Introduction

Total knee arthroplasty (TKA) is an effective surgical intervention, which alleviates pain and improves function and health-related quality of life in patients with end-stage arthritis of the knee joint. With improvements in anesthesia, general health care, and surgical techniques, this procedure has become widely accepted for use in very elderly patients. However, many elderly patients tend to have compromised function and low reserve capabilities of organs and are therefore likely to develop various complications during the perioperative period. Thus, elderly patients often hesitate to undergo simultaneous bilateral TKA (SBTKA). Our purpose was to report the short-term results and clinical complications of octogenarians undergoing SBTKA.

A-70-year old woman underwent uncomplicated total hip arthroplasty using a titanium modular stem with a 46mm CoCr femoral head, a titanium shell, and a metal linear (Wright Medical Technology). Eight years after implantation, she presented with a painful left hip. A pelvic radiograph revealed adequate positioning of both hip implants without any signs of wear of loosening. CT scanning confirmed the presence of a 5 × 5 cm soft tissue mass in the ilium above the cup component accompanied by the iliac fracture. The patient was diagnosed as having an adverse reaction to metal debris (ARMD) after a metal-on-metal THA and revision was performed. Perioperatively?tissue necrosis and partial destruction of the abductor mechanism were found in the absence of any macroscopic infection. Both the neck trunnion and bore of the head showed slight signs of corrosion. The modular neck was revised with a ceramic 28mm head and a new dual-mobility liner(Zimmer Biomet). The iliac fracture was fixed with a porous trabecular metal augment(Zimmer Biomet).

The histopathology of tissue sample revealed extensively necrotic material with focal cellular areas of inflammatory cells containing macrophages and neutrophilas. Metalic debris was also scattered in the necrotic materials. After the revision, the patient was recovered without pain or dislocation, and iliac fracture was well fixed.

Instability is a substantial problem in the revision of ARMD. Extensive necrosis with gross deficiency of the abductor mechanism is associated with postoperative dislocation. Revision of failed MoM THA a dual-mobility device an effective strategy.

Hydroxyapatite (HA) is a bioactive material with a high affinity for bone. Ti-6Al-4V is lightweight and less biotoxic. Using these materials, a cementless hip prosthesis has been clinically used, consisting mainly of a Ti femoral stem coated with plasma-sprayed biocompatible HA. However, this type of stem entails several disadvantages: HA is likely to decompose at the coating; long term HA coating layer bonding to Ti is unstable and optimal HA thickness is unfeasible. In many actual cases, debonding of HA coating layer from the Ti surface was found upon removal of stems.

To resolve these concerns, we started developing a new hip prosthesis using composite materials comprised of Ti-6Al-4V and HA containing bioinactive and highly stable glass in 1985. The cementless hip prosthesis, named HAPG-Profile, unites the bioactive stem surface with the surrounding bone via adhesive glass. In basic experiments, the glass-coated HAPG-Profile has been demonstrated to possess much higher bonding stability than the plasma-sprayed HA, with bone affinity and safety not compromised. On the basis of these results, we manufactured the HAPG-Profile jointly with DePuy International, UK, and initiated a clinical trial in January 1997 in the teaching Hospital, Nagoya University School of Medicine, and Tokyo Kosei Nenkin Hospital. A total of 63 patients were followed up for more than two year and evaluated according to the Japanese Orthopedic Association Score and Harris Hip Score (HHS) clinically, functionally and radiographically. The results of the two-year follow-up study indicated success of early fixation associated with favorable outcomes.

The aim of the study was to evaluate THA using Robodoc system for osteoarthritis of the hip joint.

The Robodoc system consists of: 1. the Orthodoc computer workstation that simultaneously displays computerised tomography images of patient’s femur and a selected prosthesis, 2.a five-axis robot, 3.the operating room display, 4. the control cabinet.

