Twenty-one femoral neck fractures in 21 patients with rheumatoid arthritis (RA), 6 with extracapsular fracture and 15 with intracapsular fracture, were treated by a conservative method in 2 hips, ostheosynthesis in 10 hips, hemiathroplasty (HA) in 3 hips and total hip replacement (THR) in 6 hips. Treatment of 4 of the 10 fractures by internal fixation was not successful. Three hips in which bone fusion was successful showed progressive joint destruction. Six of these 7 hips required surgery a second time. No primary THR presented postsurgical complications. Treatment for femoral neck fracture in patients with RA thus appears adequate with THR except in the case of younger patients and those with severe systemic illness.

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Post-operative results were studied in 10 joints with RA which had received ankle joint replacement at least five years previously. Clinical results, including pain-relief effect, range of motion and walking ability, were satisfactory, but loosening of the tibial component was discovered in 6 of the joints by X-ray examination. We are now studying how to deal with this complication.

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By January 1992, 27 operations had been performed for hallux valgus in RA patients at our hospital, modified Hohmann operations in 10 feet of 5 female patients as a first operation, and in 13 feet of 7 female patients and in 4 feet of 2 male patients as a reoperation following procedures performed at other hospitals.
After the modified Hohmann operation, the subjective assessment of every patient was graded as excellent or good. Our review of them showed that the normalizing of the shifting of the sesamoid complex is very significant, and that instruction in the fitting of shoes after operation is also necessary.

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The clinical results and the changes of physical properties of synovial fluid after intraarticular injection of sodium hyaluronate (SH, Artz (R) ) in patients with rheumatoid arthritis (RA) are reported. Eleven knee joints of 11 RA patients received intra-articular injection of 25mg of SH once a week for five weeks. This treatment was clinically evaluated with respect to pain, activities of daily living, swelling and range of motion. The activities of daily living were significantly improved, and pain and swelling were ameliorated in half, although the range of motion in such cases was only 18%.
We also evaluated the effects on the physical properties of synovial fluid, namely, hyaluronate concentration, hyaluronate molecular weight, viscosity, stringing, protein concentration, protein pattern and the number of leucocytes. Hyaluronate concentration, hyaluronate molecular weight, viscosity and stringing were distinctively improved.
We concluded that intra-articular injection of SH should be considered as having the possibility of being an effective local treatment for patients with RA.

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It has been reported that intraarticular injection of Hyaluronate (HA), especially that of high molecular weight (MW), provides symptomatic relief and improves joint function in arthritic joints. However, neither the mode of action nor mechanism of the therapeutic effect is fully understood.
We subsequently tried to clarify the effect of HA injection from the aspect of joint lubrication. First, using an apparatus with which it was possible to measure the thickness and the pressure of the fluid film formed between articular cartilage and a glass plate under a loading condition, we investigated the results with high MWHA in saline in comparison with those of low MWHA in saline. A thicker fluid film with higher pressure was maintained by introducing high MWHA. This suggests that better fluid film lubrication becomes possible by injection of high MWHA in saline into a joint, thus preventing the involved surfaces from direct contact and protecting them.
Second, we measured the coefficient of friction (CF) between articular cartilage and a glass plate using a pin-on-disc device and investigated the change of CF by adding HA of high MW or low MW in saline. The results showed that CF always decreased when introducing HA in saline. The percentage of decrease was about 60% with high MWHA, while 35% with low MWHA, suggesting that high MWHA improves joint lubrication by forming a lubricating film on the joint surface. It therefore seems that high MWHA improves joint lubrication through preventing the involved joint surface from experiencing friction and thus protects the surface.

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we evaluated roentogenographically 38 total hip arthroplasties that were performed in combination with autogenous femoral head grafts to the acetabulum in 32 patients who had arthritis secondary to congenital displasia. The average period of follow-up was 6 years and 5 months (ranging from 5 to 9 years) ; the average age at operation was 53 (from 44 to 65) . The mean JOA score before surgery of 46 points increased to 86 points afterwards. All of the autogenous grafts had united with the host bone within 1 year and remodeling of the graft bone was observed on roentgenograms. But there was a 40% incidence of a radiolucent line between the bone graft and bone cement, and 1 hip had a continuous radiolucent zone at the acetabular component at the cement-bone interface.

