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At least 199 records · Page 11Linked to original sources
PubMed2003

Randomised controlled trial of hip protectors for the prevention of second hip fractures.

OBJECTIVE: to assess whether the use of Safehip hip protectors would prevent second hip fractures among men and women living in the community. DESIGN: pragmatic randomised controlled trial. SETTING: people living in the community. PARTICIPANTS: men and women aged 70 years and over who had sustained one hip fracture and who were living in the community. RESULTS: 366 men and women who were either living outside residential care or were about to be discharged back home were randomised to receive three pairs of hip protectors or to act as controls. Approximately 34% of participants allocated to receive hip protectors wore them every day. After a median follow up of 14 months 8 participants had a second hip fracture with 6 in the intervention and 2 in the control group (Odds Ratio for second hip fracture=3.10, 95% confidence interval 0.62-15.58). Hip protectors had no effect on risk of other fractures or on falls. CONCLUSION: this trial does not suggest a benefit of the studied hip protector among people living outside residential accommodation.

Accidental Falls↗
PubMed1998

Individual risk factors for hip osteoarthritis: obesity, hip injury, and physical activity.

Hip osteoarthritis is a major cause of pain and disability. The authors explored individual risk factors for hip osteoarthritis in a population-based case-control study. The study was performed in two English health districts (Portsmouth and North Staffordshire) from 1993 to 1995. A total of 611 patients (210 men and 401 women) listed for hip replacement because of osteoarthritis over an 18-month period were compared with an equal number of controls selected from the general population and individually matched for age, sex, and family practitioner. Information about suspected risk factors was obtained by a questionnaire administered at interview and a short physical examination. Obesity (odds ratio (OR) = 1.7, 95% confidence interval (CI) 1.3-2.4; highest vs. lowest third of body mass index), previous hip injury (OR = 4.3, 95% CI 2.2-8.4), and the presence of Heberden's nodes (OR = 1.6, 95% CI 1.2-2.2) were independent risk factors for hip osteoarthritis among men and women. Hip injury was more closely related to unilateral as compared with bilateral disease. There were a negative association between cigarette smoking and osteoarthritis among men and a weak positive association with prolonged regular sporting activity. Obesity and hip injury are important independent risk factors for hip osteoarthritis, which might be amenable to primary prevention. Hip osteoarthritis may also arise as part of the polyarticular involvement found in generalized osteoarthritis.

Aged↗
PubMed1988

Comparison of maximal isometric hip abductor muscle torques between hip sides.

A posturally induced "stretch weakness" of the right hip abductor muscles has been reported in many healthy right-handed persons in the literature. The purpose of this study was to test for differences in the maximal isometric hip abduction torque produced between hip sides across multiple hip abduction angles. The torques were measured on 40 healthy right-handed individuals using a specialized torque-testing table at hip abduction angles of -10, 0, 10, 20, 30, and 40 degrees. Statistical analysis of the results did not demonstrate a specific "weakness" of the right hip abductor muscles at the hip angle used to clinically test them. The results, however, did demonstrate statistically significant differences in the torque-hip angle slopes across hip sides. We hypothesized that these slope differences may result from muscle adaptation to lengths imposed by standing posture. We discuss how manual muscle testing procedures may bias the likelihood of encountering stretch weakness in muscles that are habitually maintained at near-maximal elongation.

Adult↗
PubMed2005

Ilizarov hip reconstruction for the late sequelae of infantile hip infection.

