The purpose of this survey is to identify the health-related quality of life (HRQOL) and cost-effectiveness of inpatient rehabilitation services for traumatic brain injury (TBI), spinal cord injury (SCI) and osteoarthritis of the hip in our rehabilitation hospital. Subjects were 112 patients who could answer the questions, did not have serious complications and stayed to our hospital more than 30 days. In this survey the EuroQOL utility score, visual analogue scale, and Functional Independence Measure (FIM) scores were applied at hospitalization and discharge. The mean FIM scores in TBI and SCI improved significantly at discharge. The EuroQOL utility score and Visual analogue scale (VAS) for the three groups also improved at discharge. The mean hospital cost per person in TBI, SCI and osteoarthritis of the hip were 1, 462±504 thousand yen, 1, 822±790 thousand yen and 1, 389±407 thousand yen, respectively. The costs to obtain 1 quality adjusted life year (QALY) were 431±124 thousand yen, 425±551 thousand yen and 478±487 thousand yen, respectively. This survey indicates that in-hospital rehabilitation services for these three groups are cost-effective.

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Cocontraction of pairs of antagonistic muscles is not always pathological; it may be a type of normal voluntary movement. It functions to keep the position of the joint constant and markedly increases its stiffness. It is reported that there is selective activation of the medial gastrocnemius muscle during cocontraction at the ankle joint. Activity in the Ib inhibitory pathway, which leads to the soleus motoneuron from the gastrocnemius medialis nerve (GM), is important in the cocontraction mechanism. We examined the activity of this circuit during cocontraction and compared it with activity in the ankle at rest and in tonic dorsiflexion and tonic plantarflexion. Ib inhibition did not significantly differ in the four situations. Although reciprocal Ia inhibition was markedly depressed during cocontraction, Ib inhibition to the soleus from the medial gastrocnemius muscle was maintained throughout. This constant activity in the Ib inhibitory pathway might be attributable to the fact that the excitability of the medial gastrocnemius muscle is relatively larger than that of soleus muscle during cocontraction.

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Despite the early widespread clinical success with cemented stems using the second generation cement technique, many changes were introduced into stem design and material. In more recent years, many early failures of cemented stems have been reported. Many of these introduced changes based on industrial investigations, including circular stem cross-section, rough surface finish, increased stem offset, modular head-neck system, PMMA pre-coating and titanium alloy, have resulted in failure due to biological diversity and reactions. Failed stems were all designed as a composite-beam system with a rough surface finish. Composite-beam stems were less tolerant of human factors, compared to those incorporating the Taper-slip system with a smooth surface finish. Consequently, new design features should be introduced prudently with extensive pre-market testing, limited clinical release, and careful post-market surveillance. By reviewing the past history of total hip replacement, we learn an important lesson in view of the relationship between industrial innovation and clinical application. In this way we can take a lesson from the evolution of total hip replacement and understand “Yesterday's Successes and Today's Failures”.

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