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Extreme changes of the hip joint often require individual technical supplements in addition to the endoprosthesis. But the base of success are procedures using a model of prosthesis and a technique that are matured. This is available e.g. with the old M. E. Muller curved stem hip joint prosthesis. In special cases of extreme changes or damage of the proximal femur we perform in artificial joint-replacement of the hip or changing of prostheses a special kind of operative treatment. This is a combination of the Original-M. E. Muller curved stem endoprosthesis, long or short version of the femoral part, in addition fixated by bone-cement and M. E. Muller's special metal socket--primary indicated for stabilization of the acetabular roof. The indications for this method can be changes of proximal femur and hip-joint, especially dysplasias of pelvis or hip joint, extensive fractures especially in old patients, destructions in polyarthritis, dysplasia of pelvis and coxitis caused by juvenile chronic arthritis and long time therapy with corticosteroids, destructions, loosenings and fractures in changing operations of hip-endoprostheses. Until today we treated 15 different cases by this method--one case was operated 13 years ago--with good results, prooved by Merle d'Aubigne's score.

Detritus synovitis is a sequel of cartilage and osseous destruction in diarthrosis. Cartilage and bone fragments are enclosed by granulation tissue. Remnants of the destroyed bone and calcified cartilage appear as defined accumulations of hydroxylapatite crystals in the granulation tissue. These hydroxylapatite tissues resemble those considered by other authors as being responsible for a "third crystal synovitis, namely, hydroxylapatite synovitis". However, the findings communicated here allow us to conclude that these crystals are the sequel of a destruction of diarthrosis, so that it is not justified to consider hydroxylapatite synovitis as a separate disease entity.

Examination by light- and transmission electron microscopy of synovial tissues from 11 patients with psoriatic arthritis revealed several morphologic pictures. Besides the previously well described zones of fibrosis and degeneration of superficial cells, now the following were shown: 1. vascular alterations, especially of endotheliocytes, 2. transitional forms among endotheliocytes, perivascular cells, and fibroblasts as well as 3. lymphoidfollice-like accumulations of round cells. These changes could indicate the presence of an exogenous agent with perhaps strong antigenic effect but in low concentration. Such findings could be interpreted as indicating that in psoriasis there is an immunologic process in stratum synoviale which leads through abnormal cell proliferation and fibrosis to the final destructive event, osterarthritis and ankylosis.

Objective There is increasing evidence that T cell-independent pathways, such as the up-regulation of protooncogenes and the production of growth factors and matrix-degrading enzymes, lead to progressive destruction of affected joints. Therefore, identification of differentially regulated genes restricted to rheumatoid arthritis (RA) synovial fibroblasts is essential. A combination of RNA arbitrarily primed–polymerase chain reaction (RAP-PCR) and complementary DNA (cDNA) array with defined genes was used for a highly sensitive differential screening using small amounts of RNA. Methods RNA was extracted from cultured synovial fibroblasts obtained from 6 patients with RA and 6 patients with osteoarthritis (OA). RAP-PCR was performed using different arbitrary primers for first- and second-strand synthesis. PCRs were hybridized to cDNA array membranes. RA samples were compared with OA samples for differentially expressed genes. Results In contrast to standard cDNA array, the identification of 12 differentially expressed genes in RA compared with OA (∼6%) was possible. Differentially expressed genes of interest were confirmed using semiquantitative RT-PCR and in situ hybridization. Conclusion Numerous variants of the differential display method and continuous improvements, including RAP-PCR, have proven to be both efficient and reliable for examining differentially regulated genes. Our results show that RAP-PCR combined with cDNA arrays is a suitable method for identifying differentially expressed genes in rheumatoid synovial fibroblasts, using very small amounts of RNA.

As a part of a long-term follow up (I) of 544 cemented Muller-curved stem total hip replacements (THR), implanted 1977 to 1983, 207 THR in 163 patients with rheumatoid arthritis (RA) were evaluated 9 to 15 years (11 on an average) postoperatively. The feed back rate was 96.9 % so the results are very reliable. 18 cups were loosened (13 already changed), but no stem had to be changed for aseptic loosening. 2 THR (1.0 %) had to be revised because of deep infection. Survival rate of Kaplan and Meier for aseptic loosening was 94.6 % after 10 years, 83.5 % after 15 years. The ARO multi-center-study 1995 (II) includes 3113 THR implanted 1987 and 1988. Within a follow-up period of 7 to 9 years the over all rate of aseptic changing for cemented cups (1.4 %) was significantly lower than for uncemented cups (2.9 %) – in RA even 1 % versus 5.7 %. The corresponding rates for stems was 1.0 % (cemented) versus 1.8 % (uncemented). We contributed 110 THR in 94 patients with RA with feed back of 100 %. Because of deep infection one THR had to be changed and two were explanted. But no change of cup or stem because of aseptic loosening was observed. Also in the literature survival rates up to 97 % after 10 years or 77 % after 25 years even in younger patients with RA can be stated. Conclusions: Cemented THR shows good long-term-results in RA which with uncemented designs have also to be proved. As a consequence of analysing the (few) failures the cemented THR of Wessinghage with optimized bone-cement-implant-compound was introduced. We demand a high feed back rate in long-term follow-ups also with respect to quality management and comparing data.

