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ID PMID Title PublicationDate abstract
19785852 [Correct use of methotrexate]. 2009 Insufficient knowledge about the correct dosage and potential implications of overdose have played an important role in recent accidents involving methotrexate (MTX). Therefore, it is important that the prescribing physician as well as the pharmacist and pharmacist's assistant have sufficient knowledge of the usual dosages, precautionary measures, side-effects, interactions and contraindications of MTX, to ensure a correct dosing regimen is prescribed. For nearly all indications, MTX is prescribed in a weekly dose of 5-30 mg and preferably in combination with 5 mg folic acid twice a week on a day that MTX is not used. The toxic dose of MTX lies very close to the effective MTX dose. It is therefore important to look out for signs of toxicity.
19687490 Comparison of Tripterygium wilfordii Hook F versus sulfasalazine in the treatment of rheum 2009 Aug 18 BACKGROUND: Extracts of the medicinal plant Tripterygium wilfordii Hook F (TwHF) have been used in China for centuries to treat a spectrum of inflammatory diseases. OBJECTIVE: To compare the benefits and side effects of TwHF extract with those of sulfasalazine for the treatment of active rheumatoid arthritis. DESIGN: Randomized, controlled trial. A computer-generated code with random, permuted blocks was used to assign treatment. SETTING: 2 U.S. academic centers (National Institutes of Health, Bethesda, Maryland, and University of Texas, Dallas, Texas) and 9 rheumatology subspecialty clinics (in Dallas and Austin, Texas; Tampa and Fort Lauderdale, Florida; Arlington, Virginia; Duncanville, Pennsylvania; Wheaton and Greenbelt, Maryland; and Lansing, Michigan). PATIENTS: 121 patients with active rheumatoid arthritis and 6 or more painful and swollen joints. INTERVENTION: TwHF extract, 60 mg 3 times daily, or sulfasalazine, 1 g twice daily. Patients could continue stable doses of oral prednisone or nonsteroidal anti-inflammatory drugs but had to stop taking disease-modifying antirheumatic drugs at least 28 days before randomization. MEASUREMENTS: The primary outcome was the rate of achievement of 20% improvement in the American College of Rheumatology criteria (ACR 20) at 24 weeks. Secondary end points were safety; radiographic scores of joint damage; and serum levels of interleukin-6, cholesterol, cortisol, and adrenocorticotropic hormone. RESULTS: Outcome data were available for only 62 patients at 24 weeks. In a mixed-model analysis that imputed data for patients who dropped out, 65.0% (95% CI, 51.6% to 76.9%) of the TwHF group and 32.8% (CI, 21.3% to 46.0%) of the sulfasalazine group met the ACR 20 response criteria (P=0.001). Patients receiving TwHF also had significantly higher response rates for ACR 50 and ACR 70 in mixed-model analyses. Analyses of only completers showed similar significant differences between the treatment groups. Significant improvement was demonstrated in all individual components of the ACR response, including the Health Assessment Questionnaire disability score. Interleukin-6 levels rapidly and significantly decreased in the TwHF group. Although not statistically significant, radiographic progression was lower in the TwHF group. The frequency of adverse events was similar in both groups. LIMITATIONS: Only 62% and 41% of patients continued receiving TwHF extract and sulfasalazine, respectively, during the 24 weeks of the study. Long-term outcome data were not collected on participants who discontinued treatment. CONCLUSION: In patients who continued treatment for 24 weeks and could also use stable oral prednisone and nonsteroidal anti-inflammatory drugs, attainment of the ACR 20 response criteria was significantly greater with TwHF extract than with sulfasalazine.
