Objective: We performed LIPUS irradiation of or FGF-2 administration to rat bone-marrow mesenchymal stem cells (BMSC) and the mouse parietal bone preosteoblast cell line (MC3T3-E1), and examined the involvement of HA in bone formation by measuring the DNA content and HA producton.
Methods: F-2, F-10, F-50, MF-2, MF-10, and MF-50 groups were produced by administering 2, 10, and 50 ng/mL of FGF-2 to BMSC and MC3T3-E1, respectively, and FL-2, FL-10, FL-50, MFL-2, MFL-10, and MFL-50 groups were also prepared by additional LIPUS irradiation. The DNA content and HA production were measured in these groups.
Results: The DNA contents in the BMSC was increased by FGF-2 administration, but not by LIPUS irradiation. The combination of FGF-2 administration and LIPUS irradiation did not further increase the DNA content. HA production was increased by FGF-2 administration, and further elevated by LIPUS irradiation. In the MC3T3-D1, the DNA contents was increased by FGF-2 administration, but not by LIPUS irradiation nor the combination of FGF-2 administration and LIPUS irradiation. HA production was not increased by FGF-2 administration, LIPUS irradiation, nor their simultaneous application.
Conclusion: It was suggested that FGF-2 administration and LIPUS irradiation promote the healing of fractures via HA in the undifferentiated cell stage.

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Objective: We analyzed the effect of lateral wedged insoles which is one of conservative treatment of medial knee osteoarthritis by gait analysis using a 3-axis accelerometer. Furthermore, we compared the changes of acceleration by differences in constraint on ankle motion.
Methods: 40 patients with medial knee osteoarthritis were enrolled. Subjects were tested during walking with barefoot and during walking with four types of insoles. We fixed a 3-axis acceleration sensor in the proximal f ibular head and measured the 3-axial acceleration. Gait analysis was performed on a 20 m walkway for each subject under 5 different walking conditions; barefoot, wearing a conventional insole, sock type insole, banding type insole and semi-rigid type insole. The 3-axial acceleration during gait was measured and compared among the 5 conditions.
Results: When wearing insoles, the peak value of lateral acceleration that occurred after a heel strike significantly decreased compared to when wearing non-insoles. The semi-rigid type had the largest decrease rate of peak value, followed by the banding type. It was found that the peak value in the socks type and the conventional type were inferior to the former two. The peak value was largest in the non-insole wearing.
Conclusion: We concluded that instability is restrained by wearing lateral wedged insoles and, the results suggest that the stronger the constraining force of the subtalar joint is, the greater the restraining effect.

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(目的) 生物学的製剤 (インフリキシマブ) の関節破壊抑制効果を検討した。両手などの小関節だけでなく, 下肢荷重大関節での関節破壊抑制効果も検討を加えた。
(対象と方法) 2年以上投与を継続した33例の両手レントゲン像をシャープスコアー変法 (van der Heijde) で評価した。さらに, 下肢荷重大関節である膝関節の立位正面レントゲン像19例33関節をラールセン分類で評価した。
(結果) シャープスコアー変法による評価では, 骨びらんスコアーが1年後から-0.21と改善し, 総スコアーも-0.17と1年後, 2年後とも改善を維持していた。ラールセン分類による膝関節評価では33関節中2関節で悪化を認めたが, 骨びらんの消失や関節裂隙が開大してみえる症例も存在した。
(結論) 生物学的製剤 (インフリキシマブ) は下肢荷重大関節でも関節破壊抑制効果が期待できる。