From 5/87 to 7/90 in the I. Orthopadische Klinik des BRK-Rheumazentrums Bad Abbach/Regensburg, partial unicompartimental replacement of surfaces of 102 knee joints was performed in 96 patients. The operation with an improved technique took place mostly in older women suffering from varus gonarthrosis. Complications were rare and could be corrected. In most of the cases the preoperative malposition and instability could be corrected, and pain could be relieved. In the postoperative course we noted an essential improvement of both the extension and the flexion. In der Zeit von 5/87-7/90 wurde an der I. Orthopadischen Klinik des BRK-Rheumazentrums Bad Abbach/Regensburg bei 96 Patienten an 102 Kniegelenken, davon 6mal doppelseitig, ein partieller Gelenkflachenersatz eines Kompartements vorgenommen. Die Eingriffe erfolgten mit erheblich verbesserter Technik vorwiegend bei Frauen hoheren Alters mit Varusgonarthrose. Komplikationen waren selten und konnten insgesamt behoben werden. Es gelang in allen Fallen, die praoperative Fehlstellung und Instabilitat zu korrigieren, den Schmerz deutlich zu mindern bzw. Schmerzfreiheit zu erzielen. Im Gesamtverlauf zeigte sich durchschnittlich eine erhebliche Verbesserung des Streckdefizits und der direkt postoperativ kurzfristig bestehenden Beugungseinbusen.

Radiolunate arthrodesis (RLA) has become an established surgical technique for stabilising wrists destroyed by RA. Our modified surgical technique with special osteosynthesis material has enabled the spectrum of indications to be expanded to include stage IV a--sagittal instability.44 radiolunate arthrodeses were carried out from 10.96 to 6.98. 19 (43.2%) satisfied the criteria for correction RLA with correction of sagittal instability. All (100%) of the 19 radiolunate arthrodeses were included in a follow-up examination, and all were examined clinically and radiologically at specified intervals. The mean follow-up is 22.8 months.Correction of the lunate drift in the sagittal plane was successful. The radiolunate angle was reduced from a mean 23.7 degrees before surgery to 9.3 degrees afterwards. The lunate drift in the frontal plane, which is shown by the ulnar translation index (UTI) was corrected from an average of 0.35 before surgery to 0.30 afterwards. Restoration of the carpal height by bone grafting from a mean preoperative CHI of 0.47 to 0.50 after surgery was achieved. We discovered one failure, thus the consolidation rate dropped to 94.7%.Since the capitate is the centre of rotation and movement at the wrist, a stable central pivot is essential, and correction of sagittal instability is particularly important. This demand can also be met by our modified radiolunate arthrodesis.

Erosive-destructive changes in rheumatoid arthritis particularly in the large joints of the lower limbs often result in the patient's immobility. The aim of this retrospective study was to weigh the benefits of multiple joint replacement in rheumatoid arthritis against the specific complications.From January 1977 until 31 December 1998, 215 patients with proven rheumatoid arthritis (according to the ACR classification) received three or four endoprostheses in the lover limbs. In a retrospective study with a standard questionnaire and evaluation of the patient record, we were able to assess 201 rheumatoid patients (93.5%) who received 688 endoprostheses (93.7%), with 347 total hip prostheses (THR) and 341 total knee prostheses (TKR).There was a significant improvement of the patient's ability to walk and in 16.9% of the cases even a remobilization of the rheumatoid patients who had been unable to walk before surgery. On the other hand, there were significant complications--in the majority of the cases (appr. 60%) with total knee replacement. Together the complications per implant had an extremely high complication rate of 43.8% (n=88) per rheumatoid patient.Due to the long-term follow-up of 22 years (1977 through 1998), we were able to demonstrate that with a new implant generation and a more a careful indication this unacceptable complication rate can be reduced considerably. However, the multiple joint replacement of the lower limbs remains a difficult method with a high complication rate and should therefore only be performed at orthopedic rheumatological centers.

