Recently we have experienced a case of the lumbar disc extruded posterolaterally in the extradural space, which suspected a spinal cord tumor. A 42-year-old man was admitted to our clinic with complaints of gait and rectovesicular disturbance. Lumbar myelogram showed incomplete block at the L2-L3 spece. Laminectomy was done and an extradural tumor was removed completely. The histological findings showed a slightly degenerative intervertebral disc. Now ten months after surgery, motor and sensory disorder has disappeared.
There have been few reports of intraspinal teratomas. We have found only 44 cases in English and 3 cases in Japanese literature. A seven-year-old boy was admitted to the Ryukyu University Hospital with chief complaints of low back pain, limping, and limitation of forward flexion of his trunk. On examination, deep tendon reflex of his lower extremities was normal without pathological reflex. Muscle weakness was recognized only on his left flexor hallucis longus. No sensory and no vesico-rectal disturbance were found. Both straight leg raising tests were positive, and his pubic hair appeared already. Spinal tap showed xanthochromia, hypercellularity and increased protein content. Myelogram revealed complete block at the interspace between first and second lumbar spine. Removal of tumor at cauda equina connected with sacral cord was performed surgically after laminectomy. Histopathological diagnosis of this tumor was teratoma with germinoma, showing high liquor level of H. C. G. (Human Chorionic Gonadotropin). This case showed higher level of one of the three laboratory determinats (α-fetoprotein, H. C. G, and F. S. H.) for the diagnosis of this tumor, still after the surgical removal of the tumor. So, carefull follow up study is needed.
Four cases with sacrococcygeal chordoma seen and treated at our department from 1971 to 1983 are reported, with an average age of 63.8 years, ranging from 57 to 69, and a male sex predominance of three to one. Excision of the tumor in two patients could not result in a cure, of whom one has a recurrent tumor with a metastatic lesion in the right lower lung, and the other had undergone excisions of recurrent nodules three times since the original operation, but his tumor could not be resected perfectly. For one of the remainder, radiation therapy alone had been employed with the results of some regression of the tumor. However the patient died of heart failure 8 years and 4 months after the first visit to our department. Another is alive without surgical treatment, but some neurological symptoms and signs of lower extremities are slowly progressing. Although three patients have survived 2, 3 and 3 years respectively after treatment, they all have the evidence of the disease.
A case of osteosarcoma arising in the patella was reported. The patient was a 51-year-old male, complaining of pain and swelling in the patellar region for 5 months duration. On physical examination, a large tumor measuring 15×7cm was palpated in the patellar region. All laboratory studies were within normal limits. Rentgenograms revealed a geographic destruction of the distal half of the patella. A thin periosteal shell was found in the anterior aspect of the tumor, but no demineralization was noted within the tumor. A CT scan demonstrated expansion of the patella and extensive infiltration of the tumor to the soft tissue. Angiograms demonstrated a slight increase in number of small arteries to the tumor. An above-knee amputation was performed followed by an open biopsy. Histologically, the tumor was composed of tumor cells with slight atypism, benign giant cells and woven bones. A diagnosis of well to moderately differentiated osteosarocoma was made. No anticancer agent was administered. The patient is disease free 2 years and 2 months after surgery.
The Osteosarcoma arising in elderly persons is very rare. In Kumamoto university medical school we have had 32 cases of osteosarcoma in the past 15 years. The age of the two cases in this group was older than 60 years of age. We reported a 66-year-old female who had a osteosarcoma at the distal end of the right femur. The histological findings were those of typical osteosarcoma and showed numerous proliferation of bizarr cells and osteoid formation.
