The results of total knee arthroplasty were studied in 11 cases with severely destructed knee, 13 rheumatoid (RA) and 5 osteoarthritic (OA) . The femorotibial angle (FTA) was over 190 degrees in 5 knees and under 165 degrees in 10 knees. Two RA cases and one OA case had windswept deformity. A ceramic stemmed prosthesis (Kyocera, KC-1 type) was used for 4 knees and a Kinematic Stabilizer for 14. The average age at operation of RA patients was 63.1 and of OA patients 64.8. The average follow-up time was 35.1 months (10 to 99 months) . The mean knee function score according to the Three Universities scoring system was 36.5 points at preoperation and had improved to 81.9 points at the follow-up, while the mean flexion angle went from 115.0 degrees to 101.5 degrees. Stemmed proshesis was thus shown to be an available procedure for severely deformed knees with large bone defect.

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Alignment of the patellar component following total knee arthroplasty was evaluated in 90 knees. The Omnifit total knee was used for 30 knees under the following criteria: keep the joint lines (femoro-tibial and patello-femoral) unchanged, cut the patella symmetrically, place the patellar component medially, check the rotational alignment of the femoral and tibial components, and add lateral release (a new method) . We selected, for comparison, sixty knees using the Ortholoc II that had been operated on with conventional methods previously, i.e., with lateral release but without careful consideration of the other techniques mentioned above. Six to 18 months after surgery the tilting angle and the lateral shift of the patellar component in the group treated with the new method were an average of 2.0±1.6 degrees and 1.2±1.2mm, and significantly smaller than in those treated with the conventional method (average of 4.5±2.2 degrees and 3.2±2.1mm, respectively) . With the new method, 80% of the knees had good alignment and none poor alignment, while with the conventional method, 44% good and 30% poor alignment was noted.

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we evaluated 47 total knee arthroplasties with a cementless component in 32 patients, performed from August, 1988 to November, 1992 with 34 Miller/Galante (M/G) type protheses and 13 Omnifit (OM) type. The mean age at operation was 67.8 (range, 50-80) . Twenty-two knees were in 16 patients with osteoarthritis (OA), 24 knees in 15 patients with rheumatoid arthritis (RA), and 1 knee had osteonecrosis of the femoral medial condyle. The mean follow-up period was 29.9 months (range, 6.8-57.8) . The knee scores using the Three University Plan knee scoring system improved from an average of 47.4 preoperatively to 87.4 in OA patients and from 38.6 to 78.1 in RA patients. The mean FTA and ROM at follow-up were 176.3 degrees and 104.9 degrees/-2.9 degrees (flexion/ extension) in OA patients, and 173.6 and 102.9/ - 3.3 degrees in RA patients, respectively. Using radiographic findings we evaluated the risk factors of fixation failure between bone and components. Clear zones of bone-component interfaces were revealed in 48.9% of all cases. In 2 cases of RA these were over 2mm in width. Eight knees with OM type components had clear zones with displaced beads, which had the risk of migrating into the joint surface. One case with RA showed massive bone atrophy near the femoral and tibial components. Sinking of tibial components was revealed in 36.2% of all cases, 82.3% of which were thought to be caused by either malpositioning of tibial components and/or the use of smaller size tibial components.

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The Darrach procedure, an ulnar head resection, has been the standard treatment for painful disorders of the distal radioulnar joint of the rheumatoid wrist. However, recent articles have described unsatisfactory results after this procedure including ulnar translocation of the carpus. We used the Sauve-Kapandji procedure, a distal radioulnar arthrodesis with surgical creation of a pseudoarthrosis in the distal ulna, to maintain the stability of the ulnar side of the wrist joint after synovectomy. Investigation of the postoperative results of the Darrach and the Sauve-Kapandji procedures showed that ulnar translocation of the carpus was significantly (p<0.05) smaller with the Sauve-Kapandji procedure than with the Darrach procedure.

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The results with arthroscopic subacromial decompression (ASD) are shown in this report. Twenty joints in 19 patients, 15 males and 4 females, with an average age of 48.8 (range, 24-78) were treated with ASD. Six cases had complete cuff tears, 4 had incomplete tears, 4 had fractures of the humerus, and 3 had SLAP lesion. Postoperative follow-ups were at an average of 16.1 months (range, 6 to 27) . The average JOA score went from 88.8 before operation to 95.1 after it. The results of one varus deformity patient after humeral neck fracture were not satisfactory. The patients with an SLAP lesion could not return to thier previous level of sport's activity. Arthroscopic subacromial decompression has been considered to be a useful technique for subacromial impingement, but it is necessary to investigate the related lesion of the shoulder joint and treat both properly at the same time.

