Arthrographic and anatomical research of the posterior region of the medial meniscus were performed in 27 cadaver knees. In all cases the anatomical recesses were found. Also we found the arthrographic recesses in 4 knees, especially in the posterior horn reflecting the anatomical recesses. The anatomical recess at the posterior horn was bigger than the one at the posterior segment. In the clinical case we predicted that the arthrographic recess in the posterior horn was normal becase of reflecting the anatomical recess.
The arthroscopic managements of tibial plateau fractures have the advantages of allowing accurate reduction and treatment of concomitant injuries. We performed the arthroscopic managements on 13 cases of a total of 24 tibial plateau fractures. 4 cases were implanted hydroxyapatite as a bone graft substitute. One case of them was examined pathologically 8 months after grafting. Roentgenographic and clinical assessment at follow-up periods averaging 18 months demonstrated no loss of reduction. Interporous hydroxyapatitie is a safe, effective alternative to autogenous cancellous bone for the filling of metaphyseal defects associated with tibial plateau fractures.
During the period from June 1985 to July 1989, eighteen patients with degenerative joint disease of the knee were treated by arthroscopic debridement. The average age was 64.8 years with a range from 51 to 76 years and the average follow-up period was 19.1 months (range, 6-48 months). We removed mechanical irritants like torn menisci or loose bodies and attempted to create drill hole perforations in sclerotic lesions on the femoral and tibial condyles. Of the 18 patients who underwent arthroscopic debridement, 17 patients were improved, while only one patient had no change. The procedure is only palliative, not in any way curative, but many authors have reported good results using the arthroscope to debride irritants from osteoarthritic knees. The arthroscopic approach decreases incision size and simplifies postoperative rehabilitation. Arthroscopic debridement of the knee joint can be recommended as a useful treatment for patients with degenerative arthritis of the knee.
Six cases (six knees) of the painful bipartite patellae were treated by surgical method because conservative treatment wasn't effective. The first case was treated by an excision of the accessory ossification center, but the knee pain remained. So we tried to get osteosynthesis of the bipartite patellae by peg bone autograft and all of them were treated well. As surgical treatment for painful bipartite patellae, we recommend osteosynthesis by peg bone autograft when there is no subluxation of the patella. And when there is suluxation, at first we should think of reduction of the patella for example by transposition of the tibial tuberosity.
We used CPM in postoperative patients undergoing TKR for RA. CPM was used for 14 days from postoperative day 2 on, for an average of 12 hours per day. A wider range of knee motion was abtained in patients with CPM (CPM group) than in those without it (control group). One year postoperatively the range of motion was found decreased than it was at the time of discharge from the hospital in both groups. Our experience with the use of CPM indicated that CPM proved to be effective in preserving the range of motion during the postoperative period of hospital stay and also in lessening individual variations in range of motion when assessed on a long-term basis.
There are various methods concerning the ACL reconstruction. We have tried the autogenous free graft in ACL reconstruction in forty subjects. The substitutes were as follows: thirty-seven cases were patellar ligament augumented by retinaculum, and three cases were iliotibial band augumented by retinaculum. The mean follow-up period was twenty-eight months. The average age at surgery was twenty-three years and seven months. Thirty-two cases were old and light cases were fresh. They were evaluated by roentgenograms, ligament injury criteria and manual examinations. The results were satisfactory.
The purpose of this study was to investigate the influence of exercise on the anterior cruciate ligament of bipedal rats biomechanically and histologically. Thirty-six female Wistar rats were divided into three groups as follows: (1) Quadripedal rat [QG]; (2) Bipedal rat without exercise [B-E (-) G]; and (3) Bipedal rat with exercise [B-E (+) G]. The rats of each group were terminated accordingly at the age of 20 weeks. The femur-anterior cruciate ligament-tibia prepared and arranged from each group were tested to failure on tensile testing machine and the anterior cruciate ligament of a group of rats were observed by light and electron microscopy. All femur-anterior cruciate ligament-tibia's complexes failed in the site of interstitial ligaments. The strength of the anterior cruciate ligament in B-E (+) G showed a significant increase as compared with QG and B-E (-) G. Observed under light microscopically there were no microtear and degradation change in the anterior cruciate ligament of each group, but again observed under electron microscopically the collagen fibril had a cross-sectional diameter of various sizes from 30nm to 110nm in the anterior cruciate ligament of B-E (+) G.
