When treating coxarthrosis, each treatment method including conservative treatment, osteotomy, or artificial joint replacement, has an optimal stage for treatment of the disease. Joint preservation surgery has a good result for cases in the early stage, but total hip arthroplasty (THA) is selected for advanced stage hip osteoarthritis, and in Japan, more than a 40000 THAs are performed each year. Good postoperative results lasting up to 15 years are reported today, but, on the other hand, postoperative problems still clearly exist. Deep venous thrombosis/pulmonary embolism (VTE/PTE) are given as perioperative problems, and postoperative dislocation and postoperative range of motion of the hip joint are given as the problems that most relate to ADL. These days, information about THA is abundant so that there is extensive demand for the procedure amongst patients, and elevated technique is demanded of the surgeon. The onset of postoperative VTE/PTE as a lethal complication and interest about its prevention have risen these days with the increase in the number of artificial joint replacements performed in Japan. This time, we introduce a postoperative THA rehabilitation schedule and report the results of our postoperative complication prevention efforts carried out in our hospital. When THA of late years is thought about, for a patient, it is natural that the long-term results are good, and the postoperative satisfaction degree from an early stage is the demand that it is necessary. In consideration of these things, the range of hip motion needed about the origin and preventing dislocation that were one element of long-term satisfaction since only a short-term of normal ADL movement was investigated, and this was viewed from the aspect of joint stability against postoperative dislocation by difference in the approach method of surgery. Finally, we also discussed the importance of early rehabilitation after surgery for the prevention of VTE/PTE as a serious complication of surgery.

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変形性

痛に加え，関節可動域・下肢筋力・日常生活動作能力・生活の質の低下を伴う代表的な整形外科疾患である。しかしながら，変形性症の進行を遅延させるエビデンスは十分には確立されていない。我々は，動作中のモーメントインパルスに着目し，歩行中の内・外転モーメントインパルスと立ち上がり動作中の伸展モーメントインパルスを検討した。歩行に関して，対側杖の使用により内・外転モーメントインパルスが減少すること，および歩行速度の低下に伴い内・外転モーメントインパルスが増加することを明らかにした。また，立ち上がり動作に関して，立ち上がり時間の減少に伴い伸展モーメントインパルスが減少することを明らかにした。我々の知見は，内・外転モーメントインパルスが低い（または高い）歩行パターン，および伸展モーメントインパルスが低い（または高い）立ち上がり動作パターンを理解するために役立つと考える。さらに，我々の知見は変形性症の進行を遅延させるために将来役立つ可能性があると考えられる。

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症例は56歳男性．15歳時に下前腸骨棘剥離骨折を受傷し保存治療を行い，経過良好であった．55歳頃から右

痛が出現したため当院受診となった．右前面に骨性隆起を触れ，圧痛と可動域制限を認めた．画像所見で増大した下前腸骨棘を認め，深屈曲で下前腸骨棘と大腿骨が衝突しており，外インピンジメントと診断した．直視下に下前腸骨棘の切除を行い，良好な術後経過を得たため報告する．

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下肢動静脈奇形が原因と考えられた変形性

症に対する人工手術の1例を経験した．局所での血流欠損による大腿骨頭壊死症が疑われたが，画像上，壊死所見は認めず，術前診断は変形性症となった．病理検査でも骨頭に壊死所見は認めず，変形性症で矛盾しない所見であった．本症例は動静脈奇形を伴う，変形性症で術中に大量出血した症例であり，1例報告する．

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We report an adult case of pyogenic arthritis of the hip. A 74-year-old woman was admitted to our hospital because of fever and increasing right hip pain. She was scheduled to undergo right total hip arthroplasty (THA) because of rheumatoid arthritis. There was no history of joint puncture or trauma. The patient’s body temperature was 38.2°C and movement of her right hip was restricted because of severe pain. The white blood cell count was 9100/μl and CRP was 13.4mg/dl. Plain radiography showed narrowing of the joint space in the right hip, and magnetic resonance imaging showed right hip effusion. One day after admission, aspiration of the right hip joint was performed, and culture of the aspirate grew α-Streptococcus. The patient therefore received intravenous antibiotics. Five days after admission, debridement, irrigation and the Girdlestone procedure were performed on the right hip. After surgery, intravenous antibiotics were continued for 10 days. The body temperature and other clinical indicators of inflammation gradually improved, and the patient was discharged 19 days after surgery. As Indium-111 scintigraphy at 5 months after surgery showed no signs of infection, THA of the right hip was performed. Six months after THA, the patient has no problems with the treated hip.
Adult cases of pyogenic arthritis without a history of joint puncture or trauma are rare. However, as the prognosis of such cases is sometimes very poor, joint puncture must be performed immediately and adequate treatment should be instituted whenever such cases are suspected.

