Autogenous osteochondral grafting is advantageous for repairing cartilage defects in hyaline cartilage, and so-called mosaicplasty has recently drawn interest. The purpose of this study is to investigate histologically the effect of hyaluronic acid (HA) on restoration of articular cartilage with autogenous osteochondral grafting in mimicked mosaicplasty rabbit models. Osteochondral defects of 3mm diameter and 5mm depth were created in the medial femoral condyles of bilateral knees of twenty-two mature White Rabbits using a cylindrical chisel. The right and left harvested plugs were switched and press-fitted into the defects. Right knees (HA group) were injected with 0.1ml/kg of HA (average molecular weight, 800, 000) once per week until sacrifice. Left knees (control group) were similarly injected with physiological saline solution. Four rabbits were sacrificed at 1, 2, 4 and 8 weeks and six at 12 weeks after surgery. Microscopic sections were taken from the distal femur, stained with H&E and Safranin O, and histologically evaluated. Thickness of right and left grafted articular cartilage sections were measured on computer images and compared statistically. In both groups at 4 weeks, fibrocartilage nests at the base of the cleft, and cancellous bony union were seen, and at 8 weeks, this fibrocartilage had grown to the surface. At 12 weeks, hypercellularity was seen in the transitional zone of grafted cartilage and the articular surface had risen to the level of surrounding cartilage in the HA group. The grafted cartilage was significantly thicker in the HA group. This finding suggests that HA promotes healing of the articular cartilage in autogenous osteochondral grafts.

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Titers of Epstein-Barr (EB) virus-related antibodies were determined in sera from 62 patients with rheumatoid arthritis (RA) and 53 healthy subjects to assess their structure and their clinical significance. Also investigated was the relationship between various types of rheumatoid factors (RF), and clinical markers and signs.
The mean VCA antibody titer was 1543 in RA cases against 605 in the control group. The proportion of RA patients who showed a positive reaction to EA antibody was 71%, as compared to 20% in the control group, suggesting a high rate of activation by EBV.
The mean EBNA antibody titer was 39 in RA and 118 in the control group, indicating an abnormal immune response to EBV in RA patients.
After comparing both groups in terms of the relationship between VCA antibody titer and EBNA antibody titer, the RA group was divided into two subgroups, i.e. those demonstrating an antibody titer distribution ratio similar to that observed in the control group, and the others demonstrating a different antibody titer distribution ratio. In the latter subgroup there was a correlation with lgMRF, suggesting intense B cell clonal activity. In this group, the erythrocyte sedimentation rates (ESR) and CRP scores were also higher, demonsrtrating the presence of active rheumatoid arthritis.
It is necessary to take both these different subgroups into consideration in the diagnosis of RA. The patients may be classified objectively into these subgroups by determining the titers of EBV related antibodies.

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Objective: Although cementless total hip arthroplasty (THA) has been used in the treatment of osteoarthritis with successful results, it has not been widely adopted for the treatment of rheumatoid arthritis, especially for protrusio acetabuli.
Methods: We reviewed 15 patients with 21 primary cementless THAs with a mean age of 57 years (31 to 60) at the time of surgery. The mean follow-up period was 3 years. All the THAs were done with autologous cancellous bone grafts obtained from the femoral head.
Results: Two patients (2 hips) died before the final follow-up. Of the remaining 19 hips, only one cup was revised for aseptic loosening. Excellent bone remodeling was found in the acetabulum, including 6 cases of previous severe protrusio acetabuli.
Conclusion: Our study indicates the excellent long-term results which can be achieved with cementless THAs in patients with rheumatoid arthritis.

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Osteoarthritis (OA) of the knee is often associated with OA of hands, which are non weight-bearing joints, in the commonly termed generalized OA. In this study, we investigated the differences between knee OA patients with hand OA and those without hand OA, with respect to constitutional and radiographic variables.
Consecutive female patients with symptomatic tibiofemoral OA visiting our outpatient clinic were included in this study. Among them, 37 patients with polyarticular hand OA (GOA group) as well as 37 age-matched patients without hand OA (KOA group) were randomly selected. For a control group, 37 age-matched healthy women, with neither knee pain nor clinical nodes in the hands were randomly chosen from subjects who underwent health care examination in the community. Physical constitutional and radiographic findings were compared between the groups.
The results indicated that BMI (body mass index) was significantly higher in the KOA group than in the controls, whereas there was less of an association in the GOA group. Between the GOA and KOA groups, there were no radiographic differences in varus or valgus deformity of the knee, patellof emoral OA, chondrocalcinosis, or ossification at the enthesis of the patella, although the patients in the GOA group had OA in various joints of the hands.
The results suggest that some undetermined systemic factors, rather than only mechanical stress to the articular cartilage, may play a role in the pathogenesis of knee OA associated with hand OA.

