人工関節センターを開設します
はじめに
日本の高齢化は世界で類を見ない早さで進んでおり、超高齢社会の到来に伴い、平均寿命と健康寿命の乖離が問題となっています。要介護・要支援の原因となる疾患の第1位は関節疾患や骨折などによる運動器疾患です。誰もが生涯、他人の手を借りず、自分の足で歩くことを望んでおり、日本整形外科学会でもロコモティブシンドロームという疾患概念を提唱し、運動器障害の予防・移動能力の維持に取り組んでいます。膝関節や股関節の痛みのため、散歩や買い物などの日常生活に支障が生じたり、旅行やスポーツなどの趣味・運動を制限している方が多くいらっしゃいます。歩行能力が低下すると、生活の質が徐々に下がり、寝たきりになってしまう危険性もあります。投薬やリハビリテーションなどの保存的加療を行っても、痛みが続き、歩行、日常生活に支障がある場合は手術加療が有効です。全国的には人工膝関節置換術は年間11万件以上、人工股関節置換術は年間6万件以上施行されており、術後成績の安定した手術です。
当院では患者さん個々の全身状態、関節の状態、生活に応じて手術法を決定しており、正確で安全な手術を心がけています。
人工関節センター
整形外科診療部長 小林秀郎
対象疾患
- 変形性膝関節症
- 大腿骨内側顆骨壊死
- 関節リウマチ
- 変形性股関節症
- 大腿骨頭壊死
- 外傷性関節症
変形性膝関節症
加齢性変化の一種で男性よりも女性に多く見られ、推定患者数は2530万人とも言われています。膝関節の軟骨が変性・摩耗し、次第にO脚やX脚変形を来し、それに伴いさまざまな症状が生じます。初期の症状としては、椅子や畳から立ち上がる時・階段の昇降時の膝関節の痛み、関節の腫れなどが挙げられます。症状の進行に伴い、膝の曲げ伸ばしできる角度が悪くなり、正座ができなくなります。歩行の度に、膝にぐらぐらと不安定性が生じ、平地の歩行でも痛みが強くなり日常生活に支障を来します。
ひざの痛みと治療方法（オリンパス テルモ バイオマテリアル株式会社作成）パンフレットから抜粋
変形性股関節症
股関節の軟骨が変性・摩耗し、次第に股関節の痛み、機能障害を来します。臼蓋形成不全など小児期の発育障害の後遺症として発症することが多いと言われていますが、近年は超高齢社会に伴い、明らかな股関節疾患の既往がなくても、年齢とともに股関節の軟骨が摩耗し発症する患者さんも増えています。症状が進行すると、股関節の痛みの強さや頻度が増し歩行障害を来し、立ち仕事や靴下などの着替えが困難になり、乗り物や階段の乗り降りにも手すりが必要になります。
関節リウマチ
自己免疫疾患で、関節内の滑膜が炎症を起こすことにより、関節に痛みや腫れが生じ、関節の変形をきたす疾患です。典型的には手足の関節におこることが多いですが、膝関節や股関節に発症することも比較的多くあります。投薬や注射などによる保存加療を行いますが、痛みが強く、日常生活に支障がある場合は人工関節置換術を行います。
治療法
保存加療
筋力訓練、減量などのリハビリテーション、装具療法、薬物療法があります。保存加療で効果が得られない場合に手術加療を行います。
ひざの痛みと治療方法（オリンパス テルモ バイオマテリアル株式会社作成）パンフレットから抜粋
手術加療
- 膝周囲骨切り術
高位脛骨骨切り術(HTO)に代表される関節温存手術です。変形性膝関節症では多くの患者さんが、膝関節の内側軟骨が擦り減り、O脚変形を来します。そのためにますます膝関節内側にかかる負荷が増加するという悪循環を来します。O脚のために内側に偏った荷重に対して、脛骨または大腿骨を切り、下肢全体の角度を変えて、荷重を外側に移動させる、下肢アライメントの矯正手術です。関節温存手術であるため、スポーツ復帰や仕事復帰する患者さんが多くいます。変形の程度や矯正角度によって、様々な術式があります。各術式を使い分け、適応のある患者さんには積極的に関節温存手術を行っています。 
- 単顆型人工膝関節置換術
関節の変形が、関節の内側や外側に限局しており、靭帯の損傷も認めない場合に行います。関節半分だけの置換ですので、人工膝関節全置換術に比べて身体への侵襲は軽度です。 
- 人工膝関節全置換術
変形した膝関節の表面を金属や高分子ポリエチレンでできた人工関節に置き換える手術です。関節の変形が強い場合に選択します。痛みを取ることが主な目的です。O脚またはX脚に変形した下肢をまっすぐにすることで、歩きやすく、また術後膝にかかる負担を軽減します。両膝の変形が同程度に進行することが多く、両側同日手術も積極的に行っています。
◎特に膝関節手術に関しては以下のことに取り組んでいます。
- 患者様1人1人の全身状態、関節の状態、生活背景を正確に把握し、最適な手術法を提案します。関節温存手術である膝周囲骨切り術や人工関節手術のなかでは侵襲の少ない単顆型人工膝関節置換術も適応があれば積極的に行っています。
- 麻酔法・手術法の工夫、止血薬の使用により、以前に比べ周術期の出血量は減少しています。自己血貯血は基本的には行っておらず、輸血を行うこともほとんどありません。
- 術後の手術による痛みは患者様にとっては非常に辛いものです。術後疼痛を緩和するため、周術期の疼痛管理にも力を入れ積極的に取り組んでいます。