Seit langem gilt das an einen Pfahl gebundene krumme Baumchen aus NICOLAS ANDRYS Werk von 1741 als Symbol des Faches Orthopadie (Abb. 1). Diese Abbildung ist so bekannt, dass man annehmen konnte, der Verfasser habe sie als Titelkupfer dem Werk vorangestellt, weil er selbst schon darin das Sinnbild des Fachgebietes gesehen habe, dem er den neuen Namen Orthopadie gab. Doch gehort die Abbildung nur zu einem einzelnen Kapitel, namlich zum Kapitel uber krumme Beine von Kindern, und soll lediglich eine entsprechende mechanische Korrekturmasnahme illustrieren. Fur das Titelkup fer wahlte ANDRY dagegen einen ganz anderen, viel abstrakteren Entwurf (Abb. 2) Eine von drei wohlgebildeten Kindern umgebene weibliche Gestalt halt einen langen geraden Stab in den Handen mit der Aufschrift: „haec est regula recti“, „dies ist das Richtmas fur das Gerade [d. h. das Richtige, Normgerechte]“.

Johann Friedrich Dieffenbach (Abb.1) gilt als der Vater der Plastischen aber auch der Orthopadischen Chirurgie. Er war, geboren am 1.2. 1792, ein Sohn Konigsbergs, der Kronungsstadt Friedrichs I., Konig in Preusen. Die Universitat war Alma mater auch des grosen deutschen Philosophen Immanuel Kant und vieler anderer beruhmter deutscher Gelehrter. Heute - obwohl nie russisch und nie polnisch -, mit fremdem Namen belegt, lauft die Stadt und ihr Name Konigsberg, trotz ihrer grosen Bedeutung fur die preusische und deutsche Geschichte, fur Kultur und Wissenschaft, trotz ihrer Tradition, Gefahr, auch schon bei vielen unserer Landsleute der Vergessenheit anheim zu fallen [11]. Nach seiner Teilnahme am Befreiungskampf gegen Napoleon I., nach dem Studium der Medizin in seiner Vaterstadt und in Bonn, nach Studienaufenthalten vor allem in Paris, wobei er die Grosen seines Fachs: D.J. Larrey (1766-1842) und G. LE Dupuytren (1777-1835), F. Magendie(1783-1855) und A. Boyer (1757-1833), vor allem auch J.-M. Delpech (1777-1832) – Begrunder der Orthopadie in Frankreich - kennenlernte, promovierte er in Wurzburg. Seit 1823, auf Anraten Wilhelm VON Humboldts, erwarb er in Berliner in Berlin als „Arzt und Operateur“ die Approbation, mit der er schliesich 1829 als „Charitearzt bei der Chirurgischen Station“ neben Johann Nepomuk Rust (1775-1845) in die Leitung der grosn Berliner Klinik eintrat. Im 50. Lebensjahr wurde er in der Nachfolge Carl Ferdinand VON Graefes (1828-1870) - Vater des berumten ophthalmologen Albrecht VON Graefe -, Direktor des Koiglichen Chirurgischen Klinikums in der Ziegelstrase.

Long-term results of unicompartmental arthroplasty (UCA) in medial osteoarthritis are analyzed and the influencing covariates were explored.261 UCA in 229 patients were evaluated mainly by use of a structured questionnaire, 98.5% of the UCA were analyzed after 10 (5-20) years.In the Knee Sec. Score, the items pain and function were improved significantly. Patients were very content with the UCA. Failures (total 30) were especially caused by destruction of the non-replaced compartment (n = 11) and loosening of the tibial component (n = 5). Survival with aseptic failures as the endpoint was 84.9% after 10 and 74.4% after 20 years. Gender, age at operation, design (St. Georg, Tönnis, Endo, Wessinghage) and height of tibial component could not be proved as determining covariates with sufficient statistical significance.Cemented unicompartmental knee arthroplasties show good long-term results in medial osteoarthritis, when the criteria for the indication are strictly respected.

Im Jahre 2000 ist zu gedenken des jeweiligen 200. Geburtstags zweier beruhmter Vettern aus der Orthopaden-FamilieHeine in Wurzburg: Bernhards und des spater geadelten Jacob Von Heine. Der Weg dieser Familie wurde fast uber ein Jahrhundert zunachst durch Johann Georg Heine und dann durch ihn gepragte vier weitere Namenstrager - seinen Sohn Joseph und zwei Neffen (drei Vettern), ferner den Grosneffen K(C) Arl Wilhelm (1838–77) - bestimmt [16, 16]. Um die berufliche Entwicklung und die Leistungen der beiden Jubilare besser zu wurdigen, mussen wir uns zunachst ihrem Onkel zuwenden (Abb.1).

