Greeting from the clinical director
On January 1, 2012, I was appointed as the third professor of the Department of Orthopedic, Yamagata University Faculty of Medicine. The department was established on 1976, by emeritus Professor Yoshihiro Watanabe (first Professor), and succeeded by the second professor, Toshihiko Ogino. Our department has steadily developed until now. Currently, many fellows of the department are actively involved in medical care and research of the musculoskeletal systems, including Orthopedic surgeries and Rehabilitation, in the Tohoku region and throughout Japan, as well as in Yamagata Prefecture.
Orthopedic surgeries are closely associated with various interdisciplinary fields and contribute to health recovery, maintenance, and promotion through the improvements of musculoskeletal functions. We have been involved in various specialized fields, namely, orthopaedic trauma, osteoarthritis, rheumatoid arthritis, bone metabolism diseases, spinal disease, bone soft tissue tumor, osteoporosis, bone disorders, congenital anomalies, infectious diseases. Furthermore, rehabilitation, sports medicine, biomaterials, and microvascular surgery have been involved. Basic research activity in musculoskeletal fields serves as a driving force for clinical practice.
Japan has entered a super-aging society, arousing a great social interest in "health and longevity." For this purpose, normal musculoskeletal functions should be maintained. Currently, there are various urgent issues in the field of locomotive syndrome in the elderly. Demands of musculoskeletal medicine and its medical care in the elderly are increasing. In such situation, orthopedic surgeons play an important main role for the treatment of bone fracture, osteoporosis, osteoarthritis, and spinal disorders, The physical health of younger generations who supports the super-aging society is also an important issue. Thus, musculoskeletal medicine and its medical care can contribute to support a wide range of generations from children, youth, middle-aged, and elderly is critical. In addition, emergency medical care during disasters is essential.
We will collaborate in various fields to meet current and future needs, develop young people who will lead the future, and contribute to the society through musculoskeletal medicine, mainly orthopedic surgery.
Michiaki Takagi, MD, PhD, Professor and Chair, Department of Orthopedic Surgery, Yamagata University Faculty of Medicine
Target diseases and contents and characteristics of medical treatments
In our department, musculoskeletal disorders are treated. The musculoskeletal system consists of limb/trunk skeletons, joints, ligaments, muscles, spinal cord, and nerves, i.e., an organ that transfers physical sensations to the brain to carry out reflexive or intentional body movements. Movements performed by the motor system plays a critical role in activating the brain and nervous system and maintaining the normal circulatory and metabolic systems. We will treat musculoskeletal disorders to improve quality of life (QOL).
Spine: scoliosis, kyphotic deformity, osteoporosis, spinal/spinal cord tumor, lumbar spinal canal stenosis, myelopathy, disc herniation, spondylolysis, and other allied conditions.
Shoulder joint: frozen shoulder, repetitive dislocation, rotator cuff tear, pitcher's shoulder joint disorder, trauma, and other allied conditions.
Hand surgery: limb malformations, surgical reattachment of severed finger, peripheral nerve disorders, spring finger, Dupuytren's contracture, toe transplantation, paralyzed hand reconstruction, and other allied conditions.
Hip joint: osteoarthritis, femoral head necrosis, rheumatoid arthritis, acetabular dysplasia, femoroacetabular impingement, developmental dysplasia of the hip, and other allied conditions.
Knee joint: osteoarthritis, rheumatoid arthritis, ligament injury, meniscal lesion, and other allied conditions. Autologous culture cartilage transplantation for traumatic defect of the cartilage is now intensively performed (photograph).
Cartilage tissue collected from the knee joint (left) and cartilage tissue after culturing (immediately before transplantation) (right)
Foot and ankle: clubfoot, toe shortening, osteoarthritis, rheumatoid arthritis, ligament injury, and other allied conditions.
Tumors: bone and soft tissue tumors, especially malignant tumors are targeted for multidisciplinary treatment. Surgical reconstruction and chemotherapy, often radiation therapy, are performed.
In addition to abovementioned teams, another specialized teams (e.g., rheumatoid arthritis team) to promote careful and specialized advanced treatments by multidisciplinary manner, i.e., surgical reconstruction, rehabilitation, and drug therapy. Osteoporosis treatment and specialized musculoskeletal rehabilitation are also performed.
