Recurrent subluxation of the shoulder is rarely encountered in wrestlers. This is a report of such a case with subsequent ectopic ossification, for which there was histological as well as plain radiographical and arthrotomographical evidence. The formation of ectopic bone was in the anterior capsule. This might be in response to chronic injury occurred in forced positioning into abduction and external rotation of the shoulder in wrestling.

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Six patients with posterior recurrent dislocation of the shoulder were treated by the Scott procedure. Three were male and three female. The age distribution was from 8 to 29. The follow-up period ranged from 1 year, 3 months to 9 years, 3 months with an average of 7 years, 2 months. The range of motion and X -ray findings were good in all cases at follow-up time.
Thus good results could be predicable by the Scott procedure for posterior dislocation of the shoulder. Another merit of the Scott procedures is that glenoplasty can be simultaneously performed in a patient with loose shoulder. Only one case developed redislocation after a year and a half. This case was salvaged by the Iino procedure (bone graft at acromion) and the result remains satisfactory after 1 year, 3 months.

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The efficacy of ultrasonography (US) and MR imaging in evaluating rotator cuff tear were compared by using them to examine 2 2 shoulders. Of the 22, 18 had complete rotator cuff tears and 4 had incomplete tears. Both the sensitivity and the specif ity of US and MRI were satisfactory in detecting the 18 complete cuff tears. But US was superior to MR imaging in identifying the 4 incomplete cuff tears. Based on these results, it appears that US and MRI are useful for detecting complete cuff tear, but in evaluating the localization of the cuff tears, US is superior to MR imaging.

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To learn the present state of complication of arthroplasty in patients who have rheumatoid arthritis, the authors investigated the complications of 70 patients or 126 joints who were admitted to the Kamiitabashi Hospital, a private hospital, and had received arthroplasty anywhere including Showa University Hospital in the past.
Complications were observed in 32 out of 126 joints or 25.4%. The major complications were infection and non-septic loosening. Infection was seen in 6 knees or 7.4 % out of 81 total knee arthroplasties (TKA) and in 3 hips or 9.1 % out of 33 total hip arthroplasties (THA) . Non- septic loosening was observed in 6 knees or 7.4 % in TKA and 4 hips or 12.4% in THA. Early complications were considered to be caused mainly by surgical technical failure. Multiple arthroplasties appeared to be one of the risk factors influencing the occurrence of late infection. Many complications were observed in the Geometric total knee arthroplasty, the total condylar knee arthroplasty with non-metalbacked HDP tibial plate, the total knee arthroplasty with patellar replacement, and the Muller type total hip arthroplasty. To avoid a bed-ridden state after arthroplasty, it is necessary to treat thoroughly other involved joints including cervical subluxation, and the indication for arthroplasty should be decided after determining whether a patient has sufficient volition.

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It is well known that steroids and alcohol are major factors possibly involved in the onset of idiopathic osteonecrosis of the femoral head (INFH) . The etiology of this disease has already been studied considerably with respect to steroids. However, as about one-third of the patients with INFH suggest an involvement of alcohol, this disease should be studied also in relation to it. In the present study, blood examinations, histological analyses and histochemical examination for lactate dehydrogenase (LDH) were carried out following long-term alcohol treatment in a rabbit model.
The aberration of fat metabolism (hyperlipidemia, relative decrease of HDL cholesterol and lecithin cholesterol acyltranseferase (LCAT) ) and increase of the serum cortisol level were disclosed following alcohol dosing. Histologically, fatty liver and deposition of lipid in osteocytes of the femoral head were observed. These findings became more severe with time. Histochemically, the positive-stained deposition in osteocytes, which showed LDH activity and indicated viability of the osteocytes, disappeared in the subchondral area of the femoral head 3 months after the commencement of alcohol dosing.
The hyperlipidemia and the elevation of cortisol level may help to increase the inflow of lipid into the osteocytes. On the other hand, the depression of viability of osteocytes and relative decrease of lipid clearance agents (HDL cholesterol and LCAT) may reduce the outflow of lipid from the osteocytes. It is thus suggested that alcohol dosing brings about the accumulation of lipid in the osteocytes by these mechanisms, and that the serum cortisol level should be examined clinically as a pathogenic factor of INFH.