Mit der Einfuhrung seiner zementierten Bogenschaft-Huftendoprothese En­de der 60er Jahre hat M. E. Muller entscheidend zur weiten Verbreitung des kunstlichen Huftgelenkersatzes mit Totalendoprothesen (TEP) beigetragen 13. Wie die Prothese von Charnley beruht die Bogenschaft-TEP auf dem low friction-Prinzip: der relativ geringen Reibung zwischen Polyethylen­pfanne und artikulierendem Metallkopf des Prothesenschaftes. Diese TEP erfullte bereits weitgehend die Anforderungen, die sowohl von Seiten des Operateurs, als auch des Patienten an ein kunstliches Gelenk gestellt wer­den. Andererseits hat die Analyse von Fehlschlagen zu Weiterentwicklungen auf dem bewahrten Prinzip dieser TEP beigetragen.

Between January 1983 and December 1987, metatarsal head-resections were performed on 203 patients, comprising a total of 370 feet, using the Hueter/Mayo and Hoffmann procedure. Seventy-two patients, comprising a total of 126 feet, were available for post-operative review after an average of 11.4 years from the date of the original operations. The information obtained from standardized questionnaires was compared to the information found in each patient's file. In addition, every available pre- and post-operative x-ray taken from 1983 to 1987 was analyzed. Thus, with an average follow-up period of 5.6 years, the changes found in the pre- and post-operative x-rays from a total of 183 feet could be compared. Before the operations, nearly 100% of the examined feet suffered from painful synovial hypertrophy and erosion of the metatarsophalangeal joints with dislocation and subluxation, causing approximately 70% of all patients to have great difficulties in walking. After the operations, however, 90.2% of the patients reported that this condition had noticeably improved or had completely disappeared. In fact, 87.5% of all patients reported a lasting improvement in their ability to walk longer distances. As the main criteria in determining the success of an operation (namely, the noticeable reduction of pain and increased mobility) were achieved in 87.5% of the patients, we consider the metatarsal head-resection a reliable method of correcting forefoot deformities in rheumatoid arthritis.

Es war ein weiter Weg von der aus der Antike stammenden Idee des Gelenkersatzes bis zu dessen Realisierung in der Moderne. Fur die Parze Klotho — fruhzeitig und vor Generationen von Mannern als Frau „chirurgisch“tatig — verwandte zur Zusammenfugung der verspeisten Schulter des Junglings Pelops als Mittel des Ersatzes den edlen Stoff, das Elfenbein; eine Substanz, dem angestammten Knochen in Entwicklung, Form und Eigenschaften, fur jeden erkennbar, auserst ahnlich. Die „arztliche“Grostat der Klotho, basierend auf dem Elfenbein, erschien erfolgreich, denn bildlich last sich — noch heute — nachweisen, das weder die Gestalt noch die Funktion der Schultern des Pelops gelitten haben. Wie anders hatte er als Wagenlenker im Brautkampf vier kraftige Rosser lenken, sie anfeuern und zugeln konnen (Abb. 1). Der Parze Klotho mit ihrem Pelops war mehr Gluck beschieden als denjenigen, die die Idee mit dem Gelenkersatz aus Elfenbein viele Jahrhunderte spater praktizierten.

Auf der Basis langer Erfahrungen mit Unikompartiment-Kniegelenksschlittenprothesen (UCS) hat Wessinghage eine neue zementierbare UCS entwickelt, die ab 1987 zur Implantation freigegeben wurde. Die UCS nach Wessinghage (Fa. Sulzer Orthopedics (AlloPro), Gelsenkirchen, Abb. 1) zeichnet sich durch einen optimalen Knochen-Zement-Implantat-Verbund aus, was durch Zementtaschen auf der Entfernung uberschussigen Zements. Die Femurkufe aus Protasul-1® ist in vier, das Plateau aus Sulene® in drei Grosen und vier Hohen (6, 8, 12 mm) verfugbar. Gerade Kantenfuhrungen im dorsalen Kufenbereich erleichtern die Implantation. Ziel dieser Arbeit wahr es, Langzeitergebnisse (>5 Jahre) mit dieser UCS bei der typischen Indikation (Destruktion des medialen Kompartiments) zu evaluiren und mit denen von vor 1987 implantieren UCS anderer Hersteller zu vergleichen.

Open synovectomy of the knee in early cases has become a standard procedure in rheumatoid patients. Therefore, this study was performed to evaluate long-term results of open knee synovectomy in later cases of rheumatoid arthritis. Clinical findings in 93 knees after late open synovectomy are presented. The average follow-up was 10.1 (6.4-12.7) years. The failure rate was 39.8 per cent and so in 60.2 per cent (56 knees) no further operation was necessary. In 12 of 37 cases the revision was done by resynovectomy and reconstructive surgery. Thus during the follow-up period (10.1 years) in 73.1 (n=68) per cent of knee synovectomy no knee arthroplasty was performed. Patients reported as well reduction of pain and swelling with a high grade of satisfaction. Despite these reasonable functional results, radiographic progression of disease (Larsen stage 2.2 to 3.7) is common after synovectomy. Our study shows that late open synovectomy can delay the need for definite replacement surgery in nearly three-quarters of the patients.