Follow up were 3months and 1 year on 27cases (Male 5, Female 22). Selected stems: Zimmer anatomic, 13, Versis 14(VSS,7, VSL,7). Mean age 57.9. Among 27 cases of osteoarthritis, one is after osteotomy and two are after osteonecrosis. Pain, ROM, Radiographs and ADL were evaluated using JOA hip score system. Sockets were fixed with cementless conventional technique.

Mean operating time, 2 hours and 40min.; Mean bleeding, 455 ml; Mean Ant. Version, 29.26 degree (22.0–39.7); Level of osteotomy of the femur neck, Mean, 9.19 mm from the trochanter minor. JOA hip score after THA, 82.20. In one case, 5 mm sinking occurred 5 days after the operation. No intraoperative femoral fractures and varus or valgus insertion of stems occurred in 27cases. The thigh pains were nothing. The patients were discharged at 4weeks after the operation with one crutch. The results showed statistically better fit and fill of the femoral component in the Robodoc system.

The Robodoc system is thought to be safe and effective in producing radiographically superior implant fit and positioning without fractures and other complication. Precise fit of the implant may be increase bone-to-implant contact, providing stress transfer from prosthesis to bone and more bone growth into prosthesis.

Segmental collapse occurs in the early stage of a vascular necrosis (AVN) of the femoral head, and is associated with a poor prognosis. Since it develops at a relatively young age, the long-term outcome after total hip replacement is a major concern. We have compared the long-term results of pedicle bone grafting (PBG) with those of transtrochanteric rotational osteotomy (TRO). In the PBG group there were 23 men (27 hips) and three women (4 hips) with a mean age at the time of surgery of 38 years and a mean follow-up of 13 years. In the TRO group there were 44 men (55 hips) and 19 women (22 hips) with a mean age at the time of surgery of 39 years and a mean follow-up of seven years. Failure was defined as a need for total hip replacement or a Harris hip score below 70.

The long-term results were similar for the two groups. The survival rates at five and ten years were 85% and 67%, respectively, in the PBG group, and 71% and 61%, respectively, in the TRO group, according to Kaplan-Meier survivorship analysis. In the TRO group patients in stage II had significantly better results that those in stage III.

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.

We reviewed 98 children (133 hips) with developmental dysplasia of the hip who underwent arthrography immediately after closed reduction by overhead traction. We followed the patients to skeletal maturity to investigate whether soft-tissue interposition influences acetabular development and avascular necrosis over the long term.

The shape of the limbus and the thickness of the soft-tissue interposition at the acetabular floor, as shown on arthrograms at the time of reduction, were not directly related to the final radiological results or to the incidence of avascular necrosis. Even if marked soft-tissue interposition was found on the initial arthrogram, spontaneous disappearance was noted in 71% up to the age of five years. The final radiological results showed no difference between those in which the interposition disappeared and those with none at the time of closed reduction. However, the requirement for secondary surgery at the age of five years was significantly higher in those with more than 3.5 mm of soft-tissue interposition. In the no-disappearance group (group C) further operation was necessary in 100% and the results were significantly worse at maturity according to Severin’s classification.

We suggest that the indications for open reduction should not be based solely on the arthrographic findings at the time of closed reduction.

We studied the morphological changes in the proximal femur in 42 patients (42 hips) who had had varus derotation osteotomy of the upper femur for residual acetabular dysplasia and congenital subluxation of the hip and who did not show deformity of the head of the femur. In 19 patients the alignment of the whole leg was examined. The femoral neck-shaft angle (FNSA) at the final examination was unrelated to that immediately after operation or to the state of the acetabulum at that time. The postoperative FNSA was not related to the final result but the CE angle obtained at surgery influenced the outcome. The femoral length did not differ significantly between the unaffected and affected sides. Significant differences were found in the femorotibial angle (176.6 degrees v 174.5 degrees) and in the point of intersection between the mechanical axis and knee (65.0% v 57.2%).