BACKGROUND: The late sequelae of infantile hip infection include absence of the femoral head and neck, proximal migration of the femur, lower-extremity length discrepancy, abnormal gait, and pain. The Ilizarov hip reconstruction includes an acute valgus and extension osteotomy at the proximal part of the femur combined with gradual distraction for realignment and lengthening at a second, more distal, femoral osteotomy. The purpose of this study was to determine whether this technique can successfully treat the sequelae of infantile hip infection. METHODS: We performed a retrospective review of a series of eight consecutive patients with a Type-IV or V hip deformity, according to the classification system of Hunka et al., after an infantile hip infection. The patients' mean age at surgery was 11.2 years. All hips were unstable, with a mean of 3.8 cm of proximal migration. A mean valgus angulation of 44 degrees and a mean extension angulation of 19 degrees were created with the proximal osteotomies. Distal femoral lengthening averaged 5.7 cm, and distal femoral varus angular correction averaged 10 degrees. The mean time in the Ilizarov frame was 4.7 months. Outcomes were evaluated clinically and radiographically. The clinical evaluation included gait analysis and the use of a modified Harris hip score. RESULTS: At the time of follow-up, at a mean of five years, the mean lower-extremity length discrepancy had improved from 4.6 cm preoperatively to 0.7 cm. The mean modified Harris hip score had improved from 51 points to 73 points (p = 0.007). All extremities were well aligned, with a mean pelvic mechanical axis angle of 89 degrees. The mean deviation of the mechanical axis was 2 mm in a lateral direction. The mean stance-time asymmetry improved from 16% to 5.4% (p = 0.0037), and the mean ground-reaction force (second peak) improved from 102% of body weight to 122% of body weight (p = 0.0005). CONCLUSIONS: The Ilizarov hip reconstruction can successfully correct a Trendelenburg gait and simultaneously restore knee alignment and correct lower-extremity length discrepancy. When the procedure is performed on a young patient, remodeling of the proximal osteotomy site and development of lower-extremity length discrepancy should be expected and the procedure may need to be repeated.

Biomechanical Phenomena↗
PubMed2000

The development and validation of a radiographic grading system for the hip in ankylosing spondylitis: the bath ankylosing spondylitis radiology hip index.

OBJECTIVE: To develop a simple but reproducible radiological scoring system for the hip in ankylosing spondylitis (AS). METHODS: A consensus approach was used to develop a grading system whereby hip radiographs of 470 patients with AS were scored from 0 to 4 (normal, suspicious, mild, moderate, and severe), producing the Bath Ankylosing Spondylitis Radiology Hip Index ( BASRI-hip or BASRI-h). The system was designed to be specific for AS radiographic change at the hip and includes circumferential joint space narrowing, osteophytes, erosions, and protrusio acetabulae. This score can then be added to the BASRI-spine, forming the grading system BASRI-total, scored 2-16. Radiographs of 134 patients were used to test reproducibility. Blinded radiographs of 100 non-AS patients were included randomly to assess disease specificity. Sensitivity to change was determined using 438 radiographs from 122 patients, over 219 time intervals. RESULTS: Inter and intraobserver variation for the right and left hip showed 83-84% and 94-96% complete agreement, respectively. Disease specificity was 0.76. If non-AS patients with a total hip replacement were excluded, disease specificity was 0.83. Sensitivity to change became apparent at one year (p < 0.001). Grading the hips using a single radiograph takes seconds. CONCLUSION: BASRI-h is a reliable method for grading hip radiographic change in AS. It is disease-specific, sensitive to change, simple to use, and rapid to perform.

Female↗
PubMedDate not supplied

Treatment of developmental dysplasia of the hip before walking: results of closed reduction and immobilization in hip spica cast.

We retrospectively evaluated 200 hips of 129 patients with the diagnosis of developmental dysplasia of the hip treated with closed reduction and hip spica cast. There were 153 female and 47 male hips in the group. The mean age of the patients at the time of the reduction were six (range. 2-13) months and mean follow-up was 51 (range: 16-240) months. All the patients were treated with closed reduction and were immobilized in hip spica cast. The mean time of immobilization in the cast was 102 (range: 45-190) days. Avascular necrosis was observed in 15% of the hips. Clinical and radiological end results of the patients were evaluated with modified McKay criteria and Severin classification. Eighty-two percent of the patients had satisfactory results according to modified McKay criteria and 76% of the patients according to Severin classification. The most important parameters affecting the end result were pre-reduction location of the hip, pre-operative acetabular index values and avascular necrosis. Based on the results of this study, treatment of developmental hip dysplasia with closed reduction and hip spica cast is a relatively safe and effective method.