Reports on patients with hemiparalysis indicate the importance of the nervous system for the pathophysiology of rheumatoid arthritis (RA) or osteoarthritis (OA). Norepinephrine (NE) and opioids seem to be more antiinflammatory neurotransmitters whereas substance P is proinflammatory. The study aimed to investigate the direct noradrenergic nerve-immune cell interaction in human synovial membrane. We used a recently developed superfusion technique with electrical stimulation of synovial membrane to elicit local NE from synovial membrane slices. The readout parameter of synovial immune cells was interleukin-6 (IL-6). IL-6 was spontaneously secreted from RA and OA synovial membranes. Electrical field stimulation intensively reduced IL-6 secretion. In patients with OA or RA, this electrically induced reduction of IL-6 secretion was not significantly changed by alpha- or beta-adrenergic antagonists. The study demonstrates that local endogenous NE seem to play a minor role, which may be due to a depletion of NE or loss of noradrenergic fibers during chronic RA and OA.

Destruction of articular cartilage and bone by invading synovial fibroblasts is a typical histopathologic feature in rheumatoid arthritis (RA). However, little is known about specific up- or downregulation of genes leading to this aggressive phenotype. Thus, our aim was to identify genes, which are differentially expressed in RA synovial fibroblasts as compared to synovial fibroblasts derived from patients with osteoarthritis (OA) using RAP-PCR for differential display.After extraction of total RNA, the first step of RAP-PCR was performed using various different arbitrary 10-12-base primers for first-strand cDNA synthesis. Second-strand synthesis was achieved by cycling at low stringency conditions for 35 cycles using different arbitrary 10-base primers, followed by electrophoretic separation and sequence analysis of the amplified fingerprint products.On average, approximately 70 different RNAs were obtained per primer, of which most were expressed both by RA and OA synovial fibroblasts. Using 26 different primer combinations, in total 12 cDNAs were differentially expressed between RA and OA synovial fibroblasts. In the RA group strong amplification of distinct PCR products suitable for sequencing could be observed. Sequence analysis identified these PCR products as highly homologous to various genes involved in regulation of cell cycle and metabolism.The data indicate that RAP-PCR is a suitable method to identify differentially expressed genes in rheumatoid synovial fibroblasts potentially involved in the specific pathophysiology of RA.