人工股関節置換術
摩耗し変形した股関節の寛骨臼や大腿骨頭を切除し、コバルトクロム合金、チタン、高分子ポリエチレンで構成される人工股関節に置き換える手術です。術後は股関節痛の改善の他、脚長差や関節可動域が改善します。股関節周囲の筋肉や軟部組織への手術侵襲を最小限に抑えるよう工夫を行い、早期のリハビリテーション、社会復帰を目指せるように心がけています。
術後のリハビリテーション、入院期間について
手術翌日から、理学療法士の指導の下、筋力訓練、関節可動域訓練など歩行に向けたリハビリテーションを行います。立位訓練から平行棒、歩行器、杖を使用した歩行訓練を行い、階段の昇降など患者さんの退院後の日常生活様式に即した訓練も行います。人工膝関節置換術、人工股関節置換術後の入院期間は平均3週間程度ですが、リハビリテーションが順調にすすみ、早期退院を希望される場合は2週間程度で退院することも可能です。同居家族が仕事で多忙である、高齢夫婦での暮らしや1人暮らしであるため退院後に家族のサポートが受けられない、坂や階段の多い住環境であるなど、退院後の生活に不安を感じ手術を躊躇されている方も多くいらっしゃいます。当院は地域包括ケア病棟を併設しております。短期間の入院に不安のある患者様は、患者様のペースにあわせて、退院後の生活に自信が持てるまで、少しゆっくり入院してリハビリテーションを行っていただくことも可能です。
人工関節専門外来
毎週月曜日の午後(13:30~15:00)に人工関節専門外来を行っています。
論文発表 (英文のみ)
Kobayashi H, Takeno M, Saito T, Takeda Y, Kirino Y, Noyori K, Hayashi T, Ueda A, Ishigatsubo Y: Regulatory role of heme oxygenase 1 in inflammation of rheumatoid arthritis. Arthritis Rheum, 54(4): 1132-42, 2006.
Kobayashi H, Mahovlic D, Bauer TW; Feature Article: Interpreting and Avoiding Histologic Artifacts in Hard-Tissue Research. J histotechnol, 29(4): 223-8, 2006.
Kobayashi H, Fujishiro T, Belkoff SM, Kobayashi N, Turner AS, Seim HB, Zitelli J, Hawkins M, Bauer TW: Long- term evaluation of a calcium phosphate bone cement with carboxymethyl cellulose in a vertebral defect model. J Biomed Mat Res A, 88(4): 880-8, 2009.
Kobayashi H, Oethinger M, Tuohy MJ, Procop GW, Hall GS, Bauer TW. Improved Detection of Biofilm-Formative Bacteria on Polymethylmethacrylate by Vortexing and Ultrasonication: a pilot study. Clin Orthop Rel Res, 467(5): 1360-4, 2009.
Kobayashi H, Oethinger M, Tuohy MJ, Hall GS, Bauer TW. Improving clinical significance of PCR: use of propidium monoazide to distinguish viable from dead Staphylococcus aureus and Staphylococcus epidermidis. J Orthop Res, 27(9): 1243-7, 2009.
Kobayashi H, Oethinger M, Tuohy MJ, Hall GS, Bauer TW. Unsuitable distinction between viable and dead Staphylococcus aureus and Staphylococcus epidermidis by ethidium bromide monoazide.Lett Appl Microbiol, 48(5): 633-8, 2009.
Kobayashi H, Oethinger M, Tuohy MJ, Procop GW, Hall GS, Bauer TW. Limiting false-positive polymerase chain reaction results: detection of DNA and mRNA to differentiate viable from dead bacteria. Diagn Microbiol Infect Dis, 64(4): 445-7, 2009.