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We report a case of subtrochanteric femoral shortening oblique osteotomy in high dislocation of the hip with total hip arthroplasty. A 71-year-old woman, suffering from a dislocated hip (Crowe type IV), was treated with a modular femoral component (S-ROM-A). The operation was carried out through a posterior approach. The acetabular component was placed at the level of the true acetabulum. The lengthening of the treated limb was 40mm. At follow-up, she reported significant pain relief and functional improvement. The osteotomy appeared to be healed on radiograph by 3 months. This technique minimizes potential complications, allows for correction of severe femoral neck anteversion, and gives excellent rotationary stability, while preserving the proximal femur for better press-fit cementless fixation. THA for Crowe type IV developmental hip dysplasia is a safe and effective procedure, that can improve not only hip function, but also lumbosacral and knee pain owing to a dramatic correction of static body balance. However this procedure poses a wide spectrum of difficulties and can present a serious risk of complications. A successful result depends on a complete preoperative assessment of the patient, attention to the details of the surgical procedure performed with an adequate prosthesis, and a reasonable selection of indications.

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　膝前十字靱帯損傷の予防において

外転筋力が注目されているが、指導現場で実施可能な筋力評価法は無い。そこで、外転筋力の簡便な評価法としてSideways Benchトレーニング法に着目し、その有効性を検証した。研究１として、外転筋力と、30秒間でSideways Bench姿勢を繰り返しできる回数（SBテスト）との関係を調査した（n＝71）。研究２として、表面筋電図を用いて、外転筋力とSBテスト中の中殿筋活動水準との関係を調査した（n＝７）。研究３として、外転筋トレーニングを12週間行わせ、介入前後で外転筋力、SBテスト、片脚着地時におけるKnee-in角度を調査した（n＝12）。結果、外転筋力はSBテスト（r＝0.79；研究1）、およびテスト中の中殿筋活動水準（r＝0.71；研究２）とも有意な相関関係を示した。12週のトレーニング介入の結果、外転筋力、SBテストは有意に向上し、片脚着地時におけるKnee-in角度は有意に減少した（研究３）。SBテストは外転筋力評価法として有効であると思われた。

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本研究の目的は，片麻痺者の麻痺側荷重応答期における

伸展モーメントのアシストを，伸展アシスト型の歩行支援機ACSIVEを用いて行い，麻痺側に及ぼす影響を明らかにすることである．対象は片麻痺者12例である．ACSIVE装着により，初期接地時の屈曲角度は減少し，立脚期最大伸展角度は増大した．また，荷重応答期の最大伸展モーメントは減少し，立脚期最大屈曲モーメントは増大した．ACSIVE装着により，立脚期屈曲モーメントの増大が得られたことから，歩行能力を改善させ得ることが考えられる．

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Clinical and radiological studies were performed on forty total hip replacements (THR) (38 patients) using bone graft acetabuloplasty. Using the Japanese Orthopaedic Association hip score, the mean preoperative total score improved from 41.3 to 84.6 points 1 year postoperatively, and slightly decreased to 84.1 point by the mean follow-up period of 4 years and 5 months. By radiological evaluation, the setting angle of the socket was an almost ideal angle (41.5°) and the mean Sharp angle was 44.5°C pre-operatively and 33.3° post-operatively. The lesser trochanter was lowered to the normal position, and therefore leg length was corrected to almost equal. The size of the grafted bone was about 1/32/3 of the femoral head of the other side, and the resected femoral head was suitable for grafted bone. The grafted bone was united about 3 months after the operation. Prosthetic loosening reached stage II in the socket side by Uno's classification, but on the stem side, Müller type showed an increased rate. Bone graft acetabuloplasty was an useful method to set the socket at the ideal position in THR of dysplastic hips.

