Eighty-six total hip arthroplasties in 70 patients with rheumatoid arthritis were performed between 1981 and 1997. Eighteen patients (20 hips) died, and 17 patients (21 hips) were lost to follow-up, leaving 35 patients (45 hips) for review at a minimum 5-year follow-up after surgery (mean, 11.6 years; range, 5-20 years) . There were 8 men and 27 women, with a mean age at the time of surgery of 48.6 years (range, 28-69) . Different designs were used, including Anatomic (9 hips), Anatomic BR (5 hips), BIAS (10 hips), Harris-Galante (11 hips), PCA (2 hips), Kyocera Bioceram (5 hips), and Charnley (3 hips) . Twelve cemented THAs, 3 hybrid THAs, and 30 uncemented THAs were performed.
Of thirty-seven uncemented acetabular cups, 2 cups (5.9%) were revised due to aseptic loosening. Five (63.7%) of the cemented acetabular components had radiographic loosening. None of the 11 cemented femoral components subsided. Of the 34 uncemented femoral components, subsidence occurred in only one hip. Our study shows cemented acetabular components have a high rate of aseptic loosening in the long-term follow-up, and uncemented THAs have successful radiographic results in RA patients.

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We investigated the prevalence and characteristics of complimentary and alternative medicine (CAM) use by patients with rheumatoid arthritis (RA) in Shiga, Japan, One hundred forty-two consecutive RA patients were interviewed regarding their use of CAM, which was classified as either oral products or practitioner visits. As results, 27.5% of all patients stated that they were using CAM, while 38.0% had experienced it in the past, and 34.5% had no experience. Those who were using or had used CAM showed significantly longer disease durations than those who had never used it. However, the duration of CAM use was relatively short, with a median of 6 months for oral products and 8 months for visiting a practitioner, though subjective efficacy varied. Our results imply that patients in progressive chronic situations, who looked to CAM over the course of long disease duration, had an over-expectation of effectiveness, and discontinued use when the expectation was not met. We concluded that clinicians should have an open mind and routinely inquire about the use of CAM, and advise and discuss its objective benefits, possible toxicity, and potential interaction with medication.

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Thirty patients (32 hips) with a total hip arthroplasty using a porous-coated femoral implant were clinically assessed, and radiographic images were analyzed 2 years post operatively. Half of the patients had received a femoral component coated with hydroxyapatite and tricalcium phosphate (HA/TCP) and the other half received an identical component without HA/TCP (non-HA/TCP) .
There was no difference between HA/TCP and non-HA/TCP coating with regard to the canal fill rate. Four of the patients with a non-HA/TCP stem complained of thigh pain. Radiolucent lines were found significantly more frequently around the porous-coated femoral implants without HA/TCP. These data show that HA/TCP coatings markedly enhance the osseointegration of a porous-coated femoral implant.

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Surgical reconstruction has been recommended by most authors for old ruptures of the Achilles tendon. We successfully treated old and neglected ruptures of the Achilles tendon by direct repair without any reconstructive procedures.
To clarify indications for the direct-repair method, we reviewed the results of three patients treated with this method and those of three other patients treated with one or other reconstruction method for an old, recurrent rupture of the Achilles tendon after primary suture. We compared MRI and histological findings as well as clinical results.
On sagittal T2-weighted images, the three neglected tendons were spindle-shaped with diffuse high-signal changes seen throughout the whole tendon. The three tendons which had been primarily sutured and re-injured showed sudden narrowing of the tendon and focal high-signal changes at the site of rupture. Histologically, the neglected tendons had dense collagen fibers running parallel to one another along the tendon axis, consistent with good healing. In contrast, degenerative findings such as mucoid degeneration, tendolipomatosis, and stenosis of arterioles were seen in the re-ruptured tendons. After surgery, all patients reported no pain in daily activities or sports. All the repaired patients and two of the three reconstructed patients could stand on tiptoe. There was no infection or nerve damage in either group.
We recommend direct repair without reconstruction for neglected Achilles tendon ruptures, and note that preoperative MRI is useful for evaluating the pathological conditions of tendons with old rupture.

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Objective : Post-operative infection is a serious complication following joint arthroplasty. One of its pathologic forms is haematogeneous infection associated with dental treatment such as tooth extraction. The authors examined the frequency of dental diseases in patients who were scheduled to undergo arthroplasty.
Methods : Subjects were 105 patients (113 joints) . There were 81 females and 24 males, and their ages ranged between 43 and 87 years (mean : 70 years) . Ninety-three joints had osteoarthritis (OA), and 20 joints had rheumatoid arthritis (RA) . Surgical procedures were : total hip arthroplasty in 43 joints, total knee arthroplasty in 66 joints, total elbow arthroplasty in 3 joints, and total shoulder arthroplasty in 1 joint. Each patient received dental examination before joint arthroplasty, and dental treatment, including tooth extraction, was administered when necessary. Follow-up periods ranged between 3 and 31 months (mean: 19 months) after surgery.
Results : Dental diseases that needed tooth extraction were present with 25 of the 113 joints (22.1%), or with 17 of the 93 OA joints (18.3%) and 8 of the 20 RA joints (40.0%, p<0.05) . Each patient received pre-operative dental treatment as appropriate, and none of them needed additional treatment after surgery.
Conclusion : With pre-operative examination and treatment, our patients did not need invasive post-operative dental treatment such as tooth extraction, which is known as a potential cause of haematogenous infections. No patients had post-operative deep infections originating from oral lesions. Pre-operative dental treatment seems useful in order to prevent late haematogenous infections.

