From 1984 to 1988, 37 revisions in 35 cases of failed aseptic cemented total hip arthroplasties were performed with allograft acetabular reconstruction and cemented implants. The allograf is were all preserved at-75°C. The average age at revision was 61.8 years, ranging from 36 to 81. There were 33 women, two of whom had bilateral revision, and 2 men in this series. The average follow-up period was 4 years, 8 months, with a range of 3 years to 6 years, 9 months. The average postoperative JOA hip score was 76.2, and 34 of the revised joints had no or slight pain. Radiographic loosening or collapse of the graft occurred in four hips, but none of the components has required revision. Though our clinical experience is short, we find it very encouraging.

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Ninety-five hip joints in 8 8 patients suffering from osteoarthritis have been treated by bipolar hip prosthesis over the past 9 years. Out of them, 26 joints in 23 patients were followed up clinically and roentgenographically for more than 5 years, with a mean of 5 years, 7 months. The age at operation ranged from 35 to 75, averaging 59.7 years. The Bateman UPF ll with curved Moore stem was used as the component in all cases. Good results were obtained. In a clinical evaluation done by the criteria for JOA hip score, the averag total score of 45.8±11.0 at preoperation changed to 83.2±9.1 postoperatively. On roentgenograms the medial migrated distance of the outer head was 0.04±1.8mm on an average. Apparent medial migration was recognized in 2 (7.7 %) out of the 26 and their migrated distances were 5mm and 4mm. On the other hand, greater upward migration was seen 2.3±1. 7mm on an average. This outer head migration showed a tendency to move upward and outward. The average distal migration of the stem was 4.8±4.3mm. One case had a distal migration of 2 0.5 mm and there was some trouble achieving fixation on the femoral site. Functional roentgenograms showed that the movability between the stem head and the inner bearing was much more dominant than that between the outer head and the acetabulum.

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A case of metallosis caused by alumina ceramic screw fixation of grafted bone in a Bateman UPF is reported. A 51-year-old woman underwent bone grafting acetabuloplasty with alumina ceramic screws in a Bateman UPF in September, 1983. She did well for a few years and then began having pain. Radiographs showed that the screws had broken, resulting in migration of the outer head. At revision in January, 1991, the capsule and bone adjacent to the component were seen to be densely and diffusely stained with a black material. Whereas the outer surface of the outer head in contact with the screws showed little sign of wear, the inner head was worn to a Rugby ball shape. SEM revealed many fragments of smashed alumina ceramic, whose rough edges were embedded in the inner surface of the HDP bearing insert. Furthermore, small metallic particles were seen adhering to hollow areas between the rough edges. EDX revealed peaks for Co, Cr and Mo, which were the constituents of the prosthesis alloy. The concentration of Co in the serum decreased markedly just after the operation. We therefore concluded that the smashed screw fragments had entered the joint space and penetrated the HDP, thereafter causing continuous abrasion of the metal head. Since alumina ceramic screws tend to fragment when they break, the outer head of a UPF should be removed as soon as possible if it comes into contact with the screws.

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Twenty-five Chiari pelvic osteotomies for advanced stage osteoarthritis of the hip joint were studied with follow-up periods of 4.1 years on an average. The mean Japanese Orthopaedic Association score was 63 before surgery and 87 after. Postoperative remodeling of the acetablum was classified according to X-ray findings, and there was significant correlation between the degree of acetabular remodeling and acetabular head index (AHI) . The hips with non-spherical heads showed better acetabular remodeling than the hips with spherical heads. These observations suggest that Chiari pelvic osteotomy is useful for advanced stage osteoarthritis of the hip joint.

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The purpose of this report is to evaluate the radiographical patellofemoral positioning after total knee arthroplasty (TKA) with different designs in rheumatoid arthritis (RA), and to identify the cause of subluxation of the patella. Between 1982 and 1990, 119 TKA were performed in 87 RA patients, 6 males and 81 females, whose average age at the time of surgery was 57.8 years. The prostheses that were used were Insall-Burstein total condylar knee (I/B II) in 47 knees, Miller-Galante total knee (M/GI) in 50, and Yamamoto Mark IQ total knee (Mark III) in 22. Anteroposterior, lateral and patellar skyline radiographs were made postoperatively to evaluate the results. Patellar prosthesis positioning was evaluated with regard to patellar tilt ( α angle) and lateral patellar shift ratio (PH/AB) . The incidence of postoperative patellar subluxation and dislocation using I/B II, M/G I, and Mark 1ff was 6.4 %, 24 % and 4.5 % respectively. In the M/G I, subluxation or dislocation of patella appeared respective of the Femoro tibial angle. The average postoperative α angle was 2.7 ± 3.10 (I/B II), 10.0±77° (M/G I ) and 4.8±3.7° (Mark III) . The mean of the α angle increased in time in M/G I. The PH/AB was 0.035±0.039 (I/B II), 0.054±0.058 (M/G I) and 0.152±0.030 (Mark III) . The design of the implant appears to be a factor in causing subluxation or dislocation in the M/G I.

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MR imagings (0.5 Tesula 5mm slice, TR/TE : 510-6 2 0 msec/ 27-30) of the injured menisci in 38 knees of 38 patients (28 men and 10 women, with an average age of 25.9) were compared with their arthroscopic findings and classified into two types, the one with linear high-density area and the non-linear one.
Menisci with longitudinal tears in 10 knees of 17 and with horizontal tears in 4 of 8 showed a linear high-density area in MRI, but the others including menisci with transverse tears (in 8 knees) or bucket-handle tears (in 7 knees) showed a non-linear high density area. These results may be due to both the angle between the tear and the slice lines of MR imaging, and the degeneration of menisci.
The MRI of normal menisci in 10 knees were also investigated. A false-positive. high-density area was often seen at the synovia-meniscal junction in the coronal plane of MR imaging and was seen at the posterior or anterior menisci in the saggital plane.