Casts, Surgical↗
PubMed1989

[Disappearing hip--algodystrophy of the hip].

Algodystrophy of the hip--also characterized as disappearing hip, transient demineralization of the hip, neurotropic rheumatism of the hips, or osteolytic arthropathy of the hips--is a pseudoinflammatory disease entity with normal inflammatory parameters involving movement- and load-dependent pain and radiologically visible demineralization of the femoral head. The osteolysis may be so pronounced that the femoral head has become virtually invisible (disappearing hip). The wide spectrum of possibilities in differential diagnosis, including inflammatory hip diseases in particular, together with the rarity of "disappearing hip", often allow diagnosis only retrospectively if the condition has not been thought of from the outset. The usually spontaneous course without residues can be markedly shortened by calcitonin treatment, therapy with nonsteroid antirheumatic agents, or by prednisone treatment. We report 2 cases of "disappearing hip" with typical course treated at the Orthopedic Clinic of Olten Cantonal Hospital in the period 1980 to 1988.

Adult↗
PubMed1981

Wagner surface replacement arthroplasty of the hip. Analysis of fourteen failures in forty-one hips.

Wagner resurfacing arthroplasty of the hip was performed on forty-one hips in forty patients from 1977 to 1979. Results were analyzed with particular attention to prosthetic failures, which occurred in fourteen hips. Loosening of the femoral component occurred in five hips; loosening of both the femoral and the acetabular component, in two hips; loosening of the acetabular component, in two hips; loosening of the acetabular component, in two hips; avascular necrosis of the femoral head (with no concomitant femoral-component loosening), in two hips; and femoral neck fracture, in three hips. Time to failure averaged eighteen months (range, three months to two and one-half years). The over-all failure rate of 34 per cent is considered unacceptably high and therefore I do not recommend the Wagner arthroplasty for routine use. Factors tht may be responsible for the increased failure rate include a high susceptibility to avascular necrosis of the femoral head, the younger age of patients in whom this operation is performed, and the biomechanical design properties of the prosthesis.

Adolescent↗
PubMed1996

[Prevention with hip protectors. Biomechanical aspects in falls and hip fractures].

The cascade of events leading to hip fracture is: a fall, protective responses, impact to the hip, local energy absorption and bone strength. A fall from standing height on the hip corresponds to a force of about 3500 N and the bone strength of the proximal femur in elderly women and men ranges between 2000 to 6000 N. Efficient hip protective systems have been developed and may be a significant factor in the prevention of hip fractures among the elderly with propensity to fall and osteoporosis. Theoretically, more than 90 per cent of all hip fractures can be prevented, and a substantial reduction in the rate of hip fractures can be obtained, when systematic intervention programs are initiated among nursing home residents. Prevention of hip fractures among home dwellers may be a greater challenge, although preliminary results seem promising. Improvement in design has made the protectors more compliant and may facilitate the aim of preventing hip fractures.

Accidental Falls↗
PubMed2003

The Artek cup for total hip replacement of dysplastic hip joints.

