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Features of Orthopedics in Japan

Orthopedics is a therapeutic field that focuses on motor disorders with the goal of improving impaired activities in daily life.

In improving quality of life for patients, Japan is particularly adept at treating the symptoms listed here.

Degenerative Hip Disease

Degenerative hip disease is a condition in which the cartilage covering the surface of the hip joint disappears due to wear, causing strong pain and walking difficulty. Treatment methods include osteotomy, shelf procedure, and hip replacement surgery. Hip replacement surgery is a method in which the impaired hip joint is replaced with an implant. This method has been in use for over 40 years, and is one of the most appropriate treatment methods.

Osteoarthritis of the Knee

This is normally a condition in which the joint cartilage has worn away with age, causing pain and walking difficulty. Surgical treatments include osteotomy, surgery to partially replace joints with implants, and knee replacement surgery. The pain is alleviated through these procedures, allowing the patient to do light exercise, and thus leading to a significant improvement in everyday life.

Bone Fractures (Trauma)

This is a condition in which the bone breaks as a result of strong external force applied to the bone due to a fall or traffic accident, etc. Typical bone fractures include spinal compression fractures, wrist fractures (radius), and femoral neck fractures. Femoral head replacement is generally performed for femoral neck fractures, enabling the patient to walk again shortly after surgery. Apart from femoral head replacement, advanced treatment methods are used, including low intensity pulsed ultrasound (LIPUS). When bone fractures have become intractable, treatments that combine bone transplantation are also performed.

Intervertebral Disc Hernias, Spinal Canal Stenosis

Intervertebral disc hernias occur in the neck and lower back, and treatment methods include surgical removal of the protruding hernia. Spinal canal stenosis is a condition in which the spinal canal through which the nerves pass has become narrower with age, and it is treated by surgically widening the spinal canal.

Avascular Necrosis of the Femoral Head

This is a condition in which the blood flow through the femoral head decreases, causing bone tissue to die and become brittle. It is known to be caused by taking steroids and consuming alcohol. Surgical methods include rotational osteotomy of the femoral head, femoral head replacement, and hip replacement surgery.

Characteristics of New Orthopedic Implant Treatments in Japan

In Japan, medical devices are regulated according to the Pharmaceutical Affairs Act, and their safety and effectiveness has to be confirmed. All medical devices used on patients have ultimately been approved by the Ministry of Health, Labor and Welfare. More than 200,000 joint replacement surgeries are performed every year, including 40,000 hip replacement surgeries, 80,000 femoral head replacement surgeries, and 70,000 artificial knee joint replacement surgeries. About 300,000 surgeries are performed for traumatic fractures, and more than 200,000 for spinal canal stenosis.

The development and commercialization of new implant types with novel product designs and material components is progressing in Japan. Treatment is possible utilizing these new implant types, which better suit each patient‘s conditions and possess high durability, and from which superior postoperative functional recovery can be expected.

Japanese-made implants are designed to have a wider range of joint motion and allow the patient to do deep knee bends. Good functional recovery can also be expected for finger and ankle joints. In the treatment of fractures, treatment of intractable fractures with significant bone defects is also possible. There are also cases where existing products do not sufficiently meet the skeletal structural and symptomatic requirements of individual patients. In these cases, it is effective to use custom-made implants to fulfill these needs, and development toward their practical realization in the near future is proceeding.

From the perspective of long-term biological safety, highly functional materials with superior durability and biocompatibility are called for, and progress is being made toward their commercialization. For example, there is concern over the loosening of the sliding member in an artificial joint due to biological reaction with the small amount of wear powder that is formed. As a countermeasure, an artificial joint has been developed that includes a small amount of vitamin E (which possesses little toxicity in association with wear powder) in an ultrahigh molecular weight polyethylene material, and this is being used in clinical practice in Japan. A review is being conducted that could allow the selection of low-cost, high quality, and highly functional shapes and materials according to patient circumstances. If this comes about, metal sensitivity and breakage from long-term use for more than 20–30 years will no longer be a concern. For example, a Ti-15Zr-4Nb-4Ta alloy that combines zirconium (Zr), niobium (Nb), and tantalum (Ta) — elements that improve the biocompatibility of titanium (Ti) — is starting to be used in clinical practice as a Ti alloy that affords long-term peace of mind.

Examples of Implants

Artificial Finger JointHighly Biocompatible Artificial Elbow Joint Highly Biocompatible Artificial Hip Joint
Artificial Finger Joint Highly Biocompatible Artificial Elbow Joint Highly Biocompatible Artificial Hip Joint
High-Flexion Artificial Knee JointHighly Biocompatible Artificial Ankle Joint  
High-Flexion Artificial Knee Joint Highly Biocompatible Artificial Ankle Joint