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Objective: The purpose of this study is to investigate the availability of the D-dimer as a screening marker, the factors affecting on the value of the D-dimer, and the patient's background with the deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) before total knee arthroplasty (TKA) prospective trial.
Material and Methods: The total of 85 patients scheduled for TKA from March 2004 to Aril 2007 were enrolled under the criteria excluding the revison surgery and the medication of anticoagulant. There were 20 men and 65 women with a mean age of 73 years-old (range, 52-89) . All patients were measured the D-dimer preoperatively. If the value was more than 1.0μg/ml, the multidetector-CT (MD-CT) examination was followed to determined the diagnosis for DVT and/or PE. In addition, six clinical factors including the age, sex, BMI, disease, heart function, and walking ability were examined in order to analyze their influences on the value of D-dimer and the formation of DVT/PE.
Results: The mean value of D-dimer was 2.5±2.7μg/ml and 71 patients (83.5%) had the value more than 1.0μg/ml. The incidence of DVT/PE was 9.4% (1.2-15.0μg/ml) . There were no symptomatic cases. No clinical factors had significant differnces in the occurrence of DVT/PE.
Conclusions: Our findings demonstrated that the preoperative screening for DVT/PE using the MD-CT selectively in patients with a high value of D-dimer was not always available. Additional anticoagulant treatment, therefore, may be necessary for the prevention of DVT/PE after TKA.

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The number of elderly patients with rheumatoid arthritis (RA) has been increasing as a result of Japan's aging society. Elderly patients with RA can be divided into those who grow old after the disease onset of average age and those prevail RA at an older age than normal. Elderly RA should be differentiated from polymyalgia rheumatica, remitting seronegative symmetrical synovitis with pitting edema, and microscopic polyangiitis. Since elderly RA patients are likely to have many concurrent diseases such as renal insufficiency, diabetes mellitus, and old tuberculosis, surgical procedures as well as the appropriate dosages of nonsteroidal anti-inflammatory drugs, disease modifying anti-rheumatic drugs, or biological agents should be carefully determined. In particular, attention should be paid to carefully monitor the patient's renal function since elderly RA patients often have a normal serum creatinine level despite of impaired renal function due to low muscular volume. Cystatin C may be a good marker of renal function since its blood level is not affected by sex and muscular volume. Mizoribine might be a good option for elderly RA patients with mild renal dysfunction since it dose not increase side effects and possibly effective due to the elevation of the concentration in the blood. Steroid hormones should be used in combination with drugs for the treatment of osteoporosis such as bisphosphonates, vitamin D₃, and Vitamin K₂. Vitamin D₃ should be used while monitoring the urinary calcium excretion levels to prevent the occurrence of renal stones. The most important point when treating elderly RA patients is that a sufficient degree of cooperation is obtained by both orthopedic surgeons and internal physicians.

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Objective: The purpose of this report is to describe the results of Kyocera Type I Total Elbow Arthroplasty in patients who had rheumatoid arthritis.
Materials and methods: TEA was performed on 29 elbows of 28 patients, at a mean age of 59 years. The duration of therapy for RA was from 6 to 28 years (average, 15 years) and follow-up was from 1 year and 6 months to 12 years and 3 months (average, 6 years and 2 months) . We used the JOA score for clinical evaluation, and examined X-ray findings and complications after surgery.
Results: The average JOA score reading improved from a presurgical reading of 39 points to a postsurgical reading 73 points in the uncemented group, and also, from 38 points to 74 points in cemented group. On X-ray findings, loosening of the components were found in uncemented group. However we could not find loosening of the components in the cemented group. Complications were less in cemented group than in uncemented group.
Conclusions: TEA is a useful procedure for RA patients. As occasion demands, it is thought that the components should be cemented.

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Objective: The Bi-Surface knee prosthesis has a posterior stabilizing cam (unique ball and socket joint) in the med-posterior region of the femorotibial joint in an attempt to improve the range of movement. The objective of the present study was to evaluate the short-term results of total knee arthroplasty (TKA) using the Bi-Surf ace knee (KU 4)
Materials and Methods: From September 2002, Bi-Surf ace knee (KU 4) TKAs was performed in 122 knees of 98 patients. The 115 knees of 95 patients (14 males and 81 females) who could be followed for one year were enrolled in this study. The mean age at the operation was 72 years, and the mean follow-up period was 2.3 years. The 20 knees had rheumatoid arthritis (RA) and 95 knees had osteoarthritis (QA) . Clinical evaluation was based on the Japanese Orthopaedic Association (JOA) scores for RA and OA, and we also assessed the range of motion and radiographic results.
Results: The mean JOA score for RA increased from 47.4 preoperatively to 84.2 at the last follow-up. The mean JOA score for OA increased from 52.4 preoperatively to 79.4 at the last follow-up. The mean flexion range improved from 111.6° to 114.6° for OA, but decreased from 116° to 112° for RA. The mean extension range improved from 13.6° to 3.0° for Amend from 12.5° to 3° for RA.Radiographically, there were 23 knees with a radiolucent line, but no knees with sinking and noncontimuous radiolucent line.
Conclusions: Good clinical and radiographical results were obtained with Bi-Surf ace knee (KU 4) on the short-term follow-up.