Our aim was to identify specifically expressed genes using RNA arbitrarily primed (RAP)-polymerase chain reaction (PCR) for differential display in patients with rheumatoid arthritis (RA). In RA, amplification of a distinct PCR product suitable for sequencing could be observed. Sequence analysis identified the PCR product as highly homologous to a 434 base pair segment of the human centromere kinesin-like protein CENP-E. Differential expression of CENP-E was confirmed by quantitative reverse transcription PCR, immunohistochemistry and in situ hybridization. CENP-E expression was independent from prednisolone and could not be completely inhibited by serum starvation. RAP-PCR is a suitable method to identify differentially expressed genes in rheumatoid synovial fibroblasts. Also, because motifs of CENP-E show homologies to jun and fos oncogene products and are involved in virus assembly, CENP-E may be involved in the pathophysiology of RA., Introduction: Articular destruction by invading synovial fibroblasts is a typical feature in rheumatoid arthritis (RA). Recent data support the hypothesis that key players in this scenario are transformed-appearing synovial fibroblasts at the site of invasion into articular cartilage and bone. They maintain their aggressive phenotype toward cartilage, even when first cultured and thereafter coimplanted together with normal human cartilage into severe combined immunodeficient mice for an extended period of time. However, little is known about the upregulation of genes that leads to this aggressive fibroblast phenotype. To inhibit this progressive growth without interfering with pathways of physiological matrix remodelling, identification of pathways that operate specifically in RA synovial fibroblasts is required. In order to achieve this goal, identification of genes showing upregulation restricted to RA synovial fibroblasts is essential. Aims: To identify specifically expressed genes using RNA arbitrarily primed (RAP)-polymerase chain reaction (PCR) for differential display in patients with RA. Methods: RNA was extracted from cultured synovial fibroblasts from 10 patients with RA, four patients with osteoarthritis (OA), and one patient with psoriatic arthritis. RAP-PCR was performed using different arbitrary primers for first-strand and second-strand synthesis. First-strand and second-strand synthesis were performed using arbitrary primers: US6 (5' -GTGGTGACAG-3') for first strand, and Nuclear 1+ (5' -ACGAAGAAGAG-3'), OPN28 (5' -GCACCAGGGG-3'), Kinase A2+ (5' -GGTGCCTTTGG-3')and OPN24 (5' -AGGGGCACCA-3') for second-strand synthesis. PCR reactions were loaded onto 8 mol/l urea/6% polyacrylamide-sequencing gels and electrophoresed.Gel slices carrying the target fragment were then excised with a razor blade, eluated and reamplified. After verifying their correct size and purity on 4% agarose gels, the reamplified products derived from the single-strand confirmation polymorphism gel were cloned, and five clones per transcript were sequenced. Thereafter, a GenBank® analysis was performed. Quantitative reverse transcription PCR of the segments was performed using the PCR MIMIC® technique.In-situ expression of centromere kinesin-like protein-E (CENP-E) messenger (m)RNA in RA synovium was assessed using digoxigenin-labelled riboprobes, and CENP-E protein expression in fibroblasts and synovium was performed by immunogold-silver immunohistochemistry and cytochemistry. Functional analysis of CENP-E was done using different approaches (eg glucocorticoid stimulation, serum starvation and growth rate analysis of synovial fibroblasts that expressed CENP-E). Results: In RA, amplification of a distinct PCR product suitable for sequencing could be observed. The indicated complementary DNA fragment of 434 base pairs from RA mRNA corresponded to nucleotides 6615-7048 in the human centromere kinesin-like protein CENP-E mRNA (GenBank® accession No. emb/Z15005).The isolated sequence shared greater than 99% nucleic acid (P = 2.9e-169) identity with the human centromere kinesin-like protein CENP-E. Two base changes at positions 6624 (A to C) and 6739 (A to G) did not result in alteration in the amino acid sequence, and therefore 100% amino acid identity could be confirmed. The amplification of 10 clones of the cloned RAP product revealed the presence of CENP-E mRNA in every fibroblast culture examined, showing from 50% (271.000 ± 54.000 phosphor imager arbitrary units) up to fivefold (961.000 ± 145.000 phosphor imager arbitrary units) upregulation when compared with OA fibroblasts. Neither therapy with disease-modifying antirheumatic drugs such as methotrexate, gold, resochine or cyclosporine A, nor therapy with oral steroids influenced CENP-E expression in the RA fibroblasts. Of the eight RA fibroblast populations from RA patients who were receiving disease-modifying antirheumatic drugs, five showed CENP-E upregulation; and of the eight fibroblast populations from RA patients receiving steroids, four showed CENP-E upregulation. Numerous synovial cells of the patients with RA showed a positive in situ signal for the isolated CENP-E gene segment, confirming CENP-E mRNA production in rheumatoid synovium, whereas in OA synovial tissue CENP-E mRNA could not be detected. In addition, CENP-E expression was independent from medication. This was further confirmed by analysis of the effect of prednisolone on CENP-E expression, which revealed no alteration in CENP-E mRNA after exposure to different (physiological) concentrations of prednisolone. Serum starvation also could not suppress CENP-E mRNA completely. Discussion: Since its introduction in 1992, numerous variants of the differential display method and continuous improvements including RAP-PCR have proved to have both efficiency and reliability in examination of differentially regulated genes. The results of the present study reveal that RAP-PCR is a suitable method to identify differentially expressed genes in rheumatoid synovial fibroblasts. The mRNA, which has been found to be upregulated in rheumatoid synovial fibroblasts, codes for a kinesin-like motor protein named CENP-E, which was first characterized in 1991. It is a member of a family of centromere-associated proteins, of which six (CENP-A to CENP-F) are currently known. CENP-E itself is a kinetochore motor, which accumulates transiently at kinetochores in the G2 phase of the cell cycle before mitosis takes place, appears to modulate chromosome movement and spindle elongation,and is degraded at the end of mitosis. The presence or upregulation of CENP-E has never been associated with RA. The three-dimensional structure of CENP-E includes a coiled-coil domain. This has important functions and shows links to known pathways in RA pathophysiology. Coiled-coil domains can also be found in jun and fos oncogene products, which are frequently upregulated in RA synovial fibroblasts. They are also involved in DNA binding and transactivation processes resembling the situation in AP-1 (Jun/Fos)-dependent DNA-binding in rheumatoid synovium. Most interestingly, these coiled-coil motifs are crucial for the assembly of viral proteins, and the upregulation of CENP-E might reflect the influence of infectious agents in RA synovium. We also performed experiments showing that serum starvation decreased, but did not completely inhibit CENP-E mRNA expression. This shows that CENP-E is related to, but does not completely depend on proliferation of these cells. In addition, we determined the growth rate of CENP-E high and low expressors, showing that it was independent from the amount of CENP-E expression. supporting the statement that upregulation of CENP-E reflects an activated RA fibroblast phenotype. In summary, the results of the present study support the hypothesis that CENP-E, presumably independently from medication, may not only be upregulated, but may also be involved in RA pathophysiology.