We reported a case of a 58-year-old man who sustained dislocation of the knee with patella tendon rapture. Primary operative treatment was carried out. The treated knee was placed in a cast for seven days, then early quadriceps exercise was started. One year after surgery, the knee was stable and painless with flexion movement from 0 to 120 degrees.
We treated 27 cases of meniscal injury due to sports in the last five years. 18 cases were male and 9 cases were female with the age ranged from 14 to 60 years old. 13 cases were medial side and 14 cases were lateral side. The follow-up period ranged from 4 to 48 months (mean, 16 months). Clinical scores by Kurosawa's method were 8.67; 8.94 in male and 8.11 in female. The rate of the return to sports was good in the group of male, younger age, arthroscopic surgery and partial meniscectomy. The period of the start of sports from operation was shorter in the group that was operated within 6 months from injury.
A 20-year old woman visited our hospital in October 1987. She complained of intermittent pain, flexion contracture, and locking of the rigth knee. Physical examination rivealed tenderness, a pathological plica, and a positive McMurray's test, but radiograph demonstrated no abnormalities. The lateral meniscectomy and resection of the plica were performed at arthrotomy in December 1987. Postoperatively the knee pain and contracture persisted despite early ambulation, physical therapy, and non-steroidal antiinflammatory drugs. Radiograph 3 months after surgery demonstrated patchy osteoporosis of the distal femur, patella, and proxymal tibia. Physical examination revealed diffuse tenderness, swollen, warm, contracture, and skin atrophy of the affected knee. Results of laboratory investigation were normal or negative. The patient was diagnosed reflex sympathetic dystrophy of the knee following meniscectomy and resection of the plica, treated by kindly physical examination and steroidal drugs. The sympyoms were relieved gradually after the treatment. To date 22 weeks following surgery, the patient returned to a Bialy life without disability. Reflex sympathetic dystrophy must be an unusual complication following meniscectomy.
Total knee replacement was performed on three cases with severe valgus deformity. Kinematic Rotating Hinge was used for two cases that had ligamentous instability and loss of bone. Kinematic Stabilizer prosthesis was used for a case by releasing of lateral structure and reefing of medial stracture. We released the peroneal nerve for all the cases to prevent the peroneal palsy. The patella dislocation was treated by proximal realignment of the quadriceps, lateral retinacular release and advancing the medial flap.
Nine arthroplasties in which the cemented kinematic-stabilizer total knee prosthesis was used for severe varus and valgus deformity of the rheumatoid knee were reviewed. There were two varus and seven valgus knees which should be recommended using the hinge-type prosthesis. None of the patients could walk before operation, but all of them came out to be able to walk with or without canes. The average femorotibial angle was 174 degrees at the final follow-up. We prefer using the semi-constrained type prosthesis with soft tissue release, bone graft and postoperative orthosis for severely deformed knee to the hinge-type prosthesis which needs more bone resection.
Since 1984, Yoshino-Shoji total knee replacement which was developed in 1984 was performed in 41 knees of 37 patients. Twenty-eight replacements were performed for osteoarthritis and 13 for rheumatoid arthritis. The average follow-up period was 25 months (range, 6 to 61 months) and average age at surgery was 64 years (range, 45 to 81 years). The mean postoperative flexion was 113° (range, 70° to 150°). All paCients had no or only mild pain and ability to walk was remarkably improved. No revisions were performed. This total knee system showed good stability and range of motion in the correct leg alignment, owing to keeping the tension of optimal soft tissue (meinly medial and lateral collateral ligaments) equally. We reported this total knee system and our results.
We have reviewed 11 procedures in 9 patients with metastatic malignant tumor of the spine. An anterior decompressive spinal fusion was performed in 3 cases, a posterior spinal fixation alone in 5 csses, a posterior spinal fixation with laminectomy in 2 cases, and a laminectomy alone in the other. All patients were suffering from pain and they all had relief of pain after operation. 10 cases of 9 patients had neurological deficits and neurological return was achieved in 8 cases. In these 8 cases, 2 cases was perfomed posterior spinal fixation only. Spinal instability is one of the main causes for pain and neurological deficits in the patients with metastatic malignant spinal tumor, and rigid internal stabilization is the first choice for the surgical treatment of these patients.