20226018 Work disability remains a major problem in rheumatoid arthritis in the 2000s: data from 32 2010 INTRODUCTION: Work disability is a major consequence of rheumatoid arthritis (RA), associated not only with traditional disease activity variables, but also more significantly with demographic, functional, occupational, and societal variables. Recent reports suggest that the use of biologic agents offers potential for reduced work disability rates, but the conclusions are based on surrogate disease activity measures derived from studies primarily from Western countries. METHODS: The Quantitative Standard Monitoring of Patients with RA (QUEST-RA) multinational database of 8,039 patients in 86 sites in 32 countries, 16 with high gross domestic product (GDP) (>24K US dollars (USD) per capita) and 16 low-GDP countries (<11K USD), was analyzed for work and disability status at onset and over the course of RA and clinical status of patients who continued working or had stopped working in high-GDP versus low-GDP countries according to all RA Core Data Set measures. Associations of work disability status with RA Core Data Set variables and indices were analyzed using descriptive statistics and regression analyses. RESULTS: At the time of first symptoms, 86% of men (range 57%-100% among countries) and 64% (19%-87%) of women <65 years were working. More than one third (37%) of these patients reported subsequent work disability because of RA. Among 1,756 patients whose symptoms had begun during the 2000s, the probabilities of continuing to work were 80% (95% confidence interval (CI) 78%-82%) at 2 years and 68% (95% CI 65%-71%) at 5 years, with similar patterns in high-GDP and low-GDP countries. Patients who continued working versus stopped working had significantly better clinical status for all clinical status measures and patient self-report scores, with similar patterns in high-GDP and low-GDP countries. However, patients who had stopped working in high-GDP countries had better clinical status than patients who continued working in low-GDP countries. The most significant identifier of work disability in all subgroups was Health Assessment Questionnaire (HAQ) functional disability score. CONCLUSIONS: Work disability rates remain high among people with RA during this millennium. In low-GDP countries, people remain working with high levels of disability and disease activity. Cultural and economic differences between societies affect work disability as an outcome measure for RA.
20112357 Bim-Bcl-2 homology 3 mimetic therapy is effective at suppressing inflammatory arthritis th 2010 Feb OBJECTIVE: Rheumatoid arthritis (RA) is a destructive autoimmune disease characterized by an increased inflammation in the joint. Therapies that activate the apoptotic cascade may have potential for use in RA; however, few therapeutic agents fit this category. The purpose of this study was to examine the potential of Bim, an agent that mimics the action of Bcl-2 homology 3 (BH3) domain-only proteins that have shown success in preclinical studies of cancer, in the treatment of autoimmune disease. METHODS: Synovial tissues from RA and osteoarthritis patients were analyzed for the expression of Bim and CD68 using immunohistochemistry. Macrophages from Bim(-/-) mice were examined for their response to lipopolysaccharide (LPS) using flow cytometry, real-time polymerase chain reaction analysis, enzyme-linked immunosorbent assay, and immunoblotting. Bim(-/-) mice were stimulated with thioglycollate or LPS and examined for macrophage activation and cytokine production. Experimental arthritis was induced using the K/BxN serum-transfer model. A mimetic peptide corresponding to the BH3 domain of Bim (TAT-BH3) was administered as a prophylactic agent and as a therapeutic agent. Edema of the ankles and histopathologic analysis of ankle tissue sections were used to determine the severity of arthritis, its cellular composition, and the degree of apoptosis. RESULTS: The expression of Bim was reduced in RA synovial tissue as compared with controls, particularly in macrophages. Bim(-/-) macrophages displayed elevated expression of markers of inflammation and secreted more interleukin-1beta following stimulation with LPS or thioglycollate. TAT-BH3 ameliorated arthritis development, reduced the number of myeloid cells in the joint, and enhanced apoptosis without inducing cytotoxicity. CONCLUSION: These data demonstrate that BH3 mimetic therapy may have significant potential for the treatment of RA.
21074358 The Stanmore knee arthrodesis prosthesis. 2011 Sep Knee arthrodesis is most commonly performed for failed total knee arthroplasty. Conventional arthrodesis techniques are associated with a high incidence of complications and are unsuitable in cases with extensive bone loss. We report our medium-term results using a custom-made cemented knee arthrodesis prosthesis in 10 patients with a mean follow-up of 56.4 months (range, 15-199 months). The prosthesis was implanted as a 1- or 2-stage procedure for infected revision knee arthroplasty or tumor endoprosthesis in 9 patients and as a primary procedure in 1 patient with angiosarcoma involving the knee extensor mechanism. The average combined femoral and tibial bone deficit was 170 mm (range, 56-220 mm). Implant survivorship was 90%. All patients with retained prosthesis had no evidence of residual infection or loosening and were able to mobilize independently. One prosthesis was revised though retained following a prosthetic fracture, and 1 patient underwent above-knee amputation for uncontrolled infection. We conclude that the Stanmore knee arthrodesis prosthesis provides reliable fusion in an otherwise difficult-to-treat group of patients.
