Total hip arthroplasty (THA) and hemiarthroplasty have improved hip joint function of patients suffering from hip disease or trauma with excellent clinical results and long-term survivorship. Conversely, there has been an increase in the number of revision surgeries after THA and hemiarthroplasty due to bone deficiency. The reconstruction of deficient bone remains a challenging problem following THA. While performing revision surgery, we have previously classified the preoperative bone deficiency using X-ray, CT and three-dimensional CT imaging according to location and severity of the deficiencies. We then predicted the shape and amount of the required bone allograft and the type of implant. Due to the accepted reconstruction methods of bone deficiency following revision surgeries, it is important to pre-operatively assess the site and size of the bone deficiency to be repaired in the revision THA (re-THA). Bone allograft makes it possible to repair massive bone deficiency, recover bone stock, and improve long-term implant stability. Performing bone allograft will require a bone bank for harvesting, treating, and storing bone in Japan.

To determine the killing effect of microwave irradiation on Acanthamoeba polyphaga.

The trophozoites and cysts of A. polyphaga both in water and on agar were exposed to microwave irradiation with a capacity of 750 W for 0, 1, 3, 5, and 10 minutes, respectively. Furthermore, the trophozoites and cysts of A. polyphaga in water were exposed to microwave irradiation with a capacity of 100, 300, and 500 W for 1 minute, respectively.

The trophozoites and cysts of A. polyphaga on agar were completely killed by 3 minutes of microwave irradiation with a capacity of 750 W. The trophozoites and cysts of A. polyphaga in water were completely killed by microwave irradiation with a capacity of 300 W for 1 minute.

We demonstrate that microwave treatment is effective in killing A. polyphaga both in water and on agar and may be a helpful modality to prevent Acanthamoeba keratitis.

This study was aimed to investigate the clinical outcome of lumbosacral tuberculosis treatment by one-stage radical debridement with bone allograft reconstruction and anterior instrumentation via a retroperitoneal approach.

We retrospectively analyzed a series of 43 patients with lumbosacral tuberculosis in whom the lumbosacral junction was exposed via an anterior midline retroperitoneal approach. After radical debridement, two parallel tricortical iliac crest bone allografts were placed to reconstruct the anterior column, and then anterior fixation was performed.

The mean follow-up period was 34 months (range, 24-91 months), during which no obvious loss of correction was observed. No case experienced recurrence, tuberculous peritonitis, erectile dysfunction, or retrograde ejaculation.

The midline retroperitoneal approach provides direct and safe access to lesions of lumbosacral tuberculosis. Two parallel structural iliac crest allografts and anterior instrumentation effectively stabilize the lumbosacral junction.

Bone allografts are used to enhance healing in osteotomies, arthrodesis, fractures and to replace bone loss resulting from tumour or trauma. However, a major concern associated with the bone allografts is the potential for disease transmission. Various sterilization techniques have been developed to prevent infection through allografts. This study was undertaken with the aim of exploring the use of microwave radiation for sterilization of bone allografts and to compare with gamma radiation sterilization.

Bone allografts were processed from femoral heads obtained from living donors. The effect of microwave and gamma radiation on the bacteria isolated from bone allograft was evaluated. The microwave radiation treatment was performed at 2450 MHz (frequency) for varying lengths of time at maximum power 900 Watts (W). Viability of three Gram-positive bacteria - Bacillus subtilis, Corynebacterium, Staphylococcus aureus and three Gram-negative bacteria - Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa was examined after irradiation of bacterial suspensions and contaminated processed bone allografts. The sterility test of microwave and gamma irradiated bone allograft was carried out in accordance with ISO (International Organization for Standardization) 11737-2.

Microwave irradiation (2450 MHz and 900 W) of bacterial isolates resulted in complete inactivation within 60 seconds. The contaminated bone samples showed no growth of organisms after 2 minutes of exposure to microwave irradiation. No viable counts were detected in bone grafts inoculated with Gram-negative bacterial species on gamma irradiation to a dose of 15 kGy. Bones contaminated with Gram-positive bacteria required a higher dose of 20 kGy for complete inactivation.