Treatment results: osteosarcoma
Osteosarcoma
- Outline of treatment
- 5-year-survival rate: 72.9%
(87.5% after excluding 2 metastatic cases at the first visit)
Preservation of affected limb: 9 cases (60%)
Postoperative infection: 0 cases (100%)
Local recurrence: 0 cases (100%)
* Subjects: 15 patients (12 males and 3 females, aged 7-35 years (mean age: 17.4)) who underwent chemotherapy by the Rosen-T20 modified method
* Survey period: 1995-2003
Treatment results: upper crotch
Attachment of amputated fingers
- Short-term outcomes
- 90% survival rate
- Long-term outcomes
- Almost satisfactory in spite of some movement restrictions.
- Degree of difficulty
- High
Practicable at limited facilities (about 90% success rate).
Open carpal tunnel release for carpal tunnel syndrome
- Short-term outcomes
- Pain relief
- Long-term outcomes
- Remission
- Degree of difficulty
- Low
- Others
- Arthroscopic surgery
Conservative therapy (steroid injection) for spring fingers
- Short-term outcomes
- 90% Remission
- Long-term outcomes
- 75% Remission
- Degree of difficulty
- Low
- Others
- 50-90% remission at other facilities
Conservative treatment for baseball elbow
- Short-term outcomes
- 90% cure
>90% return to baseball - Long-term outcomes
- 80% cure
80% full return to baseball - Degree of difficulty
- Moderate
- Others
- 60-90% cure at other facilities
Surgical treatment for baseball elbow
- Short-term outcomes
- 90% Remission
90% return to baseball - Long-term outcomes
- 90% Remission
80% full return to baseball - Degree of difficulty
- Moderate
- Others
- 60-90% full return to baseball at other facilities
Radial shortening for lunatomalacia
- Short-term outcomes
- 80% Remission
- Long-term outcomes
- 70% Remission
- Degree of difficulty
- Moderate
- Others
- 60-90% full return to baseball at other facilities
Treatment results: knee joints
Total knee replacement
- Short-term outcomes
- Deep infection: 0.3%
Symptomatic venous thromboembolism: 0% - Long-term outcomes
- Replacement due to infection: 0.5%
Replacement due to loosening: 0.5% - Others
- 40-50 joints/year
Surgery of patients with complications by taking the advantages of the university hospital
Unicompartmental knee arthroplasty
- Short-term outcomes
- Deep infection: 1%
Symptomatic venous thromboembolism: 0% - Long-term outcomes
- Replacement due to infection: 0%
Replacement due to loosening or dislocation: 1% - Others
- 10-20 joints/year
Anterior cruciate ligament reconstruction
- Short-term outcomes
- Measurement difference in forward movements between affected and unaffected ligaments: 1-2 mm
- Long-term outcomes
- Reconstruction due to retearing and loosening 2.5%
- Others
- About 10 cases/year
Reconstruction with a knee flexor (hamstring) or patellar tendon depending on cases.
Transplantation of cultured autologous cartilage
- Short-term outcomes
- Infection: 0%
- Others
- About 3 cases/year
Treatment results: total hip arthroplasty
Total hip arthroplasty
- Short-term outcomes
- Early deep infection: 1 joint (0.4%)
Dislocation: 3 cases (1.1%)
Death due to pulmonary embolism: 0 cases (0%)
<Subjects >
258 joints that underwent surgery between April 2008 and April 2013 - Long-term outcomes
- Re-replacement due to late-onset infection: 1 joint (0.5%)
Re-replacement due to repeated dislocation: 1 joint (0.5%)
Re-replacement due to loosening: 1 joint (0.5%)
<Subjects>
209 joints that underwent surgery between January 1992 and December 2012 - Others
- 40-50 joints/year
Treatment of rheumatoid arthritis and general complications
Artificial hip replacement
- Short-term outcomes
- Early deep infection: 0 joint (0%)
Death due to pulmonary embolism: 0 cases (0%)
<Subjects>
22 joints that underwent surgery between April 2008 and December 2011 - Long-term outcomes
- Late-onset infection: 3/74 (4%)
<Subjects>
74 joints that underwent surgery between January 1995 and April 2011 - Others
- 10-20 joints/year
Replacement of hip prostheses placed at other hospitals