Kobayashi H, Hall GS, Tuohy MJ, Knothe U, Procop GW, Bauer TW. Bilateral periprosthetic joint infection caused by Salmonella enterica serotype Enteritidis, and identification of Salmonella sp using molecular techniques. Int J Infect Dis, 13(6): e463-6, 2009.
Kobayashi H, Turner AS, Seim HB, Kawamoto T, Bauer TW. Evaluation of a silica-containing bone graft substitute in a vertebral defect model. J Biomed Mat Res A, 92(2): 596-603, 2010.
Kobayashi H, Oethinger M, Tuohy MJ, Hall GS, Bauer TW. Distinction between intact and antibiotic-inactivated bacteria by real-time PCR after treatment with propidium monoazide. J Orthop Res, 28(9): 1245-51, 2010.
Kobayashi H, Akamatsu Y, Taki N, Ota H, Mitsugi N, Saito T. Spontaneous dislocation of a mobile-bearing polyethylene insert after posterior-stabilized rotating platform total knee arthroplasty: a case report. Knee, 18(6): 496-8, 2011.
Kobayashi H, Mitsugi N, Mochida Y, Taki N, Akamatsu Y, Aratake M, Ota H, Ishii K, Harigane K, Ideno T, Saito T. Mid- term results of stryker scorpio plus mobile bearing total knee arthroplasty. Sports Med Arthrosc Rehabil Ther Technol, 4(1): 38, 2012.
Kobayashi H, Akamatsu Y, Kumagai K, Kusayama Y, Ishigatsubo R, Muramatsu S, Saito T. The surgical epicondylar axis is a consistent reference of the distal femur in the coronal and axial planes. Knee Surg Sports Traumatol Arthrosc, 22(12): 2947-53, 2014.
Kobayashi H, Aratake M, Akamatsu Y, Mitsugi N, Taki N, Saito T. Reproducibility of condylar twist angle measurement using computed tomography and axial radiography of the distal femur. Orthop Traumatol Surg Res, 100(8): 885-90, 2014.
Kobayashi H, Akamatsu Y, Kumagai K, Kusayama Y, Aratake M, Saito T. Is the surgical epicondylar axis the center of rotation in the osteoarthritic knee? J Arthroplasty, 30(3): 479-83, 2015.
Kobayashi H, Akamatsu Y, Kumagai K, Kusayama Y, Ishigatsubo R, Mitsuhashi S, Kobayashi A, Aratake M, Saito T. The use of factor Xa inhibitors following opening-wedge high tibial osteotomy for venous thromboembolism prophylaxis. Knee Surg Sports Traumatol Arthrosc, 25(9): 2929-35, 2017.
Kobayashi H, Akamatsu Y, Kumagai K, Kusayama Y, Aratake M, Saito T. Influence of coronal bowing on the lower alignment and the positioning of component in navigation and conventional total knee arthroplasty. Orthop Traumatol Surg Res. 103(2): 251-6, 2017.
Kobayashi H, Akamatsu Y, Kumagai K, Kusayama Y, Saito T. Radiographic and computed tomographic evaluation of bone union after medial opening wedge high tibial osteotomy with filling gap. Knee. 24(5): 1108-17, 2017.
Kobayashi H, Akamatsu Y, Kumagai K, Kusayama Y, Okuyama H, Hirotomi K, Shinohara K, Saito T. Edoxaban is effective in reducing the incidence of asymptomatic phlebographic events following closed-wedge high tibial osteotomy. Orthop Traumatol Surg Res. 103(8): 1193-6, 2017.
Takeda Y, Takeno M, Iwasaki M, Kobayashi H, Kirino Y, Ueda A, Nagahama K, Aoki I, Ishigatsubo Y; Chemical induction of HO-1 suppresses lupus nephritis by reducing local iNOS expression and synthesis of anti-dsDNA antibody. Clin Exp Immunol, 138, 237-44, 2004
Kirino Y, Takeno M, Murakami S, Kobayashi M, Kobayashi H, Miura K, Ideguchi H, Ohno S, Ueda A, Ishigatsubo Y: Tumor necrosis factor alpha acceleration of inflammatory responses by down-regulating heme oxygenase 1 in human peripheral monocytes. Arthritis Rheum, 56(2): 464-75, 2007.
Fujishiro T, Bauer TW, Kobayashi N, Kobayashi H, Sunwoo MH, Seim HBⅢ, Turner AS: Histological evaluation of an impacted bone graft substitute composed of a combination of mineralized and demineralized allograft in a sheep vertebral bone defect. J Biomed Mater Res A, 82(3): 538-44, 2007.