A 57-year-old female had the pain at her left popliteal region in September 1980, and followed by the tumor formation in May 1981. Because of a rapid growth since January 1982, she admitted to our hospital in March 1982. At admission, her tumor was elastic soft with 12cm in diameter, the irregular surface and the obscure margin, which was adhesive to gastrocunemius muscle. In April 1982, amputation above the knee was done. Microscopically, typical biphasic pattern with the mixture of fibrosarcomatous pattern and pseudoglandular pattern was revealed. In the latter, pseudoepithelial cells ware stained positively with PAS and Alcian Blue Stain. Adjuvant chemotherapy, consisted of Adriamycin, Cyclophosphamide and Vincristine, had been perfomed during the one year since March 1982. She is alive with the disease-free status one year three months after adjuvant chemotherapy.
We have experienced three cases of synovial sarcoma which is said to be rare in children. Two out of three cases had the onset in childhood. Another case had been conservatively seen after several times of tumor resection, but finally she was referred to us due to tremendous amount of tumor.
A solitary eosinophilic granuloma of bone is the most benign variant in Histiocytosis X. Any bone in the skeletal system may be affected in childhood, and common sites for bone lesions include the skull, the shafts of long bones, and the ilium. Only one case involving foot bone was reported by Campbell and Leupold during the last ten years. We documented a case of eosinophilic granuloma arising in the left calcaneus of one year and seven months old boy. Eight months after the curettage and bone graft from his mother's iliac bone, he was free from symptoms and there were neither local recurrences nor metastases even on X-ray examination.
This brief paper presents a 31-year-old woman with a tumor in the left buttock. The histological findings of this tumor are consistent with a diagnosis of clear-cell sarcoma described by Enzinger. This tumor was intimately bound to tendon-like tissue and was composed of aggregates of round or fusiform, pale-staining cells showing prominent nucleoli.
Pseudohypoparathyroidism was first described by Albright in 1942. Since then, over forty cases have been reported in Japan. We report a case of a eighteen-year-old female. She was born at term without complications, and first seen at our hospital in 1972, complaining epileptic convulsion, short stature and mental deficiency. Laboratory studies showed low serum Ca, and high serum P, and defect of active response to P. T. H. (Ellisworth-Howard test). Activity of P. T. H. was not measured. After admission, the patient was medicated with 5, 000units of Vit. D 2, 300, 000u. of D 3 and Ca Gluconate. After three months, serum Ca and P got back to the normal level, and epileptic convulsion was also diminished. Since 1972, no epileptic convulsion was occurred but short stature and brachydactylia remained unchanged.
We experienced a case of polyarthropathy with pituitary adenoma. The patient was a 44 years old male who had bilateral coxalgia and bilateral gonalgia. The roentgenographic findings showed osteoarthritic changes in these joints. We suspected a metabolic disease, because the roentgenograms in his skull and fingers showed arcomegalic changes. The growth hormone in his serum was 46ng/dl. The T. H. R. was performed in his right hip joint. Histologically, the pituitary adenoma was an acidophilic adenoma.
Pachydermoperiostosis is a syndrome characterized by clubbing of the digits, periosteal new bone formation, and coarsening of the facial features. The patient is a thirty-one years old man with hydrops of left knee. This case is typical, and has all abnormalities of digits, skin, and diaphyseal bone. We showed this case and discussed the pathogenesis.
Recently we have experienced a case of monostotic melorheostosis. A 35-year-old female suffering a spontaneous pain and a deformity of her right leg visited our clinic in order to get a proper diagnosis. The x-ray findings of her right tibia showed hyperostosis, like the wax flowing down a candle. bone biopsy and histological examination for differential diagnosis revealed this case as melortheostosis.
In this report we describe the clinical and histological findings of osteopetrosis. She was 29 year-old and admitted to our hospital for treatment of the fracture of right femur. She had typical histories such as recurrent fractures of left femur, osteomyelitis of right mandibula, hardness of hearing, dumbness, nystagmus and optic atrophy. Biochemical investigation revealed high serum alkaline and acid phosphatase. The X-ray pictures demonstrated typical osteopetrosis just like as chalk bone in skull, rib, spine, pelvis and femur bones. Histologically the bone taken from the iliac crest showed irregular osteoid and chondral matrix, and callus taken from the fractured femur bone showed focal bone formation but no lamellar bone trabeculae. We treated the fracture by internal fixation using a plate but there was no sign of bone union.
