From January 1986 to December 1991, 111 total knee arthroplasties (Miller-Galante 1 System) were performed in 71 patients. Of those, 90 joints in 60 patients, 37 with rheumatoid arthritis and 23 with osteoarthritis, were observed before, during, and after operation for this study. They were divided into four groups according to the degree of postoperative ROM at follow-up, which averaged 51 months. The excellent group, that having more than 130 degrees, consisted of 10 knees in 6 patients; the good group, that with 120 to 129 degrees, of 19 knees in 13; the fair group, that with 91 to 119 degrees, of 40 knees in 24; and the poor group, that with 90 degrees or less, of 21 knees in 17. The results indicated that the factors influencing the ROM were preoperative ROM, primary indication, heights of postoperative joint line, patellar thickness, postoperative pain and successive postoperative rehabilitation.

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With the purpose of performing direct treatment of chondral lesions in the cases with gonarthrosis or chondromalacia patellae, we introduced MEDICARB an osteochondral defect filling material, made of carbon fiber, and carried out animal experiments and clinical application. For the animal experiment, on each of the patellae of 35 female rabbits, which were just before maturation, a predetermined osteochondral defect was prepared. MEDICARB was filled on the left side, and the defect was left intact on the right side and this was used as control. On the left side, regeneration of fibrous cartilage was noted from an early stage. The surface turned to a single plane, and this condition continued for long time with no noticeable degeneration of the surrounding cartilages. On the right side, regeneration of cartilaginous tissues was slow and gradual and required a long period. The regenerated cartilage on the defect was insufficient and no single plane was formed. Within 30 weeks, the entire defect was covered, while degeneration of the surrounding cartilage was observed at the same time. In the clinical application, a defect was filled with MEDICARB in 21 cases (including 26 joints) of gonarthrosis and recurrent dislocation of patella. Remission of pain in the early postoperative stage and extinction of crepitation were noted, and the results of arthroscopy showed a relatively satisfactory covering with regenerated cartilage. Further, in the histological evaluation by biopsy, MEDICARB was adhered well to the regenerated cartilage, and fibrous cartilaginous cells with high activity and regeneration of mature matrix collagen were confirmed.

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We have evaluated by a comparative study the clinical usefulness of EHDP for heterotopic ossification (HO) following total hip replacement. The subjects were 29 patients with osteoarthritis or fracture of the femoral neck whose hips were replaced by artificial joints. A total of 14 received 600-1000mg EHDP once a day between meals from the day of surgery for 12 weeks, and 15 did not receive it.
In postoperative roentogenographic findings, HO was seen in 4 patients, or 28.6% (Grade 1 HO; 3 patients, Grade 2 HO; 1 patient) of those who received EHDP compared with in 6 patients or 40% (Grade 1 HO; 2 patients, Grade 2 HO; 4 patients) of those who did not. Thus EHDP appeared to suppress development of HO more than EHDP did. There were no particular differences between the EHDP group and the non-EHDP group in range of motion, ability of walking, pain, swelling, fever, redness or in bone density of the lumber spine. From these results it is concluded that EHDP may be an effective drug for suppressing HO following total hip replacement, but further study is necessary for statistically establishing its clinical usefulness.

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Recently autologous blood transfusion has been recommended to prevent complications from homologous blood transfusion. We have analyzed the unwashed filtered drainage blood after knee and hip arthroplasties to establish its safeness for reinfusion. Stryker CBC ConstaVac closed wound drainage systems were used with 30 patients who underwent total joint arthroplasty. The average value of plasma hemoglobin in the drainage blood was 133.6mg/dl and the level of fibrinogen was less than 20mg/dl. These data show that unwashed filtered closed wound drainage blood can be used for reinfusion after arthroplasties.

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MRI findings of 45 cases with medial type osteoarthritis of the knee were reported. Various pathological findings which could not be detected by X-ray were revealed. Moreover, the MRI findings paralleled those of knee pain more than the X-ray findings did. There were also cases in which diffuse or wedge shaped signal changes were found deep in the femoral condyle. This suggests that the etiology for osteoarthritis of the knee should not discussed within the limited area of cartilage and subchondral bone.

