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[ABSTRACT]Methotrexate-related lymphoproliferative disorder (MTX-LPD) is a serious complication of methotrexate (MTX) treatment in patients with rheumatoid arthritis. We treated 3 patients with MTX-LPD associated with rheumatoid arthritis. Patient 1 was a 55-year-old woman whose chest X-ray showed abnormal shadows 16 years after she started MTX treatment. Patient 2 was a 63-year-old woman who had signs/symptoms of viral rhinitis and whose chest X-ray showed multiple shadows and lung infiltrates. A definitive diagnosis of MTX-LPD was obtained from a bronchoscopic biopsy specimen. Patient 3 was a 44-year-old woman whose chest computed tomography scans showed incidental bilateral axillary lymphadenopathy after anaphylactic shock associated with an injection of a biosimilar of infliximab. After MTX discontinuation, the LPD resolved in all 3 patients and has not recurred through up to 5 years of follow-up.

[SUMMARY] An acetabular component of total hip arthroplasty that protrudes into the pelvis carries a risk of injury to the iliac blood vessels during removal of the implant. We report three cases of intrapelvic migration of an acetabular component in contact with the iliac vessels. Preoperative computed tomography angiography in all cases revealed that the external /or internal iliac vessels were displaced superiomedially due to compression by the migrated cup. The implants were removed safely using a conventional hip approach in combination with release of vessels via a retroperitoneal approach in two cases, and via temporal intra-aortic balloon occlusion in one case. One of the two patients treated with a retroperitoneal approach underwent acetabular reconstruction in a consecutive surgery in a supine position through a direct anterior approach, and the other underwent reconstruction through a direct lateral approach after a postural change. For the patient who underwent intra-aortic balloon occlusion, we performed resection arthroplasty to allow a less invasive treatment. No marked intraoperative bleeding caused by injury to iliac vessels occurred in any patient, although one case required blood transfusion for oozing. These cases show that dissection of the iliac vessels via a retroperitoneal approach is safe with minimum morbidity during handling of the migrated acetabular components. A direct anterior approach can be used for acetabular revision of the protruded components without patient repositioning by combining this procedure with a retroperitoneal approach. Intra-aortic balloon occlusion is an alternative for protruded components in a case with a risk of vessel injury during dissection.

[SUMMARY] The introduction of new efficacious therapeutic agents and a treatment strategy aiming at early diagnosis and aggressive treatment intervention has drastically changed the treatment of rheumatoid arthritis（RA） over the past 20 years. Two large observational cohort studies, namely Institute of Rheumatology Rheumatoid Arthritis（IORRA）, Tokyo Women’s Medical University, and National database of rheumatic diseases by iR-net in Japan（NinJa）, have shown the current treatment trends in patients with RA in Japan. The present study aimed to investigate the current situation of the treatment of patients with RA at Chiba University Orthopaedic department. A cross-sectional observational study including 195 patients with RA（45 males/150 females ; mean age: 64.8 years ; mean disease duration : 15.3 years） was conducted to address this question. Information on drug use, previous medical history, type of orthopedic surgeries related to RA, and laboratory data of the patients were examined. The rates of using methotrexate（mean dosage: 7.7 mg/week） and biologic agent were approximately 76% and 30%, respectively. Approximately 30% of patients had previously undergone orthopedic surgeries, and 16% underwent multiple surgeries. Total knee arthroplasty（TKA） was the most frequent surgery （22%）, and bilateral procedure was performed in almost half of these patients with TKA. However, further studies corroborating the findings regarding the treatment of RA at our institution are required.

