Introduction: The purpose of this study was to evaluate clinical results of total knee arthroplasty with three different implants for patients with osteoarthritis (OA) and rheumatoid arthritis (RA) in our institution.

Materials and methods: From January 1993 to October 1998, 41 total knee arthroplasties were done at our institution. Clinical assessment was performed preoperatively and at most recent follow-up using the Japan Orthopaedic Association scoring system (JOA score). The Knee Society Radiological Evaluation System was used to evaluate a series of 41 total knee arthroplasties. The population consisted of 41 patients, 37 women and four men, with an average age of 71.8 (55-85) who had total knee arthroplasty, and the average BMI was 24.5 (18.1-36.0). Preoperative diagnoses were osteoarthritis in 25 patients and rheumatoid arthritis in 16 patients. Used implants were Miller-Garante 2 (Zimmer) in 15 knees, KU3 (Kyocera) in seven knees and Nexgen (Zimmer) in 19 knees.

Results: The average preoperative JOA score were 48.0 points and postoperative score were 74 points. Preoperative and postoperative maximum extension was −16.4 ± 10.9° and –2.86 ± 4.9°. Preoperative and postoperative maximum flexion was 105 ± 21.6° and 106 ± 15.0°. On the AP radiographs, the average angulation of the femoral component was 96.9 ± 2.2° and tibial component position was 88.0 ± 2.5°. The lateral radiographs revealed an average femoral component flexion of 3.03 ± 3.9° The average tibial component flexion was 3.53 ± 3.02°. And there was no significant difference in radiographic evaluation among those implants.

Conclusion: In the middle term results, there was a significant correlation between preoperative and postoperative flexion and a significant improvement of maximum extension of the knee after total knee arthroplasty.

Between 1995 and 1999, 12 patients aged 65 years or more (mean 70.2) with lumbar disc herniation, underwent partial laminectomy and nucleotomy. The results were compared with those of 25 younger patients aged between 20 and 40 years (mean 30.1), who underwent the same surgical procedure. The Japanese Orthopedic Association (JOA) score was used to assess the clinical outcome. The minimum follow-up was 12 months. The pre- and post-operative total JOA scores and the rate of improvement of the JOA score were not significantly different between the elderly (11.1, 24.3 points, and 74.1%), and the younger group (11.6, 26.4 points and 84.5%).

The results of this study indicate that the outcome of lumbar discectomy in elderly patients is as good as in younger patients.

Objective: The objective was to evaluate mortality and ambulatory ability for elderly patients over 80 years with a femoral neck fracture treated surgically. A strategy for managing elderly patients with various problems is proposed.

Materials and Methods: From January 1, 1998 to March 31, 1999, 122 patients with femoral neck fractures were treated in our hospital. Sixty patients aged over 80 years were chosen from this series for the present study. The 60 patients included 50 women and 10 men with a mean age of 87.1years (range 80–97years). The fractures included 26 intracapsular and 34 extracapsular fractures. The mean follow-up period was 12.9 months. The patients were classified into three groups according to age: group A (80–84 years old), group B (85–89 years old) and group C (over 90 years old). The following parameters were evaluated: duration between injury and operative treatment, duration of hospital stay, senile dementia, prefracture and postoperative walking abilities, and mortality. Walking ability was graded on a scale of 0–4: 0, free gait; 1, gait with a walking stick; 2, gait with a wheelchair; 3, ability only to walk a few steps; and 4, bedridden.

Results: The rates of regained postoperative walking ability to better than grade 2 were 72.2% (13/18) in group A, 65.2% (15/23) in group B and 84.2% (16/19) in group C. These patients were followed until death or for at least one year. The overall mortality rates were 11.1% (2/18) in group A, 17.4% (4/23) in group B and 10.5% (2/19) in group C.

Conclusion: In cooperation with internists, medical staff and family members, we were able to overcome various problems and achieve good clinical outcomes. Cooperation of family members was needed for the elderly patients to return to where they had lived before the trauma and to improve their quality of life.

Objective: To compare the functional results with the anatomical results of treatment for fractures of the distal end of radius in patients aged over 60 years.

Methods: The results of treatment for fractures of the distal end of radius in 25 elderly patients were evaluated retrospectively. The average age of the patients was 70 years and the average follow-up period was 24 months. Twenty-one fractures were treated by percutaneous pinning, two were treated with plates, and two were treated conservatively. All patients were right-handed. The functional results were evaluated according to the sum of demerit points (Saito, 1983), and the following three parameters were used for evaluation of anatomical results: radial tilt, ulnar variance, and palmar tilt.

Results: The latest follow-up functional end results were excellent in 52 % of the fractures and good in 48%. In the final radiographs, the average radial tilt was 20.5 degrees, ulnar variance was 3.7 mm, and palmar tilt was 2.5 degrees. The values of ulnar variance and palmar tilt were often found to be out of the normal range. Most of the patients had a satisfactory outcome, and the functional results were not correlated with the magnitude of residual deformities. Grip power was the most significant factor related to subjective evaluation. Grip power recovered 75.2 % of uninjured side grip power in patients fractured left hands and 103.4 per cent in patients fractured right hands. This difference was significant (p< 0.05).

Conclusions: A good functional outcome of treatment for fractures of the distal end of radius in elderly patients can be expected irrespective of radiographic evidence of minor deformities.