We report the results of our method of debridement arthroplasty for treatment of advanced primary osteoarthritis of the elbow. The triceps and the periosteum of the olecranon are stripped to the ulnar side and the joint is opened by dividing the radial collateral ligament. Osteophytes are removed, the olecranon and coronoid fossae are deepened, and the fibrosed anterior joint capsule is excised. Degenerative changes are more advanced on the radial side, with erosion of the capitellum. First we discuss the definition of advanced osteoarthritis, then long-term results in 25 cases are reviewed from 5 to 11 years. The average gain of range of motion was 30°in extension-flexion and 9°in rotation, with good pain relief. Ectopic ossification was found in two cases. Causes were thought to be traumatic surgery or forceful manipulation. In one case satisfactory results were obtained after local excision. Based on these results, we find our procedure to be a useful and efficacious form of treatment.

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We investigated the relationship between morphological changes due to angiogenesis and expression of type II and type X collagen mRNA in rat growth plate. Histological examination revealed that the growth plate became thinner over time and that capillaries had penetrated the hypertrophic zone at 16 weeks of age. Immunohistochemistry showed that both the type II collagen-positive cells predominantly localized in the proliferative zone, and the type X collagen-positive cells, predominantly localized in the hypertrophic zone, diminished in number as the number of weeks of age increased. Further investigation by the reverse transcription-polymerase chain reaction (RT-PCR) showed that the level of expression of type X collagen mRNA was highest at 4 and 8 weeks, and considerably lower at 16 and 36 weeks, while the highest level of type II collagen mRNA expression was at 4 weeks, gradually decreasing thereafter. Our findings demonstrated that angiogenesis itself caused changes in the extracellular environment around the hypertrophic chondrocytes, and that this became a factor causing the decrease in production of type X collagen.

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We evaluated the >5-year postoperative results of patients 65-years of age or older with medial osteoarthritic knees after high tibial osteotomy, and compared the results to those of patients under 65-years old.
In patients 65 or older, 26 knees in 23 patients were followed; 9 knees in men and 17 knees in women. The average age of patients at surgery was 69.8 years (range, 65-78 years) and the average period of follow-up was 9.8 years (range, 5-18 years) . In patients under 65 years old, 29 knees in 24 patients were followed; 3 knees in men and 26 knees in woman. The average age of patients at surgery was 56.9 years (range, 49-64 years) and the average period of follow up was 10.1 years (range, 5-18 years) . The clinical score by the Japanese Orthopaedic Association for osteoarthritic knees was 57.5±18.2 preoperatively and 73.4±17.2 at follow-up in patients 65 or older and 71.0±13.7 preoperatively and 81.6±10.2 at follow-up patients under 65. In each group, there were significant differences between the score at surgery and follow-up. The standing femoro-tibial angle was 185.0±5.8 preoperatively and 171.4±7.5 at follow-up in patients 65 or older and 182.5±4.3 preoperatively and 171.1±5.7 at follow-up patients under 65.
The results of patients 65 or older were satisfactory and were comparable to those of patients under 65 years old.

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Decrease in bone mineral content was investigated in 55 RA female patients (mean age: 53.7 years) who had not been treated with steroids. A reduction in bone mineral content was noticed in the early stage at the distal end of the radius where arthritis frequently occurs. On the other hand, in the lumbar vertebrae and femoral neck, a reduction in bone mineral content was seen in Stage N, and even in the same stage, bone mineral content showed a decreasing tendency as the class progressed. These findings indicate that not only periarticular osteoporo sis but also generalized osteoporosis occur in RA diseases. In order to investigate the mecha nism of generalized osteoporosis, changes in the index of remodeling and the endocrine envi ronment of the bone were analyzed. Osteocalcin, which reflects osteoblastic differentiation, increased as the stage progressed, but ALP, serum corrected Ca, serum P and Ca/Cre in the urine did not show any change according to the stage. PTH-HS increased significantly with stage progression. Calcitonin and 1, 25 (OH) 2 vitamin D did not change with stage progression, while estraadiol tended to decrease.

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Clinical results of total knee arthroplasties were evaluated after resection of malignant bone tumors in the femur and the tibia of 16 patients (9 men and 7 women) using the criteria of the Musculoskeletal Tumor Society for evaluation of function. The right knee was involved in 6 cases, and the left in 10. Mean age at surgery was 31±17 (15-65) years, and the mean follow up period was 40±35 (12-139) months. There were 13 osteosarcomas and 3 malignant fibrous histiocytomas. The site of the tumor was the distal part of the femur in 13 patients and the proximal part of the tibia in 3. Constrained type prostheses (Kotz type) were used in 11 cases and unconstrained type (Kyocera type) in 5. At follow-up, the mean functional score was 17.5±4.3 (13-28) in 11 cases, which was estimated by the Kaplan-Meier method. The survival rate of the prostheses at 5 years was 53.4% for all 16 cases, which was 49.7% in 11 cases with the Kotz type prostheses and 60% in 5 cases with the Kyocera type. There were infections in 2 cases, loosening of the prostheses in 2, local recurrence in 1, and lung metastasis in 2.