A study of congruity of the patellofemoral joint was made on 31 cases (51 joints) of total knee arthroplasty (Miller-Galante type) which were performed from 1986 to 1989. There were 5 males and 31 females. Their mean age was 70.5 years and their ages ranged from 37 years to 82 years. 24 cases (35 joints) were gonarthrosis and 12 cases (16 joints) were rheumatoid arthritis. These were 2 cases (2 joints) of luxation, 3 cases (3 joints) of subluxation and 7 cases (9 joints) of lateral tilt. The causes of luxation were unbalance of soft tissue, increase of Q-angle and design of the femoral component. The patella of the M-G type has tendency to luxation due to small anterior flange and shallow patellar groove of the femoral component. Therefore, the soft tissue balancing at the time of operation was more important in the M-G type than in the other types of total knee arthroplasty.
we treated a patient with pusturotic arthro-osteitis who had the typical skin rash of Pustulosis Palmaris et plantaris and persistent pulling pain in the antior chest. Xrays showed hyperostosis of sternum and both first ribs, and Technetium-99m scintigraphy showed increased uptake in the same region and both sacroiliac joints. Destructive changes of the knee and wrist joints gradually have advanced for 10 years. RA factor was positive and HLA-B27 typing was negative, and especially flexion contructure of his knee joints remained at shout 45°. The following findings were deficient of the feature of RA; Sterno-costal ossification, manubrio-sternal arthritis, sacro-iliitis, and a little bone atrophy.
We have performed resection arthroplasty of the metatarsophalangeal joint by Clayton's procedure for correction of foot in rheumatoid arth-ritis (RA) patients. In the present study, the effect of this surgical treatment was evaluated by static and dynamic analyses of motor function. The subjects used in this study were 8 RA patients (13 joints) undergoing Clayton's operation, all female with an age range of 38-65 years. In one of these patients (2 joints), replacement of the first metatarsophalangeal joint by Swanson's procedure was combined. The result of this surgical treatment was evaluated by both static analysis using the method of Preskale and dynamic analysis using three-demensional steteoscopic gait tracking method. Postoperative measurement of static plantar pressure by the method of Preskale showed an improved, almost uniform distribution of pressure over the sole brought about by Claiton's operation, while gait analysis revealed that the stability of gait was unsatisfactory. The gait of patients who underwent replacement of the first metatarsophalangeal joint with Swanson's prosthesis was more stable postoperatively than preoperatively.
Total protein and its fractions were measured in fifteen patients of rheumatoid arthritis. A/G ratio, globulin volume, and gamma-globulin volume were co-related to erythrocyte sedimentation ratio and C-reactive protein which were evaluated as the indication of activity of rheumatoid arthritis. When synovial fluid is analized, the measurement of protein volume and its fraction is re-commended.
Recently we have experimented witn the treatment of three cases associated with OPLL and OYL in the thoracic spine. For three cases with myelopathy we carried out resection of the OPLL and OYL using the posterior and lateral approach. Results of them were good, but one case needed Halo-pelvic apparatus for post-operative instability.
We have treated rheumatoid arthritis (RA) at an expert outpatient department since July 1986. Now we report present status of 64 patients attending this department and discuss the role of orthopedists in treating patients with RA. One of the most crucial problemsin the treatment for RA may be that true etiology of this disease remains obscure in spite of the amount of studies up to date and then patients recieve only symptomatic treatment throughout. We considered that orthopedists who treat RA should carefully attend to the changes of degree and stage of illness, select more reasonable treatments for individuals and evaluate therapeutic response. From these reasons, the number of patients consistently treated by an orthopedist seem to be limited to less than 50.