BACKGROUND: One specific difficulty in total hip replacement for developmental dysplasia of the hip is a shallow acetabulum with a short anteroposterior diameter. In a prospective cohort study we investigated the short-term results of the Artek cup, designed with a shallow outline and a height-reduced metal inlay for a large size 38 mm metal head, in a group of female patients with mild dysplasia of the hip. METHODS: Fourteen consecutive patients with 17 dysplastic hip joints were included in the study. Their average age was 42 years. Fourteen hips had dysplasia Crowe grade I; 3 hips had dysplasia Crowe grade II. The femoral head centre was localized according to Pagnano in zone 1 in 3 cases, in zone 3 in 6 cases, and in zone 4 in 8 cases. The Harris hip score was 49 points (range 30-68 points). RESULTS: Mean follow-up was 20 months (range 14-24 months). The Harris hip score improved to a mean of 91 points (range 78-98 points). The postoperative radiographic measurements showed an inclination angle of 52.1 degrees (range 43-66 degrees ). The femoral head centre was in Pagnano zone 1 in 13 cases, in zone 2 in 1 case, in zone 3 in 1 case, and in zone 4 in 2 cases. The mean postoperative deviation from the approximative rotational centre was 0.17 mm (range -15 to 13 cm) in the superior direction and 5.3 mm (range -5 to 17 mm) in the lateral direction. CONCLUSION: In a small series of 17 implantations, stable press-fit fixation without screws or bone grafting was achieved despite acetabular defects. The complication rates were high. Inclination angles up to 54 degrees were not correlated with complications. Inclination angles of 60 degrees and more led to subtotal or complete dislocation. Mid-term results are still to follow concerning wear, dislocation rate, loosening and revision.

Adult↗
PubMed2005

Revision total hip arthroplasty in hip joints with metallosis: a single-center experience with 31 cases.

Clinical and radiographic findings of metallosis in relation to the clinical outcome of revision total hip arthroplasty were analyzed for 31 hips. Causes of metallosis were dissociation of polyethylene liner in 24 hips, catastrophic wear in 6, and the screw used for stem fixation in 1. Metallosis was grade I in 12 hips, grade II in 7, and grade III in 12. Osteolysis around the acetabular cup was observed in 24 (77.4%) of 31 hips. At the time of final follow-up evaluation, none of the hips showed osteolysis, acetabular cup migration, or any change in inclination. Although metallosis could not be completely eradicated in severe cases, the clinical outcome for these hips was favorable. This study demonstrates that metallosis frequently causes osteolysis and that complete elimination of it is not a prerequisite for the success of revision total hip arthroplasty.

Adult↗
PubMed2005

Structural differences between hip endoprostheses, and implications on a hip kinetics.

We compared kinetic characteristic of unipolar, bipolar and total hip endoprostheses, implanted after dislocated femoral neck fracture. Ninety patients were divided into three groups (30 patients in each group); a group with unipolar partial hip endoprosthesis (UPEP), a group with bipolar partial hip endoprosthesis (BPEP) and a group with total hip endoprosthesis (TEP). The patients from different groups were paired by parameters which could influence the long term functional result: follow up period, comorbidities, functional capabilities before injury, etc. After the average follow up 3.8 +/- 1.9 years, a measuring of range of hip motions (ROM) was conducted. The largest mean amplitudes in flexion (104 degrees), extension (13 degrees), abduction (35 degrees) and external rotation (38 degrees) was achieved BPEP, the largest adduction (14 degrees) was achieved UPEP, and internal rotation (34 degrees) TEP. Differences in ROMs are partially related to the clinical parameters such as: level of the hip pain, gait pattern, age and rehabilitation period (P < 0.05). Measuring of ROMs is the most reliable part of the clinical exam and it does not depend on subjectivity of patient, as opposed to other clinical parameters (level of pain, walking distance, aids usage, etc). The results obtained are favorable for the bipolar hip endoprosthesis, and they can be related to the biomechanical differences between the three types of hip endoprostheses. Kinetic advantages of the BPEP as compared to the UPEP, can be explained by the BPEP's structure: two-level mobility and a thinner neck which delays impingement in the late motion phase. In comparison to the TEP, clinical advantages of the BPEP can be attributed to less extensive surgery and scarring.

Aged↗
PubMed2004

Patient survival after hip arthroplasty for metastatic disease of the hip.