19791825 Newer biological agents in the treatment of rheumatoid arthritis: do the benefits outweigh 2009 Oct 22 Recently, three new biological agents, rituximab, abatacept and tocilizumab, have become available for the treatment of rheumatoid arthritis (RA) in patients with active disease, who have not responded to at least one disease-modifying antirheumatic drug (DMARD). Rituximab is an anti-CD20 monoclonal antibody, abatacept modulates T-cell activation and tocilizumab is an interleukin-6 receptor antagonist. Clinical studies with these agents have demonstrated that they are effective in RA patients with moderate to active disease, who have not responded to treatment with at least one DMARD and/or tumour necrosis factor (TNF) inhibitor. Thus far, there is no convincing evidence to show that one of these three new drugs has a superior efficacy over the others or that they have other benefits compared with the TNF inhibitors. The use of rituximab, instead of another TNF inhibitor, might be an option in patients who have not responded to TNF blockade. Abatacept could also be considered, but this has not yet been formally tested. A practical advantage of tocilizumab is that it may be administered as a first-line biological agent. Adverse events, including (usually mild) infusion reactions, are common. There is a small increased risk of serious infections that appears to be similar to that with TNF inhibitors, although each drug may have its own particular risk profile. Thus far, there is no convincing evidence that the new biological agents are associated with an increased risk of malignancies. However, the number of patient-years studied is still rather limited and, hence, continuous postmarketing surveillance is necessary. Adequate studies directly comparing new biological agents with each other and with other biological agents, such as TNF inhibitors, are not available. Hence, no firm conclusions regarding the benefit-risk profile of these agents versus each other can be reached. However, the benefit for a given new biological agent currently appears to outweigh the risk for an individual RA patient with active disease, despite earlier drug treatment.
19195831 Cementless total hip arthroplasty using a spongy metal surface hip prosthesis with a colla 2010 Apr A collarless, proximally porous-coated type of Spongiosa Metal II hip prosthesis was used for cementless total hip arthroplasty in 52 hips, and 48 hips were followed and assessed during a mean follow-up period of 6.3 years (minimum 5 years). There were 8 hips (16.7%) that had stress shielding, and 2 hips (4.2%) that had thigh pain. In terms of stability, the stem was bony stable in 39 hips, fibrous stable in 6, and unstable in 3. The stability of the stem was significantly correlated with the stem canal filling ratio. It was suggested that the much more proximal transfer of loading stress by a collarless, proximally porous-coated stem is not suitable for the Spongiosa Metal II series because it may unacceptably reduce the stability of the stem.
20962851 Members 6B and 14 of the TNF receptor superfamily in multiple sclerosis predisposition. 2011 Mar TNFRSF6B and TNFRSF14 genes were recently associated with Crohn's disease and rheumatoid arthritis. TNFRSF14 is known as herpes virus entry mediator (HVEM), and herpes viruses have been involved in the aetiology of multiple sclerosis (MS). MS patients present human herpes virus 6 (HHV6) in active plaques and increased antibody responses to HHV6. We aimed to ascertain the role of these genes in MS susceptibility and to investigate the relationship of the gene encoding the widely expressed HVEM receptor with the active replication of HHV6 found in some MS patients. Genotyping of 1370 Spanish MS patients and 1715 ethnically matched controls was performed. HHV6A DNA levels (surrogate of active viral replication) were analysed in serum of MS patients during a 2-year follow-up. Both polymorphisms were associated with MS predisposition, with stronger effect in patients with HHV6 active replication-TNFRSF6B-rs4809330(*)A: P=0.028, OR=1.13; TNFRSF14-rs6684865(*)A: overall P=0.0008, OR=1.2; and HHV6-positive patients vs controls: P=0.017, OR=1.69.
21247763 Pyridylmethylthio derivatives as VEGF inhibitors: part 2. 2011 Feb 15 Optimization of compounds 5 and 6 led to the discovery of VEGF inhibitor 10g which reduced CYP inhibition. It was highly active in vitro (VEGF induced HUVEC proliferation assay) and showed efficacies in three disease models in vivo (cancer, RA, and AMD).