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The aim of this study was to investigate the clinical and radiographic changes, including Lunsbury Index, rate of complete remission, and radiographic pattern of wrist and other joints, in patients with elderly (over 65-year-old) -onset rheumatoid arthritis, and to compare the changes with those in younger-onset patients. It was revealed that there were no significant differences in the clinical and radiographic courses between the two groups. The results therefore suggest that the modifications observed in elderly-onset rheumatoid arthritis are caused by the pathophysiology of aging.

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Ultrasonography (US) of the rotator cuff tear is very useful because it has many merits, such as high accuracy and noninvasiveness. The purpose of this study was to compare US findings with intra-operative findings.
Since 1987 we have performed US on 120 shoulders in 117 patients. Of 8 patients studied, who had been operated on recently, 4 had one tendon rupture and 4 sustained ruptures of two or more.
With a small size transducer of real time 7.5MHz (Toshiba-SSA), US observation which consisted of measuring the width of the rotator cuff tear, was performed before operation. Subsequently, the width of the cuff tear was measured directly during the operation and ranged from 15 to 50 mm. The difference between the US findings and the intra-operative findings averaged 3.9 mm. The maximum difference was 10 mm and in only two patients, while the US measurements in the remaining 6 patients were almost correct. We therefore believe that US can be used in rotator cuff tears to detect their location and size accurately and easily.

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Between 1987 and 1993 we have treated 62 pyogenic infection cases, 28 with osteomyelitis and 34 with arthritis. There were also 13 MRSA (methicillin resistant Staph. aureus) joint infections in 9 cases. The total MRSA infection rate in bone and joint infections was 15%, the numbers of the affected hips, knee and MP joints being 5, 5, and 3, respectively. Three knee joints which had received intra-articular corticosteroid injection were treated with synovectomy and continuous irrigation, and 2 cases in association with a biomaterial (internal fixation devices and joint replacements) were treated by removal of the device and continuous closed irrigation. Two hip joints with prosthesisrelated infections showed prolonged infection and 3 others were referable to an internal fixation device. The treatments used to reduce the infection were removal of the prosthesis with continuous closed irrigation or antibiotic impregnated cement beads. Infection engrafted on a biomaterial responded poorly to antibiotic therapy and was not cured until the internal fixation device or joint replacement had been removed.

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We performed arthroscopy in 8 patients with lateral ligamentous injury of the ankle joint and evaluated intra-articular lesions. Osteochondral lesions were observed at 11 sites in 7 of the 8 patients. Of the 11 sites, 5 were present in the medial tibial cartilage and 3 in the medial talar dome. Synovial proliferation was observed in 6 of the 8 patients. Other diagnostic imaging methods performed before arthroscopy had demonstrated intra-articular lesions in only 1 patient. Three of the 7 patients showing Intra-articular lesions had ankle joint pain probably due to these lesions. In the treatment of lateral ligamentous injury of the ankle joint, the presence of such intra-articular lesions should be considered.

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The distribution and number of mast cells at the site of adjuvant rat enthesis caused by the insertion of Achilles tendons were analyzed by light and electron microscopy. The light microscopic findings showed inflammatory cell infiltration (enthesitis) followed by new bone formation at the site of enthesis. Increasing numbers of mast cells were observed around the capillaries in the inflammatory granulation tissue formed at the enthesis. In addition, the mast cell count was increased in the marrow of newly formed bone. The electron microscopic findings demonstrated that the mast cells observed were closely related with fibroblasts and newly formed bone. These findings suggested that mast cells have important roles not only in immunological reactions but also in the process of new bone formation in the adjuvant enthesitis.

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Seven months after osteosynthesis of ankle fractures with stainless steel plates and screws in a 60 year-old female eczema appeared all over her body. Skin patch test and lymphocyte transformation test were negative. However, the skin lesions disappeared after the removal of the metals. We thus diagnosed this case as allergic dermatitis induced by the metals used in osteosynthesis.

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