Objective: We reconsidered the indication for Rotational Acetabular Osteotomy (RAO) for advanced coxarthrosis near terminal stage the (“a⁺”group), and at the“terminal stage”, in consideration of long term results, because postoperative results in these groups were inferior to those in cases of precoxarthrosis and early stages.
Methods: The subjects of this study were 34 joints in the“a⁺” (advanced) group, and 25 joints in the“terminal stage”group, which we could follow over ten years. We divided the“a⁺”group into “good”“fair”and“poor”groups by joint congruity in abducted-position X-ray pictures. We considered these cases by JOA score, joint congruity and survival rate. Regarding survival rate we defined any JOA score less than 70 points as end-point.
Results: There were 8 joints in the “good”group, 17 joints in the“fair”group, 9 joints in the “poor”group, and 25 joints in the“terminal stage”group. The average age at operation was 36.8 (19-52), and the average period of follow-up was 158.4 months (120-241) . JOA scores at the last follow-up time were higher than before operation in all groups, but the scores in the“fair”, “poor”, and“terminal stage” groups were much lower than in the“good” group. The survival rate in the“good” group was also comparatively good (75.0%), but in the“fair”, “poor”, and“terminal stage” groups they were much lower than in the“good” group.
Conclusion: Results in the“good” group were comparatively good, so we consider that RAO may be indicated for this group. Long term results in the“fair”, “poor”, and“terminal stage” groups were lower. We consider that RAO would not be indicated for cases in which any combined operations did not work to give good joint congruity. On the other hand, there are cases which have maintained good results over ten years ; we consider that these may indicate a role as a“time-saving” procedure before total hip arthroplasty.

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One hundred and fifty one total hip arthroplasties using metal on metal hip joints were followed at a mean of 4 years (range 1.6 to 6 years) . The average JOA score before operation was 43.5 and at follow-up the average score was 87.4.
Radiographic findings of the incidence of partial radiolucent lines around the components: at the acetabular components, no radiolucent lines were observed, at the femoral components, they were seen in 8.6% (13 hips) . Cortical hypertrophy was observed in a high proportion, of 27.2% (41 hips) . There was no loosening, nor component tilt over 5°, observed in any patient. Post-operative dislocation of the hip was observed in 9 hips (6.0%) .
Cobalt and chromium concentrations in serum were measured in metal on poly and metal on metal total hip arthroplasty patients and in controls without implants. Serum was assayed using graphite furnace atomic absorption spectrophotometry. No patients were found to have elevations in serum cobalt and chromium concentrations.
The authors conclude that metal on metal joints showed excellent results at short-term follow-up.

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We reviewed clinical results of 35 uncemented bipolar endoprosthesis implantations using a Link ribbed hip prosthesis in 34 patients with an average follow-up of 4.0 years. The clinical evaluation showed very good improvement. Radiological evidence of reactive lines around the stems was more significant in the smooth surfaced group than in the microporous surfaced group. There was a significant negative correlation between the medullary canal filling ratio and the cumulative appearance rate of reactive lines. Even for an uncemented prosthesis with macro-anchoring, a microporous surface structure and sufficient canal filling are essential to obtain successful stem fixation.

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We carried out SEM analysis on the surface of retrieved polyethylene cups in different stages of wear, to examine the wear process. Nineteen UHMWPE liners were retrieved at revision surgery (seventeen of H1900 resin irradiated by 2.5Mrad in air, two of RCH1000 resin irradiated by 2.5Mrad in air) . Implant period was from 3 months to 20.7 years (average 9.9 years) . The cups were classified into high-wear cups (wear rate: above 140mm³/year), intermediate-wear cups (wear rate: 80 to 140mm³/year) and low-wear cups (wear rate: below 80mm³/year) . The wear rates were measured by a fluid displacement method. The cups were studied by SEM.
Ripples mainly appeared on the low-wear cups; nodules and fibrils mainly appeared on the high-wear cups. Folding was observed on all cups, but folding with numerous fibrils was striking on the high-wear cups. The cup retrieved at 3 months already exhibited folding. From these results, the wear-response appeared to be a 3-step process, involving (1) first the formation of folds, (2) formation of surface ripples, and then (3) the toughness of the PE matrix in releasing a wear-fibril to form a debris particle. These retrieved-cup data will provide better understanding of competing PE wear mechanisms.