Cranio-carpo-tarsal dysplasia is a rare syndrome first descrived by Freeman and Sheldon in 1938. Major features of this syndrome consist of a characteristic facial appearance causing the individual to appear as if whistling, ulnar deviations of fingers, scoliosis and talipes equinovarus. Our patient has this complex of congenital malformations.
The multiple pterygium syndrome is a rare condition which consists of pterygia of neck, antecubital, digital, popliteal, and intercrural areas, growth reteardation, peculiar facies, foot deformities, multiple joint contractures, vertebral anomalies. Here we report a girl with multiple pterygium syndrome. This case is a sporadic type because of mild symptom and no evidence in her family history. We believe this is the first reported case of the multiple pterygium syndrome in Japan.
As for 290 patients, 160 cases which are thought to be owing to the pelvis were found concerning the patients complaining of low extremity pain by ceiropractic therapy. In these cases 23.4% (68 cases) were of piriformis syndrome, and 31.7% (92 cases) were of sciatic syndrome. We can call these pelvis outlet syndrome. Low back pain is said by Naito to be found most in parts of second and third 1umbar nerves, but ceiropractic therapy made it clear that a little movement of position of iliac crest causes most stimulus. Ceiropractic therapy is indispensable in the treatment of pain and numbness, but in the adaptation of ceiropractic therapy, orthopaedists must systematically grapple with the adaptability and watch excess of treatment.
It is important to differentiate emotional responses from the organic disorders in treating the patients of low back pain. Especially in indicating surgery, little attention has been paid to psychogenic low back pain in the children. We report four young patients who showed remarkable manifestations of sciatica. We revealed that emotional factors or psychogenic manifestations of symptoms with lumbar disc herniation were involved in these patients after surgery or careful observations and examinations.
A female aged forty-eight had suffered severe low back pain in June '82 without any trauma. She had an attack of apoplexia in past history. Radiographic examination of the spine showed osteolytic changes of the 3rd and 4th lumbar spines, and tuberculous spondylitis or spinal tumor was suspected. In November '82, she was admitted to our hospital complaining of the symptome of acute renal insufficiency. Four days later, she had the inflammatory change resembling phlegmone around left low back region and was drained a large amount of pus with puncture. ESR, WBC and CRP were noted to be abnomal. Tuberculin test revealed negative. In December 1982, also abscess formation was manifested around the left-hypoabdominal region, and 330 grams of pus was drained. After all, the fistula closed a month later. Needle biopsy showed chronic inflammation but the bacterial culture from the 3rd and 4th lumbar spine was negative. Antibiotics therapy and surgical therapy by anterior fusion led to a good prougosis.
Autopsy was performed in 2 cases of metastatic spinal tumors with complete paralysis and with non-paralysis. Histopathological findings in both cases were comparatively examined. Although all the circumference of the dura mator were infiltrated with tumors in both cases, the shape of the spinal cord was kept well without being flat-tened, and the degenerative changes to sponges in the whole white substances were characteristic. The degerative changes in the white substance were more remarkable in the case of complete paralysis than that of nonparalysis. However, the findings showing circulatory disturbance in the venous system were observed more apparently in the case of non-paralysis. Particularly in the dura mater with the finding of a lot of bleeding, the secondary changes occurred and circulatory disturbance further progressed. Thus, the spinal cord has a possibility to fall into a state of critical destruction of the tissue. In other words, during the period until falling into a complete paralysis in this disease, it is anticipated that the patent venous circulatory disturbance may progress in the spinal cord. It is quite possible that the spinal cord may have been fallen into the irreversible destruction of the tissues.