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In patients with rheumatoid arthritis (RA), functions of activities of daily living (ADL) are often limited to a great extent and the patient's quality of life (QOL) is not a little disturbed. In this study, the possible relation between clinical results and QOL was examined in RA patients who received total knee arthroplasty (TKA) . Subjects included 17 RA patients, with 28 affected knees, who received total condylar type TKA. Observation period after operation averaged 6 years and 4 months. By direct examination and questionnaire, clinical results were assessed according to the JOA score, and QOL according to the Arthritis Impact Measurement Score (AIMS), together with results of the questionnaire concerning patient satisfaction. TKA was sat isfactory in 82.4% of the subjects, mainly due to diminished pain. Furthermore, a strong posi tive correlation was observed between the physical factors of AIMS and JOA scoring. According to the AIMS, mental factors were the most remarkably improved after operation. In addition, results of the questionnaire indicated that leg function improved in many cases after operation, enhancing patient satisfaction. Even in those patients with unfavorable JOA scoring results, some expressed a high level of satisfaction due to improved social and/or mental factors.

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We performed three dynamic studies and a clinical radiographical study comparing the clamp fixation method (used by the tibial base plate damper) and the pusher method to deter mine the efficiency of the clamp fixation method. As a result, the tibial base plate damper proved to be a useful device for fixation of the tibial component with acrylic cement, attribut able to the large initial pressure force and the lack of variance in the force applied over time, as well as greater depth of cement penetration. Contact pressure distribution was almost equal from medial to lateral in the anterior tibial surface. In the posterior tibial surface, pressure was not equal and the pressure force was less than at the anterior, however no tibial plate tilting was shown. This method has many advantages, of being simple, gentle, strong, constant, and surgeons can cement both prostheses simultaneously if necessary. The clamp fixation method is a superior procedure compared to conventional cement fixation methods.

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The purpose of this study is to determine if MR images detect morphological changes in the early stages of osteoarthritis. A total of 11 Japanese white rabbits were used as an experi mental model of osteoarthritis, and sectioning of the anterior cruciate ligament was performed. At 1, 3, 6 and 24 months after operation we performed MR imaging under general anesthesia, and then the animals were sacrificed. Finally we examined the sections from each specimen by gross and histological observation. Until three months after operation there were no signal changes in the MR images. Histologically, however, partial-thickness chondral lesions were detected. At 6 months after operation, signal intensity on Ti and T2- weighted spin-echo images was found to be decreased in subchondral areas. These changes indicated early stages of osteoarthritis. The changes were confirmed by histological observation as indicating full-thick-ness chondral defects. At 24 months after operation osteoarthritis was manifested on standard radiographs. MR imaging is a useful tool for detecting osteochondral lesions in the early stages of osteoarthritis.

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Fifteen primary cementless total hip arthroplasties (THAs) were performed in 11 patients with rheumatoid arthritis. The average age was 55.5 years. The follow-up period averaged 4.1 years (range, 2 to 7 years) . Most of the patients had poor bone quality. Clinical evaluation based on the Japanese Orthopedic Association score indicated significant improvements from preoperative to the most recent follow-up examination for pain. Rentogenographical evaluation was performed using the Engh Fixation score. Eleven hips (70%) were classified as “stable” at the last follow-up evaluation. There was no evidence of rentogenographical failure. There was no femoral component subsidence or acetabular component migration in any of the hips. None of the hips required revision surgery. Complications included only two dislocations. No deep sepsis occurred. These short-term results suggest that cementless THA may be successful in rheumatoid hips, despite poorer bone quality. Clinical outcomes are similar to those seen in our past cemented THAs with the same follow-up period. However, a longer follow-up study is necessary for an accurate evaluation of the efficacy of cementless THA in rheumatoid patients.

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Following arthroscopy, 11 knees of 6 rheumatoid arthritis (RA) patients were operated on for treatment of snapping knee. Patients ranged in age from 30 to 60 years. Radiographic changes evaluated according to Larsen grade were grade I for 7 knees and grade III for 4 knees. Clinically, the intraarticular nodule was palpable lateral to the inferior aspect of the patella. Snapping occured when the knee was flexed 30-40 degrees. Histologically, the nodule showed typical characteristic features of the RA nodule in 3 knees only, and active rheumatoid synovial mass in 5 knees, while other changes were observed in 3 knees. Arthroscopic findings of synovium in typical RA nodules revealed no inflammation, while the synovial mass cases showed hypertrophic synovial villi.

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An 18-year-old woman had locking in the right knee joint several times a month and later complained of knee pain during bowling game. She noticed swelling on her right knee for a month after the pain first occurred. Her knee lacked 20°of extension on locking. She was admitted with a one-and-a-half year history of knee locking. Clinical examination showed no significant findings. The arthroscopic procedure demonstrated a soft substance such as a tumor which originated from the posterior part of the medial surface of the lateral femoral condyle and extended on the lateral tibial plateau along the lateral edge of the anterior cruciate liga-ment. After resection, she had complete relief. Histologic findings identified it as ligamentous tissue. The distal superficial layer was lined with dense connective tissue, and necrotic tissue was surrounding abundant blood vessels in the distal profound area. These findings suggested that the knee locking occurred as a result of an isolated partial tear of the anterior cruciate lig ament.

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