Five uncontrolled rheumatoid arthritis patients were treated with low-dose weekly methotrexate as part of the drug. A significant improvement from base line in all patients was recogized. In clinical paramters tested, ESR, CRP, grip power, and joint scores were improved, but RA and mornig stiffness were not distinctly improved during the short study (6-12 months). Also, predonine dose was decreased in all cases. An elevation of the transamylase value to 3 times the normal level forced us to withhold MTX treatment from two cases. In one case, the drug was restarted at the same dosage after this value returned to normal, and in the other case this treatment was given up for her apprehension.
We treated 73 patients who met the new diagnostic criteria for RA with Bucillamine, Auranofin and gold sodium thiomalate (GST) for more than 12 consecutive weeks to explore therapeutic effects of these drugs. The results indicate that Bucillamine proved to be effective in 67.7% of patients while Auranofin and GST were effective in 65.5% and 90%, respectively, of patients. Improvement rates of Lansbury index achieved were 29.3% with Bucillamine, 21.4% with Auranofin and 50.1% with GST. Remission by the ARA criteria was attained in 14.3% of Bucillamine-treated patients, in 17.4% of Auranofin-treated patients and in 20.0% of GST-treated patients. Side effects necessitating discontinuation of treatment occurred in 11.8% and 20.6% respectively, of Bucillamine-and Auranofin-treated patients. An effective response to any these three drugs was elicited more frequently in early RA cases. The results led us to conclude that GST needs to be revalued as the drug of second choice for RA next to NSAIDS.
We have been performing a bipolar hip arthroplasty with bone grafts in the acetabulum for protrusio acetabuli in the patients of rheumatoid arthritis since 1985. In this study, 4 cases with 5 joints were evaluated radiologically and clinically. Central migration of outer head and sinking of stem stopped almost 6 months after surgery with appearance of sclerosis in the acetabulum and around the stem. For clinical evaluation we used the JOA score; preoperative total average score of 16 points was improved to 78.4 points postoperatively with marked relief of pain and improvement of ROM. The short-term results of bioplar hip prosthesis with bone grafts for RA were satisfactory.
We have treated the hip joints with osteoarthrosis (OA) and reumatoid arthritis (RA) by bipolar arthroplasty (OMNIFIT UHR), adding the acetabular bone grafts in cases of severe bone defects. Migrations of implants were survayed roentgenographically. Of 17 coxarthroses, 4 hips were grafted bone using resected femoral head to the lateral side of the acetabulum, and of 16 hips with reumatoid arthritis, 8 hips were grafted the ilium or resected head to the acetabulum. In OA cases without bone graft, some outer heads of artificial joints have migrated both to the center and superior, and only superior migration was noted in RA cases. On the other hand, almost all outer heads of bone grafted cases have migrated from the result of collapse in the grafted bone. Sinking of stems was noticed slightly. In conclusion, it is necessary to graft solid bone and avoid full weight bearing of the hips for at least six months for the prevention of bone collapse.
A total of twenty-four Harris-Galante porous total hip replacements were performed in twenty patients with a minimal follow-up of one year. We examined clinical and radiological findings. Clinically all but 2 cases with thigh pain were satisfactory. Bone ingrowth was not achieved in two cases, in which one case was a severe osteoporotic patient and the other had improper postoperative care. Radiological findings in the femoral components revealed radiopaque line at the site of non-porous parts of the femoral stems in many cases, bone sclerosis at the site of the femoral stems in 8 hip joints, and bone resorption at the proximal site of the femur in about half joints. The significance of these radiographic findings is unclear and, therefore a longterm follow-up study is necessary to make some conclusions about them.
A clinical and roentgenographic two-year follow-up study was done on 27 primary total hip arthroplasties with the Harris/Galante porous hip system. Ten of the 25 patients experienced thigh pain. The postoperative activities of the patients were the one of the most important factors to the clinical results. The cause of the thigh pain seems to be the micromotion of the stem. So the proximal portion of the cementless stem should be fit in the intramedullary canal of the proximal femur to obtain an initial stability of the stem. One of the problems of the Harris/Galante porous hip system seems to be the proximal design of the stem.
