Patients with lateral humeral epicondylitis who had received conservative treatment were traced to clarify the end results. Out of a total of 109 patients studied after a mean period of three years, 63 cases (58%) were graded excellent, 19 cases (17%) good, 17 cases (16%) fair, and 10 cases (9%) poor. No statistical significance was noted between the recovery rate and patients' background factors, which included age, involved site, sex, and responsible causes.

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Dynamic pressure distribution on the foot sole was measured in normal people and in patients with disabled feet of various origins. When examinees stepped on a sensor plate while walking, the pressure distribution of the sole was recorded and color-displayed throughout the time from heel-contact to toe-off.
The data from 14 patients (26 feet) with hallux valgus, 9 patients (17 feet) with clubfoot and 46 patients (76 feet) with rheumatoid arthritis were compared with those from a normal control group (17 patients, 34 feet) .
Normal feet unanimously displayed the pattern in which the maximun pressure points moved along a path starting at the tuber calcamei, via the head of the 5th metatarsus and ending at the belly of the great toe. This normal pattern was independent of walking speed.
Whatever the basic illness was, the pressure beneath the midfoot in disabled feet, was often higher than normal. This was caused by decreased height of the longitudinal foot arch.
The additional abnormality observed in patients with rheumatoid arthritis or residual clubfoot deformity was an interruption of the normal procession of maximum pressure points in the lateral forefoot. Furthermore, abnormal pressure concentrations in the rheumatoid feet coincided well with the sites of callosities. In the rheumatoid patients with severely destructed ankle joints, only the initial heel contact was recorded and there was no further advancing of the maximum pressure points.

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One hundred and ten cases of acute injury of the lateral ligament of the ankle were treated by immobilization using plaster cast for 4 weeks and functional brace for the following 2 or 3 months. Follow-up studies were carried out 3, 6, 12 and 18 months after this treatment. Instability was measured by a stress roentgenogram using a Telos-SE stress device. Comparison of the injured ankle to the opposite uninjured ankle showed a difference in talar tilt angles of less than 1°three months after treatment and no significant increase was seen at 18 months after injury, even with cases where the angle was over 15° right after injury.

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Sterno-costo-clavicular hyperostosis is a disease of unknown origin. We tried to clarify the relationship in it between dermatological symptoms and hyperostosis changes of the sternocostoclavicular region by evaluating clinical courses and radiological findings in 30 of 112 house cases over 1 to 12 years (average 5.3 years) . The cases, 9 male and 22 female, ranged in age from 26 to 74.
The arthrotic symptoms were pain in 43%, swelling in 20%, local fever in 23.3% and ossif ical protrusion in 73%. The dermatological symptoms were classified into 3 types. There were 17 cases of transient type, 7 cases of recurrent type, and 6 cases of continuous type. Of the osteotic changes, 20% were negative, 36.7% atrophic, 20% hypertrophic, 50% sclerotic and 16.7% cystic. The artrophic changes were negative in 53.3%, narrow in 16.7% and irregular in 26.7%, and had fused in 23.3%. In bone scintigraphy, a strong uptake was found especially in irregular, fused and sclerotic types. The relationship between sternocostoclavicular hyperostosis and Pustulosis Palmaris et Plantaris (P.P.P.) was that the more severe the clinical symptoms were the greater the trend to dermatological disorders, especially in the continuous type. This suggested that the symptomatic courses of sternocostoclavicular hyperostosis and P.P.P. have a positive association.

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Surgical treatments in neuropathic arthropathy have been studied on the basis of a follow-up study of 24 joints of 23 cases (13 males and 10 females) . The post-operative follow-up period varied from 2 months to 19 years (average, 5 years) .
Joint debridement was performed in 1 shoulder, 1 elbow, 1 hip, 5 knees, and 2 ankles. Debridement in the upper extremities had favorable results at follow-up, whereas that in the lower extremities, especially in the knees, was not found to prevent the affected joint from progressive destruction. Among the 3 cases which received total knee replacement (TKR, hinge type), 1 had femoral shaft fracture after TKR, 1 received arthrodesis on account of persisting postoperative hydrops, and 1 knee was revised due to loosening a year and a half after TKR. Arthrodesis was performed in 13 knees and 1 ankle. Bony fusion was attained in 7 of 13 knees, but arthrodesis of the ankle was not successful.
Surgical treatment is not necessarily required in the upper extremities on account of their well-developed substitutive functions. Arthrodesis is recommended to obtain joint stability in the lower extremities. As bony fusion is likely to be delayed in neuropathic joints, firm fixation using an external fixator and bone graft as well as meticulous resection of the joint capsule and synovium is required to promote successful fusion.

