The anterolateral MIS-THA approach can be divided into the Modified Watson-Jones approach (MWJ) performed in the lateral position and the Anterolateral Supine method (ALS) performed in the supine position. Femoral preparation is flexible in stem selection in the MWJ method. On the other hand, the ALS method is more stable for placement on the acetabular implant.

Now we introduce novel anterolateral MIS approach named AL60, it makes use of the merits of both MWJ and ALS methods.

Introduction

Simultaneous bilateral total hip arthroplasty is now widely accepted for their economically and functionally advantages than staged total hip arthroplasty.

But there is concerning higher demands of blood transfusion than unilateral procedure.

Multiple studies suggest that tranexiamic acid (TXA) reduces perioperative blood loss.

However there is no report for simultaneous bilateral total hip arthroplasty in these studies.

Hypothesis

TXA reduces significant blood loss after bilateral total hip arthroplasty.

Introduction: “Spongiosa metal” this unique implant surface was introduced in 1982 by ESKA implants Germany.

Pore size was between 800 and 1500 microns with an overall porosity of 60%. The pore depth of the interconnecting surface structure reached up to 3000 microns.

The purpose of this retrospective study is to report the long term results of Spongiosa Metal I cement less total hip prosthesis in Japan.

Materials and Methods: Between 1986 and end 1990 total 113 prostheses were implanted and consecutive 106 implants could be evaluated.

The all evaluated prosthesis combined 28mm ceramic head and polyethylene inlay.

Results: Average follow up period was 17 years.

2 cups and 1 stem were revised by aseptic loosening.

2 stem breakage and 7 ceramic head fracture were seen while following up.

85% of the patients had retained the original prostheses (cup, stem, ceramic head, and inlay).

Survival rate was investigated by Kaplan-Meier method.

Survival rate for the cup component was 95%, and for the stem component was 93%.

Discussion: Main reason of the revision surgery was the ceramic head fracture (7 implants 6%)

We thought that beating with the hammer when we install the ceramic head to the taper was one problem.

On the other hand, few aseptic loosening was seen while following up.

These results suggest that spongiosa metal system can bear for long term of use.

Conclusion: 85% of the patients had retained the original prostheses average 17years following up period.

Main reason for the revision surgery is ceramic head fracture.

We are convinced with this spongiosa metal surface can bear long term of use.

Expecting the low wear property and the longevity, since October 1998, we have been using the alumina on alumina bearing for the hip arthroplasty. Until July 2008, for dysplastic 1078 hips we have implanted the bearing couple. Among them, we evaluated 86 hips in 79 patients (male 3, female 76) with the primary arthroplasty, Spongiosa Metal II Total Hip System (GHE: ESKA implants, Lübeck, Germany/Biolox Forte^®: Ceramtec AG, Plochingen, Germany), osteoarthritis secondary to developmental dysplasia, age 60 or below, and a minimum of five years follow-up. The preoperative diagnosis included the failed pelvic and/or femoral osteotomy, avascular necrosis after DDH, dislocation, and subdislocation. The average age at the surgery was 53 (27 to 60). The average of follow-up period was 6.3 (4.6 to 9.1) years. The implants have a macro-porous structure on the surface. To set the metal shell in the intended position, the sclerotic lesion was adequately resected by the chisels and then we used the acetabulum reamers. Otherwise the sclerotic lesion would prevent the reamer to go into the suitable direction. We reamed the acetabulum until the lamina interna to use the maximum size of the metal shell (i.e. to use the liner as thick as possible) and at the same time for the medialization of the hip center. To avoid impingement, the osteophyte was resected without hesitating. We added the adductor tenotomy for 19 hips, the extensive release of the flexor tendons (including the quadriceps origin, the sartroius origin, and the gluteus maximus insertion) for three hips, and the release of the extensor insertion (the gluteus maximus) for two hips, and the release of the flexor insertion (the iliopsoas) for two hips.

The hip score was improved in all patients. The average amount of the hip score was 59 before the surgery and was 90 at the final follow-up. A positive Trendelenburg sign was observed in 53 hips (62%) before the surgery and 12 hips (14%) at the final follow-up. We had no revision, no bearing failure (alumina fracture or excessive wear), no dislocation, and no squeaking in these patients. The average inclination angle of the cup was 41 (29 to 49) degrees. The average anteversion angle of the cup was 19 (13 to 27) degrees. No patient required the revision surgery. At the final follow-up, all implants were stable. In the acetabulum, the radio-lucent line was observed in two hips (2%) (zone I). In the femur the line was observed in 13 hips (15%). All lines existed in the proximal femur. There was no cystic osteolytic lesion. The prevalence of these periprosthetic reactions was less than those in the same type implant with the polyethylene on alumina bearing.

Some authors alerted that the alumina on alumina articulation should only be applied in when the optimized implant orientation is obtained so as to prevent the impingement and dislocation. Fortunately the alignment in this study was within the safe zone. However, we must always be very careful of the joint alignment, range of motion, and the muscle tension during the surgery to avoid the bearing failure, as setting an adequate alignment and obtaining a firm uncemented fixation of the cup is relatively difficult in dysplastic hips. From this view point, Spongiosa Metal II cup suits the use of the alumina on alumina bearing especially for dysplastic hips.