21211394 [Expressions of CD147 in peripheral monocytes and T lymphocytes of patients with ankylosin 2010 Nov 9 OBJECTIVE: To investigate the roles of CD147 in the pathogenesis and development of ankylosing spondylitis (AS). METHODS: Flow cytometry was used to detect the expression levels of CD147 in peripheral monocytes and T lymphocytes of 30 AS patients, 30 rheumatoid arthritis (RA) patients and 30 healthy controls (HC). reverse transcription-polymerase chain reaction (RT-PCR) was used to evaluate the expression levels of CD147 mRNA in peripheral blood mononuclear cells (PBMC). Then the expression levels of CD147 were compared among the groups. And a correlation analysis was conducted between CD147 levels and disease activity indices of AS patients. RESULTS: The mean fluorescence intensities of CD147 in monocytes of AS, RA and HC group were 213.5 ± 37.8, 228.7 ± 49.7 and 163.6 ± 44.8, and in T lymphocytes 36.8 ± 10.1, 40.2 ± 10.5 and 28.3 ± 10.6 respectively. Both the expression levels of CD147 in monocytes and T lymphocytes of AS patients were slightly lower than those of RA patients. But the differences was not statistically significant (P > 0.05). Both the CD147 levels in monocytes and T lymphocytes of AS and RA group were significantly higher than those of HC group (P < 0.05). The expression levels of CD147 mRNA in PBMC of AS and RA group were significantly higher than those of HC group (P < 0.05) while no significant difference was found between AS and RA group (P > 0.05). Both the expression levels of CD147 in monocytes and T lymphocytes of AS patients were positively correlated with the patients' erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). CONCLUSION: The expressions of CD147 in peripheral monocytes and T lymphocytes of AS patients are up-regulated and their levels are positively correlated with patients' ESR and CRP. It implies that CD147 plays critical roles in the pathogenesis and development of AS.
19195829 Successful performance of the bi-metric uncemented femoral stem at a minimum follow-up of 2010 Feb We report the mean 15.2 year follow-up results for a porous coated version of the Bi-Metric (Biomet UK Ltd, Bridgend, UK) uncemented femoral stem in young patients. Sixty-four hips were implanted into 54 patients (mean age, 54.3 years) and followed up using the Hospital for Special Surgery score and regular radiographs. The first 13 patients had a TTAP-ST acetabulum (Biomet UK), the remainder receiving a Universal cup (Biomet UK). At 15.2 years, there were no stem failures or femoral revisions. The mean Hospital for Special Surgery score was 34.7 (20-40), and there was no evidence of stem loosening radiologically. There were 3 acetabular revisions and 3 liner changes at 10 years, with a further 5 cup revisions and 9 liner changes at final follow-up.
19882783 Tocilizumab: new drug. Rheumatoid arthritis: another 'mab', no therapeutic advantage. 2009 Oct (1) First-line disease-modifying treatment for rheumatoid arthritis is based on "slow-acting" antirheumatic agents, generally methotrexate. Subsequent options include a TNF-alpha antagonist, followed by rituximab or possibly abatacept; (2) Tocilizumab, a monoclonal antibody, inhibits interleukin-6 receptors. It is licensed in the European Union for patients with rheumatoid arthritis in whom other drugs have failed; (3) Clinical evaluation includes 4 placebo-controlled trials of the methotrexate-tocilizumab combination, after failure of a slow-acting antirheumatic drug (3 trials) or failure of a slow-acting antirheumatic drug and a TNF-alpha antagonist (1 trial). An indirect comparison suggests that tocilizumab is no more effective than rituximab in patients with multiple treatment failure; (4) Tocilizumab, like TNF-alpha antagonists, is an immunosuppressant. It carries a risk of serious infections, haematological disorders (neutropenia, thrombocytopenia), gastrointestinal bleeding, hepatic disorders, and systemic and local reactions during the infusion; (5) the adverse effects of long-term tocilizumab therapy are unknown, particularly the risk of cancer; (6) Tocilizumab carries a risk of interactions with drugs that are metabolised by cytochrome P450 isoenzymes. Clinical consequences cannot be ruled out when co-administered drugs have a narrow therapeutic margin; (7) Tocilizumab is administered intravenously every 4 weeks, making it slightly more convenient that rituximab at the beginning of treatment; (8) In patients with rheumatoid arthritis and multiple treatment failure, it remains to be shown whether tocilizumab has a better risk-benefit balance than rituximab, a drug with which we have more experience. It is therefore better to continue to use rituximab, or possibly abatacept.