BACKGROUND: The hip joint is a common location for metastatic disease. Actual as well as impending fractures at this site are frequently due to mechanical instability after tumor invasion and are usually treated surgically with hip arthroplasty. The objective of this study was to analyze survival and influences on survival after hip arthroplasty for metastatic hip disease. METHODS: Two hundred and ninety-nine patients who had undergone a total of 306 hemiarthroplasty or total hip arthroplasty procedures for treatment of a pathologic or an impending pathologic hip fracture between 1969 and 1996 at our institution were included in this study. Data that had been acquired prospectively within the total joint registry of our institution were reviewed retrospectively. RESULTS: The median duration of survival after the arthroplasty was 8.6 months. The duration of survival was significantly associated with the site of the fracture, location of the primary tumor, and time from the diagnosis of the primary tumor to the surgery for the fracture (p < or = 0.05). The time from the diagnosis to the arthroplasty was a significant independent predictor of survival. CONCLUSIONS: Patients undergoing hip arthroplasty for metastatic disease have a limited life expectancy, with only 40% (120) of the 299 patients in our series still alive at one year after the surgery. By identifying prognostic factors regarding life expectancy, this study provides surgeons and oncologists with information with which to weigh risks and benefits of hip arthroplasty for individual patients preoperatively.

Adult↗
PubMed2006

Long-term survival of the acetabular component after total hip arthroplasty with cement in patients with developmental dysplasia of the hip.

BACKGROUND: Total hip arthroplasty with cement remains a difficult procedure in patients with osteoarthritis secondary to developmental dysplasia of the hip as it is associated with high rates of aseptic loosening of the acetabular component. The purpose of the present study was to evaluate the rate of revision of the acetabular component in this group of patients and the variables that are associated with it. METHODS: We retrospectively reviewed the records and radiographs of 292 hips in 206 patients who had undergone total hip arthroplasty with cement for the treatment of osteoarthritis secondary to developmental dysplasia of the hip. The average age of the patients at the time of the index procedure was 42.6 years, and the average duration of follow-up was 15.7 years (range, 2.2 to 31.2 years). Fourteen patients were lost to follow-up, and seven patients died from causes unrelated to surgery. A 22.25-mm head was used in all cases, and bone-grafting of the acetabulum was performed in forty-eight hips. Survival of the acetabular component was calculated with revision for aseptic loosening as the end point. Individual survival rates based on age, component type, previous surgery, and annual polyethylene wear also were calculated. RESULTS: The most common reason for revision was aseptic loosening of the acetabular component, which led to 87.2% of the revision procedures. The overall rate of survival of the acetabular component was 90.6% at ten years and 63% at twenty years. A higher rate of acetabular revision was noted in association with previous acetabular surgery, the offset-bore cup, younger age, and accelerated polyethylene wear (p < 0.05 for all comparisons). CONCLUSIONS: Aseptic loosening of the acetabular component affects the longevity of total hip replacements in patients with osteoarthritis secondary to developmental dysplasia of the hip. The present study identified the risk factors associated with the long-term survival of the acetabular component in this group of patients.

Acetabulum↗
PubMed2005

Modular femoral component for conversion of previous hip surgery in total hip arthroplasty.

The conversion of previous hip surgery to total hip arthroplasty creates a durable construct that is anatomically accurate. Most femoral components with either cemented or cementless design have a fixed tapered proximal shape. The proximal femoral anatomy is changed due to previous hip surgery for fixation of an intertrochanteric hip fracture, proximal femoral osteotomy, or a fibular allograft for avascular necrosis. The modular S-ROM (DePuy Orthopaedics Inc., Warsaw, Ind) hip stem accommodates these issues and independently prepares the proximal and distal portion of the femur. In preparation and implantation, the S-ROM hip stem creates less hoop stresses on potentially fragile stress risers from screws and thin bone. The S-ROM hip stem also prepares a previously distorted anatomy by milling through cortical bone that can occlude the femoral medullar canals and recreate proper femoral anteversion and reduces the risk of intraoperative or postoperative periprosthetic fracture due to the flexible titanium-slotted stem. The S-ROM femoral stem is recommended for challenging total hip reconstructions.

