One hundred and fifty eight obese women with osteoarthritis of the knee (knee OA), who participated in a six-week program of supervised exercise and energy restriction, took part in a one-year follow-up study. In the original study, these patients were treated with one of the following interventions: A nonsteroidal anti-inflammatory drug (NSAID) combined with walking exercise (NW, n=16), NSAID with non-weight-bearing exercises (NE, n=16), an energy restriction diet plus the NSAID (ND, n=32), a diet combined with the NSAID and walking (NDW, n=25), the diet combined with both the NSAID and exercise (NDE, n=24), NSAID with conventional shoe inserts and wedged insoles (NT, n=20), and NSAID with novel insoles with an elastic subtalar strapping (NN, n=25) . All patients were interviewed during the one-year follow-up study. Nine patients (56%) in the NW group, 11 patients (69%) in the NE group, 22 patients (69%) in the ND group, 12 patients (48%) in the NDW group, 17 patients (71%) in the NDE group, 3 patients (15%) in the NT group, and 2 patients (8%) in the NN group did not continue the intervention. Seven patients (44%) in the NW group, 8 patients (50%) in the NE group, 19 patients (59%) in the ND group, 8 patients (32%) in the NDW group, 14 patients (58%) in the NDE group, 8 patients (40%) in the NT group, and 4 patients (16%) in the NN group lost functional benefits that were observed at six weeks in the original study.
In conclusion, obese knee-OA patients found it difficult to continue the exercise and energy restriction regimen and to maintain any functional benefits.

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Patients with osteoarthritis of the knee, who first came to our out-patient clinic, were prescribed home-based exercises for the lower limbs. One hundred and fifty-five patients who were followed up for at least one year after their first visit to our clinic were reviewed retrospectively. The mean JOA score for the group of patients improved significantly at the final examination, compared with that at the first visit. OA knees of Grade II, III, IV and V (by X-ray grading) also improved significantly. The knees at more than 3 years after the first visit showed the same amount of improvement at the final examination as those which had passed 3 years or less. Exercise of the lower limb was thought to be a good alternative to medication in treatment for osteoarthritis of the knee.

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The authors report on quadriceps muscle exercises at home for patients with osteoarthritis of the knee.
This quadriceps muscle exercise at home consists of 20 repetitions of quadriceps femoris isometric contractions of five seconds each, and 10 repetitions of straight leg raising with 30 seconds of contraction, for a consecutive program. Patients were ordered to perform this quadriceps muscle exercise more than three times per day.
A total of 52 patients (9 men with 13 arthritic knees and 43 women with 66 arthritic knees), who completed our quadriceps muscle exercises at home, were studied.
The effect of quadriceps muscle exercise was evaluated by a point-system for degrees of pain during rest or movement, impairment of activities of daily life (ADL), and the visual analogue scale (VAS) for pain.
Improvements in scores for pain, ADL and VAS were obtained, and remarkable improvement was found in patients with grade 1-3 osteoarthritis. However, the effect of quadriceps muscle exercise for patients with grade 4 and 5 was inferior to that for patients with grade 1-3. Performing our quadriceps muscle exercises at home, following education on correct methods, was an effective conservative treatment for patients with osteoarthritis of the knee.

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Purpose: We examined the clinical effect of therapeutic exercise with Thera-Band® exercise bands (Hygenic Corporation, Akron, Ohio, USA) on patients with knee osteoarthritis (OA), and we discuss the method of proper muscle strengthening exercise for this disease.
Objectives and Methods: We evaluated seven women, with a mean age of 72.0 years, with bilateral knee OA of Grade 1 or above on the Kellgren and Lawrence scale. The patients were instructed in therapeutic exercise for both knees. Before, after 1 month, and after 3 months of exercise, we evaluated the JOA score, isokinetic muscle strength of knee extensors and flexors, and surface EMG signals recorded from the rectus femoris (RF), vastus medialis (VM), vastus lateralis (VL), and biceps femoris (BF) muscles. The integrated signal and root mean square (RMS) parameters were extracted.
Results: All except one patient, who stopped the course half way, completed the entire 3-month exercise course. The JOA score, muscle strength of knee flexors, integrated EMG from RF, VM, and VL, and the RMS from VM and VL were significantly increased after 3 months of exercise.
Conclusion: The strengthening of knee flexors and extensors was remarkable in patients with knee OA. For patients, therapeutic exercise with Thera-Band® exercise bands, to strengthen their of knee flexors, is also extremely easy to do in any location, and is very effective in promoting continued exercise.

