Level of evidence III

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Asymmetry of the knee extension deficit in standing affects weight-bearing distribution in patients with bilateral end-stage knee osteoarthritis

Harato Kengo, Nagura Takeo, Matsumoto Hideo, Otani Toshiro, Toyama Yoshiaki, Suda Yasunori

Knee Surgery, Sports Traumatology, Arthroscopy 22 （ 11 ） 2608 - 2613 2014年10月

ISSN 0942-2056

Purpose: The aim of this study was to evaluate weight-bearing distribution in patients with bilateral end-stage knee osteoarthritis (OA) and to clarify the gait parameters affecting the weight-bearing distribution during both standing and walking using gait analysis.Methods: Twenty-five patients (averaged 71 years) with symptomatic bilateral end-stage medial knee OA participated in this study. They performed relaxed standing, placing one foot on a force plate and thereafter, level walking. First, knee resultant force was calculated on bilateral knees during standing. The knees in each patient were divided into Higher and Lower force side for the definition of dominant side limb. Second, gait parameters in each subject were compared between both sides.Results: Each patient had large weight-bearing asymmetry, though passive range of motion, subjective pain level, femorotibial angle and radiographic disease severities were not significantly different between both sides. In standing, knees on Higher force side were significantly extended (11.2 ± 6.5°) than on Lower force side (14.4 ± 7.3°, P = 0.0086). Similarly, knees on Higher force side were also significantly extended at heel strike during gait. Besides, peak values of extension moment, knee adduction moment, knee adduction moment impulse and vertical force during gait were significantly greater on Higher force side.Conclusions: Ability to extend the knee in standing was considered to be an essential factor to decide loading condition. It is clinically important to examine the ability to extend the knee in standing when considering loading asymmetry during gait in patients with bilateral knee OA.Level of evidence: III.

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Stress fracture of the first metatarsal after total knee arthroplasty

Harato Kengo, Ozaki Masahiro, Sakurai Aiko, Kudo Yutaka, Otani Toshiro

Knee 21 （ 1 ） 328 - 331 2014年01月

ISSN 0968-0160

Stress fractures after total knee arthroplasty (TKA) occur mainly in patients with considerable deformity of the knee. In addition, the majority of these fractures after TKA involve the hip joint. We present two cases of stress fractures of the first metatarsal after TKA in patients with severe varus deformity. Correction of leg alignment and pain reduction obtained by TKA lead to stress fracture of the bone. Gait analysis was carried out for both cases in order to clarify the gait characteristics of the stress fracture. As a result, side-to-side differences of the distance between first metatarsal and foot center of pressure in the coronal plane were observed using gait analysis in these patients. Fortunately, conservative treatment was successful for these patients. Stress fractures should be considered when a patient who had a considerable severe deformity of the knee preoperatively complains of foot pain on the affected side. Contrary to stress fractures at the hip joint, patients with the fracture of the first metatarsal can be treated without surgery. © 2012 Elsevier B.V.

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Erratum to

Tanikawa Hidenori, Matsumoto Hideo, Harato Kengo, Kiriyama Yoshimori, Suda Yasunori, Toyama Yoshiaki, Nagura Takeo

Journal of Orthopaedic Science 19 （ 4 ） 695 - 696 2014年

ISSN 0949-2658

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Female recreational athletes demonstrate different knee biomechanics from male counterparts during jumping rope and turning activities

Tanikawa Hidenori, Matsumoto Hideo, Harato Kengo, Kiriyama Yoshimori, Suda Yasunori, Toyama Yoshiaki, Nagura Takeo

Journal of Orthopaedic Science 19 （ 1 ） 104 - 111 2014年

ISSN 0949-2658

Background: A variety of athletic exercises are performed in sports training or rehabilitation after knee injuries. However, it remains unclear whether males and females exhibit similar joint loading during the various athletic motions. The purpose of this study was to identify gender differences in knee biomechanics during the athletic motions. Methods: Three-dimensional knee kinematics and kinetics were investigated in 20 recreational athletes (10 males and 10 females) while jumping rope, backward running, side running, side-to-side running, side-to-forward running, inside turning, and outside turning. The strengths of the quadriceps and hamstring muscles, the knee joint force, the knee joint angle, and the knee joint moment were compared between males and females using one-tailed t tests. Results: Peak knee anterior force was greater in female recreational athletes than in their male counterparts during jumping rope, side-to-forward running, inside turning, and outside turning. Female subjects displayed greater peak knee abduction angles and greater peak knee flexion moments while jumping rope compared to their male counterparts. There were no significant differences between the sexes in knee kinematics and kinetics in the frontal and transverse planes during running and turning motions. Conclusions: Female recreational athletes exhibited significantly different knee biomechanics compared with male counterparts during jumping rope and turning motions. © The Japanese Orthopaedic Association 2013.