Kobayashi N, Procop GW, Krebs V, Kobayashi H, Bauer TW. Molecular Identification of Bacteria from Aseptically Loose Implants. Clin Orthop Rel Res, 466(7): 1716-25, 2008.
Oethinger M, Warner DK, Schindler SA, Kobayashi H, Bauer TW (4/5). Diagnosing periprosthetic infection: false-positive intraoperative Gram stains. Clin Orthop Relat Res, 469(4): 954-60, 2011.
Akamatsu Y, Mitsugi N, Mochida Y, Taki N, Kobayashi H, Takeuchi R, Saito T. Navigated opening wedge high tibial osteotomy improves intraoperative correction angle compared with conventional method. Knee Surg Sports Traumatol Arthrosc, 20(3): 586-93, 2012.
Akamatsu Y, Mitsugi N, Taki N, Kobayashi H, Saito T. Medial versus lateral condyle bone mineral density ratios in a cross-sectional study: a potential marker for medial knee osteoarthritis severity. Arthritis Care Res, 64(7): 1036-45, 2012.
Akamatsu Y, Mitsugi N, Hayashi T, Kobayashi H, Saito T. Low bone mineral density is associated with the onset of spontaneous osteonecrosis of the knee. Acta Orthop, 83(3): 249-55, 2012.
Zmistowski B, Della Valle C, Bauer TW, Malizos KN, Alavi A, Bedair H, Booth RE, Choong P, Deirmengian C, Ehrlich GD, Gambir A, Huang R, Kissin Y, Kobayashi H, Kobayashi N, Krenn V, Drago L, Marston SB, Meermans G, Perez J, Ploegmakers JJ, Rosenberg A, Simpendorfer C, Thomas P, Tohtz S, Villafuerte JA, Wahl P, Wagenaar FC, Witzo E. Diagnosis of periprosthetic joint infection. J Arthroplasty, 29(2 Suppl): 77-83, 2014.
J Arthroplasty. 2014 Feb;29(2 Suppl):77-83.
Zmistowski B, Della Valle C, Bauer TW, Malizos KN, Alavi A, Bedair H, Booth RE, Choong P, Deirmengian C, Ehrlich GD, Gambir A, Huang R, Kissin Y, Kobayashi H, Kobayashi N, Krenn V, Lorenzo D, Marston SB, Meermans G, Perez J, Ploegmakers JJ, Rosenberg A, C Simpfendorfer, Thomas P, Tohtz S, Villafuerte JA, Wahl P, Wagenaar FC, Witzo E. Diagnosis of periprosthetic joint infection. J Orthop Res, 32(1 Suppl): 98-107, 2014.
Saito T, Kumagai K, Akamatsu Y, Kobayashi H, Kusayama Y. Five-to ten-year outcome following medial opening-wedge high tibial osteotomy with rigid plate fixation in combination with an artificial bone substitute. Bone Joint J, 96-B(3): 339-44, 2014.
Kusayama Y, Akamatsu Y, Kumagai K, Kobayashi H, Aratake M, Saito T. Changes in synovial fluid biomarkers and clinical efficacy of intra-articular injections of hyaluronic acid for patients with knee osteoarthritis. J Exp Orthop, 1(1): 16, 2014.
Akamatsu Y, Kobayashi H, Kusayama Y, Aratake M, Kumagai K, Saito T. Predictive factors for the progression of spontaneous of the knee. Knee Surg Sports Traumatol Arthrosc, 25(2): 477-84, 2017.
Kumagai K, Akamatsu Y, Kobayashi H, Kusayama Y, Koshino T, Saito T. Factors affecting cartilage repair after medial opening-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 25(3): 779-84, 2017.
Akamatsu Y, Kobayashi H, Kusayama Y, Kumagai K, Saito T. Comparative Study of Opening-Wedge High Tibial Osteotomy With and Without a Combined Computed Tomography-Based and Image-Free Navigation System. Arthroscopy. 32(10): 2072-81, 2016.
Akamatsu Y, Kobayashi H, Kusayama Y, Kumagai K, Saito T. Femoral shaft bowing in the coronal and sagittal planes on reconstructed computed tomography in women with medial compartment knee osteoarthritis: a comparison with radiograph and its predictive factors. Arch Orthop Trauma Surg. 136(9):1227-32,2016.
Akamatsu Y, Sotozawa M, Kobayashi H, Kusayama Y, Kumagai K, Saito T. Usefulness of long tibial axis to measure medial tibial slope for opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 24(11):3661-7, 2016.
Akamatsu Y, Ohno S, Kobayashi H, Kusayama Y, Kumagai K, Saito T. Coronal subluxation of the proximal tibia relative to the distal femur after opening wedge high tibial osteotomy. Knee. 24(1): 70-5, 2017.