The study shows that sterilization of contaminated femoral head bone allografts can be achieved by short exposure of 2 min to 2450 MHz and 900 W microwave radiation.

Routine spinal fusion techniques have involved removal of all soft tissues and articular facets, decortication of all posterior elements, and application of bone graft to the fusion area. Bone grafting has been performed mainly using the patient's own bone (autograft bone), most commonly from the iliac crest. The use of autograft bone is accompanied by complications or problems because of harvesting and donor-site morbidity. Several studies have already reported the use of allograft bone in scoliosis surgery. However, these studies are small series with short-term follow-up.

Twenty-two patients with scoliosis who underwent posterior spinal fusion and pedicle-screw-alone fixation using banked allograft bone obtained from the regional bone bank in Japan were analyzed. The average age at surgery was 13 years 5 months. The average follow-up was 2 years 7 months, and the average age at the last follow-up was 15 years 6 months. Scoliosis curves were divided into two groups (single curve group and double curve group).

For the single curve group, the average preoperative coronal curve measured 78° (48°-85°) and the postoperative curve measured 22° (8°-35°), with no loss of correction at the last follow-up. For the double curve group, the average preoperative thoracic curve measured 64° (48°-85°) and the lumbar curve measured 42° (38°-60°). The average postoperative thoracic curve measured 12° (8°-34°) and lumbar curve measured 15° (8°-32°), with no significant loss of correction at the last follow-up. No patients had clinical complaints in the region of surgery at 9 months after surgery and thereafter. There were no complications including loss of correction, nonunion, infection and instrumentation failure. At the last follow-up, patients/parents were interviewed and asked to complete an outcome satisfaction questionnaire. They were asked to rate the outcome as very satisfactory, satisfactory, neither satisfactory nor unsatisfactory, unsatisfactory, or very unsatisfactory. Seventeen patients (77%) were very satisfied, four patients (17%) were satisfied, and one patient (6%) was neither satisfied nor unsatisfied. Autograft bone and banked allograft bone appear to yield comparable results and clinical outcomes.

However, in Japan, various expenses accrue to supply a safe and premium quality of banked allograft bone. Financial issue must be resolved as soon as possible.

A total of 36 consecutive nonambulatory DMD patients underwent scoliosis surgery. Patients were divided into two groups: the autogenous iliac crest bone graft group (the ICBG group; 20 patients) and the allogenous bone graft group (the ALBG group; 16 patients). The mean preoperative curves measured 87 degrees and 31 degrees at the last follow-up in the ICBG group and 83 degrees and 28 degrees in the ALBG group. In the ICBG group, three (15%) patients had intraoperative sacroiliac joint penetration, five (25%) had iliac crest inner cortex penetration and three (15%) had postoperative prolonged wound drainage at the donor site. At three months after surgery, donor site pain caused by bone harvest was found in 50% with severe pain limiting their physical function and causing difficulties in sitting in a wheelchair in 40% of the patients, whereas patients in the ALBG group returned to their preoperative level of function soon after surgery.

The effects of cryopreservation on tendon allograft have been reported, but remain unclear, particularly the potential effects on mechanical properties and histological changes by ice crystal formation. There are also few studies about effects of heating for sterilization of tendon. We evaluated the effect of cryopreservation or heating on the mechanical properties and histomorphology of rat bone-patellar tendon-bones (BTBs). BTBs were processed by cryopreservation at -80 degrees C for 3 weeks, or heating at 80 degrees C for 10 min. Tensile testing and histomorphological examination were performed. The cryopreservation of tendons showed less influences on their mechanical properties. When cryopreserved BTBs in frozen state were fixed by freeze-substitution method, many spaces were observed in interfibrillar substances. These results suggest that the collagen fibers of cryopreserved tendons were histomorphologically affected by ice crystals. The heating of tendons completely destroyed the collagen fibers of the tendons and is therefore thought to be inappropriate for the sterilization of BTBs.