We performed the anterior spinal fusion of the lumbar spine with ceramic spacer in the patient with solitary myeloma. We achieved a satisfactory stability of the lumbar spine two months after the operation. There are several techeiques to get the stability of the spine. We believe ceramic implants are very useful in the fields of reconstructive surgery of the spine in near future.
The results of under arm barcing treatments for ioiopathic scoliosis were studied in 54 patients whose ages ranged from seven years and eleven months to fifteen years and eleven months at the beginning of treatment. The results obtained were as follows; (1) The final correction rate according to Cobb angle was 13.9per cent on an average. (2) Significant correlation was found between the curve prior to treatment and the final curve without brace. (3) Significant correlation was also found between the final correction rate and the best correction rate in the brace. (4) The under arm bracing was more effective for curves of less than 30 degrees. (5) Age at bracing, level of the apex, rotation of the vertebrae, and maturation grades of the iliac apophysis had no correlation with final correction rate.
We developed a new Active Corrective Scoliosis Orthosis with an intermittent pressure systems. This orthosis is one piece brace made of polypropylene and consists of pelvic girdle, thoracic and/or lumbar pad, shoulder girdle and intermittent pressure systems. This orthosis has various advantages. 1) It is light in weight and comfortable to wear. 2) It has more effective three point pressure system than other short orthosis. 3) It can be easily put on and off because of the anterior opening pelvic girdle. 4) The position of pads can be easily controlled. 5) It can be easily adjusted because the material is thermo-plastic. 6) Exercise can be done with the orthosis on. 7) Intermittent pressure system is more effective for the scoliosis correction. Patients have to pull the pressure system 30-40 times a day. The satisfactory result is obtained in patients with flexible curves of about 30 degrees.
A patient of Apert's syndrome with congenital scoliosis, unilateral unsegmented bar, was treated by posterior spinal fusion with Harrington instrumentation. A girl of twelve years old was vexed with severe postural deformity, especialy body shift. Before the operation, Halo-Pelvic-Brace was applied with thoracic pad for improvement of body shift and to make compensatory curves. Her cosmesis and body shift were improved.
The injection of anesthetics and steroids into the lumbar facet joints was used in sixteen patients with lumbar spondylolysis as a therapeutic procedure. During this procedure, facet joint arthrography was performed in all of the patients. An abnormal communication between the two facet joints bordering the separated pars interarticularis was observed in almost of these patients. This communication occurred through a channel in the area of the defect. Pain relief following intra-articular injection of anesthetics and steroids was recorded in eleven patients for periods lasting one day to nine months. Irritation of the branches of the posterior ramus of the spinal nerve might explain certain complaints of the patients with spondylolysis.
The results of radiological measurement of four groups which were consisted of 100 cases of spondylolytic spondylolisthesis, 100 cases of low back pain, 100 cases of spondylolysis and 50 cases of degenerative spondylolisthesis were discussed. In spondylolytic spondylolisthesis, comparing with the other groups, significant decrease of lumbar index and increase of lordosis, laminar angle and lumbosacral angle were observed. These findings suggest that morphological variant is one of the important pathological factors in spondylolytic spondylolisthesis.
Thirty-three Patients (spondylotic) and 52 patients (degenerative) were operated on for the stenosis of the lumber canal stenosis due to spondylolisthesis. By myelogram, these steonosis were classified into 4 groups as follows; Type 1: Root compression, Type 2: Hour glass configulation, Type 3: Incomplete block, and Type 4: Complete block. In spondylolytic groups, all cases belong to Type 1 and 2. On the other hand, 30 cases (58%) in the degenerative groups belong to Type 3 and 4. Grade of slipping was larger in spondylolytic groups than in degenerative groups. Symptoms were clearly aggravated by standing and walking, but eased by sitting and lying down. Anterior interbody fusion was performed in about 70% of the cases. After interbody fusion, in cases which showed increase of slipping, complain of leg pain was mainly found.