A 22 year old male patient with antiphospholipid-antibody syndrome (APL) developed severe bilateral avascular necrosis of both femoral condyles. Extensive synovectomy and arthrolysis in combination with an arthroplastic remodeling of both knee joints resulted in reduction of pain and joint effusion. Therefore, synovectomy and arthroplastic remodeling might be a promising therapy to extend the period of time to prosthetic joint replacement in young patients with APL.

As a part of long-term follow up (I) of 544 cemented Müller-curved stem total hip replacements (THR), implanted 1977 to 1983, 207 THR in 163 patients with rheumatoid arthritis (RA) were evaluated 9 to 15 years (11 on an average) postoperatively. The feed back rate was 96.9% so the results are very reliable. 18 cups were loosened (13 already changed), but no stem had to be changed for aseptic loosening. 2 THR (1.0%) had to be revised because of deep infection. Survival rate of Kaplan and Meier for aseptic loosening was 94.6% after 10 years, 83.5% after 15 years. The ARO multi-center-study 1995 (II) includes 3113 THR implanted 1987 and 1988. Within a follow-up period of 7 to 9 years the over all rate of aseptic changing for cemented cups (1.4%) was significantly lower than for uncemented cups (2.9%)--in RA even 1% versus 5.7%. The corresponding rates for stems was 1.0% (cemented) versus 1.8% (uncemented). We contributed 110 THR in 94 patients with RA with feed back of 100%. Because of deep infection one THR had to be changed and two were explanted. But no change of cup or stem because of aseptic loosening was observed. Also in the literature survival rates up to 97% after 10 years or 77% after 25 years even in younger patients with RA can be stated.Cemented THR shows good long-term-results in RA which with uncemented designs have also to be proved. As a consequence of analysing the (few) failures the cemented THR of Wessinghage with optimized bone-cement-implant-compound was introduced. We demand a high feed back rate in long-term follow-ups also with respect to quality management and comparing data.

Extreme changes of the hip joint often require individual technical supplements in addition to the endoprosthesis. But the base of success are procedures using a model of prosthesis and a technique that are matured. This is available e.g. with the old M. E. Müller curved stem hip joint prosthesis. In special cases of extreme changes or damage of the proximal femur we perform in artificial joint-replacement of the hip or changing of prostheses a special kind of operative treatment. This is a combination of the Original-M. E. Müller curved stem endoprosthesis, long or short version of the femoral part, in addition fixated by bone-cement and M. E. Müller's special metal socket--primary indicated for stabilization of the acetabular roof. The indications for this method can be changes of proximal femur and hip-joint, especially dysplasias of pelvis or hip joint, extensive fractures especially in old patients, destructions in polyarthritis, dysplasia of pelvis and coxitis caused by juvenile chronic arthritis and long time therapy with corticosteroids, destructions, loosenings and fractures in changing operations of hip-endoprostheses. Until today we treated 15 different cases by this method--one case was operated 13 years ago--with good results, prooved by Merle d'Aubigné's score.

Dupuytren’s disease has a prevalence of 1%–3% (Viljanto 1973) and usually occurs in middle aged or elderly men (gt;40 years). Females suffer much less frequently from this disorder (Fig. 1), as shown by Yost et al. (1955), who found a male:female ratio of 3:1. Although there is an often mentioned “causal” association with diabetes mellitus (Pal et al. 1987), this is not etiologically significant.

Fibromatoses can be regarded as tumorous proliferations “intermediate in their biological behavior between benign fibrous lesions (e.g. nodular fasciitis) and fibrosarcoma” (Enzinger and Weiss 1988) (Fig. 1). They are usually divided into superficial (Dupuytren-type) and deeply located groups. Since they do not metastasize they should not be called low-grade fibrosarcomas (Allen 1977). Below, some of the more common types of fibromatoses with the exception of Dupuytren’s disease, will be briefly summarized. The different fibrous proliferations of infancy and childhood will not be discussed.

Between 1. 1. 1977 and 30. 6. 1988, 1470 total hip prostheses were implanted at the 1st Orthopedic Clinic in Bad Abbach/Regensburg. In 101 cases (82 patients, average age 54.8 years) the acetabular convexity was built up at the same time. This is considered indicated if the acetabulum is too shallow and thus provides insufficient lateral or dorsolateral countersupport. The main area of indication is dysplasia-coxarthrosis and congenital dislocation of the hip, destructive coxitis in chronic polyarthritis or juvenile chronic arthritis, and loosened prostheses. The material used for building up the convexity is a block of corticocancellous bone, which is fixed ventrolaterally to dorsolaterally to the ilium by osteosynthesis. Autologous material was used in 88 cases and homologous material in 13. Sixty-one patients with a total of 77 built-up convexities were followed up. In 92.2% a bony bridge between the corticocancellous block and the rising branch of the ilium was fund. The method described is a valuable addition to replacements in case of extreme hip joint changes and replacement operations. In the authors' opinion it has considerable advantages over supporting shells and similar materials.