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Object: We studied the kinematics of cruciate-retaining and -substituting total knee arthroplasty (TKA) using image free knee navigation system intra-operatively.
Methods: 14 PCL-retaining TKAs and 34 PCL-substituting TKAs were selected based on the following criteria: any flexion contracture was under 10 degrees and maximum flexion was over 130 degrees, the distribution of valgus/varus was within +/- 3 degrees and the distribution of axial rotation was within 15 degrees at full extension. Both the valgus/varus and the internal/external rotation variations were evaluated using the Navigation System at intervals of 30 degrees from 10 degrees to over 120 degrees of flexion.
Results: In the varus/valgus motion, both the PCL-retaining group and the PCL-substituting group show the similar curve patterns with a valgus tendency from about 10° to 60° of flexion, and a varus tendency from 60° to about 130° of flexion. But as for the internal/external rotation, the PCL-retaining group and the PCL-substituting group show the different curve patterns. Although the PCL-retaining group kept internal rotation from about 30° to maximum flexion, the PCL-substituting group rotated externally from 60° to 90°, and did not rotate internally nor externally from 90 to about 130° of flexion.
Conclusion: These results indicate that the kinematics functions of the navigation system are helpful and practically accurate to analyze the kinematics of a patient's knee in vivo.

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Objective: Many authors have reported good clinical results with total knee arthroplasty (TKA) in rheumatoid arthritis (RA) . We investigated the long-term clinical results of TKA in RA followed-up for more than ten years postoperatively.
Methods: From July 1989 to July 1997, we performed TKA in 108 knees of 66 patients with RA. Of these, 45 knees in 28 RA patients (4 males and 24 females) were followed up more than ten years postoperatively. The mean age at the operation was 55.7 years (43 to 71), and the mean follow-up period was 13 years (10 years and one month to 16 years and six months) . We used two types of TKA prostheses, Nagoya City University (NCU) type and Natural Knee (Zimmer) . NCU and Natural Knee were applied to 27 and 18 knees respectively. Clinical evaluation was based on the Japanese Orthopaedic Association RA knee score (JOA score), and we also assessed the range of motion, radiographic results and complications.
Results: The mean JOA score improved from 40.8 to 77.7. However, the mean flexion range decreased from 108.4° to 103.3°, whereas the mean extension range improved from -14.8° to -4.4°. Radiographically, 16 of 45 knees showed a radiolucent line. The rate of this phenomenon tended to be higher in cementless cases. One case required reoperation due to aseptic loosening of the femoral component.
Conclusions: We have obtained good clinical results with TKA in RA more than 10 years postoperatively. The improvement of flexion angle may be dependent on the preoperative joint contracture and the decreased activity of RA patients. To prevent radiographic change, each component of TKA in RA should be fixed with cement.

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Survivors of traumatic atlanto-occipital dislocation (AOD) have been increasingly reported, however, survival after traumatic AOD with atlanto-axial subluxation is extremely rare in adults. The aim of this study was to describe the treatment of traumatic AOD with atlanto-axial subluxation in an adult. A 40-year-old woman was injured in a traffic accident. She developed pulmonary arrest and, after cervical spine precautions were taken, the patient was intubated in the emergency room. Diagnosis was made by lateral cervical spine radiography and helical computerized tomography (CT) . The diagnosis was traumatic AOD with atlanto-axial subluxation. Reduction of the dislocation and posterior fixation were applied in this patient. She has survived for 1, 400 days after injury with ventilatory and nutritious support. Treatment of traumatic craniocervical dislocation (CCD) consists of early ventilatory support, spinal immobilization, and subsequent posterior surgical fusion.

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