Redundant nerve roots of the cauda equina were found at operation in three patients with lumbar canal stenosis. The literature is reviewed and clinical, radiological, surgical, and etiological aspects of these cases are discussed.
The clinical foil-up of 66 patients was obtained by re-examination and 67 patients by questionnaires. They were followed more than minimum of three years after surgery. The over-all clinical results were as follows: forty-seven patients (71.2per cent) excellent, twelve patients (18.1per cent) good, six patients (9.1per cent) fair and one patient (1.5per cent) poor. Of thirty-four patients without fusion, 97per cent were satisfactory. On the other hand, of thirty-two patients with fusion, 81per cent achieved excellent and good results. The incidence of fair and poor results, caused by residual low back pain and numbness of foot, was greater in the fusion group than in the non-fusion group. The relationship between the clinical results and roentgenographic changes was not significant.
Between April 1978 and December 1982, 14 patients were re-operated for treatment of lumber spinal lesion. At the time of initial operation, nine of these patients were diagnosed as lumbar disc hernia (LDH) and five as lumbar spinal canal stenosis (LSCS). The initial operations were performed using Love's Method on all the LDH patients, whereas four of the LSCS patients were operated by laminectomy and one by spinal canal enlargement method. On the average, the time period preceding the re-operation was 1.4 years with LDH and 3.1 years with LSCS. The re-operations were performed by laminectomy plus postero-lateral fusion (PLF) on the LDH patients, as well as on the LSCS patients except for one instance. Causes leading to the re-operation included the inadequate cleaing (four cases), recurrence (two cases), adhesion (two cases), and ligament fiavum kinking plus adhesion (one case) with LDH, and the adhesion (two cases), instability (one case), LDH plus adhesion (one case), and oppression by lamina (one case) with LSCS. When judged in accordance with kônoo's Classification Method, the post-operation recovery was rated excellent or good in five cases (55.0%) of LDH and in three cases (60%) of LSCS. Studies of the causes for re-operation and the post-operation recovery performance showed that the inadequate cleaning and recurrence tended to be more prevalent than the adhesion. In terms of degree of satisfaction, “Satisfactory” accounted for 57.1% and “Unsatisfactory” for 42.9%, with the re-operations being performed within a short period of the initial operations at Nagasaki Mitsubishi Hospital. 88.9% of the LDH patients and 80% of the LSCS patients were found to have successfully reported back to work.
We report two cases of lumbar disc herniation with dislocation of ring apophysis. They were boys and ages were 15 and 16. They complained of severe low back pain during basketball and volleyball. Lateral plain X-ray revealed small abnormal shadow in spinal canal at the level of L4/5. Myelogram showed complete block at this level. We operated on them for suspected lumbar disc hernation with dislocation of ring apophysis and results of both were good. 13 cases had been reported by other authors. 14 cases of 15 of this disease experienced trauma. We think that trauma plays a more important role in the lumbar disc herniation with dislocation of ring apophysis than other herniation in adolescent children.
Amongst the elderly, herniation of lumbar intervertebral disc is relatively rare. In a series of 101 operated patients with lumbar disc herniation, we found 5 cases between 60 and 80 years, and 7 cases between 50 and 59 years. In the aged patients, their roentgenograms showed the herniated disc levels tending to have less degenerative change and less abnormal mobility than the other disc levels. For 12 patients, operative treatment led them to excellent results.
Twelve patients with the drop-foot associated with lumbar disc lesion and lumbar canal stenosis who underwent spinal surgery were evaluated 3 months to 6 years and a holf postoperatively. There were 5 males and 7 females, ranging in age from 30 to 74 years (mean, 55.5 years). The interval between the onset of symptoms and operative procedure ranged from 14 days to 6 years with an average of 36.6 weeks. Ten patients received laminectomy, one hemilaminecomy (Love's method) and one anterior spinal fusion. The results classified as good in 4 cases, fair in 2 and no change in 6. Two of 6 cases who had no improvement underwent second operative procedure (transfer of posterior tibial tendon) for drop-foot. It seems reasonable to conclude from the results that the most important factor in predicting improvement with treatment is a short interval between onset of symptom and treatment.