Arthroplasty, Replacement, Hip↗
PubMed2000

[Clinical evaluation of the hip joint after implantation of cementless Mittelmeier type and Parhofer-Mönch type hip prosthesis].

Total hip replacement is the most common procedure in the treatment of severe degenerative changes in the hip joint. The authors present clinical evaluation of 129 patients (151 hips) who underwent total hip replacement using either the Mittelmeier type or the Parhofer-Mönch type hip prothesis. The age of the patients ranged at the time of the operation between 17 and 74 years (average 44.9). The follow-up ranged from 24 to 143 months (average 61.2 months). The P-M prothesis was implanted in 53 hips, the P-M "Plasmapore" prothesis in 42 patients, Mittelmeier Autophor 900 prothesis in 49 patients and the Mittelmeier Autophor 900S prothesis in 7 patients. Clinical evaluation was performed according to the d'Aubigne-Postel method with the Charnley modification. The results were graded as very good in 17 cases, good in 64 cases, satisfactory in 53 cases and poor in 17 cases. Very good and good results were mainly observed after implantation of the P-M type prothesis and P-M "Plasmapore" type prothesis. Worse results were observed in patients, who at the time of the operation were aged 45 years or less and who had congenital hip dysplasia. P-M type prothesis gives better clinical results in the treatment of degenerative changes of the hip joint.

Adolescent↗
PubMed2000

Impaction grafting for acetabular deficiency in total hip arthroplasty for developmental hip dysplasia.

The pathological anatomy in neglected developmental dysplasia of the hip often demands some sort of reconstructive surgery to augment the acetabular bone stock during total hip arthroplasty. We have reviewed 11 hips in 10 patients with osteoarthritis secondary to developmental hip dysplasia who underwent cemented total hip arthroplasty using impaction grafting of the acetabulum with a morselized femoral head autograft, to bring the socket down to the anatomical hip center. The mean age at the index procedure was 43.4 years (ranging from 29 to 60 years) and the mean follow-up period was 3.8 years (ranging from 2 to 7 years). Postoperative functional evaluation according to the Merle d'Aubigné and Postel score modified by Charnley revealed very satisfactory results. Radiographic review showed incorporation of all grafts. One socket is radiographically loose. No major complications have been encountered. There have been no reoperations. We believe that acetabular impaction grafting is a valuable alternative in dealing with osteoarthritic hips secondary to developmental hip dysplasia.

Acetabulum↗
PubMed2002

[Total hip arthroplasty and problems encountered in patients with high-riding developmental dysplasia of the hip].

OBJECTIVES: We evaluated total hip arthroplasty in patients with high-riding developmental dysplasia of the hip with regard to surgical method and modifications, problems encountered during surgery, and follow-up results. METHODS: A total of 42 hips (22 Crowe type III, 20 type IV) of 31 patients (29 women, 2 men; mean age 45.7 years; range 26-70 years) who underwent total hip arthroplasty were clinically and radiologically evaluated. In all cases, cementless acetabular components were placed in the true acetabulum. Fifteen acetabula required structural autografts. Cementless stems were used on the femoral side. Proximal metaphyseal step-cut osteotomy was performed in patients with high-riding hips of more than 4 cm. The mean follow-up period was 54.7 months (range 11 to 127 months). RESULTS: The mean Harris hip score increased from 37.6 preoperatively to 91.02 at the end of follow-up. No acetabular autograft resorption or non-union were observed. Non-union and delayed union in the femoral osteotomy site were encountered in two patients, respectively. Two components (1 acetabular, 1 femoral) were revised during the follow-up period. Two sciatic and two femoral temporary nerve palsies occurred. One patient developed superficial infection and was treated by debridement and antibiotics. Brooker type I heterotopic ossification was observed in seven patients. CONCLUSION: Total hip arthroplasty proved successful in high-riding developmental dysplasia of the hip.

Acetabulum↗