19026700 Interleukin-1RN gene polymorphisms in elderly patients with rheumatic inflammatory chronic 2009 Jan The objective of this study was to investigate whether there is an association between IL1RN polymorphism and disease susceptibility for three age-related inflammatory conditions: polymyalgia rheumatica (PMR), giant cell arteritis (GCA), and elderly-onset rheumatoid arthritis (EORA). A tandem-repeat polymorphism within IL1RN intron 2 was analyzed in 139 PMR, 69 GCA, and 156 RA patients (75 with EORA) as well as in 437 healthy subjects, together with the in vitro production of IL-1beta. Our results showed that the IL1RN*2/2 genotype was more frequent in PMR patients compared with controls (p = 0.032, odds ratio = 1.785, 95% confidence interval = 1.047-3.044) and GCA patients (p = 0.008, odds ratio = 4.661, 95% confidence interval = 1.352-16.065). We found no difference in the distribution of genotypes between PMR and EORA or between EORA and controls. However, the frequency of the IL-1RN*2/2 genotype had a tendency to be higher in patients with EORA compared with young onset RA. The presence of IL1RN*1 or IL1RN*2 allele was not associated with severity of the disease in PMR and GCA patients and did not influence the production of IL-1beta. In conclusion, the IL1RN*2 polymorphism in a homozygous state was associated with an increased susceptibility to PMR and may give some clues for a differential therapy with GCA.
19050894 A case of Poncet's disease (tuberculous rheumatism). 2009 Jul We describe a 37-year-old woman with recurrent polyarthritis, and recurrent erythema nodosum on the flexible side of her left forearm. On an X-ray of the chest, infiltration of the right upper lobe was observed. Transcription-reverse transcription concerted reaction in sputum samples revealed Mycobacterium tuberculosis (M. tuberculosis). Resolution of the polyarthritis with anti-tuberculosis (TB) drugs occurred in 3 days. We diagnosed her with Poncet's disease (PD). PD is considered to be a reactive arthritis, which is a different entity from tuberculous arthritis. Although PD is a rare disease, we should be aware of it as one of the differential diagnoses, even in patients without typical symptoms of TB.
20827249 Non-contraceptive benefits of hormonal contraceptives. 2010 Aug Besides the contraceptive effect of the various hormonal contraceptives, it is intended to demonstrate the non-contraceptive health benefits for treatment and prevention of bleeding problems, menstruation-related pain and other disorders, such as premenstrual syndrome and signs of androgenization. The effectiveness can be improved by choosing the proper progestogen with antiandrogenic action. Treatment but also prevention can be achieved with hormonal contraceptives in benign proliferative diseases of women, such as ovarian cysts, endometriosis, adenomyosis, endometrial hyperplasia, myoma and benign breast disease. Furthermore, hormonal contraceptives such as estrogen/progestogen combinations reduce pelvic inflammatory disease, rheumatoid arthritis, asthma symptoms and preserve bone density. In addition, a major impact in oncological prevention seems to be possible for ovarian, endometrial and colon cancer and these positive preventive effects seem to persist also after discontinuation of hormonal contraceptives. In addition, practical concepts for hormonal contraceptive selection will be outlined.
20594807 Total reconstruction of the temporomandibular joint. Up to 8 years of follow-up of patient 2010 Oct 12 patients underwent temporomandibular joint (TMJ) reconstruction with Biomet total joint prostheses. Indications for TMJ reconstruction included ankylosis, rheumatoid arthritis, degenerative joint disease and condylar resorption. Five patients had unilateral procedures, seven had bilateral. The follow-up ranged between 2 and 8 years. Amongst the ankylotic patients the mean jaw-opening capacity increased from 3.8mm preoperatively to 30.2mm 1 year after surgery, and in most of those patients the opening capacity remained stable over the years. The other patients maintained a mean opening capacity of more than 35 mm. Joint related pain and interference with eating were eliminated after TMJ reconstruction. There were no permanent facial nerve disturbance, no postoperative infections and no device related complications. The outcome supports prosthetic TMJ reconstruction as a useful treatment modality in patients with advanced TMJ disease.