[SUMMARY] Introduction: It is generally believed that total hip arthroplasty（THA） is contraindicated in Charcot arthropathy because of poor outcome. We describe a patient with Charcot arthropathy of the hip with a two-year follow-up after THA. Case report: A 59-year-old woman with Charcot-Marie-Tooth disease complained of a sense of discomfort in her right hip joint and gait disturbance. X-ray imaging revealed disappearance of the right femoral head because of joint destruction. THA was conducted under a diagnosis of Charcot arthropathy. To prevent postoperative dislocation, a tractional direct anterior approach was applied to preserve the remaining muscle strength with a minimally invasive technique providing quick rehabilitation. Three dimensional, CT-based preoperative planning was used to achieve a safe zone for the implant alignment. Conclusion: At two years after the THA, the outcome in this patient with Charcot’s arthropathy is satisfactory., [要旨] 【緒言】一般的に股関節のシャルコー関節に対する人工股関節置換術は禁忌であると考えられていた。しかし近年成績良好な報告が散見されており，適応には議論がある。 【症例】症例はCharcot-marie-tooth 病の既往のある59歳女性，誘引なく歩行困難感が出現し受診した。レントゲン，CT で右大腿骨頭の消失を認め，シャルコー関節の診断とし，人工股関節置換術を施行した。牽引手術台を用いた前方アプローチにより軟部組織の温存をはかることで脱臼を予防した。術前計画に3 次元テンプレートソフトを用い，インプラントのアライメントを確認した。 【結論】2 年と追跡期間は短いものの，シャルコー関節に対する人工股関節置換術で良好な成績を得た。

[SUMMARY] 【Objectives】To evaluate the long-term outcome of rotational acetabular osteotomy（RAO） by the cumulative 15-year survivorship with conversion to total hip arthroplasty. 【Methods】We retrospectively reviewed 30 joints in a cohort of 25 patients, who underwent RAO for hip dysplasia between August 1985 and August 2001. 【Results】The cumulative Kaplan-Meier survivorship was 100% at 15-years postoperatively. However, 6 joints were converted to THA after those 15 years and survivorship was 80% at final follow up of 19.5 years. 【Conclusion】RAO is an effective surgical procedure for treating symptomatic dysplastic hips in preosteoarthritis and early-stage osteoarthritis, and it maintained good or excellent hip function in the majority of patients at 15 years after the surgery., [要旨] 【目的】寛骨臼回転骨切り術（RAO）は，臼蓋形成不全症に対する関節温存手術の一術式である。本研究の目的はRAOの長期成績を明らかにすることである。【方法】1985年8月より2001年8月までの間に当教室でRAOを施工した25例30股関節を対象に調査した。人工関節置換術（THA）をEndpointと設定し，カプランマイヤー法を用いて生存率を調査した。【結果】術後15年の時点での生存率は100%であった。しかし，15年経過した後に徐々に生存率は低下し，最終観察時では30関節中6関節でTHAへ移行した。【結論】RAOは前関節症，初期関節症を有する臼蓋形成不全症に対する有効な術式である。術後15年の時点で多くの患者で良好な股関節機能が維持されていることが示された。

Purpose: Vertebral compression fracture (VCF) is one of the main adverse clinical consequences of osteoporosis. Pain relief is the principal objective when treating VCFs in elderly people. Balloon kyphoplasty (BKP) using bone cement is a minimally invasive approach for vertebral augmentation available for the management of symptomatic VCFs. However, to our knowledge, clinical investigation of BKP for VCFs in Japan has not yet been reported in the English literature. The purpose of the current study was to examine the clinical efficacy of BKP for VCFs in Japanese patients with osteoporosis.Methods: We evaluated 5 patients with VCFs as a result of osteoporosis. Fracture levels were T12 in one patient and L1 in 4 patients. Conservative treatment for pain was not effective in any patient over 3 months. BKP was performed under general anesthesia.Results: BKP for VCFs was effective for low back pain during 12 months compared with that before surgery. The kyphotic angle at the fracture site significantly improved immediately after surgery and was maintained for 12 months. However, one patient showed adjacent VCF 4 months after surgery. We added BKP at the adjacent VCF.Conclusions: We evaluated the efficacy of BKP for VCFs with osteoporosis. Pain reduction and maintenance of reduction of kyphotic angle were obtained after BKP surgery. However, we need to be aware of its complications.