We have studied the radiological changes of a cementless hip replacement, using a Harris/Galante porous femoral component. Seventeen arthroplasties in 15 patients with an average age of 59.6 years (1 man and 14 women) were reviewed at a minimum of 12 and up to 28 months. The diagnosis was osteoarthritis in 13 hips, avascular necrosis in two, rheumatoid arthritis in one and femoral neck fracture in one. Bony atrophy around the trochanter, calcar changes with atrophy, round off and resorption, radio-opaque line along the stem, thickening of the cortex, stress shielding and sinking of the stem were found in the postoperative radiographs. We measured percentage of the femoral component to the femoral medullary canal by anteroposterior and lateral views. An average percentage by the anteroposterior view was 92.9% and one by the lateral view was 88.2%. Presence of a radio-opaque line at the tip of the stem and an extensive radio-opaque line along the distal half stem seen on the lateral view correlate to low percentage by the lateral view.
We reviewed the early results of 23 cementless total hip replacement both clinically and radiologically. Clinically the average JOA score was 50.2 before surgery and improved to 81.6 after surgery. Especially pain score and walking ability score improved well. On follow-up X-ray examination radiopaque line around the stem was frequently seen in zone 1 (13 hips) and zone 4 (8 hips). On the acetabular side radiopaque line appeared in only 4 hips with bone transplantation. These results suggest that the cup is sufficiently anchored to the acetabulum but there are some mechanical problems in the stem of this cementless system.
A group of twenty-eight hip joints in 25 patients (one male and 24 females) with osteoarthritis of the hip joint treated by cementless total hip replacement (JIAT) were studied. Age distribution of these cases ranged from 49 to 80 years old (average, 63.0 years), and follow-up periods from 3 to 6 years (average, 4 years and 2 months). Preoperative OA hip score (J. O. A.) was 44.4 points in an average, and postoperatively they were improved to 88.8 points. Postoperative OA hip score (J. O. A.) was maintained nearly 90 points until 5 years. Slight inclination of the socket was noted in a few cases on follow-up X-ray films. However clinical findings were not changed. Complications of the surgery were noted in 3 cases of non-union of the greater trochanter and one case of dislocation.
During the period from August 1983 to January 1985, seventeen cementless total hip arthroplasties were performed and sixteen cases were completely followed. We discussed a relationship between the clinical results and the radiological evaluations. Ten were satisfactory (62.5%) but three were poor in clinical results. The five-year postoperative roentgenograms of fifteen threaded rings showed a remarkable stability, but the tilting angles of the acetabular sockets in only eight cases were within normal limits. Seven of these eight cases were evaluated as satisfactory. Most affecting factor on the clinical results was an inadequate tilting angle of the socket. Radiolucent lines were evident in seven femora but the abnormal findings with the femoral components couldn't affect the five-year clinical results.
Fifty-nine total hip replacements were performed for 56 patients since 1985 to 1989. The cases consist of of 9 males and 47 females. The age range was 36 to 94 years old with an average being 66 years old. We classified the cases into 4 groups according to methods of fixation of the acetabular cup and stem (cemented or non-cemented). These 4 groups were compared to each other about JOA score, roentgenographic findings, etc. There was no definite difference between cemented and non-cemented groups clinically.
We reviewed 44 patients who had a bipolar prosthetic replacement from July 1982 to July 1989. There were 5 men and 39 women, whose ages ranged from 33 to 82 years (average, 58.0). They were re-evaluated one year to seven years postoperatively by questionnaire and roentgenograms. According to JOA Hip Score, preoperative score (mean, 45.0 points) was improved postoperatively (mean, 80.9 points). Roentgenographically central migration was observed in 5 hips 10.4%) and proximal migration in 3 hips (6.3%). Distal migration was observed in 11 hips (22.9%) and the sclerotic change at the tip of the stem in 23 hips (47.9%).
The cemented stems of two cases were revised with cementless stems of bipolar hip prosthesis. In one patient, the femoral shaft was perforated by the drill. In another patient, a fracture of upper medial site of the femoral shaft was recognized by postoperative roentgenogram. The fracture was due to unremoved bone cement conecting to the lateral part of inner surface of the femoral canal. Prevention of these complications needs meticulous attentions. For example, preparation of operative instruments, and the careful intraoperative procedure.