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To study the effectiveness of bone peg graft from the ulna for osteochondritis dissecans of the elbow joint, we analyzed 16 patients with bone peg graft who had various types of preoperative and postoperative findings. All the cases were baseball players except for one volleyball player. The onset ages ranged from 10 to 16 years (mean 11.2), and the periods from then to the operation from 5 to 72 months (mean 2.6 years) . The follow-up periods were from 12 to 29 months (mean 20 months) . Based on Minami's X-P classification, 8 cases were categorized into the stage of fragmentation and 8 into the stage of isolation. Patients were also classified with respect to the osteochondral lesion found during operation; 9 were without abrasion of the lesion or, if with it, without invasion of fibrocartilage into the lesion and were classified into Type 1. The 7 in which the osteochondral lesion was unstable due to the invasion of fibrocartilage were classified as Type 2. The results with regard to postoperative X-P were classified as excellent when the osteochondral lesion was repaired anatomically, as ‘good’ when the lesion was under repair and the osteosclerotic halo of the capitulum had disappeared, and as ‘poor’ when the halo remained. As a result, 7 Type 1 cases (78%) were excellent and 2 cases (22%) good, while one Type 2 case (14%) was excellent, 4 (57%) were good and 2 (29%) were poor. All patients were clinically not symptomatic and were satisfied with the surgery. We emphasized that bone peg graft could be indicated in all cases of osteochondral dissecans of the elbow joint and that there were difficulties in repairing osteochondral lesion in Type 2 (unstable) cases.

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Rupture of the rotater cuff has been often diagnosed as frozen shoulder, and subsequently conservative therapy has been a common choice of treatment without suitable treatment for the rotater cuff injury. We have been following up on the outcomes of such cases; the average term was for 1 year and 5 months. Among the many choices of therapy, surgical treatment and pumping therapy gave the best results. Surgical treatment was particularly more useful in relief of pain than others, and the pumping therapy was effective in improvement of the range of motion of the shoulder joint.
We consider that early treatment was the most important factor in managing rotater cuff tears, rather than the severity of the tear itself.

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The clinical results of Marmor modular knee arthroplasties of 34 knees in 28 patients were reviewed after five to ten years, an average of 6.4. Maquet's procedures were added for 9 knees with severe patello-femoral pain.
The JOA knee score was improved from 50 points at the time of surgery to 77 points at follow-up, though the arc of motion was slightly reduced from 109 to 106 degrees. Radiologically, the average femoro-tibial angle (FTA) was 178 degrees ± 4 degrees at follow-up and the clinical results were better in patients with an FTA of less than 180 degrees.
Revision surgeries were performed in 3 knees; all had had deficient ACLs at the initial surgeries. Clinical results were revealed to be superior in cases with intact ACLs. We conclude that the function of the ACL is of paramount importance in this procedure.

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We report here the results of a follow-up study for more than 3 years postsurgically on 67 cases (80 joints) of bipolar hip arthroplasty to determine indications for and limitations of the use of bipolar endoprostheses for the treatment of osteoarthritis (OA) of the hip.
Radiological evaluation demonstrated that the rate of migration of the outer head was high (84.6%) in OA patients, particularly in cases whose acetabulum was reconstructed with grafted bone; patients with severe dysplasia of the acetabulum tended to have upward and outward migration. Among patients for whom the shortest distance between the medial wall of the ilium and the outer head was less than 5mm, the rate of migration of the outer head was also high (83.3%) .
Migration was rarely observed in patients whose CE angle was greater than 30 degrees after reaming. We therefore conclude that bipolar hip arthroplasty for the treatment of OA is indicated only for patients with mild dysplasia.

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A sixty-year-old man was admitted to our hospital because of slight pain and swelling of his right shoulder. He was diabetic and had been treated for it since he was 43. In addition he had been treated for intraperitoneal mycosis with Latamoxef (LMOX) two years previously. Physical examination demonstrated limitation of movement, swelling and local heat of the right shoulder joint; neurological examination showed glove and stocking type sensory disturbance due to diabetic neuropathy. Radiographs of the right shoulder joint showed remarkable destruction of the humeral head and glenoid fossa. These findings mimicked those of Charcot's joint. Puncture of the joint yielded 3ml of yellowish, bloody joint fluid. The culture of it revealed Methicillin-resistant staphylococcus aureus (MRSA) .
Curretage of the lesion including glenoid and humeral head was performed following continuous joint perfusion. Though range of motion of his shoulder is limited, he is now free from complaints.

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The sternoclavicular joint is rarely involved in tuberculous infection. We have recently encountered a case of tuberculous arthritis of this joint. The clinical diagnosis was verified by histological study of a surgical specimen. Curettage combined with anti-tuberculous medication was successful. The literature on the disease was reviewed.

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