Articular cartilage, obtained from the large toe during hallux valgus operations in 37 patients, was investigated for the presence of amyloid by using the Congo red staining method. Amyloid deposits were demonstrated, particularly in the superficial layer of the cartilage, in 30 cases. This amyloid did not react immunohistochemically with any of the antibodies against the known five major amyloid types (AA, A lambda, A kappa, AF, AB). From these data it is concluded that hyaline cartilage in older individuals is prone to infiltration by an amyloid of a hitherto unidentified class. From the morphological observations there seems to be no correlation between amyloid deposits and the development of osteoarthrosis.

Based on positive experiences in similar operations of the said method, we report 3 cases of periprosthetic fractures after total knee arthroplasty treated by the principle of intramedullary osteosynthesis. After preoperative X-ray-planning a shorted AO-medullar nail was positioned on the proximal site of the prostheses in combination with autogenous resp. homogeneous bone grafts located in the fracture area. In relation to other procedures the advantages of these compound osteosyntheses are undisturbed periosteal blood supply, correct alignment and consolidation of the fracture, early weight bearing and reliable cement fixation. They legitimate in our opinion the increased effort of partial revision arthroplasty.

Das den Knorpel zerstorende Pannusgewebe kann lichtmikroskopisch unterschiedliche Veranderungen aufweisen. Eine Sequenz von zerstorendem Granulationsgewebe (Abb. 1 a) uber Narbengewebe (Abb. 1 b) bis hin zu chondroidem Gewebe (Abb. 1 c) mit oft starker Safraninophilie der Matrix (Abb. 1 d) kann dabei verfolgt werden [3].

Die chronische Polyarthritis (cP) ist kein einheitliches Krankheitsbild, sondern ein polyatiologisches Syndrom, das durch einen variablen Verlauf mit uneinheitlichem Ansprechen auf die Therapie und unterschiedliche Prognose gekennzeichnet ist [12]. Generell wird dabei eine einheitliche Pathomorphologie zugrundegelegt. Jedoch findet man bei der cP in operierten Gelenken nicht nur makroskopisch [19], sondern auch mikroskopisch unterschiedlich zu wertende morphologische Veranderungen.

Der Begriff „Rheuma“ fast zahlreiche subjektive und objektive Erkrankungszeichen zusammen, die im Bereich der Bewegungsorgane — Stamm und Extremitaten — auftreten. Subjektiv handelt es sich um bagatellartig auftretende geringgradige, aber auch um den Patienten beeintrachtigende Misempfindungen, Beschwerden und Schmerzzustande. Diese konnen mit Schwellungen, Deformierungen, Fehlstellungen und Versteifungen in den entsprechenden Manifestationsbereichen auftreten, schliesen in der Folgezeit aber nicht immer Formen- bzw. Gestaltveranderungen von Extremitatenabschnitten, ganzer Extremitaten oder der Wirbelsaule bzw. des ganzen Korpers aus. Einzelne Symptome konnen sich mono-, oligo- oder polytop im Bereich von Wirbelsaule und Extremitaten, am Skelettsystem wie an den Weichteilen, auch unter Einbeziehung innerer Organe und Organsysteme, auswirken.

UNLABELLED As a part of long-term follow up (I) of 544 cemented Muller-curved stem total hip replacements (THR), implanted 1977 to 1983, 207 THR in 163 patients with rheumatoid arthritis (RA) were evaluated 9 to 15 years (11 on an average) postoperatively. The feed back rate was 96.9% so the results are very reliable. 18 cups were loosened (13 already changed), but no stem had to be changed for aseptic loosening. 2 THR (1.0%) had to be revised because of deep infection. Survival rate of Kaplan and Meier for aseptic loosening was 94.6% after 10 years, 83.5% after 15 years. The ARO multi-center-study 1995 (II) includes 3113 THR implanted 1987 and 1988. Within a follow-up period of 7 to 9 years the over all rate of aseptic changing for cemented cups (1.4%) was significantly lower than for uncemented cups (2.9%)--in RA even 1% versus 5.7%. The corresponding rates for stems was 1.0% (cemented) versus 1.8% (uncemented). We contributed 110 THR in 94 patients with RA with feed back of 100%. Because of deep infection one THR had to be changed and two were explanted. But no change of cup or stem because of aseptic loosening was observed. Also in the literature survival rates up to 97% after 10 years or 77% after 25 years even in younger patients with RA can be stated. CONCLUSIONS Cemented THR shows good long-term-results in RA which with uncemented designs have also to be proved. As a consequence of analysing the (few) failures the cemented THR of Wessinghage with optimized bone-cement-implant-compound was introduced. We demand a high feed back rate in long-term follow-ups also with respect to quality management and comparing data.