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Objective: To discover experimentally whether the Bisurface knee prosthesis has achieved its design objectives.
Methods: In vivo component positions of the Insall/Burnstein 2 (IB2) and the Bisurface knee under weight-bearing conditions were determined using lateral fluoroscopic views. Based on these data, contact areas in the two knees were measured using pressure-sensitive films. Stability of the posterior stabilizing cam was evaluated by means of vertical and horizontal dislocation distances.
Results: No significant adverse anterior translation in mid-flexion was observed in the Bisurface knee, because the cam worked at over 60° flexion. At flexion of 60° or more, total contact areas of the Bisurf ace knee were larger, because the cam worked as a weight-bearing surface. The dislocation distances of the Bisurface knee did not decrease with flexion.
Discussion: The current study demonstrated that the ball-and-socket joint could provide sufficient posterior stability, earlier commencement of flexion, and larger contact areas in the tibial polyethylene insert in flexion.
Conclusion: The Bisurface knee prosthesis achieved its design objectives.

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The purpose of this study was to evaluate ligament function in Whiteside total knee arthroplasty, using a Telos stress devise. Forty-seven knees in thirty-seven patients were observed for a minimum of 5 years. Ten knees (42%) with rheumatoid arthritis, and 2 knees (12%) with osteoarthrosis, showed posterior instability. There was a significant difference in insufficiency rates of PCL between arthritis mutilans and other types of rheumatoid arthritis (p = 0.03) . This study indicates that patients with arthritis mutilans should undergo posterior-stabilized type TKA.

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Objective : A study was conducted to evaluate the effect of intraoperative tourniquet hemostasis with intermittent release on blood loss and autologous transfusion volume in patients undergoing total knee arthroplasty (TKA) .
Methods : The volumes of blood loss and autologous transfusion were measured in 44 patients during TKA surgery. The patients were classified into two groups : Group A, 27 patients in whom blood was staunched intraoperatively with a releasing tourniquet, and Group B, 17 patients in whom blood was staunched intraoperatively with constant tourniquet compression, followed by postoperative tourniquet release and application of a compressive dressing.
Results : The volumes of intraoperative blood loss and total blood loss in group A were significantly larger than those in group B, and there was a correlation between the volume of postoperative blood loss and that of autologous transfusion.
These results show that intraoperative hemostasis with a releasing tourniquet does not decrease postoperative blood loss.
Conclusion : To avoid homologous transfusion, TKA should be performed under constant tourniquet compression, and autologous transfusion should be adopted to adjust for any postoperative blood loss.

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The purpose of this study was to evaluate the efficacy of a supplement consisting of glucosamine and chondroitin on patients with osteoarthritis.
Thirty-six osteoarthritis patients with 55 affected knees were treated with a supplement containing glucosamine hydrochloride and chondroitin compound for 3 months. As a control, 17 OA patients with 26 affected knees were compared. The effects were analyzed by the knee score, VAS for pain, the face scale, clinical symptoms and overall estimation. The levels of PGE₂ and YKL-40, a marker of tissue turnover, were measured in peripheral blood samples. The in vitro effect of glucosamine on PGE₂ production by human chondrocytes was also examined.
The knee score, the VAS for pain and the face scale improved with the treatment. Among various modes of pain, motion pain showed the most prominent improvement. Patients with mild symptom and less radiological devastation responded better. Serum PGE₂ levels significantly decreased to the levels of healthy controls, whereas serum YKL-40 levels were unchanged by the treatment. Glucosamine hydro-chloride inhibited the IL-1 stimulated production of PGE₂ by human chondrocytes derived from both osteoarthritic and normal cartilage.
Taken together with the results of other glucosamine trials, the supplement was considered effective as a treatment for osteoarthritis. One of the targets of glucosamine was considered to be PGE₂.

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We investigated the clinical results of the Sauvé-Kapandji (S-K) procedure for treatment of rheumatoid wrists. Thirty-two rheumatoid wrists were reconstructed by the S-K procedure. The clinical symptoms, range of motion of the wrist, grip strength, and X-ray findings were examined.
Pain and swelling were reduced significantly, and supination and pronation of the forearm improved.
The S-K procedure gave satisfactory results in rheumatoid wrists, in terms of less ulnar carpal migration, improved grip strength, and postoperative cosmetic appearance.

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We present a case with Charcot's joints of both knees, who had received a total knee arthroplasty (TKA) . A 52-year old woman was referred to our hospital for pain and marked effusion in both knees, and was diagnosed as bilateral Charcot's joints due to tabes dorsalis. In 1984, arthrodesis of the right knee and noncemented TKA of the left knee were performed. A radiolucent zone around the tibial component appeared at 5 months, and sinking of the tibial component was revealed at 1 year after the TKA, and it progressed slowly thereafter. In August 2000, 16 years after the operation, she was able to walk with a cane, although varus deformity and pain in the left knee increased. Radiographs of the knee showed loosening of the tibial component and a radiolucent zone around the femoral component. From this case and the previous reports, TKA could be one of the options for patients with joint destruction due to Charcot's joint.

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