We compared the tibial component alignment of 40 total knee arthroplasties (TKAs) using an intramedullary alignment system (Group I) and 40 TKAs using an extramedullary alignment system (Group II) . Coronal alignment of the tibial component within 2° of the ideal angle was achieved in 90% of Group land in 70% of GroupII. In sagittal alignment, 90% of Group I and 73% of Group II fell within 2° of the ideal angle. Both of these differences between the two groups were statistically significant (p<0.05) . An intramedullary alignment system is recommended as the standard technique for proximal tibial resection.

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The results of multiple joint replacement performed in 20 rheumatoid patients, 2 males and 18 females, are reported. The patients were followed up for an average of 54 months. Walking ability, as evaluated by the Jergesen method, improved in 6 and worsened in 14. The factors causing the poor results were the involvement of cervical myelopathy, mutilancetype RA, and low walking ability prior to the surgery. The relief of pain and the maintenance of the walking ability should be the goals of multiple joint replacement for severely handicapped rheumatoid patients.

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The clinical results of cementless revisions of Jikei cementless total hip arthroplasties were evaluated more than 3 years retrospectively.The revisions had become necessary due to loosening in 5 cases, dislocation in 3, and stem fracture in 2. The average JOA hip rating scores after surgery increased from only 51.1 to 65.1, an increment which is not satisfactory. The average postoperative score for the loosening cases was especially poor : 53.8. Such patients suffer large bone loss, while, on the other hand, the average score of those with good bone stock was 76.4. These results suggest that revision surgery requires good bone stock and should be performed before there is a decrease in it.

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The gleno-humeral joint is frequently involved in rheumatoid arthritis. Occasionally destruction of the joint may lead to severe pain. When conservative therapies were not effective for such rheumatoid shoulders, we performed the Benjamin double osteotomy. Eight patients (8 shoulders) were treated, 6 females and 2 males, with ages varying from 34 to 70 years, and an average of 49 years. There were no complications with this procedure. Patients were followed up for between 19 to 109 months (average 64 months) . All of them had no or slight pain, and pain relief had been recognized immediately after surgery. However, there was no remarkable improvement in the range of motion. The good results were long-term. We consider that double osteotomy is a useful procedure for advanced rheumatoid shoulder with continous severe pain.

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Twenty-nine ceramic total elbow prostheses designed by Inoue have been implanted in 24 patients with rheumatoid arthritis. Of the 29 prostheses, 16 were a stemless surface replacement type, and 13 were with stem, using a cementless technique. The results, as assessed by the scoring system of the Japanese Orthopedic Association, revealed a remarkable improvement in pain, range of motion, and elbow function. The major postoperative complication was loosening of the humeral component in 14 prostheses without stem.

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Studies on implant fixation have shown that hydroxyapatite (HA) coatings provide early and strong fixation to bone. This is a report of 3 4 consecutive cases of total hip arthroplasties using implants in which titanium femoral components had a proximal HA coating, usually with an HA-coated hemispherical cup. The operations were mainly for osteoarthrosis, rheumatoid arthritis, or avascular necrosis.The average follow-up period was twenty-six months. The average JOA hip score was 8 5 points after one year and 8 5 points after two years. The incidence of pain had been low immediately after surgery and was 3 % after one year. Roentogenographic examination showed a rapid integration of implants with bone apposition on the coating surface within six months. No radiolucent line formation was detected around HA-coated implant parts, and there were no revisions for loose implants. Thus implant fixation using HA coatings is a reliable procedure for good bony fixation and clinical results.

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Twenty-two patients with complete dislocation of the acromioclavicular joint received reconstruction of the coracoclavicular ligament utilizing Tetron tape. The results were excellent in 16 patients (73%), good in 5 (23%), and poor in 1 (4%) . X-rays revealed recurrent dislocation in 3 patients and subluxation in 2. Other complications included a slight restriction of range of motion in 3 patients, complaints of slight pain in 7, slight tiredness at working in 4, and slight disability in activity of daily living in 3. Thus this method utilizing Tetron tape is effective for complete dislocation of the acromioclavicular joint.

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The aim of this study is to evaluate the progression of medial and lateral arthritis after high tibial osteotomy (HTO) . Twenty-six knees of 24 patients who underwent HTO for medial osteoarthritic knees were radiologically followed up for a period of 10 to 15 years. In the medial tibiofemoral (TF) joint, radiological progression of osteoarthritis (OA) was observed in all knees at the 10th-year period examination although the FTA was overcorrected in most knees after surgery. However, the width of the medial joint space did not change during the period. In the lateral TF joint, mild progression of OA was also observed, but the width of the joint space also did not change in spite of valgus overcorrection of the FTA. In conclusion, HTO for medial OA cannot prevent the progression of OA, but OA change of the lateral joint does not accelerate.

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Nine patients were treated by muscle pedicle bone grafting using the quadratus femoris muscle. Four had post-traumatic avascular necrosis of the femoral head, 3 had nonunion of the femoral neck fracture and 2 had new femoral neck fracture. Bone union was achieved in all cases of nonunion and new cases of femoral neck fracture. However, the results with avascular necrosis of the femoral head were uneven, and selection of this method for it has to be made carefully.

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To assess the presence of generalized osteoporosis in rheumatoid arthritis (RA), we measured bone mineral density in various portions of the bodies of 59 patients with RA and 30 healthy subjects by dual energy x-ray absorptiometry. Severe bone loss from the extremities was observed in the RA patients, while loss from the trunk was modest. However, bone loss from both the extremities and the trunk was increased in patients with progressive RA. In the extremities, more bone loss was observed in the distal areas than the proximal ones.

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Autologous blood was taken from patients prior to orthopaedic surgery and returned to them at surgery. Only in 25 of the 38 patients who received no erythropoietin was it possible to obtain the estimated amount of autologous blood needed. Twenty-one of these 25 had no need for additional allogenic blood transfusion at their operation. In 33 of 36 patients who were in a program for autologous blood donation with intravenous erythropoietin (EPO) therapy, and in 24 out of 25 who received subcutaneous EPO therapy, no additional allogenic blood beyond that obtained was necessary during operation. The hemogulobin recovery rate was improved by EPO therapy: the intravenous by 30.8%, and the subcutanenous by 38.5%. No patient treated with EPO had bad side effects, and so autologous blood donation with EPO therapy is considered safe and useful in orthopaedic surgery.

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We experienced a case of snapping knee caused by an intraarticular nodule within the lateral parapatellar capsule. Histologic examination of the nodule showed f ibrinoid necrosis and therefore that it was rheumatoid. Observation from a cadaveric study revealed that the anterolateral portion of the femorotibial articular surface of the lateral femoral condyle has a sharp edge. Accordingly it is speculated that mechanical friction is likely to occur at the lateral parapatellar capsule on knee motion, and that a tumor which appears in this portion could tend to bring about snapping.

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The fact that rheumatoid arthritis (RA) often affects the temporomandibular joint (TMJ) is well known. It is rare, however, for a TMJ disturbance in an RA patient to undergo surgical treatment, and review of the literature revealed no reports of total TMJ implant arthroplasty. We therefore report a total TMJ implant arthroplasty in a 65-year-old female with RA. There was massive bone destruction in the TMJ and the patient had been suffering from dyspnea.

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