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We treated 9 patients (9 hips) with rapidly destructive coxarthropathy (RDC). We performed total hip arthroplasty (THA) for all cases, 1 with cementless, 3 with cemented and 5 with hybrid. The average age of the patients was 79 years (range from 73 to 85 years). The average follow-up period was 2 years 6 months (from 1 year to 6 years 4 months). The average postoperative JOA score improved from 34.3 to 81.3 points. There were no appearances of radiopaque lines, loosening, or migration on the radiographs. There were no complications.
The causes of RDC are not clear, however, it has been suggested that subchondral insufficiency fracture might play an important role in the initiation of RDC, and that the progression of RDC is accelerated by posterior pelvic tilt and bone fragilities of osteoporosis.
In general, the clinical results of THA for RDC are poorer than those of THA for osteoarthritis. We think that acetabular reconstruction is important for good long-term results because of early loosening of the socket in THA for RDC. When the degree of acetabular destruction is remarkable, we perform acetabular reconstruction using the K-T plate or cup supporter for RDC as indicated.

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When treating patients with secondary osteoarthritis of the hip, it is important to know the typical natural history, and the factors contributing to the progression of osteoarthritis. This is especially true in determining when to proceed to surgery.
We have made studies of several such factors affecting the natural history of prearthrotic patients followed up at our clinic. The subjects of our investigation were 35 patients (49 joints) diagnosed as prearthrosis and observed conservatively for more than five years. From A-P view X-ray films, we determined the CE-angle, the AHI, the Sharp angle and the degree of the femoralhead deformity, and then investigated the load distribution in the joints using a finite element method (FEM) .
Results showed that the progression of osteoarthritis was rare in patients younger than 30. In patients over 30, many progressing cases were seen in those with CE-angles less than 10°, and/or AHI's under 65. Under FEM, an uneven load distribution was observed in progressing cases, leading us to assume that a mechanical instability was present.

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We have studied the clinical pathology and treatment of prearthrosis by analyzing clinical, radiological and arthroscopic data on secondary coxarthrosis due to congenital dislocation of hip the joint (CDH) .
In the clinical and radiological studies, we examined 87 joints in 71 patients of prearthrosis out of 300 joints of 150 cases of coxarthrosis due to missed CDH. The symptoms occurred after adolescence and so CDH was not discovered in infancy and childhood. Also, in the arth-roscopic study, we examined 24 joints in 19 cases of pre-arthrosis including both those which were surgically treated and those which were not.
There was a high incidence of prearthrosis in the cases of coxarthrosis due to missed CDH. The distribution of this symptom was spread through the age groups, but there were less cases in the 60s and 70s groups. As for the symptoms of the disease, 60% of the patients had arthralgia and the remainder had lower back pain, thigh pain, and knee joint pain. The initial symptoms occurred mostly in the teens and 20s, and about 50 % received an initial examination less than one year from the occurrence of the first symptoms.
Classification by joint compatibility on radiographies showed that there were more type A (remained acetabular dysplasia) than type B (remained subluxation), but type B tended to be in a more advanced early stage than type A. Therefore, it can be observed that type B, the group with worse compatibility, progresses more quickly in coxarthrosis than type A does, the group with better compatibility.
In arthroscopies of the hip which we have performed, a slight irregularity of the femoral head cartilage and fibrillation of the cartilage in the acetabulum were observed. We could not diagnose any symptoms in 20 % of the arthroscopy cases.
With respect to treatment, 1) coxarthrosis which has poor compatibility with an insufficient acetabular covering and a CE angle of less than 10° should be operated on, since it is presumed that coxarthrosis progresses quickly in the early stage, and 2) coxarthrosis which has a slightly better compatibility with an insufficient acetablar covering and a CE angle of less than 10° is also suitable for operation. But for the coxarthrosis which does not belong to either 1) or 2), we consider that it is better to continue observing the natural progress and not to operate.

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