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Purpose : The main function of the articular cartilage is to disperse the burden on the joint and, with minimum friction and wearing, allow relative movement with the facing joint. In our experiment, in order to examine the characteristics of cartilage, an external force was applied to a point on the cartilage surface and the effects on the surrounding cartilage were chronologically assessed.
Materials and Methods : Twenty samples were taken from the articular cartilages of frozen (at-70°C) femoral heads of adult bovines of approximately four years of age and one ton in weight. Cartilage samples were gathered from the subchondral bone of the loaded area of the femur. Observations were made while the samples were immersed in a physiological solution.
A probe with a diameter of 1.5mm was used to add a fixed load of 0.59N to the sample's surface for 10 minutes. During the loading period, the area of deformation occurring on the cartilage surface was continuously observed by real-time holographic interferometry. At the same time, the depth of the concavity produced on the cartilage was determined with a laser displacement sensor.
Using a microcomputer to generate output from the laser displacement sensor, the AD change was reproduced and video signals were established for recording, Stress-strain curves were registered on the screen. The reproduction images were printed out and the area of modification to the cartilage was measured with a digitizer. The altered deformation of the cartilage was thus represented three-dimensionally.
Results and Discussion : Holographic interferometry revealed concentric interference circles around the loaded point of the cartilage and showed that concave deformation occurred in the surrounding area of the cartilage. The effect of the force immediately spread in a concentric manner around the loaded point. With time, the area around the loaded point (that not directly loaded) showed a gradual recovery from the initial deformation. Approximately five minutes after the commencement of loading, the changes roughly reached a balanced state. After the load was removed, the deformation immediately extended to a wider arc for several seconds, but both the concave deformation at the loaded point and the deformation in the surrounding region recovered with time. Holographic observation showed that the greatest change in concave deformation occurred not within 0.5 seconds after the load was added, but rather immediately after the load was removed. Thus a considerably wide-spread concave deformation was observed on the cartilage surface for a short period after application and after the removal of the force on the cartilage. This change seems to represent the visco-elastic properties of the cartilage that enable an abrupt change in the load (caused by a sudden application of external force) to be dispersed in a short time into the bone below the cartilage.

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We developed a novel cloning method of synovial lining cells from the bovine metacarpophalangeal joint. The synovial lining cells were mechanically dissected without contamination of cells derived from the sublining layer. Nine clones were established out of 46 trials, a success-rate of about 20%. The cell type of the established clone was determined with transmission and scanning electron microscopy. With the criteria for B-and A-cells, 5 clones could be classified as B-cells and 3 clones as A-cells with one clone unidentified. Using a patch-clamp, we further studied the excitability and distribution of ion channels in 1- to 5-month clone-cultured cells, and found that 1) B-cells lost electrical excitability, 2) the resting membrane potential was kept normal in both B- and A-cells, and 3) B- and A-cells showed a tendency to resemble each other in their distribution of channels, which originally had been different. These results show that while cells normally increase in number and their morphological characteristics are retained, their electrophysiological nature is apparently altered in long-term clone-cultured cells.

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We investigated the protective effect of hyaluronic acid (HA) on the matrix of cultured chondrocytes. The cultured chondrocytes were exposed to pathological synovial fluid from patients with rheumatoid arthritis (RA) and with osteoarthritis (OA), and to interleukin-1β (IL-1β), tumour necrosis factor α (TNFα), or oxygen-derived free radicals (ODFR) in the presence or absence of HA. The effects were evaluated by the preservation of labelled ³⁵Sproteoglycan (PG) and the release of ³⁵S into culture medium. IL-1β and TNF α concentrations in the pathological synovial fluid were determined by double antibody technique with RIA systems.
The addition of the pathological synovial fluid to culture medium, especially RA synovial fluid, significantly enhanced ³⁵S release from the matrix. Adding IL-1β, TNFα, or ODFR was also found to promote ³⁵S release. But no correlation was observed between the ³⁵S release by the pathological synovial fluid and the concentrations of IL-1β and TNF α in the same synovial fluid. On the other hand, the addition of HA together with pathological synovial fluid, IL-1β, TNFα, or ODFR preserved ³⁵S-PG in the matrix and restrained ³⁵S release into culture medium. These results indicated that HA could be effective in protecting the degradative effect of pathological synovial fluid, IL-1β, TNFα, and ODFR on the matrix of cultured chondrocytes and may suppress the destructive process in cartilage tissue.

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we investigated the inhibiting effect of the synovial fluid of patients with rheumatoid arthritis (RA) on the induction of indoleamine 2, 3-dioxygenase (IDO) in human macrophage (Mφ) stimulated by interferon-gamma (IFN-γ) . To determine the existence of such an inhibiting facter, we developed an in vitro system for examining the effect of the synovial fluid of RA and osteoarthritis (OA) patients on peripheral blood-derived Mφs. The amounts of tryptophan and kynurenine in the supernatants of cultures were determined by highperformance liquid chromatography. The induction of tryptophan degradation in Mφ was dependent upon the IFN-γ concentration in the culture. Furthermore, IFN-γ regulated mainly the activity of IDO, which is responsible for the conversion of tryptophan to kynurenine. By the addition of RA synovial fluid, the induction of IDO by IFN-γ was significantly decreased in comparison with that of OA.No correlation could be found between the inhibition of IDO activity and the stage and class of RA, or between IDO activity inhibition and inflammatory indeces such as ESR and CRP. These results suggest that IDO in Mφ will be induced by IFN-γ, and that an inhibiting factor for this induction exists in the synovial fluid of RA patients.

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