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Clinical results were investigated after high tibial osteotomy for medial compartmental osteoarthritis of the knees with flexion contracture (limitation of terminal extension) above 20° in 53 patients, 4 men (4 knees) and 49 women (57 knees) . Preoperative flexion contracture averaged 24° (range, 20° to 40°) . The average age of patients at surgery was 65 years (range, 45 to 83) and the average length of follow-up was 5.3 years (range, 0.5 to 15.8) .
Several kinds of additional surgical procedures were used alone or in combination to correct flexion contracture at the time of osteotomy. These techniques included subperiosteal elevation of pes anserinus in all 61 knees, resection of the f ibular head in 21 knees, and resection of the table-like osteophyte in front of the tibial spine in 15 knees. If flexion contracture remained after these procedures, an anteriorly-based wedge was added. In only two knees, posterior release of soft tissue was done at the removal of a blade plate after osteotomy.
Postoperative flexion contracture of the knees was corrected to an average 8° and only 7 knees had a flexion contracture above 20° at follow-up. The arc of motion was 100°±20° preoperatively and 103°±24° at follow-up. There was no significant difference between them. The femoro-tibial angle (standing) was 186.2°+5.8° preoperatively and 169.1°±7.9° at follow-up. Good postoperative limb alignment was obtained. The knee function score using the criteria for evaluation of osteoarthritis of the knee of the Japanese Orthopaedic Association was 56±10 points preoperatively and 77±14 points at follow-up.
Satisfactory results were obtained by high tibial osteotomy for osteoarthritis of the knee with severe flexion contracture.

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For 19 years since 1970, 335 cementless total knee replacements (TKR) were performed, and eighteen revisional TKRS were carried out among them. Recently clinical evaluation of the revised cases was made on 9 cases of RA (12 knees) . The average age at the initial operation was 52, and at the revision arthroplasty, 58, or an average of 6 years and 2 months later. The average follow-up term after the revision arthroplasty was 4 years and 8 months. All initial operations were with cementless surface replacement type TKRS, but for the revision the stemmed Mark II (Okayama University type) was used on 2 knees and the Kyosera's KC-1 stemmed prosthesis on 10.
According to the Japanese Orthopaedic Association's knee evaluation criteria for RA, overall improvement was noted between before and after the revisional operation (33.3 and 62.9 points, respectively) . Especially pain and walking ability were remarkably improved (17.3 to 34 points and 1.8 to 10 points) . The range of motion showed slight improvement after the initial operation, but subsequently decreased after the revision arthroplasty. At follow-up a rather satisfactory condition of 56.8 points was found to be maintained.
The results indicated that a stemmed component for revisional TKR can be useful for salvaging aseptic loosening of the cementless type of knee prosthesis.

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The decrease in thickness (or wear including creep deformation) of the socket of the Bioceram, T-28 and SUM prostheses was compared clinically in cases which were followed over six years. The Bioceram prosthesis has a 28mm alumina head and UHMWPE socket, the T-28 has a 28mm metal head and a UHMWPE socket, and the SUM has a 28mm metal head and a UHMWPE socket irradiated with 10omegarad gamma-rays. The author measured the decrease in the thickness (wear including creep deformity) of the socket by a method devised by the author, which is easier and more exact than any other. The measuring instruments used were back-light type digitizers with 0.02mm resolution, 5-magnification loupes, 0.2mm graduation angle scales developed by the author, and small computers with original software.
Total wear, that is, the sum of initial wear and steady wear, is clinically important. The initial wear in the T-28 was almost four times that in the Bioceram, and the total wear was almost three times. On the other hand, the SUM prosthesis showed much more initial wear than the Bioceram, but almost equal total wear. The relationship between the thickness of the socket and the decrease in the thickness of the socket is very important in connection with creep deformation. The larger the socket, the lower the wear including creep deformation became. These results suggested the effectiveness of the gamma rays and that the best hip prosthesis at present is the one with an almina head and a UHMWPE socket irradiated with 100megarad gamma-rays.

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In spite of the current tendency of using osteochondral allograft to replace degraded articular cartilage, the methodology of preserving cartilage tissue while maintaining the viability of the chondrocytes is still controversial. The present experiment was performed to look for the cryopreservation condition most suitable for cartilage tissue storage. When cartilage tissue was degraded partially in a medium containing 2.5mg/ml trypsin and then exposed to 10% or 15 % DMSO for 3 hours before being frozen to-80°C below zero at an initial rate of 1°C/min ., the ³⁵S- sulfate uptake after freeze-thaw procedure was about 43 and 46% of the fresh control, respectively. After 8 weeks of storage the ³⁵ S-sulfate uptake was still about 20 % of the fresh control, and autoradiography revealed many viable chondrocytes not only in the surperficial layer but also in the deep layer. Chondrocytes were found to synthesize the proteoglycans that are almost the same size as those syntheseized by fresh chondrocytes. Pretreatment of cartilage tissue with trypsin to raise the permeablity of DMSO is mandatory for maintaining viablity of the chondrocytes in cryopreservation.

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