Kumagai K, Akamatsu Y, Kobayashi H, Kusayama Y, Saito T. Mosaic Osteochondral Autograft Transplantation Versus Bone Marrow Stimulation Technique as a Concomitant Procedure With Opening-Wedge High Tibial Osteotomy for Spontanious Osteonecrosis of the Medial Femoral Condyle. Arthroscopy. 34(1): 233-40, 2018.
Mitsuhashi S, Akamatsu Y, Kobayashi H, Kusayama Y, Kumagai K, Saito T. Combined CT-based and image-free navigation systems in TKA reduces postoperative outliers of rotational alignment of the tibial component. Arch Orthop Trauma Surg. 138(2): 259-66, 2018.
Akamatsu Y, Kobayashi H, Kusayama Y, Kumagai K, Saito T. Opening Wedge High Tibial Osteotomy Using Combined Computed Tomography-Based and Image-Free Navigation System. Arthrosc Tech. 6(4): e1145-51, 2017.
Akamatsu Y, Kumagai K, Kobayashi H, Tsuji M, Saito T. Effect of Increased Coronal Inclination of the Tibial Plateau After Opening-Wedge High Tibial Osteotomy. Arthroscopy. 34(7): 2158-69, 2018.
Akamatsu Y, Kobayashi H, Tsuji M, Nejima S, Kumagai K, Saito T. Should sagittal osteotomy line be parallel to tibial posterior slope in high tibial osteotomy? BMC Musculoskelet Disord. 19(1): 338, 2018.
Tsuji M, Akamatsu Y, Kobayashi H, Mitsugi N, Inaba Y, Saito T. Joint line convergence angle predicts outliers of coronal alignment in navigated open-wedge high tibial osteotomy. Arch Orthop Trauma Surg. 140(6): 707-15, 2020.
Nejima S, Akamatsu Y, Kobayashi H, Tsuji M, Mitsuhashi S, Sasaki T, Kumagai K, Inaba Y. Relationship between lower limb torsion and coronal morphologies of the femur and tibia in patients with medial knee osteoarthritis. BMC Musculoskelet Disord. 21(1): 254, 2020.
Nejima S, Kumagai K, Kobayashi H, Yamada S, Akamatsu T, Ogino T, Sotozawa M, Inaba Y. Varus inclination of the tibia is related to patellofemoral osteoarthritis in Japanese female patients with moderate knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 29(2): 652-58, 2021.
Nejima S, Kumagai K, Kobayashi H, Yamada S, Akamatsu T, Ogino T, Sotozawa M, Inaba Y. Coronal shaft bowing of the femur affects varus inclination of the surgical transepicondylar axis in varus knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 29(3): 814-9, 2021.
Sasaki T, Akamatsu Y, Kobayashi H, Mitsuhashi S, Nejima S, Kumagai K, Saito T, Inaba Y. Rotational changes in the distal tibial fragment relative to the proximal tibial fragment at the osteotomy site after ope-wedge high tibial osteotomy. Biomed Res Int. In press 2021
Akamatsu Y, Nejima S, Tsuji M, Kobayashi H, Muramatsu S. Open-wedge high tibial osteotomy using intraoperative control of joint line convergence angle with reference to preoperative supine radiograph. Arch Orthop Trauma Surg in press
Akamatsu Y, Nejima S, Tsuji M, Kobayashi H, Muramatsu S. Joint line obliquity was maintained after double-level osteotomy, but was increased after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc in press
Nejima S, Kumagai K, Kobayashi H, Fujimaki H, Yamada S, Sotozawa M, Hisatomi K, Inaba Y. Medialization of the mechanical axis of the tibia is related to lateralization of the tibial tuberosity in knee osteoarthritis. Knee. 30: 134-40, 2021.
Kobayashi H, Mahovlic D, Bauer TW; Feature Article: Interpreting and Avoiding Histologic Artifacts in Hard-Tissue Research. J histotechnol, 29(4): 223-8, 2006.
Kobayashi H, Fujishiro T, Belkoff SM, Kobayashi N, Turner AS, Seim HB, Zitelli J, Hawkins M, Bauer TW: Long- term evaluation of a calcium phosphate bone cement with carboxymethyl cellulose in a vertebral defect model. J Biomed Mat Res A, 88(4): 880-8, 2009.
Kobayashi H, Oethinger M, Tuohy MJ, Procop GW, Hall GS, Bauer TW. Improved Detection of Biofilm-Formative Bacteria on Polymethylmethacrylate by Vortexing and Ultrasonication: a pilot study. Clin Orthop Rel Res, 467(5): 1360-4, 2009.