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We have been performing vascularized iliac bone grafts using the superficial circumflex iliac artery (SCIA) for the treatment of femoral head osteonecrosis at Toho University since 1982. The purpose of this study was to research the mechanical stress in the femoral head and the stiffness of grafted iliac bone. We made three types of theoretical femoral head models. The first was of the normal femoral head. The second was of the necrotic femoral head. The third was of the necrotic femoral head with grafted iliac bone. All models were analyzed by three-dimension finite element analysis. The normal femoral head model showed regular mechanical stress, but the necrotic femoral head showed irregular mechanical stress, under analysis. The necrotic femoral head with grafted iliac bone showed high mechanical stress at the grafted iliac bone. As a result of this, the total mechanical strain in the femoral head was less than for the normal femoral head. This analysis seems to show that the iliac bone grafted, by our method, could bear mechanical load on the femoral head, and has sufficient stiffness.

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The purpose of this study was to evaluate outcomes of bilateral total knee arthroplasty (TKA) in two groups of patients: Group A had simultaneous arthroplasty of both knees, and Group B had staged bilateral arthroplasty. Group A (17 patients) had both knees replaced simultaneously in one operation, with osteoarthritis (OA) in 16 and rheumatoid arthritis (RA) in 1 patient. Group B (22 patients) had two operations in a staged procedure, with OA in 18 and RA in 4 patients. Comparisons were made of functional score and range of motion (ROM) before and after operation, mean total blood loss, operative time, and duration of hospital stay. The simultaneously performed bilateral procedure did not influence the functional score, ROM after operation, or average total blood loss. But there was difference in operative time and hospital stay between the two groups. No increase in the incidence of operative and postoperative complications was found. Simultaneous bilateral TKA is efficient for the patient requiring bilateral knee replacements by our observations.

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Thirty-two cementless total hip arthroplasties using the second-generation Porous-Coated Anatomic (PCA) prosthesis, PCA-E series hip system were followed for one to six years (average, 2.7 years) . The acetabular components, inserted by press-fit fixation (2mm under-reaming) were of two depth designs: a low-profile cup for dysplasia and subluxation of the hip, and a deep cup for severe subluxation and dislocation of the hip. The PCA-E stem, which has a curved (anatomic) stem with a 26mm femoral head, was improved by widening the shoulder of the stem and more gently in the tip of the stem than in the initial PCA stem. The clinical results were excellent, and only 2 hips (6.6%) were found to be associated with pain in the thigh. Radiographs demonstrated also high cancellous filled rates and good femoral fixation. Aggressive reaming may account for the good intramedullary fit and the lower prevalence of pain in the thigh, and may prevent inserting under size.
We concluded that the short-term results of the cementless PCA-E series hip system is satisfactory, though further study is necessary to determine the long-term durability of this prosthesis.

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The authors report a case of infection with large bone defect after total hip arthroplasty (THA) . Conventional treatment composed of removal of the prosthesis, and debridement, followed by irrigation, failed to suppress deep infection.
Therefore, we inserted a vancomycin-loaded interval prosthesis without irrigation. There was no recurrence for at least 1 year. This procedure is considered to be one treatment for deep infection following prosthesis replacement with large bone defect.

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We describe a case of acromegaly presenting rapidly destructive coxarthrosis.
A 70-year-old man was referred for gait disturbance due to right coxalgia. Plain radiographs of the pelvis demonstrated progressive destruction of the right femoral head for 4 months. Further examination of radiographs of other joints, the spine, and the skull indicated acromegalic arthropathy, and a pituitary adenoma was diagnosed by brain MRI. He was treated by total hip arthroplasty with bone grafting.
Histological examination of the resected femoral head revealed no evidence of osteonecrosis. The association between these two rare conditions is discussed.

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