Sagittal diameter of the lumbar canal was measured on X-ray films of 141 cases with lumber disc herniation. The mean value of sagittal diameter of the canal was significantly smaller in lumbar disc herniation group than in normal adults. The cases with lumbar disc herniation were divided into three groups according to the sagittal diameter (below 15mm, 16mm or 17mm, above 18mm), and their clinical results were investigated. The narrower the sagittal diameter of the canal was, the poorer the clinical results were.
We have experienced an intraspinal extradural tuberculoma in a 51-year-old man who had pain in low back and lower limbs. These symptoms disappeared after removal of the tumor by laminectomy. This tumor was pathologically examined to be a tuberculoma.
Intraspinal ependymoma is a slightly rare tumor. We reported a case of ependymoma of the cauda equina. A fifty-year-old male admitted to our hospital due to the cervical spondylosis. After performing a cermical myelography, we happened to find a complete block at the level of the lower end of the L1 vertebral body. This block had characteristics of an intradural extramedullary lesion. But ascending myelography demonstrated a complete block at the level of the upper end of the L2 vertebral body. These demonstrated a mobile tumor. Computed tomography precisely revealed its size and its site. The histological diagnosis was an intraspinal cependymoma.
Subarachnoid hemorrhage due to spinal cord tumor is rare. We reported a case of a 43-year-old male who showed suddenly a transient aggravation of the symptom because of subarachnoid hemorrhage due to a spinal cord tumor. This tumor was located between the tenth thoracic and the second lumbar levels, and diagnosed as schwannoma.
Spinal subarachnoid hemorrhage (SAH) has the most common occurrence due to A—V malformation, but SAH from the spinal cord tumor is well documented. A case of SAH due to neurinoma of the spinal cord is reported. This case experienced the sudden onset ofsharp low back pain with radiation to both hips, and had the increasing loss of power. The early laminectomy revealed the neurinoma of the spinal cord at conus with intracapsular hematoma, and the extirpation of the tumor decreased the neurological deficit.
From 1973 to 1982, 8 cases of dumbbell tumor of the spine were treated in our hospital. To obtain satisfactory result, it is important to get enough informations about the size of the tumor, location and type, by use of X-ray, myelogram and CT.
Four cases of spinal cord tumor were treated surgically from 1980 to 1982. Complete cure was obtained in a case of extradural schwannoma and in two cases of intraduralextramedullary tumors (schwannoma and meningioma). One case of intramedullary ependymoma resulted in spastic gait with one crutch. A Nine-year-old girl with intradural-extramedullary schwannoma showed radiological instability after extensive laminectomy.
Complications after durotomy, liquorrhea and meningitis are possible. We had two cases of suspecting purulent meningitis after resection of the spinal cord tumors. The two patients with complications after durotomy, which was done for the removal of the intradural neurinoma of the cervical spinal cord in the first patient and for the removal of the extradural neurinoma of the lumbar spinal root in the second patient, were presented and discussed. Of the complications after durotomy, liquorrhea is the one to be most careful of. These patients recovered and returned to their daily activities.
Fost-meniscectomy arthrography was made in 10 to 21 days after operation. Retained fragments of the menisci were observed in 22 cases (16 of total meniscectomy, 6 of partial one), and the degree of the remnant was tried to be quantified. The posterior segment of the meniscus was retained considerably in some cases of total meniscectomy, especially in medial semilunar type. Correlation between the residual meniscus and the early results (pain, range of motion and joint effusion) was studied, but there was no significantly evident tendency.