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This study assessed muscle strength of older subjects during both open kinetic chain (OKC) and closed kinetic chain (CKC) conditions to propose a simple and safe CKC exercise method for knee osteoarthritis patients.
Twelve healthy young male subjects (21.8 ± 1.5 years) and twelve older male subjects (81.9 ± 7.5 years) were tested. A quadriceps dynamometer with a load cell was used to measure pressing force and force direction in the sagittal plane. Classical OKC knee extension and flexion forces were also measured. Results were: OKC knee extension strength of older subjects was 29.6% of the younger subjects'; OKC knee flexion strength of older subjects was 45.7% of the younger subjects'; and CKC leg press strength of older subjects was 22.0% of the younger subjects'. Pressing force was directed from the hip joint to the center of the foot in younger subjects and from a point between the hip and knee joint to the center of the foot in older subjects. The quadriceps femoris muscles were active mainly in younger subjects. Both the quadriceps femoris muscles and hamstring muscles were active in older subjects. The author concluded that the leg press is safe for knee osteoarthritis patients.
Based on this result, leg presses in a bathtub were suggested as a home exercise for knee osteoarthritis patients, for CKC. The exercise proved to be effective.

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Management of tibial bone defects is a controversial problem in total knee arthroplasty. Usually auto-bone graft is the standard technique, but some cases require allo-graft or artificial materials; metal wedge/block augmentations, custom made implants, a Rotating Hinge design, etc. This paper describes the indications for use of artificial materials, and discusses their advantages and disadvantages.

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A multicenter, prospective, epidemiologic study on prevalence of deep venous thrombosis detected by bilateral ascending venography in patients in Japan undergoing total hip or total knee arthroplasty without prophylactic anticoagulant therapy revealed that the prevalence of deep venous thrombosis was 27.4% in patients who had total hip arthroplasty and 50.0% in those who had total knee arthroplasty. The prevalence of deep venous thrombosis was significantly higher in patients who had total knee arthroplasty than in those who had total hip arthroplasty. Body mass index (taken as an indicator of obesity) and age (in elder patients) were identified as statistically significant risk factors.

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Objective: Selection of articulating surface combinations for primary total hip arthroplasty is controversial. This debate demonstrates that a highly crosslinked ultrahigh molecular weight polyethylene socket with a metal femoral head is better than metal on metal or ceramic on ceramic articulating surfaces for total arthroplasty, following our published results and other papers.
Since Sir John Charnley first reported it, ultra high molecular weight polyethylene has shown better wear performance than many other materials. Collier reported that gamma-sterilized polyethylene tended to oxidize near the surface, with features such as white bands, with long shelf storage. McKellop noted that crosslinking without any free radicals in polyethylene crystal lesion gave extremely low wear rates, compared to oxidized conventional polyethylene. Metal on metal has several problems such as metal ion release, allergy, and dissemination to other organs. Ceramic on ceramic showed “chipping”, breakage, and bad conformity at revision surgery for metal-backed acetabular cups and femoral necks. Highly crosslinked polyethylene without free radicals showed very good wear performance in hip simulator studies, but clinical long-term results were unknown.
Our aim here is to evaluate long-term clinical results using randomized prospective well-controlled studies, regarding which articulating surface is best for longevity of primary total hip arthroplasty.

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We describe a case of cup breakage in a ceramic-on-ceramic total hip arthroplasty at 3 years postoperatively. In 1999, a 68-year-old woman recieved a left cementless total hip arthroplasty for osteoarthritis, using a ceramic-on-ceramic prosthesis (Kyocera ABS cup, alumina ball) . In May, 2002, she noted a left groin creak which progressively increased. A radiograph of the pelvis revealed displacement of the cup liner, and a revisional operation was performed in August, 2002. Analysis of retrieved implants suggested that increased friction on the alumina bearing surface, possibly due to undetermined interposition, resulted in increased torque, and subsequently the liner was sheared off the metal shell. Since there have been increasing ABS cup failures, careful follow-up of operated patients is needed for early detection of breakage.

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