Kobayashi H, Oethinger M, Tuohy MJ, Hall GS, Bauer TW. Improving clinical significance of PCR: use of propidium monoazide to distinguish viable from dead Staphylococcus aureus and Staphylococcus epidermidis. J Orthop Res, 27(9): 1243-7, 2009.
Kobayashi H, Oethinger M, Tuohy MJ, Hall GS, Bauer TW. Unsuitable distinction between viable and dead Staphylococcus aureus and Staphylococcus epidermidis by ethidium bromide monoazide.Lett Appl Microbiol, 48(5): 633-8, 2009.
Kobayashi H, Oethinger M, Tuohy MJ, Procop GW, Hall GS, Bauer TW. Limiting false-positive polymerase chain reaction results: detection of DNA and mRNA to differentiate viable from dead bacteria. Diagn Microbiol Infect Dis, 64(4): 445-7, 2009.
Kobayashi H, Hall GS, Tuohy MJ, Knothe U, Procop GW, Bauer TW. Bilateral periprosthetic joint infection caused by Salmonella enterica serotype Enteritidis, and identification of Salmonella sp using molecular techniques. Int J Infect Dis, 13(6): e463-6, 2009.
Kobayashi H, Turner AS, Seim HB, Kawamoto T, Bauer TW. Evaluation of a silica-containing bone graft substitute in a vertebral defect model. J Biomed Mat Res A, 92(2): 596-603, 2010.
Kobayashi H, Oethinger M, Tuohy MJ, Hall GS, Bauer TW. Distinction between intact and antibiotic-inactivated bacteria by real-time PCR after treatment with propidium monoazide. J Orthop Res, 28(9): 1245-51, 2010.
Kobayashi H, Akamatsu Y, Taki N, Ota H, Mitsugi N, Saito T. Spontaneous dislocation of a mobile-bearing polyethylene insert after posterior-stabilized rotating platform total knee arthroplasty: a case report. Knee, 18(6): 496-8, 2011.
Kobayashi H, Mitsugi N, Mochida Y, Taki N, Akamatsu Y, Aratake M, Ota H, Ishii K, Harigane K, Ideno T, Saito T. Mid- term results of stryker scorpio plus mobile bearing total knee arthroplasty. Sports Med Arthrosc Rehabil Ther Technol, 4(1): 38, 2012.
Kobayashi H, Akamatsu Y, Kumagai K, Kusayama Y, Ishigatsubo R, Muramatsu S, Saito T. The surgical epicondylar axis is a consistent reference of the distal femur in the coronal and axial planes. Knee Surg Sports Traumatol Arthrosc, 22(12): 2947-53, 2014.
Kobayashi H, Aratake M, Akamatsu Y, Mitsugi N, Taki N, Saito T. Reproducibility of condylar twist angle measurement using computed tomography and axial radiography of the distal femur. Orthop Traumatol Surg Res, 100(8): 885-90, 2014.
Kobayashi H, Akamatsu Y, Kumagai K, Kusayama Y, Aratake M, Saito T. Is the surgical epicondylar axis the center of rotation in the osteoarthritic knee? J Arthroplasty, 30(3): 479-83, 2015.
Kobayashi H, Akamatsu Y, Kumagai K, Kusayama Y, Ishigatsubo R, Mitsuhashi S, Kobayashi A, Aratake M, Saito T. The use of factor Xa inhibitors following opening-wedge high tibial osteotomy for venous thromboembolism prophylaxis. Knee Surg Sports Traumatol Arthrosc, 25(9): 2929-35, 2017.
Kobayashi H, Akamatsu Y, Kumagai K, Kusayama Y, Aratake M, Saito T. Influence of coronal bowing on the lower alignment and the positioning of component in navigation and conventional total knee arthroplasty. Orthop Traumatol Surg Res. 103(2): 251-6, 2017.
Kobayashi H, Akamatsu Y, Kumagai K, Kusayama Y, Saito T. Radiographic and computed tomographic evaluation of bone union after medial opening wedge high tibial osteotomy with filling gap. Knee. 24(5): 1108-17, 2017.
Kobayashi H, Akamatsu Y, Kumagai K, Kusayama Y, Okuyama H, Hirotomi K, Shinohara K, Saito T. Edoxaban is effective in reducing the incidence of asymptomatic phlebographic events following closed-wedge high tibial osteotomy. Orthop Traumatol Surg Res. 103(8): 1193-6, 2017.