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Objective : The pathogenesis of idiopathic osteonecrosis of the femoral head (ION) is thought to be an ischemic event. The purpose of this study is to investigate alterations of the blood pool in the femoral head before and after renal transplantation.
Methods : After renal transplantion, all patients received the same immunosuppressive therapy : corticosteroids, cyclosporin-A, and azathioprine. We performed 3-phase bone scintigraphy on 16 renal allograf t recipients within 1 week before renal transplantation, and between week 4 and 9 after renal transplantation. Regions of interest (ROI) were assigned bilaterally in the femoral head, diaphysis, and soft tissue. The head-to-diaphysis ratios (HD ratios) were then calculated.
Results : Idiopathic osteonecrosis of the femoral head occurred in 2 femoral heads of 1 patient. The HD ratio before renal transplantation (mean HD +/- SD, 1.52 +/- 0.30) and the HD ratio after renal transplantion (1.28 +/- 0.30) were significantly different (P=0.000024) .
Discussion and Conclusion : The HD ratios before and after renal transplantation were significantly different, indicating that the administration of steroids diminished the blood pool in the femoral head. A low HD ratio before renal transplantion revealed a poor blood pool in the femoral head, which may be a risk factor for ION.

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Objective: The aim of this study was to examine the postoperative clinical results of total hip arthroplasty (THA) with a grit-blasted roughened-surface polymethyl methacrylate (PMMA) -precoated femoral component.
Methods: A retrospective study was performed on a consecutive series of 25 primary THAs for patients with rheumatoid arthritis (RA) . A roughened-surface PMMA-precoated femoral component (Centralign, Zimmer, Inc) was used with so-called third generation cementing techniques for all cases. In 16 cases, the acetabular component was a Harris-Galante II (Zimmer, Inc) and in 9 cases a Trilogy (Zimmer, Inc) with screw fixation. The average follow-up duration was 54 months (range, 31-91) . Patient's average age was 57 years at primary arthroplasty.
Results: Clinical and radiographic failure occurred in 5 hips (20%) due to aseptic mechanical loosening of the femoral component. All these 5 cases showed implant loosening within 36 months after primary surgery. All stems in the failure group were Size 2. There was a statistical trend towards failure with smaller stem sizes (p<0.01) . No loosening was seen in the acetabular component.
Conclusion: This high failure rate was unacceptable in an RA series, in spite of the subjects' limited activity. Use of Centralign femoral components may not be indicated for rheumatoid hips.

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Valgus deformity of one knee joint and varus deformity of the other knee joint is a rare condition known as “window-wiper deformity” ever since Smyth termed it so in 1980. It is commonly seen in young children in certain parts of Africa, but the deformity is rare in adults. We report here a case of TKA for a window-wiper deformed osteoarthritis (OA) patient with insufficiency fracture of the shin. The patient was an 82 year old female who complained of pain and deformity of both knee joints. We treated her with total knee arthroplasty (TKA) bilaterally and with percutaneous pinning for the insufficiency fracture of her right shin. The femoro-tibial angle (FTA) measured before surgery was 145° for the right leg and 188° for the left leg. After surgery, the measurement was 172° for the right leg and 175° for the left leg. Moreover, not only the motor pain but also the resting pain disappeared. The gait distance, that had been a few meters before surgery, extended to more than 100 meters with crutches after surgery. We are satisfied with the result.

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We reviewed a seventy-seven years old woman who had total knee arthroplasty after septic arthritis of the knee. This case involved severe septic arthritis and apophysis osteomyelitis. In the first operation, we performed joint debridement, arthrectomy and arthroplasty using a total knee arthroplasty device and inserting an antibiotic bone cement spacer. Ten weeks after that operation, total knee arthroplasty was performed. There was no recurrence of septic arthritis. Knee joint function remains good. We think that arthrectomy and -plasty is a good treatment for severe elderly septic arthritis of the knee

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Swan-neck-like deformity of the forefoot has been only rarely reported. We present a patient with rheumatoid arthritis (RA) who developed a swan-neck-like deformity in the feet. A 52-year-old woman with a 2-year history of seropositive RA was referred to our hospital, because she had been unable to walk for half a year due to knee pain, except in a squatting gait. On physical examination, both knees showed marked valgus instability due to bone defects. Notably, both forefeet showed uncommon deformities resembling the swan-neck deformities of the hands, which had developed progressively during her gait disturbance. We speculated that the altered mechanical stress on the feet, by severe gait disturbance including her squatting gait, played a role in the development of the deformity.

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