The shoe insert for the treatment of the osteoarthritic knee was made on an experimental basis. Its result was good and reduction of pain was 74.3%. Moreover, the roentgenograms, the functional evaluation of the knee joint and grade of satisfaction in patient were employed as parameter, and the multiple regression analysis was performed using a computer, and then, the range of the indication was determined.—Our results showed that the medial joint space was a most important factor followed by the score of functional evaluation of the knee joint, and varus deformity was not an expectant factor. The indication of the shoe insert was concluded as follows. 1. Width of medial joint space is over 2mm, 2. Score of functional evaluation of the knee is over 50 point, 3. OA change of knee joint is not severe.
We analysed three dimentional alignment of the lower extremity by a computer before and after the interlocking wedge osteotomy. 1) In the antero-posterior view, all cases showed that the femoro-tibial angle was decreased after the osteotomy. 2) In the lateral view, all the knees showed recurvatum from flexed-position after the osteotomy. 3) In the horizontal view, the rotation angle in the knee joint was increased in 3 cases after the osteotomy and the tibial internal torsion was increased in all the cases.
Two cases of osteoarthritis of the knee were reported which appeard to occur as an advanced stage of the chondromalacia patellae. Both cases had no previous history of infection or trauma including sports injury, however, they showed severe osteoarthritic changes in the late twenties and eary thirties respectively. Most svere changes were observed in the patello-femoral joints in both cases. Therefore, we suspected that their chondromalacia patellae were followed by the significant osteoarthiritis of the knee. Treatment consisted of anterior advancement of the tibial tubercle, shaving and drilling of the degenerated articular cartilage. Satisfactry improvement of the symptom has been obtained.
For the knee with severe pain and deformity, the total knee replacement may be one of the most effective therapy. To obtain fine results and to prevent the future migration and loosening of implants, this operation demands exact correction of the alignment of the lower limb. Some scales are designed to catch mechanical axis of thigh and lower leg. One is a staple shaped acrylic scale with buried wires at every 1cm. The position of the femoral head can be detected in a preoperative roentgenogram with this scale. Another is an isosceles triangle scale with a slit in the base. In the thigh, a bisector to the base is adjusted to the femoral mechanical axis in the coronall plane from the head to the center of condyles, and in the lower leg, to the tibial axis from the center of the tibial plateau to the center of condyles of the ankle respectively, and the bone cut is done through the slit of the base. By these scales and several techniques with this operative procedure, we are able to perform precise correction of the alignment under the direct visual orientation. In 26 joints of 22 patients, using I/B total condylar knee system, 25 joints showed strict alignment and their clinical results were good.
Three knees with geometric, seventeen with total condylar, two with Guepar, two with kinematic and one with ceramic prostheses were studied. The follow up period ranged from 6 months to 10 years with the average of 2.5 years. Pain was improved in all knees. In total condylar prosthesis, posterior subluxation of the tibia occurred in 40 percent. The average postoperative range of motion was slightly less than 100 degrees. Loosening and late infection was none. Our experience has led us to conclude that development of a new design is needed.
116 total hip replacements were performed for 112 patients in our clinic since 1974. 29 hips in 28 patients with the average age of 58 years old who received Charnleys low friction arthroplasty more than five years ago were reviewed. In the follow up study, operated hips were evaluated using the scale for osteoarthritis of the hip joint adopted by the Japanese Orthopaedic Association. Radiological examination was performed using postoperative radiological evaluation scale offered by four department of orthopaedic surgery in Japan. Results showed that preoperative total average score of 40.9 points was improved to 84.6 points postoperatively with marked improvement in relief of pain and ability to walk. Radiological loosening was noticed in the acetabular component in two cases and femoal component three cases. Early and late infections and revision were not experienced.
We performed total hip replacement combined with bone grafting acetabulopasty on 16 hips and reviewed them. Grafted bones were survived and remodeled in all cases and middle term results of them were almost good. But in a few cases which bone was unsuitably grafted to, acetabular remodeling was unsatisfactory.