Revision using bipolar prosthesis with bone-graft was performed in two cases of deep infection and one case of aseptic loosening after prosthesis replacement of cemented total hip arthroplasties. The patients are two males and one female. Deep infection was treated by removing prosthesis, currettage of the joint and femoral medullary canal and continuous irrigation for three weeks. Revision was secondarily carried out after eight months in one case and eleven weeks in another. No inflammatory symtoms are checked after two years postoperatively and result of revision is good. The patient who received cemented total hip arthroplasty for osteoarthritis of the hip joint seventeen years ago experienced one revision before visiting our clinic. X-ray showed aseptic loosening and destruction of the acetabulum. Bipolar prosthesis replacement and bone-grafting in the acetabulum were performed. Eight months postoperatively the follow-up study showed good results.
The purpose of this study was to simulate postoperative radiographs by preoperative radiographs using a personal computer. METHOD: Preoperative radiograph was scanned by image scanner and full color frame memory, and simulations of the osteotomies were carried out using a personal computer. RESULT: The quality of the pictures on the computer display was equal to the plane radiograph. More intensive calculation of the osteotomy was possible with our method than with a diagram method using the tracing paper. Furthermore, the pictures could be saved on the floppy disk.
Thirty-seven patients (39 hips) with advanced osteoarthritis of the hip were treated by a shelf operation combined with valgus osteotomy. Their clinical and radiological results were evaluated by the JOA-score and acetabular head index (AHI). The average age at operation was forty-five years and six months old (range, 28 to 58 years). The mean follow-up period was two years and nine months (range, 1 to 5 years). The clinical result was good or excellent in seventeen hips (43.6%). The good and excellent group (over 80 points) in our clinical study was 84.6% for the AHI, while in the poor group (under 70 points) was 72.0%. It is apparent that a minimum of 85% coverage using the AHI is necessary for the best result.
From 1971 to 1975, 40 McKee-Farrar total hip arthroplasty were carried out in our hospital. 20 hips could be followed for over ten years and out of them 13 hips could be followed for over 15 years. Survival rate of this artificial joint was 80% in 10 years and 55% in 15 years. 38 hips were evaluated by roentgenographically in relation to loosening. 17 sockets were migrated in three directions; 7 laterally, 4 superiorly and 6 medially. Loosening of the stem was observed only in 4 hips which had a loosening of the socket coincidentally. Sockets of 11 hips which had no loosening for over 15 years were set on operation in the original acetabulum.
We have treated the fractures of the femoral shaft after total hip replacement (THR) with K-U plate fixation. There are many kinds of metal substance in the operated region, such as femoral component, plate, screws, and wire. To estimate the affection of these mixture to fractured part, the radiographical changes in the cases were ivestigated. The number of patients was five, one man and four women. The average age at follow-up was 64.6 years old (range, fifty-three to seventy-four years old). The follow-up period after terminal operation averaged eighty months (sixty to one hundred months) except one case with short period. The radiographs of the affected side showed the clear zones in acetabulum and proximal part of the femur in two cases, but showed no changes around metal substance during those period. K-U plate fixation did not seem to cause any problem on the biocompatibility for the long period, and seemed to show little trouble for the prognosis of THR.
Pigmented villonodular synovitis (PVS) of the hip is a rare condition. The condition often presents radiological findings of the cysts in the femoral head and acetabulum. Bone is invaded and hip joint is destroyed. But the case wich showed rapid destrution of the joint is very rare. We report a case, a 71-year-old woman with PVS of the hip joint, in which bone was invaded and presented rapid destruction.
During the past 3 years we have performed arthroscopy of the hip in 19 patients (or 22 joints). Pathologic conditions in this series included necrosis of the femoral head and osteoarthritis of the hip (in 6 patients each), tear of the acetabular labrum and pain from unknown causes. There were 2 patients with tear of the acetabular labrum, both having bone changes. In osteoarthritis of the hip joint, arthroscopy permitted us to evaluate the status of articular cartilage, to obtain a three-demensional view of deformity thereof and thereby to extract correct information through proper selection of surgical procedure, e. g., osteotomy. Also in necrosis of the femoral head, arthroscopy was considered useful in deciding as to whether or not osteotomy or bone grafting is indicated. In cases of postoperative pain from unknown cause following femoral head replacement in which there was a noticeable abnormality of the acetabular cartilage, arthroscopy was useful in determining if reoperation is indicated. Arthroscopy has also been performed for the purpose of probing, biopsy, shaving or removal of joint mouse, though still posing some technical problems. Arthroscopy can also be expected to be usable for irrigation of joint cavity, is less invasive than operation under direct vision, entails a shorter period of aftertherapy and thus appears to have great clinical significance.