We apply a hydrocolloid-gel sheet (C-12, Karayaheive, Alcare, Tokyo, Japan) for the hip arthroplasty. The sheet is a kind of wound dressing film made of the Hevea sap. The Hevea sap has been widely applied for the stoma or cosmetics (e.g. facial mask, UV protection moisturizer, hair lotion). We use it since October 2004. It applies the moist wound healing mechanism without preventing the self-wound-healing. The surgical exudate is kept under the sheet to apply the moist wound healing mechanism. The sheet had been improved originally as a wound dressing material. Because of its very strong adhesiveness, we use it also as an alternative to the epidermal suture. In our method, we do not use any epidermal suture or staples. We use an anterolateral approach making an arcate incision. After the subcutaneous tissue was sutured just like as in the case of using the epidermal sutures or staples, the sheet was attached to the skin. Both the sheet and the overlaying gauze were not changed until the removals on the tenth day after surgery.

We have applied this wound closure method for 814 primary surgeries. Among them, we evaluated 56 hips in 49 patients (three males and 46 females) (including seven patients of the simultaneous bilateral surgery) with minimum of two years follow-up. The average age at the surgery was 61 (40 to 77). The diagnosis at the surgery was dysplastic osteoarthritis for 50 hips in 45 patients, primary osteoarthritis for five patients in three hips, and rheumatoid arthritis for one hip. The uncemented implants were used for all patients. In all patients, a good wound healing was obtained. The wound dehiscence occurred in two patients, however the wound healed later by attaching the hydrocolloid-gel sheet again. The hyperplastic scar was observed in one hip.

Though Orientals have less ability of wound healing than Caucasian, a satisfactory wound healing was achieved without any epidermal suture. Comparing the conventional skin closure methods, the hydrocolloid gel sheet brought about less pain; as no removal of staples was necessary, less time and labor, less medical waste, and better wound healing. As the disadvantage, some sensitive patients might mind the smell of the exudate under the gel sheet. The wound closure method using the hydrocolloid-gel sheet was very useful for the hip arthroplasty.

Introduction: Unique spongiosa like surface structure was introduced in 1982 by ESKA implants Germany. It is called “Spongiosa-Metal I surface” The purpose of this retrospective study is to report and compare long term results of Spongiosa Metal I total hip prosthesis in Japan and Germany.

Method: In Japan, between June 1986 and August 1990 total 113 prostheses were implanted and consecutive 106 implants could be evaluated. In Germany, between May 1983 and December 1985 total 209 prostheses were implanted and consecutive 165 implants could be evaluated. The all evaluated prosthesis combined ceramic head and polyethylene inlay.

Results: In Japan, average follow up period was 17 years. 85% of the patients had retained the original prostheses (cup, stem, ceramic head, and inlay). Survival rate was investigated by Kaplan-Meier method. Survival rate for the cup component was 95%, and for the stem component was 93%. In Germany, average follow up period was 21.8 years.

88.5% of the patients had retained the original prosthesis. Survival rate for the cup component was 95%, and for the stem component was 85%.

Discussion: Main reason of the revision surgery was the ceramic head fracture (7 implants 6%) in Japan and the stem component loosening (14 implants 8%) in Germany.

There was no ceramic head fracture in Germany. We thought that beating with the hammer when we install the ceramic head to the taper was one problem. Stem loosening was seen in undersized stem component. On the other hand, survival rate for the cup component was 95% in Japan and Germany. This was good result in comparison with other reports about long term survival.

Conclusion 85% of the patients had retained the original prostheses average 17years in Japan and 88.5% average 21.8 years in Germany. Main reason for the revision surgery is stem loosening and ceramic head fracture. Survival rate for the cup component was 95% in Japan and Germany. We are convinced with this spongiosa metal surface can bear long term use.

We examined solvent-dried, gamma-irradiated (SD-R) allografts and fresh-frozen (FF) allografts mechanically and morphologically. Before transplantation, FF grafts were more than six times stronger than SD-R grafts. After four weeks, the tensile strength was about the same in both groups. At 24 weeks only collagen fibrils of small diameter were observed in the SD-R grafts while in FF grafts fibrils of small and intermediate diameter were seen. Clinically, we suggest that SD-R grafts could be used as a favourable alternative to FF grafts if care was taken regarding their initial mechanical weakness.

We assessed arthroscopically 22 young athletes with an isolated acute posterior cruciate ligament (PCL) injury. Four had significant damage to the articular cartilage of the medial femorotibial compartment and were advised not to resume sports. Three underwent PCL reconstruction because of a reparable meniscal tear or instability. The other 15 were treated conservatively and resumed sport. At an average follow-up of 51 months, one had developed arthritic symptoms due to newly-developed severe chondral damage to the medial femoral condyle, but none of the other 14 had developed arthritic symptoms and most remained athletically active. Severe chondral damage should be seen at an early arthroscopy. Knees with an isolated injury to the PCL with concomitant articular damage may be successfully managed by conservative treatment.

From 1986 to 1993, we repaired 278 torn menisci in 264 patients using an arthroscopically assisted inside-out technique. A total of 132 meniscal repairs in 122 patients were evaluated by second-look arthroscopy. At review, only nine patients had meniscal symptoms, such as locking, swelling or pain. Ninety-seven menisci (73%) had healed completely at the repair site, but there were new tears in different areas of 21 menisci, some of which had complete healing at the repair site. Incomplete healing, seen in 23 menisci (17%), was frequently near the popliteus tendon, most commonly where there had been an associated anterior-cruciate-ligament injury. Arthroscopically-assisted meniscal repair seems to be a reliable procedure, but some clinically successful cases had incomplete healing at the repair site or a newly-formed tear in the meniscal body or both. These lesions may cause meniscal symptoms to appear at a later date.