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We evaluated the clinical results of high tibial osteotomy performed between 1975 and 1989 for osteoarthritis of the knee in which disappearance of the anterior cruciate ligament was verified during the operation. There were 12 knees in 11 women, with a mean age at operation of 65.1 (range : 52 to 77) . The mean length of follow-up was 3.2 years (range : 1.4 to 6.8) . We contrasted this ACL (-) group with a group that had no disappearance of ACL. In this ACL (+) group there were 231 knees of 163 cases (34 men, 129 women), whose mean age at operation was 63.4 (range : 43 to 80) . The mean length of follow-up was 5.1 years (range : 1.0 to 13.2) .
The frequency of steroid injection into the knee in the past was higher in the ACL (-) group than in the ACL (+) group (p<0.01) . The Yokohama City University radiographic knee osteoarthritis grades at preoperation were also more progressive in the ACL (-) (p<0.01) . The average of the posterior inclination angle of the tibial plateau in lateral radiographs in the ACL (-) group was 15.4±2.9° and larger than the 9.2±3.4° in the ACL (+) group (p<0 .01) . The average femoro -tibial angle (standing) in antero -posterior radiographs was 195.4±5.4° in the ACL (-) group and 185.2±5.1° in the ACL (+) group. The preoperative alignment of the knee in the ACL (-) group was also more varus (p<0.01), but the average of this angle at follow-up was 169.4±5.7° in the ACL (-) group and 167.7±57° in the ACL (+) group. The average clinical score with the Japanese Orthopaedic Association Criteria for Evaluation of Osteoarthritis of the Knee was 60±11 points in both ACL (-) and ACL (+) groups at preoperation and was 84±11 points in the ACL (-) group and 85±11 points in the ACL (+) group at the time of follow-up.

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Rheumatoid arthritis is comparatively often accompanied by subcutaneous rupture of the finger extensor tendon. In the present study we examined the preoperative status to determine the factors accountable for such rupture. The subjects were 27 rheumatoid patients (53 fingers) with extensor tendon rupture, 21 females and 6 males, and with a high incidence of those in their fifties or sixties (16 of 27 cases : 60%) . The rupture was predominantly in the right hand, most frequently in the ring and little fingers (21 of 27 cases: 78%) . X-ray findings of the wrist joint were noted more frequently to be in the advanced Steinbrocker's criteria stages III and IV. Ulnar distal dorsal dislocation was noted in 16 of 24 cases (67%), excluding those with thumb tendon ruptures. The scallop sign, an erosive change in the distal radioulnar joint as designated by Freiberg, was noted in 15 of these (62%) . Both findings may possibly be related to the factors responsible for the mechanical wear of the extensor tendon.

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The interrelationship between metalloproteases and tissue inhibitor of metalloproteases (TIMP) in the articular joint is thought to have an important regulatory role in matrix degradation of articular cartilage. The author investigated immunohistochemically the localization of stromelysin and TIMP in the joint synovium of surgical specimens obtained from rheumatoid arthritis and osteoarthritis patients. Immunostaining was done by the ABC method using a monoclonal antibody against TIMP, stromelysin and macrophage. Intense cytoplasmic staining of TIMP was observed in synovial B-cells of the lining layer. The population of TIMP positive cells in the rheumatoid synovium was larger than that in the osteoarthritic synovium. Double staining against TIMP and stromelysin showed that stromelysin positive cells were more numerous than TIMP positive cells in both rheumatoid arthritis and osteoarthritis. The results were thought to support the hypothesis that joint destruction is caused by stromelysin dominant enzymatic imbalance in the joint.

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Twenty-six coracohumeral ligaments (C-H hg) were studied by histochemical methods in order to investigate collagen structures and distribution of the nerves. The collagen structure of the C-H hg was different from that of the shoulder capsule in that tere was mainly Type III collagen in it. On the other hand, both Type I and III collagen were in the capsule of the shoulder joints. Regarding the distribution of the nerves, there were a lot of different types. Some C-H hg had many nerves and some had few nerves. Histologically the C-H hg was loose connective tissue which was connected with the periosteum of the coracoid process. We think such a characteristic of the C-H hg may be associated with the cause of frozen shoulder.

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Although many investigators had studied the innervation of the posterior longitudinal ligament (PLL) with regard to the pathogenesis of low back pain, the precise distribution of the nerve fibers had not been clarified before Kojima's acetylcholinesterase histochemical study. In my study here, innervation of the PLL of the rat lumber vertebral column was investigated by immunohistochemical staining of the calcitonin gene-related peptide (CGRP) and substance P (SP) .
The PLL was found to contain dense nerve networks of numerous CGRP and SP-like Immunoreactive fibers which demonstrated nerve endings with marked varicosity. They were divided into two systems. One was a network which was distributed in the vertebral portion and in the superficial layer of the intervertebral portion of the PLL, and the other was the network existing in the profound layer in the intervertebral portion known as enthesis of the PLL. They were supplied by nerve fibers through the meningeal branches of the spinal nerves and the gray communicating branches.
This study suggests that the CGRP and the SP-like immunoreactive fibers in the PLL are associated with not only the conduction of nociceptive stimuli but also the regulation of spinal motion and metabolism of the enthesis.

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