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Eight patients with ankylosing spondylitis underwent 13 total hip replacements between 1979 and 1990. The mean observation time was 5.5 years. The results were assessed according to pain, walking ability, mobility and activity of daily life. The over-all results were rated good. All hips improved in mobility after THR and this improvement was maintained during the follow-up period. No radiological signs of loosening were found. About 30% showed some evidence of ectopic ossification, but restriction of hip movements and coxalgia were not noted.

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The survivorship of sockets after 267 Charnley low-friction arthroplasties was studied with follow-up periods of 5 to 18 years. The end point of survivorship was defined in two ways : as incipient failure and as definite failure. When a socket migrated more than 2 millimeters or rotated more than 2 degrees from its original position just after surgery but there was no need for revision, the socket was judged to have developed incipient failure. Definite failure was indicated by the necessity for revision due to aseptic loosening of a socket. Twelve variables (age, sex, diagnosis, Charnley's categories, obesity index, socket-fixation method, socket design, socket angle, bony acetabular angle, socket height, socket wear at five years and stem subsidence) were investigated to assess socket survivorship by the Kaplan -Meier method.
In the present series, 24 sockets developed incipient failure and 14 of them developed into definite failure. Socket-fixation method, socket design, socket angle, and socket wear at five years was correlated with the development of incipient failure. Only socket wear at five years was correlated with the development of definite failure.

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Many factors have been reported as possible causes of patella dislocations. External rotation of the quadriceps muscle is one of these. The route of the quadriceps muscle was examined in 9 patients of patella dislocation and 2 normal volunteers in the abnormal position by means of MRI. All of them were female. We evaluated the rectus femolis external rotation angle (∠CR) and the vastus tilting angle (∠CV) in each case.
In 4 cases with patella dislocation, the results suggested that the causes were either external rotation of the quadriceps muscle or lateral deviation of the muscle force vector. It was shown that the ∠ CR is a useful index of the external rotation of the quadriceps muscle, and that the value of the ∠ CV depends on the condition of the distal part of the quadriceps muscle.

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Antero-medial displacement of tibial tuberosity was done on 2 2 knees with patellofemoral arthrosis of 17 patients (one man and 16 women, with ages ranging from 47 to 65, averaging 53.4) . Follow-up periods ranged from 2 to 13.1 years, 5.3 on an average.
Pain on going down stairs was noted in 22 knees and was relieved in 20 postoperatively. Retro -patellar crepitation also was relieved in 3 of 21, patellar pain on grating in 17 of 19, tenderness around the patella in 15 of 17, pain on passive motion of the patella in all of 19, and extension pain on holding the patella in place 11 of 12. The patellar subluxation was observed to be repositioned in the sky-line view in all knees. Patella baja was seen postoperatively in most cases, measured from the lateral view by the Insall-Salvati method.

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Total knee arthroplasty was performed in 20 ankylosed knees of 18 patients. The series contained 15 cases with rheumatoid arthritis, 2 with osteoarthritis and one with post-infectious ankylosis. These knees achieved a significant increase of arc of motion postoperatively from 26.6±12.4° preoperatively to 68.9±31.3° one year after surgery and 62.5±36.5° after 3.5 years. Fifteen knees were improved, 4 were unchanged and one was worse. Besides division of the bilateral para-patellar retinuculum, sufficient bone resection of the distal femur, closed continuous suction drainage and so forth, quadricepsplasty for the extension ankylosed knee and subperiosteal release at the pes anserinus region for the flexion ankylosed one were necessary to gain better arc of motion after surgery. Early postoperative rehabilitation was necessary. Especially it is important to have more than 90° flexion within one week after operation.