Takeda Y, Takeno M, Iwasaki M, Kobayashi H, Kirino Y, Ueda A, Nagahama K, Aoki I, Ishigatsubo Y; Chemical induction of HO-1 suppresses lupus nephritis by reducing local iNOS expression and synthesis of anti-dsDNA antibody. Clin Exp Immunol, 138, 237-44, 2004
Kirino Y, Takeno M, Murakami S, Kobayashi M, Kobayashi H, Miura K, Ideguchi H, Ohno S, Ueda A, Ishigatsubo Y: Tumor necrosis factor alpha acceleration of inflammatory responses by down-regulating heme oxygenase 1 in human peripheral monocytes. Arthritis Rheum, 56(2): 464-75, 2007.
Fujishiro T, Bauer TW, Kobayashi N, Kobayashi H, Sunwoo MH, Seim HBⅢ, Turner AS: Histological evaluation of an impacted bone graft substitute composed of a combination of mineralized and demineralized allograft in a sheep vertebral bone defect. J Biomed Mater Res A, 82(3): 538-44, 2007.
Kobayashi N, Procop GW, Krebs V, Kobayashi H, Bauer TW. Molecular Identification of Bacteria from Aseptically Loose Implants. Clin Orthop Rel Res, 466(7): 1716-25, 2008.
Oethinger M, Warner DK, Schindler SA, Kobayashi H, Bauer TW (4/5). Diagnosing periprosthetic infection: false-positive intraoperative Gram stains. Clin Orthop Relat Res, 469(4): 954-60, 2011.
Akamatsu Y, Mitsugi N, Mochida Y, Taki N, Kobayashi H, Takeuchi R, Saito T. Navigated opening wedge high tibial osteotomy improves intraoperative correction angle compared with conventional method. Knee Surg Sports Traumatol Arthrosc, 20(3): 586-93, 2012.
Akamatsu Y, Mitsugi N, Taki N, Kobayashi H, Saito T. Medial versus lateral condyle bone mineral density ratios in a cross-sectional study: a potential marker for medial knee osteoarthritis severity. Arthritis Care Res, 64(7): 1036-45, 2012.
Akamatsu Y, Mitsugi N, Hayashi T, Kobayashi H, Saito T. Low bone mineral density is associated with the onset of spontaneous osteonecrosis of the knee. Acta Orthop, 83(3): 249-55, 2012.
Zmistowski B, Della Valle C, Bauer TW, Malizos KN, Alavi A, Bedair H, Booth RE, Choong P, Deirmengian C, Ehrlich GD, Gambir A, Huang R, Kissin Y, Kobayashi H, Kobayashi N, Krenn V, Drago L, Marston SB, Meermans G, Perez J, Ploegmakers JJ, Rosenberg A, Simpendorfer C, Thomas P, Tohtz S, Villafuerte JA, Wahl P, Wagenaar FC, Witzo E. Diagnosis of periprosthetic joint infection. J Arthroplasty, 29(2 Suppl): 77-83, 2014.
J Arthroplasty. 2014 Feb;29(2 Suppl):77-83.
Zmistowski B, Della Valle C, Bauer TW, Malizos KN, Alavi A, Bedair H, Booth RE, Choong P, Deirmengian C, Ehrlich GD, Gambir A, Huang R, Kissin Y, Kobayashi H, Kobayashi N, Krenn V, Lorenzo D, Marston SB, Meermans G, Perez J, Ploegmakers JJ, Rosenberg A, C Simpfendorfer, Thomas P, Tohtz S, Villafuerte JA, Wahl P, Wagenaar FC, Witzo E. Diagnosis of periprosthetic joint infection. J Orthop Res, 32(1 Suppl): 98-107, 2014.
Saito T, Kumagai K, Akamatsu Y, Kobayashi H, Kusayama Y. Five-to ten-year outcome following medial opening-wedge high tibial osteotomy with rigid plate fixation in combination with an artificial bone substitute. Bone Joint J, 96-B(3): 339-44, 2014.
Kusayama Y, Akamatsu Y, Kumagai K, Kobayashi H, Aratake M, Saito T. Changes in synovial fluid biomarkers and clinical efficacy of intra-articular injections of hyaluronic acid for patients with knee osteoarthritis. J Exp Orthop, 1(1): 16, 2014.
Akamatsu Y, Kobayashi H, Kusayama Y, Aratake M, Kumagai K, Saito T. Predictive factors for the progression of spontaneous of the knee. Knee Surg Sports Traumatol Arthrosc, 25(2): 477-84, 2017.
Kumagai K, Akamatsu Y, Kobayashi H, Kusayama Y, Koshino T, Saito T. Factors affecting cartilage repair after medial opening-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 25(3): 779-84, 2017.
Akamatsu Y, Kobayashi H, Kusayama Y, Kumagai K, Saito T. Comparative Study of Opening-Wedge High Tibial Osteotomy With and Without a Combined Computed Tomography-Based and Image-Free Navigation System. Arthroscopy. 32(10): 2072-81, 2016.