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【半月(板)損傷の治療-現状と未来-】半月(板)手術の適応・術式・成績半月(板)切除術若手整形外科医のための基本手技

原藤健吾，二木康夫，大谷俊郎

関節外科 33 928 - 932 2014年

Asymmetry of the leg alignment affects trunk bending in the coronal plane after unilateral total knee arthroplasty

Harato Kengo, Yoshida Hiroki, Otani Toshiro

Journal of Arthroplasty 28 （ 7 ） 1089 - 1093 2013年08月

ISSN 0883-5403

Unilateral total knee arthroplasty (TKA) would produce asymmetric changes of lower extremity in patients with bilateral varus deformity. Our purpose was to investigate whether asymmetry of the leg alignment would affect trunk bending in the coronal plane after unilateral TKA. Twenty patients (mean 76. years old) with bilateral end-stage knee osteoarthritis (OA) participated. Spine images during relaxed standing were obtained on pre- and postoperative day 21. As a result, the shoulder tilted more to the TKA side and the pelvis inclined more to the contralateral OA side. These results suggested that the trunk would bend away from the contralateral OA side after unilateral TKA in patients with bilateral end-stage knee OA and varus deformity. Asymmetry of the leg alignment led to asymmetric trunk bending. © 2013 Elsevier Inc.

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Association between the disease severity and extraneural pressure induced by maximum elbow flexion in patients with cubital tunnel syndrome

Ochi Kensuke, Horiuchi Yukio, Morisue Hikaru, Harato Kengo, Tanikawa Hidenori, Okubo Masashi

Journal of Plastic Surgery and Hand Surgery 47 （ 3 ） 219 - 223 2013年06月

ISSN 2000-656X

Extraneural pressure in the cubital tunnel is considered to be a major pathophysiological factor for cubital tunnel syndrome. Thus, it has been hypothesised that the higher extraneural pressure in the cubital tunnel should result in a more severe stage of cubital tunnel syndrome. Extraneural pressures in cubital tunnel at elbow maximum flexion of 41 patients with cubital tunnel syndrome were evaluated, and compared with their preoperative disease severity using McGowan's classification and Dellon's staging. Mean extraneural pressure was significantly higher in maximum elbow flexion than in maximum elbow extension (p < 0.001). However, no significant relation was seen between the severity of cubital tunnel syndrome and the extraneural pressure induced by maximum elbow flexion (McGowan's classification: p = 0.62; Dellon's staging: p = 0.92). The results suggested that the progression of disease severity of cubital tunnel syndrome may not be explained simply by dynamic pressure in the cubital tunnel, and other causative factors should also be contributing to the progression. © Informa Healthcare.

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Pseudogout in the Early Postoperative Period After Total Knee Arthroplasty

Harato Kengo, Yoshida Hiroki

Journal of Arthroplasty 28 （ 2 ） 2013年02月

ISSN 0883-5403

Postoperative pseudogout after total knee arthroplasty is rare. If pseudogout attacks are misdiagnosed as periprosthetic sepsis, patients may undergo unnecessary surgical procedures. We report a case of pseudogout in the early postoperative period. The attack ensued shortly after a nonsteroidal antiinflammatory drug was discontinued. The diagnosis was confirmed by aspiration, and the patient improved after readministration of the nonsteroidal antiinflammatory drug. Although rare, pseudogout should be considered in the differential when approaching a suspected infection after total knee arthroplasty. © 2013 Elsevier Inc.

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Extension Limitation in Standing Affects Weight-Bearing Asymmetry After Unilateral Total Knee Arthroplasty

Harato Kengo, Nagura Takeo, Matsumoto Hideo, Otani Toshiro, Toyama Yoshiaki, Suda Yasunori

Journal of Arthroplasty 25 （ 2 ） 225 - 229 2010年02月

ISSN 0883-5403

The aim of this study was to evaluate weight-bearing condition after unilateral total knee arthroplasty (TKA) during standing and to examine whether the condition affects knee kinetics during gait in both limbs. Twenty-five patients, who underwent unilateral TKA for symptomatic bilateral osteoarthritis and who were on average 74 years old, participated. As a result, operated limbs became dominant in 80% of the patients. The other 20%, who had lack of knee extension during standing, showed more weight bearing in nonoperated knees. Furthermore, extension limitation in the operated knee in standing led to mechanical overload in the contralateral limb during gait. Therefore, to avoid progression of the osteoarthritis in the contralateral knee, it is important to acquire full extension in the operated knees during standing after unilateral TKA. © 2010 Elsevier Inc. All rights reserved.

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女子バレーボール選手に生じたSalter-Harris分類type IIIを呈した第1中足骨疲労骨折の1例

原藤健吾

整形外科 61 447 - 450 2010年

Scheuermann病を合併した胸椎すべり症の1例

原藤健吾

臨床整形外科 45 1153 - 1157 2010年

【脊椎・脊髄疾患に伴う歩行障害その病態、診断、治療】膝関節屈曲拘縮が体幹動態に与える影響 Knee-spine syndromeに関する歩行解析

前野晋一，佐々木孝，野本聡，山中一良，河野克己，西脇正夫，金子大毅，原藤健吾，大山順子

脊椎脊髄ジャーナル 23 703 - 707 2010年

大腿骨遠位部骨折後に生じた深部静脈血栓症の治療経験

吉峰史博，井口理，佐々木政幸，原藤健吾，塩野将平

東日本整形災害外科学会雑誌 22 143 - 148 2010年

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