19917618 A systematic comparison of combination DMARD therapy and tumour necrosis inhibitor therapy 2010 Jan OBJECTIVE: We examined how combination DMARD therapies and TNF inhibitors therapies plus MTX (TNF/MTX) affect clinical and radiological outcomes compared with MTX monotherapy in early RA. METHODS: We systematically searched EMBASE, PubMed and Ovid Medline for randomized controlled trials (RCTs) of combination therapy in early RA. We evaluated ACR responses, withdrawals for inefficacy and toxicity, HAQ and radiographic progression. Meta-analysis using Review Manager evaluated random effects odds ratios (ORs) and random effects weighted mean differences (WMDs) between treatments. RESULTS: A preliminary search identified 2029 citations; 15 were relevant RCTs (4200 randomized patients). Patients with active disease were enrolled. Compared with MTX monotherapy, both combination DMARDs and TNF/MTX increased ACR20-70 responses (OR 1.64-2.02 and 2.03-2.30, respectively), reduced withdrawals for inefficacy (OR 0.52 and 0.29), reduced HAQ (WMD -0.17 and -0.16) and reduced annual X-ray progression (WMD -1.20 and -0.84%). DMARD combinations increased withdrawals for toxicity (OR 2.69; there was no difference with TNF/MTX). The only head-to-head RCT showed comparable efficacy for combination DMARDs and TNF/MTX combinations. CONCLUSIONS: In early active RA, both combination DMARDs and TNF/MTX are more effective than MTX monotherapy. DMARD and TNF/MTX combinations had equal efficacy on ACR response, withdrawals for inefficacy, disability and erosive progression. There is an apparent advantage for TNF/MTX combinations in the effect on toxicity with fewer consequent patients. We conclude that there is strong evidence in favour of combination treatment for RA but there is still uncertainty about which regimen is preferable.
20122151 Autophagy induction and CHOP under-expression promotes survival of fibroblasts from rheuma 2010 INTRODUCTION: Synovial fibroblasts from rheumatoid arthritis show resistance to apoptotic stimuli, indicating they may be difficult to treat. To clearly understand these mechanisms of resistance, rheumatoid and osteoarthritis synovial fibroblasts (RASF and OASF) were exposed to endoplasmic reticulum (ER) stress such as thapsigargin, Ca2+-ATPase inhibitor. METHODS: Fibroblasts were assessed microscopically for cell viability by trypan blue exclusion and for autophagic cells by LC-3II formation. Caspase-3 activity was measured as aminomethyl-coumarin (AMC) liberated from AC-DEVD-AMC. Immunoblotting was performed to compare protein expression in OASF and RASF. RESULTS: ER stress caused cell death in OASF but not in RASF. Thapsigargin, a Ca2+-ATPase inhibitor, did not change the expression of GRP78, an ER chaperone in OASF and RASF, but induced another ER stress protein, CCAAT/enhancer binding protein (C/EBP) homologous protein (CHOP) differently, showing high levels in OASF and low levels in RASF. Thapsigargin increased the autophagy response in RASF, with autophagosome formation, beclin expression, and LC3-II conversion. Transfection with beclin siRNA inhibited autophagy and increased the susceptibility to ER stress-induced cell death. On the other hand, CHOP siRNA increased autophagy and improved cell survival, especially in RASF, indicating that CHOP is involved in regulation of autophagy and cell death, but that low expression of CHOP protects RASF from apoptosis. CONCLUSIONS: Autophagy induction and CHOP under-expression increases cell resistance against ER stress-induced cell death in fibroblasts from rheumatoid arthritis patients.
20875612 Manifestations of systemic diseases on thoracic imaging. 2010 Nov A familiarity with the numerous findings in commonly encountered systemic diseases is necessary for the radiologist interpreting any chest study. These systemic diseases include collagen vascular diseases, vasculitides, granulomatous diseases, neoplasms, hematologic and metabolic abnormalities, neurocutaneous syndromes, deposition disease, and miscellaneous conditions such as cystic fibrosis and Goodpasture's syndrome. Although the imaging findings of these and other recognized systemic diseases are often nonspecific and varied, an understanding of their typical manifestations allows the radiologist to play a significant role in suggesting a particular diagnosis and impacting patient care.
19336802 Charnley low-frictional torque arthroplasty: follow-up for 30 to 40 years. 2009 Apr Of the 11 054 Charnley low-frictional torque arthroplasties carried out at our hospital between 1962 and 1977, 110 (94 patients) had a minimum follow-up of 30 years with a mean of 32.3 years (30.0 to 40.5). The mean age of the patients at operation was 43.3 years (17.0 to 65.0) and 75.7 years (51.0 to 97.0) at follow-up. Overall, 90% of hips (99) were free from pain and activity was reported as normal in 58% of the patients. A total of 13 hips (11.8%) were revised at a mean follow-up of 32.3 years (30.0 to 39.5), with wear and loosening of the acetabular component as the main indications. The clinical results did not reflect the mechanical state of the implant. Follow-up with sequential radiographs of good quality is essential. Revision for radiological changes alone must be accepted if gross loss of bone stock is to be avoided. Improvements in the design, materials and operative technique, based on the long-term outcome, are highlighted.