Objective: Total hip arthroplasty is a common procedure for osteoarthritis of the hip joint. However, in young patients, it is sometimes difficult to determine the correct method of surgery. We report the clinical results of Chiari pelvic osteotomy for secondary osteoarthritis due to acetabular dysplasia.
Methods: Since 2000, we have performed Chiari pelvic osteotomy for 48 hips of 45 patients (3 hips in 3 men, 42 hips in 45 women) . Of these, 34 hips in 32 patients (2 hip in 2 men, 32 hips in 30 women) could be followed. The mean age at operation was 49.2 years (range: 27 to 67 years) . Pre- and postoperative Japan Orthopaedic Association hip scores (JOA score) and roentgenographic parameters (Sharp angle, Center-edge angle, Acetabular hip index) were examined. For some patients, a questionnaire survey on activities of daily living and quality of life was performed.
Results: The mean JOA score improved from 51.1 points preoperatively to 70.5 points postoperatively. Improvement in hip pain was prominent, but not in range of motion, ability to walk and activities of daily living. JOA scores were lower in the patients with bilateral osteoarthritis, bone cysts of the femoral head, or round femoral head. The questionnaire responses suggested that coxalgia was much improved. However, half of the patients noted difficulties in some activities of daily living such as squatting down, putting on their shoes or trousers, and cutting their nails.
Conclusion: The mechanism of pain relief in Chiari pelvic osteotomy remains unclear. Further study is needed to clarify it, to improve results of treatment.

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The Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system is comprised of a preoperative risk score (PRS), a surgical stress score (SSS), and a comprehensive risk score (CRS) determined by both the PRS and SSS. We evaluated the surgical stress and post operative risk for 617 consecutive hip fractures treated by osteosynthesis (n=407) and hemiarthoplasty (n=210) using E-PASS, which were previously reported in relation to postoperative complications and the costs of hospital stay in hip fracture operations. The postoperative morbidity and mortality rates increased linearly with PRS and CRS, and correlated significantly with both the PRS (ρ=0.2, p<0.01) and CRS (ρ=0.2, p<0.01) . In contrast, neither the morbidity nor mortality rates correlated with SSS, and they showed no differences between hemiarthoplasty and osteosynthesis. These results suggest that surgical stress is greater in hemiarthoplasty than in osteosynthesis. However, postoperative risk did not differ between the operative methods.

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Nine cases of femoral neck fracture in patients over 90 years of age were treated with Lateral Flare cementless, proximal metaphysial fitting stems. All showed excellent initial fixation, bone preservation indicating physiological load transfer from the pelvis to both the medial and lateral femoral cortex, and restoration of function. There was no evidence of stress shielding. Eight of the 9 cases achieved their pre-operative level of mobility by 5 weeks post-surgery. One patient died secondary to acute renal failure of unknown etiology, within 6 weeks of the operation. One patient was reduced in mobility postoperatively as compared to her pre-operative level of function, but this was a loss of only one level on the Fujimori scale of mobility.

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Although the effectiveness of MIS in THA is not clearly proven, less blood loss, less pain, early recovery, shorter hospital stay and better cosmetic conditions may be expected. We have developed an MIS method based on the postero-lateral approach with the incision made slightly posterior in order to obtain enough room for the procedure. This MIS method and the results of 20 MIS cases are presented.

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Nine total knee arthroplasties (TKAs) were performed on deformed knees with bone defects in 7 patients. Deformities were as follows: three valgus deformities, four varus deformities, one flexion contracture deformity and one subluxation. Posterior stabilizing (PS) type implants with long stems were used. Bone defects were filled with metal spacers in 6 knees, a metal spacer and thicker insert in 1 joint, bone graft in 1 knee, and bone graft and metal spacer in 1 joint. Arc of motion and JOA knee scores were improved in 8 knees. Deformity reappeared in two patients. Valgus with recurvatum deformity reappeared in one rheumatoid patient who had had severe valgus knee deformity preoperatively and the other joints had fixed deformities in the ipsilateral lower leg. In another patient who had severe varus knee deformity after purulent gonoarthritis, varus with recurvatum deformity reappeared. If a PS knee implant is used for a patient with severe preoperative deformity, and the deformity recurs, use of a constrained type implant may be better for such a case.

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A total hip arthroplasty case with idiopathic thrombocytopenic purpura (ITP) was experienced. The patient was a 60 years old woman who had been diagnosed with ITP. At the first consultation with our hematologist, her thrombocyte count was 90×10⁹/l, so only observation was continued. One and a half years later, her thrombocyte count had decreased to 45×10⁹/l, so 30 mg/day prednisolone was prescribed by the hematologist, but no remission was obtained. We applied gamma globulin therapy for the first time but no good response was obtained. One month later it was tried again and a good response was obtained. The thrombocyte count went up 163×10⁹/l until the operation day. A Lateralf Tare cementless stem was chosen, and no excessive bleeding during and after the operation was observed. Thrombocyte count decreased to 134×10⁹/l; which was regarded as enough, just after the surgery.

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High-riding DDH cases are often treated by THA with subtrochanteric osteotomy to avoid sciatic palsy by acute over-traction, but it has a disadvantage that leg length equality cannot be obtained. To prevent leg length inequality without sciatic palsy, we have done 2-stage surgery with leg elongation. In the first stage the proximal attachment of tensor fascia lata and the fascia of gluteus medius were detached. The adductors and iliopsoas were also released. Then the femoral neck was cut and the pins of a leg elongation device were inserted safely by means of a 3D preoperative planning system. Five centimeters of leg elongation was done safely in 2 weeks with no stiff feeling or sign of sciatic palsy.
Total hip arthroplasty was done 3 weeks later, at the anatomic hip center, with 5cm elongation, without any complications.

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This report describes a case of revision total knee arthroplasty (TKA) using a tumor prosthesis. The patient was a 79 year-old woman who had undergone left TKA at the age of 65. After her primary TKA, she continued working on a farm, but 13 years after that surgery, she became unable to walk due to severe left knee pain and instability. The x-ray images of her left knee showed a breakage of the tibial metal tray and severe bone defects of her distal femur and proximal tibia. Revision TKA was performed using a Kyocera Physio Hinge total knee system. At present, 3 years after operation, she is able to walk with a cane, and there is no loosening on x-ray images.

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Ochronosis is a rare disease caused by an inherited lack of homogentisic acid oxidase. It is associated with various systemic abnormalities and related to the deposition of homogentisic acid pigment in connective tissues. This deposition process leads to brittleness, fissuring and fragmentation of the articular cartilage, together with the development of clinically serious ochronotic arthropathy, including spondyloarthropathy. This short communication describes a typical case of an elderly woman with ochronotis who underwent multiple hip and knee arthroplasties over several years, together with a literature review.

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Imaging evaluation of two cases of giant cell tumor of tendon sheath in the wrist is reported with emphasis on the scintigraphic findings. Markedly-increased thallium and negative gallium uptakes were noted in both cases and appeared helpful in the diagnosis of this rare condition.

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