The aim of this study was to explore the significance of short stature on the occurrence and prognosis of Perthes' disease. Of the patients admitted for treatment for Perthes' disease in childhood, 61 patients over 16 years of age at the time of this survey were slected. Of these 61 patients, 46 patients were measured the height at the onset and at this timem, and 45 patients were studied on prognosis from radiographs taken at this time. The height of the patients with Perthes' disease was lower than the average height of the same aged children without disease. And the condition of short stature at the onset was consistently recognized until the patients were over 16 years old. When the patients with Perthes' disease had short stature at the onset, the radiological results were good and this disease occurred at younger age. In conclusion, the degree of short stature may be related to the occurrence and prognosis of Perthes' disease.
It is considered that the prognosis extend over a long time of Perthes disease is determined by the condition of the acetabulum. The acetabular change accompanied with the femoral head deformity and the factors concerning with it are reported in this paper. 34 patients who were treated conservatively in our hospital after 1975 and healed primarily are examined. Catterall's classification is applied. Roentgenograms at the time of pre-treatment and primary healing are estimated by ARA, AHQ, ATD, coxa magna rate (CMR) and Mose method. Age at onset, the time at the first treatment and head at risk (metaphyseal cyst, lateral ossification and lateralization) are also examined. It is revealed that acetabular roof angle tends to be steep with deformity of the femoral head. It is also important that delaying of treatment, widerange necrosis, lateralization and lateral ossification are considered to be factors of deformity of the femoral head.
We carried out a roentgenographic analysis of 83 patients with congenital dislocation of the hip complicated by avascular necrosis. This was done to clear up the relationship between damage of the femoral head and that of the femoral neck. All patients had been reduced by Lorenz's method and never received surgical treatment over ten years. They were classified into three groups of good, fair and poor according to Mose's method. Epiphyseal quotient (E. Q.) and articulo-trochanteric distance (A. T. D.) were measured to evaluate the degree of damage at the femoral head and neck on each group. We found that E. Q. did not correlate with A. T. D. in the group of good and fair, but in the poor group they correlated statistically. Most of good and fair groups belonged to the Kalamchi's group 1 (mild epiphyseal involvement), and most of poor group belonged to the Kalamchi's group 2 (involvement of the growth plate and epiphysis) or group 4 (involvement of all of epiphysis, growth plate and metaphysis) Those facts mean that growth disturbance at the epiphysis and at the metaphysis occurs independently in the most of mildly deformed femoral head, but on the contrary they occur relationally in the severely deformed femoral head. It suggests that there is a difference in site of vascular occlusion on the avascular necrosis of the femoral head following treatment of congenital dislocation of the hip.
In order to find a radiological measurement which can predict final radiological or anatomical results in early childhood, we have reviewed the serial radiographs of 37 hips in 33 children treated by manual reduction for congenital dislocation of the hip. All had been followed until at least 10 years old without operative intervention and had no apparent deformity of the femoral head at final visit. Final radiological results were judged by using Severin's classification; group I and II as good, and others as poor. OE angle and acetabular index were found to be good predictors. Prediction of cases with final good results was possible from 1 year old by acetabular index and from 2 years old by OE angle. The cases with final poor results could also be predicted by OE angle and acetabular index in combination. The values of OE angle and acetabular index for prediction at each age of infancy were obtained. Age or arthrographic finding at reduction, by themselves, was not a suitable parameter for prediction, because they were not correlated with the final results.