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Four cases of radiographically occult fracture of the proximal tibia were studied. Two of the 4 had of were bone bruise, and the remaining 2 had tibial plateau fracture and intercondylar eminence fracture. An area of signal intensity loss on T 1-weighted MR images was present in all cases. Reticulated or inhomogeneous signal intensity loss was especially the characteristic feature of bone bruise. All cases showed almost complete resolution of the findings in follow-up examination approximately 3 months later.

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Abduction-opposition wedge osteotomy of the first metacarpal bone was performed in 8 patients (10 joints) with osteoarthritis of the thumb CM joint which had resisted various conservative treatments. Within 6 months after the operation, good results were obtained in 6 cases (8 joints) . In periodic postoperative X-rays, widening of the thumb CM joint space was also observed in 8 joints (average follow-up period : 3.5 years) .

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To determine the clinical significance of synovial joint fluid, we measured its GOT, GPT, LDH, ALP, CK, TP, BUN, CREA, UA, Na, K, Cl, Ca, P, Fe, GLU, CRP, TCHO, TG and ACP by auto-analyser.
The results were as follows: the activities of enzymes in synovial joint fluid were high in inflammatory disease. There was significant correlation between CRP and LDH, CRP and GOT, CRP and ACP, ACP and ALP, ACP and LDH in synovial joint fluid in rheumatoid arthritis, and synovial glucose levels were also lower than blood glucose levels. The values of BUN, CREA, UA, Na, K, Cl, and P in the synovial joint fluid were equivalent to these in the serum. Therefore, the analysis of joint fluid is useful for knowing the inflammatory changes in joints and the general condition of patients.

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We have performed autologous blood donation before orthopaedic surgery using recombinant human erythropoietin. Twenty-five of 27 patients (including 4 RA patients) had their operation with a prearranged donation, whereas 21 of 28 patients had their operation without pre-treatment with erythropoietin. The anemia recovery rate increased 29.3% in the patients (12.4% in the case of RA) who received erythropoietin, and not at all (0%) in the patients who hadn't. None of the patients receiving it had side effects. Thus, autologous blood donation with erythropoietin is suitable in orthopaedic surgery.

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Four Supracondylar fractures after prosthetic knee arthroplasties were surgically treated between 1988 and 1990. Three of the patients had rheumatoid arthritis and one osteoarthritis. The cause of each fracture was minor trauma. The mean duration between arthroplasty and the fracture was about 5 years. All cases were treated by open reduction and internal fixation using a T plate and a May plate.
Good bone union was obtained and there were knee scores including ROM which were similar to those before operation. The results of osteoporosis measurements such as radial BMC/BW and quantitative computed tomography showed the predisposing factor of this type of fracture to be associated with severe osteoporosis. We have found that the patient with a supracondylar fracture following prosthetic knee arthroplasty could be adequately managed by secure internal fixation and early rehabilitation.

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Palindromic rheumatism was first described by Hench and Rosenberg in 1941, and three years later a detailed account of their 3 4 cases appeared in the Archives of Internal Medicine. We report on two patients with palindromic rheumatism whose complaint was recurrent attack of peripheral joint pain, swelling and redness at variable intervals lasting a few days.
There were no abnormalities found in laboratory examinations, on X-rays, or by ^99m Tc or Ga scintigraphy. Soft tissue biopsies of the sites of inflammation showed there was non -specific chronic inflammation with slight infiltration of lymphocytes and plasma cells in the skin, the tendon sheath and the synovium.

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Synovial osteochondromatosis occurring in the subacromial bursa has seldom been reported. We found only 6 cases in a recent survey, and would like to report another.
A 70-year-old female had acute pain in her shoulder without any preceding trauma. Roentgenograms and a computed tomographic scan of her shoulder revealed many oval calcified loose bodies packed into the subdeltoid space, which had caused an indentation at the proximal humerus.
At surgical exploration a sack which contained many cartilagenous loose bodies was found between the deltoid muscle and the humerus. The humerus was indented at the portion beneath the sack. At the top of the greater tubercle was a large cartilagenous loose body of 2 cm in diameter accompained by a flat ossified plate beneath it. Histological survey indentif ied the sack as a bursa filled with osteochondral free bodies, but the origin of the plate remains unknown.

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