Akamatsu Y, Kobayashi H, Kusayama Y, Kumagai K, Saito T. Femoral shaft bowing in the coronal and sagittal planes on reconstructed computed tomography in women with medial compartment knee osteoarthritis: a comparison with radiograph and its predictive factors. Arch Orthop Trauma Surg. 136(9):1227-32,2016.
Akamatsu Y, Sotozawa M, Kobayashi H, Kusayama Y, Kumagai K, Saito T. Usefulness of long tibial axis to measure medial tibial slope for opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 24(11):3661-7, 2016.
Akamatsu Y, Ohno S, Kobayashi H, Kusayama Y, Kumagai K, Saito T. Coronal subluxation of the proximal tibia relative to the distal femur after opening wedge high tibial osteotomy. Knee. 24(1): 70-5, 2017.
Kumagai K, Akamatsu Y, Kobayashi H, Kusayama Y, Saito T. Mosaic Osteochondral Autograft Transplantation Versus Bone Marrow Stimulation Technique as a Concomitant Procedure With Opening-Wedge High Tibial Osteotomy for Spontanious Osteonecrosis of the Medial Femoral Condyle. Arthroscopy. 34(1): 233-40, 2018.
Mitsuhashi S, Akamatsu Y, Kobayashi H, Kusayama Y, Kumagai K, Saito T. Combined CT-based and image-free navigation systems in TKA reduces postoperative outliers of rotational alignment of the tibial component. Arch Orthop Trauma Surg. 138(2): 259-66, 2018.
Akamatsu Y, Kobayashi H, Kusayama Y, Kumagai K, Saito T. Opening Wedge High Tibial Osteotomy Using Combined Computed Tomography-Based and Image-Free Navigation System. Arthrosc Tech. 6(4): e1145-51, 2017.
Akamatsu Y, Kumagai K, Kobayashi H, Tsuji M, Saito T. Effect of Increased Coronal Inclination of the Tibial Plateau After Opening-Wedge High Tibial Osteotomy. Arthroscopy. 34(7): 2158-69, 2018.
Akamatsu Y, Kobayashi H, Tsuji M, Nejima S, Kumagai K, Saito T. Should sagittal osteotomy line be parallel to tibial posterior slope in high tibial osteotomy? BMC Musculoskelet Disord. 19(1): 338, 2018.
Tsuji M, Akamatsu Y, Kobayashi H, Mitsugi N, Inaba Y, Saito T. Joint line convergence angle predicts outliers of coronal alignment in navigated open-wedge high tibial osteotomy. Arch Orthop Trauma Surg. 140(6): 707-15, 2020.
Nejima S, Akamatsu Y, Kobayashi H, Tsuji M, Mitsuhashi S, Sasaki T, Kumagai K, Inaba Y. Relationship between lower limb torsion and coronal morphologies of the femur and tibia in patients with medial knee osteoarthritis. BMC Musculoskelet Disord. 21(1): 254, 2020.
Nejima S, Kumagai K, Kobayashi H, Yamada S, Akamatsu T, Ogino T, Sotozawa M, Inaba Y. Varus inclination of the tibia is related to patellofemoral osteoarthritis in Japanese female patients with moderate knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 29(2): 652-58, 2021.
Nejima S, Kumagai K, Kobayashi H, Yamada S, Akamatsu T, Ogino T, Sotozawa M, Inaba Y. Coronal shaft bowing of the femur affects varus inclination of the surgical transepicondylar axis in varus knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 29(3): 814-9, 2021.
Sasaki T, Akamatsu Y, Kobayashi H, Mitsuhashi S, Nejima S, Kumagai K, Saito T, Inaba Y. Rotational changes in the distal tibial fragment relative to the proximal tibial fragment at the osteotomy site after ope-wedge high tibial osteotomy. Biomed Res Int. In press 2021
Akamatsu Y, Nejima S, Tsuji M, Kobayashi H, Muramatsu S. Open-wedge high tibial osteotomy using intraoperative control of joint line convergence angle with reference to preoperative supine radiograph. Arch Orthop Trauma Surg in press
Akamatsu Y, Nejima S, Tsuji M, Kobayashi H, Muramatsu S. Joint line obliquity was maintained after double-level osteotomy, but was increased after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc in press
Nejima S, Kumagai K, Kobayashi H, Fujimaki H, Yamada S, Sotozawa M, Hisatomi K, Inaba Y. Medialization of the mechanical axis of the tibia is related to lateralization of the tibial tuberosity in knee osteoarthritis. Knee. 30: 134-40, 2021.