128 hips in 109 patients with congenital dislocation of the hip treated by Pavlic harness initially were reviewed to analysis the radiological course of the capital femoral epiphysis. The median age at late review was 5.3 years (range, 2-15 years). The epiphyseal deformities were classified into three types according to the extent of the defect. 52 hips were recognized one of the three types of the deformities. Eight hips of 52, in which epiphyseal deformities were apparent with metaphyseal changes, developed the avascular necrosis, and were seven of eight nuclear ossification delayed. It is thought that early metaphyseal changes and delayed ossification are preceded the development of the avascular necrosis.
We evaluated 33 Salter innominate osteotomies performed in 31 patients for the treatment of CDH. 6 patients (7 hips) had complete dislocation and 25 patients (26 hips) had residual subluxation after the primary reduction of CDH. 21 patients (21 hips) showed avascular necrosis of the femoral head preoperatively. 23 patients (23 hips) had concomitant innominate osteotomy and open reduction. The average age at surgery was 3yrs and 3mos (range, 1yr and 6mos to 5yrs and 1mos) and the average duration of follow-up was 4yrs and 7mos (range, 2 to 9yrs). Acetabular index, CE angle and AHQ were measured. Correlation of these values with preoperative, surgical and postoperative factors were analysed. The mean CE angle at follow-up of the dislocation group was statistically smaller than that of the subluxation group. Coxa magna had statistically significant correlation with CE angle at follow-up. Coxa plana had correlation with AHQ at follow-up. The age at surgery, preoperative acetabular dysplasia, preoperative anteversion angle of the femoral neck, preoperative avascular necrosis of the femoral head and combination with open reduction simultaneously had no correlation with the acetabular index, CE angle or AHQ at follow-up. These results indicate that the Salter innominate osteotomy, combined with open reduction simultaneously, is effective even in the residually-subluxated hips that have avascular necrosis of the femoral head.
To elucidate the time of appearance of the dislocated and subluxated hip in cerebral palsy, 37 hip joints in 26 patients were reviewed. In spastic type, dislocation and subluxation were inclined to occur earlier, from 4 to 6 years old, than in athetotic type. And also in the patients who could not migrate, they occurred earlier than in the patients who could do. It was suggested that the diminution of the hip movement caused by contracture was a significant factor along with the muscle imbalance.
Hip dislocation of cerebral palsied children cause ambulatory children unstable of gait and non-ambulatory children impairment of dairy life. Muscle releases (adductors, gracillis, psoas, rectus femoris and hamstrings) were performed in our hospital for the patients whose hips tended to be disloced. Results of these muscle releases are reported in this paper. The patients who were performed only muscle releases after 1983 in our hospital are examined. AHI and CE-angle are applied for roentgenographic estimations. Patients are 21 cases (38 hips) and the average age at the operation is 8 years old (5-14 years old). The 14 hips, were improved after operation and 24 hips were unchanged. Secondary operation were done for 5 cases. It is revealed that although roentgenographic improvement is minimal, functional improvements such as stability of gait or daily management are found in many cases.
There are some reports on immunological investigation for the role of human sex ratio. We investigated the rate of sex in the patients with ossification of the posterior longitudinal ligament (OPLL). The male-female sex ratio among the patients and their brothers and sisters were evaluated. Among the first-born ones the tatio of male-female was 1.95/1.00 (with p<0.01). Considering all of them together the ratio of male-female was 1.44/1.00 (with p<0.01). Some special HLA-haplotypes were recognized in the patients with OPLL. From these results, We concluded that some immunological roles influence on the excess male births among the patients with OPLL.
Radial bone mineral density (BMD) in the distal 1/6 and 1/3 sites of the radius was measured by single photon absorptiometry in forty-one patients with ossification of the posterior longitudinal ligament (OPLL) in the cervical spine. In the cross-sectional study, values of BMD in the cervical OPLL showed no differance from those of age, sex-matched control. In the longitudinal study, follow-up values of 1/6 BMC/BW in the cervical OPLLadvancing group decreased significantly than initial values of it. Follow-up values of trabeculo-cortical ratio (1/6/1/3 ratio of BMC/BW) in the cervical OPLL-advancing group decreased significantly compared with the cervical OPLL non-advancing group. These results suggest that in the OPLL-advancing period, trabecular bone mass is decreasing and cortical bone mass is kept. We speculate that unknown factors force shift of trabecular bone mass to ossification sites.