A transtrochanteric curved varus osteotomy (TCVO) is an excellent joint preserving surgical modality if the necrotic lesion can be moved to the non-weight bearing area as assessed by maximum abduction antero-posterior radiographs. The purpose of this article was to elucidate whether TCVO can reduce the volume of osteonecrosis after an index osteotomy as assessed by magnetic resonance imaging (MRI). Twenty patients (twenty hips) with non-traumatic osteonecrosis of the femoral head were followed for more than three years after an index operation and MRI examinations both before and at two years after surgery were retrospectively investigated. The average age at the time of operation was 40 years (range, 18 to 60 years), consisting of 13 men (13 hips) and 7 women (7 hips). The etiology and/or associated risk factors was steroid-associated osteonecrosis in 11 hips, alcohol associated in 7 hips, and idiopathic in 2. According to the classification of the Japanese Investigation Committee there was Type B in one hip, Type C-1 in 17 hips, and Type C-2 in 2 hips. Eight hips were in Stage 2, 10 in Stage 3A, and 2 in Stage 3B. Average follow-up was 4 years (range, 3 to 5 years).Introduction
Methods
The purpose of this study was to investigate the long-term outcome of Sugioka's transtrochanteric rotational osteotomy (TRO) for nontraumatic osteonecrosis of the femoral head. Seventy-eight patients (87 hips) were consecutively treated by TRO from 1989 to 1994. All patients followed 15 years or more were included. Four patients (4 hips) with traumatic osteonecrosis and five patients (5 hips) followed less than 15 years were excluded. A total of 69 patients (78 hips) were included. Average age at the time of operation was 42 years. There were 51 men (57 hips) and 18 women (21 hips). The average follow-up was 17 years (range, 15 to 20 years). Type of osteonecrosis was as follows: Type B; 2 hips, Type C1; 50 hips, and Type C2; 26 hips. Stage was as follows: stage 2; 29 hips, stage 3A; 34 hips, stage 3B; 13 hips, and stage 4; 2 hips. Transtrochanteric anterior rotational osteotomy was performed in 76 hips and posterior rotational osteotomy was performed in 2 hips. Clinical evaluation was evaluated by Harris hip score. Kaplan-Meier survivorship analysis was performed based on the end point of conversion to total hip arthroplasty (THA) or re-collapse.Introduction
Methods
We have measured the concentration of cartilage-derived retinoic-acid-sensitive protein (CD-RAP) in synovial fluid (SF) from the knees of 49 patients with osteoarthritis (OA) and 79 with rheumatoid arthritis (RA) in order to investigate the correlation between the type of joint disease and level of CD-RAP. The mean concentration of CD-RAP in synovial fluid was significantly higher in OA than in RA. The level of CD-RAP in the group of patients with mild OA was significantly higher than in the moderate or severe groups and that in the group with mild RA was also significantly higher than in the other RA groups and decreased with progression of the disease. Immunohistochemical studies showed expression of CD-RAP in the cytoplasm of chondrocytes in newly-formed fibrocartilage. Since CD-RAP is mainly produced in young and proliferating chondrocytes, our results suggest that the level of CD-RAP in synovial fluid reflects remodelling of articular cartilage and may be used as a marker to estimate objectively the restorative reaction of chondrocytes.
